Intimate partner violence in the COVID-19 pandemic: co-occurrence and associated factors

Abstract

Objective  To estimate the prevalence of general intimate partner violence during the COVID-19 pandemic, the co-occurrence of this condition, and associated factors.

Methods  This is a cross-sectional, population-based study conducted in the municipality of Vitória, Espírito Santo, Brazil. Data collection took place between January and May 2022. A total of 1,086 women aged 18 or older participated. An instrument validated by the World Health Organization was used to identify cases of general intimate partner violence, and prevalence was estimated and analyzed according to socioeconomic characteristics, family, and life experiences. Logistic regression was used to estimate the unadjusted and adjusted Odds Ratio (OR) and their respective 95% Confidence Intervals (95%CI).

Results  The prevalence of overall intimate partner violence against women during the pandemic was 21.3%. Regarding associated factors, women most likely to be victims of intimate partner violence during the pandemic were younger, those living without a partner, those with less education, and those with a history of childhood sexual violence (p<0.05).

Conclusion  Socioeconomic factors and life experience were associated with intimate partner violence during the pandemic.

Keywords:
Violence against women; Intimate partner violence; Violence; Pandemics; COVID-19

Resumo

Objetivo  Estimar a prevalência da violência geral por parceiro íntimo durante a pandemia de COVID-19, a coocorrência desse agravo e os fatores associados.

Métodos  Estudo transversal de base populacional, realizado no município de Vitória, Espírito Santo, Brasil. A coleta de dados ocorreu entre janeiro e maio de 2022. Participaram 1.086 mulheres com 18 anos ou mais. Para identificar os casos de violência geral por parceiro íntimo, utilizou-se instrumento validado pela Organização Mundial da Saúde, e a prevalência foi estimada e analisada de acordo com as características socioeconômicas, experiências familiares e de vida. A regressão logística foi utilizada para estimar o Odds Ratio (OR) bruto e ajustado, e seus respectivos Intervalos de Confiança de 95% (IC95%).

Resultados  A prevalência de violência geral contra a mulher perpetrada pelo parceiro íntimo durante a pandemia foi de 21,3%. Quanto aos fatores associados, observa-se que as mulheres com maior probabilidade de serem vítimas de violência por parceiro íntimo na pandemia eram as mais jovens, as que viviam sem o companheiro, as que tinham menor escolaridade e aquelas com histórico de violência sexual na infância (p<0,05).

Conclusão  Fatores socioeconômicos e a experiência de vida estiveram associados à violência praticada pelo parceiro íntimo na pandemia.

Descritores:
Violência contra a mulher; Violência por parceiro íntimo; Violência; Pandemias; COVID-19

Resumen

Objetivo  Estimar la prevalencia de la violencia general por parte de la pareja íntima durante la pandemia de COVID-19, la coocurrencia de esta agresión y los factores asociados.

Métodos  Estudio transversal de base poblacional, realizado en el municipio de Vitória, estado de Espírito Santo, Brasil. La recopilación de datos se llevó a cabo entre enero y mayo de 2022. Participaron 1086 mujeres mayores de 18 años. Para identificar los casos de violencia general por parte de la pareja íntima, se utilizó un instrumento validado por la Organización Mundial de la Salud, y la prevalencia se estimó y analizó de acuerdo con las características socioeconómicas, las experiencias familiares y las experiencias de vida. Se utilizó la regresión logística para estimar la odds ratio (OR) bruta y ajustada, y sus respectivos intervalos de confianza del 95 % (IC95 %).

Resultados  La prevalencia de la violencia general contra la mujer perpetrada por la pareja íntima durante la pandemia fue del 21,3 %. En cuanto a los factores asociados, se observó que las mujeres con mayor probabilidad de ser víctimas de violencia por parte de la pareja íntima durante la pandemia eran las más jóvenes, las que vivían sin pareja, las que tenían menor nivel educativo y las que tenían antecedentes de violencia sexual en la infancia (p<0,05).

