Preventing violence against women and girls - what works: evidence summary

Forms of VAWG and overarching moderating factors

This report has been predominantly organised by intervention type^[22], rather than violence type (e.g. gender-based violence, domestic abuse, sexual violence). However, it is important to provide a brief overview of these types of VAWG; looking at how they can overlap, and considering overarching moderating factors that should be taken into account alongside the interventions presented^[23].

Gender based violence (GBV)

This report includes interventions that promote gender equality and seek to challenge and change social norms, behaviours, and attitudes to prevent GBV. As the European Institute for Gender Equality (2019) states:

Gender based violence is a phenomenon deeply rooted in gender inequality, and continues to be one of the most notable human rights violations within all societies. Gender-based violence is violence directed against a person because of their gender. Both women and men experience gender-based violence but the majority of victims are women and girls.

Following this understanding, this report outlines the international and Scottish evidence on the effectiveness of interventions in preventing various forms of GBV (see also Equally Safe, 2016).

GBV is disproportionately experienced by women (WHO, 2010). As the Scottish Social Attitude Survey report (2014:10) highlights:

Framing violence as gender based – that is, as violence that is directed against a woman because she is a woman, or which affects women disproportionately – highlights the need to situate it within the context of women’s status in society, taking into account norms, social structures, and perceived gender roles which influence women’s vulnerability to violence.

This report reflects this framing, concentrating on interventions that change social norms and attitudes to prevent violence against women.

Overarching moderating factors for GBV interventions

Potential facilitators

To address GBV and its causes, ScotPHN (2019:27) outline a set of recommendations as part of their Violence Prevention Framework, including highlighting the need to account and advocate for wider understandings of both the root causes of violence, and the “need for intervention at individual, relationship, community and societal level”.

More specifically, according to Ellsberg (2015:1555), effective^[24] GBV interventions which focus on addressing societal and gender norms alongside VAWG are often:

• participatory
• engage multiple stakeholders
• support critical discussions about gender and the acceptability of violence
• support greater communication and shared decision making among family members

According to the WHO (2019), the implementation of interventions to prevent VAWG must apply their guiding principles for effective programming. These ten principles^[25] are:

Core Values

• Put women’s safety first and do no harm
• Promote gender equality and women’s human rights
• Leave no one behind

Generate and Disseminate Knowledge

• Develop a theory of change
• Promote evidence informed programming

Programme Design

• Use participatory approaches
• Promote coordination
• Implement combined interventions
• Address the prevention continuum
• Take a life-course approach

Potential barriers

There are a number of barriers to making GBV interventions effective related to:

• the behaviour of the perpetrator
• a victims-survivors’ access to services
• their available resources
• immigration status
• existing support network

As will be discussed further below, these barriers are similar to those identified for DA interventions.

As Crooks et al. (2019:46) notes:

we know quite a bit about what works to prevent GBV for cisgender, heterosexual, white youth; however, there exist many gaps in our knowledge. These gaps are critical to address if we are to promote healthy relationships for all youths and ensure access to meaningful and effective prevention programs.

This report therefore acknowledges that the experience of victims-survivors and the effectiveness of interventions may vary greatly depending on their protected characteristics, identity, and access to resources.

Domestic abuse and sexual violence are forms of GBV. It is therefore important to provide brief background on these forms of VAWG. This report takes into account that many of the interventions aimed at reducing GBV may also be effective at addressing DA and SV.

Barriers for women from minority, marginalised, or disadvantaged communities

It is important to consider the specific circumstances that may be barriers to help and support^[26] for women who have other protected characteristics (e.g. race, disability, LGBT+, and others). As such, the different issues and barriers that women from marginalised or disadvantaged communities face must be accounted for within interventions to prevent VAWG such as domestic abuse (Femi-Ajao et al. 2020).

There are specific challenges for women and girls who have other protected characteristics^[27] that increase their risk of violence and in some cases act as barriers to effective interventions (Equally Safe, 2016:19).

The risk factors associated with the intersection of gender and other protected characteristics^[28] are underpinned by prejudice and continuing structural inequalities in society (Equally Safe, 2016).

In a UK context having ‘no recourse to public funds’ (NRPF) due to circumstances such as immigration status or spousal visa can also be a barrier to accessing support^[29].

Moreover, research by Femi-Ajoa et al. (2020) indicates the following barriers to disclosing domestic violence among women from ethnic minority populations:

• immigration status
• community influences
• problems with language and interpretation
• unsupportive attitudes of staff within mainstream services

In this context, Femi-Ajoa et al. (2020:746) conclude that:

There is an on-going need for staff from domestic violence services to be aware of the complexities within which women from ethnic minority populations experience domestic violence and abuse.

For more resources and research on barriers to accessing support for women who have experienced DA see Annex F.

Domestic abuse (DA)

Domestic abuse is understood as a particular form of VAWG (United Nations, 2015), and is the term adopted throughout this report. According to the Crown Office and Procurator Fiscal Service (COPFS) and Police Scotland, DA is defined as:

Any form of physical, verbal, sexual, psychological or financial abuse which might amount to criminal conduct and which takes place within the context of a relationship. The relationship will be between partners (married, cohabiting, civil partnership or otherwise) or ex-partners. The abuse can be committed in the home or elsewhere including online.

