Domestic Violence in a COVID-19 Context: Exploring Emerging Issues through a Systematic Analysis of the Literature

Extreme events, such as pandemics lead to a rise of domestic violence (DV) and create additional challenges for practice. The social work profession as well as many other professions works with women who have experienced DV and so it is important to be up-to-date with the emerging issues brought about by the Coronavirus (COVID-19) pandemic. The aim of this article is to identify emerging issues related to DV within the context of COVID-19. The article presents the results of a systematic literature search and analysis of DV within the COVID-19 pandemic in 2020. A systematic search of 10 data bases was conducted. All articles in peer reviewed journals discussing DV in the context of COVID-19 were included. For the articles to be included they had to be written in the English language and to be included in peer reviewed journals between 1 January 2020 to 9 May 2020. Of the 413 articles initially recorded, 12 articles were identified which focused on DV. The analysis of the 12 identified articles offers some useful insights. It suggests that lockdown measures imposed by governments intensify perpetrators’ power over survivors’ lives, hence reinforcing gender inequality. Furthermore, it indicates that online provision of support might not be the most effective response in cases of DV and identifies appropriate emergency warning systems. Additionally, the risk of scapegoating COVID-19 for DV is identified. These insights are briefly discussed in relation to practice and policy responses.


Introduction
Social workers as well as other professionals such as doctors, nurses, and psychologists work with women who have experienced Domestic Violence (DV)/Intimate Partner Violence (IPV) (Allen, 2014;Danis, 2003;Fogel & Woods, 2008;Holt et al., 2017;Nicolson, 2019;Williamson, 2000). Thus, it is important for these professionals to be up-to-date with the emerging issues brought about by the COVID-19 pandemic in 2020. Traditionally, one of the foci of social work has been the interaction between people and the environment. Changes in the environment (Pentaraki, 2013b), such as those related to the pandemic highlight issues about which the social work profession should be informed. Thus, this paper aims to identify and highlight emerging issues in the area of DV linked to  which can inform the social work profession as well as other relevant professions. It reports on a systematic search and analysis of literature in peer reviewed journals on DV and the COVID-19 pandemic. Before reporting on this process, the underlying context for this work is introduced.
Women across the world are subjected to physical, psychological, sexual, economic and other forms of violence and abuse by their (ex)partners (Council of Europe, 2011). This form of violence has been referred to as domestic violence (DV) or intimate partner violence (IPV). DV/IPV is a widespread social and public health problem (World Health Organization (WHO), 2013). IPV is a gendered phenomenon as it primarily affects women (World Health Organization (WHO), 2013) and to a lesser degree, men. This paper reflects this by utilizing a gender-based language which recognizes that the majority of survivors in heterosexual relationships are women. However, the authors acknowledge that both women and men in same sex (Pentaraki, 2017) and opposite sex relationships may be survivors. Worldwide, 18% of ever-partnered women aged 15 to 49 years experienced sexual and/or physical violence by an intimate partner in the previous 12 months (United Nations Women (UN Women), 2020b). Once lifetime statistics are taken into consideration, this number rises to approximately one in three women experiencing DV during their lifetime (United Nations (UN), 2015; World Health Organization (WHO), 2013). Moreover, previous research has indicated that within the context of extreme events such as war, conflicts, disaster, and pandemic emergencies, there is an increase in the prevalence of IPV (Ali et al., 2011;Bermudez et al., 2019;Castañeda Camey et al., 2020;Garcia-Moreno et al., 2006;Gearhart et al., 2018;Kumar, 2020;Parkinson & Zara, 2013;Peterman et al., 2020;Schumacher et al., 2010;United Nations (UN), 2015). One of the latest extreme events being faced globally is the COVID-19 health emergency which has crossed international boundaries and constitutes a pandemic and has infected millions of people across the world. Up to 23 May 2020 a total of 5,103,006 cases of COVID-19 and 333,401 deaths had been reported (World Health Organization (WHO), 2020a). Movement restrictions necessary to flatten the exponential growth curve of the pandemic, have forced people to spend more time at home during government imposed quaran-tine/lockdown measures. Home, however, is a very dangerous place for women survivors of DV (Diemer et al., 2017) and the enforced measures of distancing force women survivors to spend more time at home with their abusers. Thus, as expected on the basis of research relating to DV during other extreme events, the COVID-19 pandemic context brought increased reported cases of DV (Graham-Harrison et al., 2020;Kumar, 2020). In China, it has been reported that occurrences of DV have nearly doubled in the city of Jingzhou, southern Hubei province (Zhang, 2020). In Singapore, Cyprus, and the UK, helplines have recorded increases in calls by 33%, 30% and 25% respectively (Αντωνοπούλου, 2020;Hingorani, 2020;Refuge, 2020). According to data from the "180 Hotline" provided by the Ministry for Women, Family, and Human Rights in Brazil there was a 17% increase in DV related calls during March 2020, the month that social distancing was recommended (Marques et al., 2020).
In many countries, there have been reports on the increase of domestic homicides/femicides (Bradbury-Jones & Isham, 2020;Ingala Smith, 2020). In Greece, the UK, France, and South Africa for example, increases in DV have been reported by government authorities (Αντωνοπούλου, 2020;Taub, 2020;UK Parliament, 2020;Weiner, 2020). The United Nations Population Fund (United Nations Population Fund (UNFPA), 2020) projected that for every three months that the lockdown continued, an additional 15 million cases of IPV were expected across all 193 United Nations member states.
Only when the increase of DV was highlighted by concerned individuals, groups, and the media did governments attempt to provide relevant measures to support survivors of DV (Taub, 2020). Initially there was an absence of such provision during government imposed lockdown and quarantine measures. This seems to be related to a predominance of virologists, epidemiologists and politicians in COVID-19 government decision making bodies (Rajan et al., 2020).
Civil society, community groups, child development specialists, social workers, and human rights lawyers as well as other professionals whose expertise is relevant to address human needs holistically were not being engaged in the primary discussion stages (Rajan et al., 2020). This accounts for the absence of information related to the challenges of isolation measures faced by various groups in society such as the survivors of domestic violence (Rajan et al., 2020). Having provided a background context, the paper now presents the systematic search and analysis of the literature.