Conclusión  Los factores socioeconómicos y la experiencia de vida se asociaron con la violencia ejercida por la pareja íntima durante la pandemia.

Descriptores:
Violencia contra la mujer; Violencia de Pareja; Violencia; Pandemia; COVID-19

Introduction

Intimate partner violence (IPV) is the most common form of violence against women. It is estimated that up to 38% of murders of women worldwide are committed by a male intimate partner, and one in four girls and women aged 15 and older in the Americas has experienced physical and/or sexual violence.(¹) In Brazil, data from the 2019 National Health Survey showed that 7.6% of Brazilian women aged 18 to 59 reported IPV in the last year.(²)

Violent intimate relationships often directly affect women’s social ties and harm their relationships with family, friends, and neighbors, in addition to hindering access to and seeking support from institutions such as health, social services, security, and education.(³) In this context, it is worth highlighting that situations of economic instability, social turmoil, and natural disasters are often associated with several risk factors that contribute to the increase in violence against women, with pandemics being one of these aggravating factors.(⁴)

In March 2020, the World Health Organization (WHO) declared the COVID-19 pandemic, and national and international organizations estimated an increase in violence during this period, especially that perpetrated by intimate partners.(⁵,⁶) The health crisis generated by the pandemic, combined with social isolation, can trigger or exacerbate various forms of violence, as they exacerbate the social, structural, and economic determinants involved in the dynamics of IPV.(⁴,⁶)

According to a meta-analysis study, which analyzed 103 studies, the majority of which used the WHO standardized IPV screening instrument, the combined prevalence estimate for any type of violence against women during the pandemic was 21.0%.(⁷) In another review study, the overall prevalence of IPV was 31%, being higher in developing countries when compared to developed countries.(⁸) During the COVID-19 pandemic, changes in the prevalence of IPV were observed; however, methodological aspects such as data source and sample type must be taken into account, as there is a lack of representative data on IPV during this period.(⁷,⁸)

Concerning factors associated with this condition, according to the ecological model proposed by the WHO on causality,(⁹) factors related to the pandemic clearly have repercussions at various levels, including community, relationship, and individual. At the community level, social cohesion and access to public services and social institutions are reduced, making it difficult to seek support and protection against violence. In the relationship sphere, increased time spent with the aggressor and decreased social contact between women and friends and family increase the risk of violence. At the individual level, factors such as increased stress, uncertainty about the future, excessive housework, alcohol consumption, and financial dependence contribute to exacerbating violence.(¹⁰)

However, there are still many gaps regarding the effects of the COVID-19 pandemic on IPV.(⁴) Therefore, understanding the occurrence of violence against women and its characteristics in different contexts, such as during the health crisis, is necessary to guarantee women’s rights and protection, in addition to supporting public policies aimed at improving the capacity to respond to new emergencies.(⁶,¹¹)

Given the above, this study aimed to estimate the prevalence of general IPV during the COVID-19 pandemic, the co-occurrence of this condition, and associated factors.

Methods

This is a cross-sectional, analytical, population-based study, organized according to the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guideline,(¹²) held in the municipality of Vitória, state of Espírito Santo, Brazil.

The study population consisted of women aged 18 or older who had or had an intimate partner in the 24 months prior to the interview. In this study, an intimate partner was defined as a current or former partner and/or boyfriend, provided they maintained sexual relations, regardless of whether the relationship was formal or informal. Women who lacked the ability to understand or communicate due to intellectual or sensory impairment and were therefore unable to respond to the survey data collection instruments were excluded.

