Sexual and reproductive health, violence and coercion during COVID-19
As a global pandemic, COVID-19 has enhanced existing and created new stresses and strains on the structural and interpersonal aspects of our lives. The initial evidence that is emerging from countries across the world is indicating that the pandemic has increased the risk and occurrence of violence, including reproductive coercion and gender-based violence.
While it is important to investigate the impacts that COVID-19 has on gender based violence, including various forms of family, domestic and sexual violence, it is important to note that the pandemic has not directly caused this violence and coercion to occur. Rather it has contributed to stress factors, coercion has escalated, and some people have experienced reproductive coercion or physical violence for the first time.
People who already have restricted bodily autonomy have also faced uniquely coercive contexts during COVID-19, including people with living with a disability, people on temporary visas, people who are incarcerated and people in institutional or state care.
Global trends and statistics
There are established links between environmental disasters and pandemics with violence and coercion. Evidence from events such as Zika, Hurricane Katrina, Ebola and bushfires in Australia has shown that the social, economic and psychological consequences of such intense events can lead to increased family, domestic and sexual violence.
A number of countries have indicated an increase in family and domestic violence help-seeking during COVID-19. While we are yet to have broader prevalence studies undertaken, these initial changes have been measured by increased calls to police, numbers of people accessing refuges and support services and search terms on Google.
The far-reaching economic impacts of COVID-19 have also placed many people and households in financial distress, limiting their abilities to access health care, support services and, exacerbating household tensions. Such tensions can increase the likelihood of violence and coercion.
Given the economic impacts of COVID-19 are likely to continue for a decade, the risk of increased violence and coercion driven by household economic tensions will also remain long after the initial threat of COVID-19 has passed.
Isolation and restricted movement
In Australia some of the most effective measures in limiting the spread of the disease have been strict quarantine, physical distancing (including working and schooling from home arrangements) and isolation measures that have caused many people to be house-bound. While these measures have supported our healthcare response, they have meant that some people have had additional time spent in already coercive or violent environments.
Unfortunately, the isolation and restricted movement measures inadvertently bear a strong resemblance to measures used by perpetrators of violence and coercion to maintain power and control over victim-survivors. For women living with disabilities, isolation measures have highlighted and reinforced aspects of interpersonal and structural coercion that further limit decision-making powers and reduce bodily autonomy.
We are yet to see whether restrictions have limited opportunities for people experiencing violence to access formal support services, such as refuges, General Practitioners, social workers and family violence responders. Restrictions have meant that people have found creative ways to access community, cultural and peer support networks. One day we will be able to reflect on the pandemic and consider how, where and when formal and informal support opportunities during the pandemic supported everyday survival for people living in coercive contexts.
Long term health impacts of violence and coercion during COVID-19
The impacts of violence and coercion that are perpetrated during COVID-19 will have long term health impacts. Exposure to violence, particularly for children, can result in impaired cognitive development, learning and behavioural difficulties, mental and physical health and wellbeing problems such as depression, anxiety, suicidal thoughts, self-harm, eating disorders and chronic pain.
Adult victim-survivors are also at increased risk of sexual and reproductive health problems such as increased prevalence and exposure to STIs, gynaecological issues such as vaginal bleeding, fibroids and chronic pelvic pain. There are also potential long-term impacts on maternal and perinatal health.
Structural reproductive coercion has increased through decreased access to sexual and reproductive healthcare related to movement restrictions and strain on health systems. Isolation and restricted movement measures have also impacted on people’s abilities to access pregnancy choices during the pandemic. These include access to timely abortion care, contraception, maternal and neonatal health and pregnancy choices counselling.
Addressing the violence and coercion during COVID-19 recovery
The Australian Government’s announcement of an initial $150 million to support people experiencing domestic violence and coercion has been an important measure to address the increased risks and reporting during COVID-19. However, as the nation moves towards recovery, the prevention of, and responses to, violence and coercion must also be considered in long-term recovery plans led by the various State and Territory Governments across Australia.
Specific considerations and recommendations must include adequate funding and support to front-line family, domestic and sexual violence response and for women’s health services to address the short, medium and long-term health impacts. This includes resourcing for specialist women’s support services and women’s alliances who provide policy and practice guidance on gender equity, trauma-informed care and anti-discrimination in healthcare.
COVID-19 has shown us that reproductive coercion needs to be a key consideration in community-wide pandemic plans so that risks can be addressed or avoided prior to the onset of quarantine and movement restrictions. Preventative measures such as resourcing Community Controlled Health providers to be in key decision making positions, supporting public health literacy campaigns related to sexual health, and having publicly available access to condoms, gloves, dental dams and pregnancy test kits can be powerful.
Pandemic recovery requires social, cultural, environmental and economic recovery for all. It is impossible to consider recovery from COVID-19 without integrating recovery from violence and coercion. Now is an opportune time to invest long term in better health outcomes for all communities, with community led, person centred, trauma informed care.
If you or anyone you know needs support, you can contact the National Sexual Assault, Domestic and Family Violence Counselling Service on 1800RESPECT (1800 737 732)
Dr Catriona Melville MBChB MSc FRCOG MFSRH DipGUM, Deputy Medical Director
Ms Jacquie O’Brien, BA, MIDEA, Director Public Affairs and Policy
Ms Bonney Corbin, BSc, MA, Senior Policy Officer