Method
A systematic search of the literature was conducted to identify articles reporting on COVID-19 and domestic violence published in peer reviewed journals from 1 January 2020 to 9 May 2020. This systematic search was conducted in order to enhance our understanding of emerging issues related to DV in the changing environment of the pandemic. Systematic search guidelines based on the Preferred Reporting Items for Systematic Reviews and Me-  (Moher et al., 2009) were rigorously followed in order to eliminate search bias (see Figure 1). The paper reports on this systematic literature search and its analysis, even though no original research articles were identified due to the recent nature of the pandemic. However, as the social work profession acknowledges that in addition to research knowledge there are a wide range of sources of knowledge (Nevo & Slonim-Nevo, 2011;Pawson et al., 2003). This systematic literature search and analysis builds on this understanding and as such aimed to locate every relevant article in peer reviewed academic journals.
The literature search focused on articles which discussed DV within the context of COVID-19. An article was included if it met the following three criteria namely that it: 1) reported on COVID-19 and DV; 2) was published in a peer reviewed journal between 1 January 2020 and 9 May 2020; 3) was written in the English Language. CINAHL Plus (n = 6), PUBMED (n = 8), Science Direct (n = 55). Scopus (n = 1) Web of Science (n = 1), and Google Scholar (n = 333). together these data bases searches revealed 413 records in total. Of these, 29 were removed due to duplication, leaving a total of 384 records to be screened by two reviewers. First the titles and abstracts of these records were screened by a reviewer to identify which articles addressed domestic violence and COVID-19. During this first stage of title and abstract scanning 357 articles were excluded and 27 articles were retained. The principal reason for the exclusion of the articles at this stage was that they focused on either DV or COVID-19 but not both together. In the second stage of article selection, a more detailed assessment was conducted by two reviewers. The two reviewers independently screened the abstracts and/or content of the retained 27 articles to determine eligibility for further analysis. When the reviewers' assessments were compared both reviewers had identified the same 12 articles to be retained for further examination. The reasons for the exclusion of the other 15 articles were mostly due to lack of specific focus on domestic violence. At the third stage the reviewers engaged in an in-depth review of the full text of the 12 identified articles, the results of which are presented next.