Data collection took place between January and May 2022, and was conducted by a team of fully trained female interviewers. The research team also included field supervisors. Upon arriving at the selected household, the interviewer introduced herself to the woman, presented her research cover letter, and extended an invitation to participate. According to protocol, the interview was conducted in the home, in a private location, with only the interviewee and the interviewer present, respecting women’s privacy and confidentiality. If a partner and/or other people were present, and there was no space to guarantee privacy, the interview was scheduled for a later date. Refusal occurred when the selected participant declined to participate. If a woman was not found at home after three attempts by the interviewer, the participant was considered a loss. Losses and refusals were not replaced.

Regarding the outcome under study (general IPV during the pandemic), the World Health Organization Violence Against Women (WHO VAW STUDY) questionnaire, translated and validated in Brazil, was used.(¹³) The instrument tracks the occurrence of different types of IPV (psychological, physical, and/or sexual). General IPV during the pandemic, i.e., in the 24 months prior to the interview, was considered present when the interviewee answered “yes” to at least one item on the questionnaire.

The study independent variables were age group (18 to 29 years, 30 to 39 years, 40 to 49 years, 50 to 59 years, 60 years or older), race/skin color (white, black, brown), Catholic religion (no, yes), Evangelical religion (no, yes), current marital status (lives without a partner, lives with a partner), years of education (0 to 8 years, 9 to 11 years, 12 years or more) and family income tertile (1^st tertile – poorest, 2^nd tertile, 3^rd tertile – richest).

The race/skin color variable was collected, according to the Brazilian Institute of Geography and Statistics, in five categories: white, black, brown, yellow and indigenous. Women who self-identified as Asian or Indigenous were excluded from the analysis, as they accounted for less than 1% of the sample, similar to other studies.(¹⁴,¹⁵) The religion variable was collected in five categories, such as no religion, Catholic, Evangelical, African and/or Spiritist, and others, and was later categorized as Catholic (no, yes) or Evangelical (no, yes), according to other studies carried out in the same municipality and state.(¹⁵,¹⁶) Regarding family characteristics and life experience, variables were mother has suffered aggression from her partner (no, yes) and sexual violence in childhood (no, yes).

The sample size calculated to achieve the study objective was 1,100 women. For the calculation, a 50% prevalence of the outcome was assumed, with a 95% confidence level and a 5% margin of error. For associations, a 95% confidence level, 80% power, and a 1:1 exposed/unexposed ratio were considered, adding 10% for losses and 30% for confounding factors. The sampling process adopted was multistage, with census tracts as the primary unit. After reordering, 100 tracts were randomly selected, with a systematic skip selection for the households, with probability proportional to the number of households and women within each tract. A total of 1,086 women participated in the study; 14 women refused to participate or were not found at home after three contact attempts throughout the study.

The analyses were performed using Stata^® version 15.1 statistical program. The descriptive analysis of the prevalence of IPV was performed using unadjusted and relative frequencies. For bivariate analysis, the homogeneity chi-square test was used. Logistic regression was used to estimate the unadjusted and adjusted Odds Ratio (OR) and their respective 95% Confidence Intervals (95%CI). Initially, variables associated with the outcome under study (p<0.20) were included in the model to consider possible confounding factors, and the backward selection method was used to select the variables. In the final model, a significance level of 5% (p<0.05) was adopted. Quality criteria were assessed using the Hosmer-Lemeshow test and adjusted R². Contrast analysis was also performed to obtain more precise and specific information, thus assessing the difference between groups within the same variable.(¹⁷)

The research was approved by the Universidade Federal do Espírito Santo Research Ethics Committee, under Opinion 4.974.080 (Certificate of Presentation of Ethical Consideration 41628820.6.0000.5060). All interviewees signed the Informed Consent Form, and any doubts regarding study objectives and its possible risks and benefits were clarified.

Results

The prevalence of general IPV during the pandemic in the municipality of Vitória was 21.3% (95%CI 18.9–23.8). Among the participants (N=1,086), 4.7% (N=51) reported co-occurrence of psychological, physical, and sexual violence. The co-occurrence of psychological and physical violence was 3.9%. The co-occurrence of physical and sexual violence was 0.1%, and the co-occurrence of psychological and sexual violence was 1.1%. Furthermore, 78.7% of the women interviewed did not report having experienced any type of violence (Figure 1).