Results
Twelve articles were identified for analysis from the systematic literature search as outlined in the previous section (see Table 1). This scholarly work comprised articles (n = 5), commentaries (n = 5), editorial piece (n = 1) and notes from the field (n = 1). No research studies were identified. This is due to the recent nature of the pandemic which has precluded the publication of research studies to date.
The origin and the content of the identified articles reflect the global nature of DV and the COVID-19 pandemic. The work covers examples from both the global north (n = 9) and the global south (n = 3). The articles were from a variety of disciplines, including mental health, nursing and medicine. DV associated with COVID-19 is a concern in many disciplines which reflects a multidisciplinary recognition of the serious nature of DV. All of the articles but one (Ragavan et al., 2020), refer to general issues of DV in adult intimate relationships.

Theme 1: Lockdown Measures Imposed by Governments during Quarantine Reinforce Perpetrator's Coercive Control Tactics
Six articles discuss that lockdown imposed measures by the government facilitate and reinforce perpetrators' coercive control, which is one   Ragavan et al., 2020). The control tactics of the perpetrator are discussed in terms of perpetrator imposed restrictions, perpetrator surveillance of social media, internet, and cell phones, all of which limit out the ability of survivors to obtain help through online and digital means (Campbell, 2020). Another insight made is that confinement in smaller spaces raise additional difficulties for survivors to ask for help safely and confidentially (Marques et al., 2020). Smaller homes make it more difficult to find a space from which to seek help and harder to escape round the clock contact and surveillance by the perpetrator. (2020)  which to engage in online support services such as telehealth. Within this context they argue for free or low-cost technology.

Theme 3: Specific Interventions and Strategies Related to Addressing DV within the Context of COVID-19
Three articles discuss specific interventions (Bradley et al., 2020;John et al., 2020;Usher et al., 2020) which have emerged to address DV within the context of COVID-19. The main theme of the discussed approaches is the ability to ask for help without leaving a digital trace. Bradley et al. (2020) refer to the "The Signal for Help" emergency warning system of the Canadian Women's Foundation which aims to provide the ability to women survivors to safely ask for help without leaving a digital trace during telemedicine. It is a hand signal made by survivors of DV which acts as a silent request for assistance from health care practitioners. When health care practitioners see this signal, they are made aware that assistance is required. In addition to "The Signal for Help" system, Usher et al. (2020) discuss "Safe Word" emergency warning systems adopted in France by pharmacies and grocery stores by which survivors can indicate they need support through the use of safe words.

Theme 4: Contesting Understandings of DV within the COVID-19 Context and the Risk of Scapegoating COVID-19 as the Cause of DV
The literature analysis reflected a contested understanding of DV. This ranged from scapegoating COVID-19 as a cause of DV to approaching COVID-19 as providing a context which exposed existing gender inequalities such as DV.  Mazza et al. (2020) discuss that DV aggression arises due to the feelings of frustration and agitation arising from the COVID-19 context. This approach risks scapegoating COVID-19 as the cause of DV. However, other identified publications (John et al., 2020;Van Gelder et al., 2020) recognize that these are just the trigger. Moreover, John et al. (2020) state that COVID-19 exposes existing inequalities, such as gender based violence, a dimension of which is DV.
In summary, overall the results suggest that lockdown measures imposed by governments intensify perpetrators' power over survivors' lives, hence reinforcing gender inequality. They indicate that online provision of support might not be the most effective response in cases of DV and identify appropriate emergency warning systems. Furthermore, the risk of scapegoating COVID-19 for DV is also identified. In addition to these insights a number of evidence gaps were revealed. These were the absence of empirical evidence on COVID-19 and DV/IPV, lack of evaluation of best practices to address DV/IPV, lack of articles related to social work, and a scarcity of literature on issues related to LGBT, migrant, asylum seekers, refugees, and other minority survivors. All of these offer foci for future research.