Figure 1
Co-occurrence of psychological, physical, and sexual intimate partner violence during the COVID-19 pandemic

Higher prevalence rates of general IPV during the pandemic were observed among women aged 18 to 29, non-Catholic, Evangelical, living with a partner, with up to eight years of education, and poorer. Regarding family and life experience, the highest frequencies of victimization were among women whose mothers had been beaten by partners and with a history of childhood sexual abuse (p<0.05) (Table 1).

Table 1
Prevalence of general intimate partner violence in the last 24 months according to socioeconomic, family, and life experience characteristics

Variables	n(%)	95%CI	p-value
Socioeconomic
Age range (years)			0.045
18 to 29	55(27.2)	21.5–33.8
30 to 39	50(24.5)	19.1–30.9
40 to 49	44(19.8)	15.1–25.6
50 to 59	39(19.9)	14.9–26.1
60 or more	43(16.4)	12.4–21.4
Race/skin color			0.022
White	76(17.4)	14.1–21.3
Black	44(22.5)	17.1–28.8
Brown	108(25.1)	21.2–29.4
Catholic			0.001
No	155(24.6)	21.4–28.2
Yes	76(16.6)	13.5–20.3
Evangelical			0.006
No	134(18.8)	16.1–21.8
Yes	97(26)	21.8–30.7
Current marital status			<0.001
Lives with a partner	168(19)	16.5–21.7
Lives without a partner	63(31.5)	25.4–38.3
Years of study			<0.001
0 to 8	67(33)	26.9–39.8
9 to 11	87(24.7)	20.5–29.5
12 or more	77(14.5)	11.8–17.8
Family income tertile			<0.001
1st tercile – poorest	117(30.2)	25.9–35.0
2nd tercile	71(19.8)	16.0–24.2
3rd tercile – richest	42(13)	9.7–17.1
Family characteristics and life experience
Mother has already suffered aggression from her partner			<0.001
No	149(18.6)	16.1–21.5
Yes	71(31.3)	25.6–37.6
Childhood sexual violence			0.001
No	193(19.9)	17.5–22.5
Yes	38(33)	25.1–42.1

• 95%CI - 95% Confidence Interval; Ref - reference group

Table 2 presents the unadjusted and adjusted analysis of general IPV during the pandemic according to women’s socioeconomic, family, and life experience characteristics. The variables that remained associated with the occurrence of general violence from the unadjusted to adjusted analysis were age group, current marital status, years of education, and childhood sexual violence (p<0.05). After adjustments, it was observed that younger women were 2.25 times more likely to be victims of IPV during the pandemic compared to older women (OR: 2.25; 95%CI 1.37–3.69). Those living without a partner were 107% more likely to experience violence (OR: 2.07; 95%CI 1.44–2.99). Those with less education (up to eight years of education) were more likely to experience general violence than those with more education (OR: 4.23; 95%CI 2.78–6.44). Furthermore, women with a history of sexual violence in childhood were 1.9 times more likely to be victims of partner violence during the pandemic (p<0.05) (Table 2).

Table 2
Unadjusted and adjusted analysis of general intimate partner violence during the pandemic and women’s socioeconomic, family, and lifestyle characteristics

Variables	Unadjusted analysis			Adjusted analysis
	OR	95%CI	p-value	OR	95%CI	p-value
Socioeconomic
Age range (years)			0.045			0.003
18 to 29	1.91	1.21–2.99	0.005	2.25	1.37–3.69	0.001
30 to 39	1.65	1.05–2.61	0.031	2.41	1.47–3.96	0.001
40 to 49	1.26	0.79–2.00	0.331	1.70	1.04–2.79	0.035
50 to 59	1.27	0.78–2.04	0.336	1.29	0.78–2.12	0.320
60 or more	Ref.			Ref.
Race/skin color			0.021			0.494
White	Ref.			Ref.
Black	1.37	0.90–2.08	0.138	0.81	0.50–1.31	0.390
Brown	1.58	1.14–2.20	0.006	1.05	0.72–1.53	0.782
Catholic			0.001			0.119
No	Ref.			Ref.
Yes	0.61	0.45–0.83		0.76	0.53–1.07
Evangelical			0.006			0.756
No	Ref.			Ref.
Yes	1.52	1.13–2.05		1.07	0.70–1.64
Current marital status			<0.001			<0.001
Living with a partner	Ref.			Ref.
Lives without a partner	1.97	1.40–2.77		2.07	1.44–2.99
Years of education			<0.001			<0.001
0 to 8	2.90	1.99–4.24	<0.001	4.23	2.78–6.44	<0.001
9 to 11	1.94	1.37–2.73	<0.001	2.06	1.45–2.93	<0.001
12 or more	Ref.			Ref.
Family income tercile			<0.001			0.130
1st tercile – poorest	1.66	1.09–2.51	0.017	1.23	0.78–1.92	0.376
2nd tercile	2.91	1.97–4.30	<0.001	1.58	0.99–2.52	0.053
3rd tercile – richest	Ref.			Ref.
Family characteristics and life experience
Mother has already suffered aggression from her partner			<0.001			0.100
No	Ref.			Ref.
Yes	1.99	1.43–2.77		1.36	0.94–1.96
Childhood sexual abuse			0.001			0.005
No	Ref.			Ref.
Yes	1.99	1.31–3.03		1.90	1.22–2.95

• OR – Odds Ratio; 95%CI - 95% Confidence Interval; Ref - reference group

Table 3 presents the results of contrast analysis. The results show a statistical difference in the odds of general IPV during the pandemic, when comparing women up to 29 years old, and those in the 30-39 age group with women aged 60 or older (p<0.05). Conversely, when comparing the age group of women aged 40 or older with those aged 60 or older, no statistically significant difference was observed (p>0.05). Comparing the intermediate categories of the variables such as year of education and family income in tertiles, it was found that women belonging to the category of fewer years of education and lower family income had a higher chance of general partner violence during COVID-19, while women with more years of education and belonging to the highest family income tertile had a lower chance than those in the intermediate category (p<0.05).

Table 3
Contrast analysis between general intimate partner violence during the pandemic and women’s socioeconomic characteristics

Variables	Contrast analysis
	OR	95%CI	p-value
Socioeconomic
Age range (Ref: 18 to 29 years)			0.046
30 to 39	0.87	0.56-1.35	0.532
40 to 49	0.66	0.42-1.04	0.073
50 to 59	0.66	0.42-1.06	0.086
60 or older	0.52	0.33-0.82	0.005
Age range (Ref: 30 to 39 years)			0.046
18 to 29	1.15	0.74-1.80	0.532
40 to 49	0.76	0.48-1.20	0.244
50 to 59	0.77	0.48-1.23	0.268
60 or older	0.60	0.38-0.95	0.031
Age range (Ref: 40 to 49 years)			0.046
18 to 29	1.51	0.96-2.38	0.073
30 to 39	1.31	0.83-2.08	0.244
50 to 59	1.00	0.62-1.62	0.984
60 or older	0.79	0.20-1.26	0.331
Age range (Ref: 50 to 59 years)			0.046
18 to 29	1.51	0.94-2.40	0.086
30 to 39	1.31	0.81-2.10	0.268
40 to 49	1.00	0.61-1.61	0.984
60 and over	0.79	0.49-1.28	0.336
Years of study (Ref: 9 to 11)			<0.001
0 to 8	1.50	1.03-2.19	0.036
12 and over	0.52	0.37-0.73	<0.001
Family income tercile (Ref: 2nd tercile)			<0.001
1st tercile – poorest	1.82	1.30-2.56	0.001
3rd tercile – richest	0.58	0.39-0.88	0.010