Discussion
The aim of this systematic search of the literature was to identify emerging issues related to DV within the context of the COVID-19 pandemic. The review of the available literature in peer reviewed journals provides some useful insights to inform social work practice and other relevant professions practice and research.
One of these insights is that the provision of online services is not an appropriate medium for survivors of DV during the pandemic for two basic reasons. First is that some women may not be able to afford technological means of communication and broadband (Joska et al., 2020;Ragavan et al., 2020). This leads to a necessity for the social work profession to lobby to promote greater digital equality in order to address this digital divide and leave no one behind in an era of rapid advances in online technologies. Secondly and importantly, is that the online provision of support entails risks for DV survivors. Survivors who are being enclosed with a perpetrator due to lockdown measures cannot safely communicate with support services. It has been identified in pre COVID-19 research that perpetrators may monitor the technological means by which survivors may communicate (Pentaraki & Speake, under review;Woodlock et al., 2020) 1 . The opportunities to monitor the communication channels have been increased during the COVID-19 context due to the greater time that survivors spend with the perpetrator. Social workers, as well as the other professionals working in the area of DV, need to assume that perpetrators see, hear and monitor every form of the survivors' communications (World Health Or-ganization (WHO), 2020b) which increases the danger to them. Thus, emphasis needs to be placed in providing very discreet ways of activating the process of help-seeking, such as "The Signal for Help" hand gesture as is carried out in Canada, which enable the survivor to activate the help-seeking process without leaving a digital trace. Relevant toolkits for "The Signal for Help" and strategies on its utilization are provided in the website of the Canadian Women's Foundation (2020).
Likewise, pharmacies and supermarkets provide important alternative community avenues of activating the process of help-seeking within the wider community. In France survivors can activate the process of help-seeking through the use of safety words (Usher et al., 2020). This finding highlights the importance of community development work (Pentaraki, 2009) and the need to mobilize every sector in the community to play a role in addressing DV. In addition to France this approach has also been implemented in Spain, Germany, Italy, Norway and Argentina where, similarly, survivors can use a safe word such as "Mask 19" in pharmacies to indicate they need help (Higgins, 2020;Vieira et al., 2020). This seems to be an approach which should be maintained and even expanded after the end of lockdowns linked to the COVID-19 pandemic. However, this might be easier in some countries than others depending on each community's attitudes towards DV and available structures which can respond. Additional proposals which enhance the safety of survivors are provided by the World Health Organization (WHO) (2020b) and United Nations Women (UN Women) (2020a) including one from Cumbria, UK where postal workers and delivery drivers have been enlisted by the police to look out for signs of abuse (United Nations Women (UN Women), 2020a). Also in the UK, a "silent solution" is provided whereby survivors calling the emergency number (999) instead of talking they can respond by tapping into the handset or coughing and if prompted can press 55 on the phone. This will indicate that there is an emergency. For additional suggested safety measures within the COVID-19 context see Women's Aid (2020).
Another insight is that survivors of abuse face double risks during pandemics, the risk of the pandemic and the increased risk of the violence. The literature highlighted that the coercive control tactics of perpetrators are intensified by government imposed quarantine and lockdown measures. At the core of DV/IPV has been a pattern of coercive control (Pence & Paymar, 1993;Stark, 2007). Perpetrators seek to exercise control over the survivors and one of the major tactics used is the isolation of the survivors from support networks (Pence & Paymar, 1993;Stark, 2007). Lockdown scenarios reinforce this isolation through the enforced continuous coexistence between perpetrator and survivor. Isolation reinforces the power of the perpetrator. The perpetrator spends more time with the survivor and uses the COVID-19 context as an opportunity to further intimidate them in various ways, such as telling them what they can or cannot do (wash or do not wash their hands etc.) and spreading false information regarding the quarantine measures. Opportunities for abuse increase and the lockdown measures further isolate the survivor from support. Thus, from the start government decision making bodies and emergency response authorities should exclude survivors of IPV from restricted movement during periods of lockdown. Social workers, due to their expertise in working with DV survivors, should highlight the need for their inclusion in government decision making emergency response teams in order to account not only for the need of DV survivors but also for the needs of others such as abused children, who face heightened risk during pandemics. This will help to overcome the "tyranny of the urgent" (Smith, 2019: p. 355) and provide a more inclusive way of addressing people's needs from the onset of the lockdown measures (John et al., 2020;Rajan et al., 2020).
A further issue identified is the risk of scapegoating COVID-19 for causing DV (Mazza et al., 2020). It is important to remember that COVID-19 and its related stressful conditions do not transform people who have no inclination to control their partner into perpetrators (Dalton, 2020). Control is the primary feature of the majority of cases of DV (Allen, 2014;Johnson, 2006;Johnson et al., 2014;Pence & Paymar, 1993;Stark, 2007;True, 2012). To assume that the predominant cause of DV during the pandemic are the conditions created by COVID-19 can lead to ineffective responses. Stress or substance abuse can be the trigger for violence, however it should only be regarded as the cause of violence when the perpetrators of DV are also violent towards other people with whom they come into contact (Pence & Paymar, 1993). In most cases COVID-19 conditions are the trigger rather than the cause (Van Gelder et al., 2020). Such issues can be explored in follow-up research in post COVID-19 conditions.
The understanding of COVID-19 conditions as a cause rather than a trigger of violence relocates the responsibility away from the perpetrators to factors that are beyond their control, such as stress connected to COVID-19 and the associated measures of quarantine and lockdown etc. This understanding can lead to a reductionist approach to DV as it ignores its social causes (Allen, 2014;Johnson, 2006;Johnson et al., 2014;Pence & Paymar, 1993;Stark, 2007;True, 2012). However, John et al. (2020) drawing from previous scholarly work on extreme events, highlight the social causes of DV in their assertion that COVID-19 exposes existing inequalities, such as gender inequalities and gender based violence, of which a dimension is DV.
Scholarly work on extreme events indicate that these are inherently social processes (Blaikie et al., 1994) which impact individuals differently based on class, gender, ethnicity, age and disability (Ariyabandu & Wickramasinghe, 2003;Blaikie et al., 1994;Fisher, 2010;Pentaraki, 2013b) thereby reinforcing existing inequalities. This is indicated in the way that survivors of DV are impacted by extreme events. Gender inequality, which underlines the majority of DV cases (Jakobsen, 2014;Stark, 2007;True, 2012) is reinforced within the context of the COVID-19 pandemic (John et al., 2020). Women are intimidated, told not to wash their hands, threatened with medical neglect, and given false information regarding lockdown measures etc. These examples reflect the power and control tactics of the perpetrator, which in turn can reinforce gender inequality. Gender inequality is reinforced if governments impose measures from the outset of pandemic, which do not enable survivors to break lockdown to seek help. Survivors are thus double-isolated as a result of perpetrators and governments' actions. Furthermore, living in remote rural areas can add an additional layer of isolation (triple-isolation). However, women's lives within COVID-19 are not only negatively impacted by DV. Their lives have become more burdened with additional caring responsibilities, job insecurity and reduced earnings as evidenced from real-time surveys (Adams-Prassl et al., 2020). Additional challenges are faced by survivors of DV due to "race", ethnicity, sexual orientation, disability and age inequalities (Pentaraki, 2017). These are issues which will need to be considered through an intersectional approach (Slakoff et al., 2020) in order to respond appropriately to DV and furthermore necessitate well-funded services which in many countries have been undermined by austerity (O'Hara, 2015;Pentaraki, 2013a). There is a concern that COVID-19 government spending will be used as a pretext to impose further austerity cuts and thus further undermine existing social services, such as those related to addressing domestic violence, in the same way that the financial crisis was used as a pretext for social spending cuts (Pentaraki, 2013c(Pentaraki, , 2019b(Pentaraki, , 2019c. However, we need to remember that social spending cuts are a result of the concentration of wealth in the hands of few (Gneiting et al., 2020) and as such demand the restructuring of society to meet the needs of all with well-funded services. Survivors of domestic violence need well-funded services, their lives depend on it (Weil, 2020).

Conclusion
The present paper has through a systematic literature search identified emerging issues in the area of DV linked to COVID-19 which are of relevance to many countries. These issues should be considered in order to respond to DV not only during the COVID-19 pandemic but also in future pandemics. Extreme events highlight issues surrounding DV about which the social work profession as well as other professions needs to be informed and continue to explore.