• OR – Odds Ratio; 95%CI - 95% Confidence Interval; Ref - reference group

Discussion

During the COVID-19 pandemic, the prevalence of overall violence (psychological, physical, and sexual) against women by intimate partners in Vitória, Espírito Santo, was 21.3% (95%CI 18.9–23.8). Furthermore, the association analysis showed that younger women, those living without a partner, those with fewer years of education, and those with a history of sexual violence in childhood were more likely to be victims of IPV during the pandemic.

The findings of this study indicate that approximately one in five women experienced IPV during the pandemic. A systematic review of 103 publications from different countries identified an overall prevalence of IPV against women of 21% during the pandemic, reinforcing the proportion of one in five women experiencing IPV during this period.(⁷) This same study indicates that IPV against women did not increase during the pandemic compared to the pre-pandemic period. The findings of this study are consistent with those reported in the literature, which highlight IPV as a significant public health problem that requires attention both in Brazil and worldwide.(⁷)

The co-occurrence of the three types of violence tracked (psychological, physical, and sexual) was observed in approximately 5% of participants. When analyzing the co-occurrence of one type of violence with another, psychological and physical violence stood out, which supports another study conducted in Pelotas, Rio Grande do Sul, which found a 13.2% co-occurrence between these two forms of violence and 2.6% of all three types.(¹⁸) These data reinforce the continuity and worsening of violence. Sometimes, violent relationships persist as long as there is emotional or financial dependence, transforming as a result of escalating conflicts, relationship wear and tear, or empowerment stemming from other women’s achievements.(¹⁹,²⁰,²¹)

During the COVID-19 pandemic, young women were 2.25 times more likely to experience IPV than older women. This association was also observed in a nationally representative population-based survey with data from six East African countries, in which older women were less likely to experience IPV than younger women.(²²) A likely explanation for this result is that younger women are more dependent on their partners when it comes to childcare and household expenses.(²³,²⁴) Furthermore, this finding may indicate the dominance exerted by aggressors over these women, which may be related to the emotional immaturity of younger women.(²⁵) On the other hand, older women may have greater financial and social independence, which gives them an advantage in leaving abusive relationships.(²⁶)

When analyzing marital status, it was noted that women who lived without a partner were 107% more likely to experience IPV during the COVID-19 pandemic compared to those who lived with a partner. Similarly, another cross-sectional study conducted in Vitória, Espírito Santo, with 991 participants found a higher prevalence of IPV among women without a partner. It is possible that these women had previously experienced violent relationships and were able to break away from them.(²⁷)

Another finding in the present research was the greater chance of general partner violence among women with less education (OR: 4.23; 95%CI 2.78–6.44). This result supports a study carried out in Nepal in which women without formal education were four times more likely to suffer violence compared to those who had formal education both before (OR: 3.94; 95%CI: 2.07–7.52) and after (OR: 4.13; 95%CI: 2.11–8.06) the pandemic.(²⁸) Furthermore, a systematic review found that higher levels of education are generally associated with reduced victimization of violence against women.(²⁹) Still, reflecting that there are different hypotheses for associating schooling with victimization is important, but, according to Mascarenhas,(³⁰) one possibility would be that a higher educational level could provide protection to women, as it could represent the acquisition of social skills and resources to deal with situations of violence.(³⁰)

Another notable finding was that women with a history of childhood sexual violence were 1.9 times more likely to be victims of IPV during the pandemic (p<0.05). This finding is consistent with a study conducted in England and Wales, which found that childhood abuse, regardless of type (physical, sexual, or psychological), increases the risk of experiencing IPV in adulthood.(³¹) Furthermore, a study carried out in Brazil found a 45% higher prevalence of physical violence in adulthood in women with a history of sexual violence in childhood.(³²) Revictimization in adulthood may be associated with greater vulnerability of victims, due to sequelae of previous abuse, such as post-traumatic stress disorder and symptoms of dissociation.(¹⁵,³³) Furthermore, survivors of childhood violence, when revealing the situation they suffered in adulthood to their partners, were exposed to further abuse, since the information was used as a control mechanism.(³⁴)

Given these findings, it is important to consider that strategies to strengthen support networks, expand access to specialized services, and encourage victims’ economic independence are crucial. Government programs that promote financial education and professional development for women can reduce their economic dependence on abusive partners, enabling greater autonomy to break cycles of violence.(¹⁹)Another important approach is educating society about gender-based violence. Educational campaigns and awareness-raising initiatives in schools, workplaces, and communities can help deconstruct social norms that normalize violence, reinforcing the importance of gender equality.

It is also necessary to expand the services of the intersectoral protection network for women in situations of violence to ensure the safety and necessary support for those at risk. Furthermore, intersectoral training, including for health, public safety, and social assistance professionals, to foster prevention actions, promote a culture of peace, and intervene is essential to mitigating this problem.

Among the study’s limitations, we must mention those inherent to its cross-sectional nature, which may have influenced the results, such as the possibility of bias during data collection, as victims tend to conceal the violence. However, it is important to emphasize that, to minimize this, the data were collected in a private space: only with the woman and the interviewer. Another point is the impossibility of determining causal relationships, but rather exploring the relationships between the outcomes and the variables under study, without assessing risk and protective factors. However, the findings of this research are similar to those of other studies, also cross-sectional in nature, as presented in the discussion, and reinforce the demand for longitudinal studies in this area that allow for establishing temporal and possible causal relationships.(¹⁵,¹⁶,²²,²⁷)

Finally, it is important to highlight that the present study contributes to knowledge by providing an overview of the prevalence of IPV during a period of social isolation and identifying more vulnerable groups. Its findings are essential for prioritizing interventions and prevention and care policies, especially during pandemic periods.

Conclusion

The study highlighted the prevalence of general IPV against women during the COVID-19 pandemic, its co-occurrence, and associated factors. The increased likelihood of violence among younger women, those living without a partner, those with a lower level of education, and those with a history of childhood sexual violence stands out. These data are concerning due to the negative impact of exposure to violence. Considering that health services were focused on meeting the demands of the pandemic during this period, many women remained without support and/or care, thus lacking the opportunity to cope and break the cycle. Therefore, this study highlights that situations of social isolation require the development of policies to assist victims of violence, as well as prevention and tracking policies, to guarantee these women their social rights, safety, and well-being.

Acknowledgments

The authors would like to thank the following funding agencies: No. 09/2020 – PPSUS, Espírito Santo Research and Innovation Support Foundation (In Portuguese, Fundação de Amparo à Pesquisa e Inovação do Espírito Santo - FAPES)/Brazilian National Council for Scientific and Technological Development (In Portuguese, Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq)/Department of Science and Technology (In Portuguese, Decit), Department of Science, Technology and Strategic Inputs (In Portuguese, Secretaria de Ciência, Tecnologia e Insumos Estratégicos - SCTIE), Ministry of Health (MoH)/Espírito Santo State Health Department (In Portuguese, Secretaria de Estado da Saúde do Espírito Santo - SESA); b) No. 04/2021 – Productivity grant from the Brazilian National Council for Scientific and Technological Development (In Portuguese, Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq).

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• Data availability:
  The authors did not make the data from this article available in repositories prior to submission.

Edited by

• Associate Editor:
  Paula Hino (https://orcid.org/0000-0002-1408-196X) Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil

Data availability

The authors did not make the data from this article available in repositories prior to submission.

Publication Dates

• Publication in this collection
  20 Apr 2026
• Date of issue
  2026

History

• Received
  26 Oct 2024
• Accepted
  31 Aug 2025