Both men and women experience DA. However, women in Scotland were almost twice as likely as men to have experienced partner abuse since the age of 16^[30] (20.0% and 10.9%, respectively) (Scottish Crime and Justice Survey, 2016/18).

Moreover, COPFS and Police Scotland’s joint protocol in challenging domestic abuse details that:

it is acknowledged that domestic abuse as a form of gender based violence is predominately perpetrated by men against women. This definition also acknowledges and includes abuse of male victims by female perpetrators and includes abuse of lesbian, gay, bisexual, transgender and intersex (LGBTI) people within relationships.

These definitions are adopted within this report. However, it is important to note that other terminology and understandings are used within the evidence presented in this report, including:

• Intimate partner violence (IPV)
• Domestic abuse
• Partner abuse
• Domestic violence

These reflect different national legislation, supranational approaches (such as the United Nations), and academic research with an international focus. These terms are often used interchangeably to describe a particular form of violence against women that can include some or all of the following:

• often perpetrated by a male partner or ex-partner
• psychological and emotional abuse (including coercive and controlling behaviours)
• economic abuse
• physical abuse
• sexual abuse
• Some understandings of DA also include abuse perpetrated by family members and other members of a household.

Interventions to prevent DA must therefore take the complex psychological, physical, emotional and financial dimensions of this form of VAWG into consideration. As discussed further below, this includes the use of coercive and controlling behaviours to underpin and sustain domestic abuse (see Stark, 2007, 2009).

It is also important to recognise the significant and detrimental impact of the COVID-19 on families experiencing domestic abuse (DA) in Scotland^[31], and internationally (WHO 2020). Evidence from Scotland suggests the isolation associated with the COVID-19 lockdown has magnified the impact and risk of domestic abuse for victims-survivors and children, and in some instances perpetrators of abuse have used violent and abusive behaviour apparently specific to lockdown^[32]. However, it is unclear whether/to what extent the nature of domestic abuse itself has changed. As such, it is not possible to draw conclusions on what the COVID-19 pandemic means for what works to prevent DA and other forms of VAWG. How the COVID-19 pandemic impacts the content and design of prevention-focused interventions should be monitored.

Overarching moderating factors for DA interventions

Potential facilitators

According to the WHO (2012a) report on intimate partner violence, international evidence highlighted a series of effective or promising approaches to preventing VAWG^[33], including DA^[34]. Although understood as particularly challenging to evaluate, this report advocates for “comprehensive, multi-sectoral, long-term collaboration between governments and civil society at all levels of the ecological framework”^[35] (WHO, 2012a:7). In relation to more specific strategies, they highlighted the following as demonstrating promise or effectiveness in preventing DA abuse:

• Use behaviour change communication to achieve social change (e.g. school-based prevention programmes)
• Engage men and boys^[36] to promote non-violence and gender equality
• Organise media and advocacy campaigns to raise awareness about existing legislation^[37]

These interventions are explored in more detail later in this report.

Reporting and seeking help

Domestic abuse as a barrier to reporting

Facilitating early intervention may be a long-term and complex process as domestic abuse victims-survivors may wait considerable time before disclosure^[38] (Cleaver et al. 2019). Research suggests that in seeking formal and informal support, women experiencing domestic abuse delayed making contact with specialised services until a crisis occurred (e.g. assault by the perpetrator), or an individual (‘an enabler’) facilitated access (Evans and Feder 2014). As such, though abuse may have begun, early detection and intervention systems are needed (Cleaver et al., 2019).

Evans and Feder (2014) noted that the women they researched faced various barriers to accessing specialist services including, but not limited to:

• Feelings of shame or denial
• Lack of trust in others
• Fear of repercussions such as the perpetrator finding out
• Poor experiences of help seeking

According to Stark (2012), between 60 and 80 per cent of female victims-survivors of domestic abuse who had sought help had been subjected to coercive and controlling behaviours^[39]. According to Biderman (1956), there are three primary elements of coercive control: dependency, debility and dread. Within these elements he detailed eight techniques used with coercive control (see Biderman’s ‘Chart of Coercion’, 1973; Hill, 2019):

• Isolation
• Monopolisation of perception
• Induced debility or exhaustion
• Cultivation of anxiety and despair
• Alternation of punishment and reward
• Demonstrations of omnipotence
• Degredation
• Enforcement of trival demands

Therefore, domestic abuse interventions must acknowledge and address how the perpetrator’s coercive and controlling behaviours can act as a barrier to victims-survivors reporting their experience or seeking help from the police or support services (see Pain and Scottish Women’s Aid report entitled Everyday Terrorism: How Fear Works in Domestic Abuse, 2017).

According to Fugate et al. (2005:298), other barriers to reporting for women experiencing DA include, but are not limited to:

• lack of money
• health insurance (USA context)
• available time to contact support services
• lack of knowledge about resources
• logistical barriers such as lack of child care or transportation

Barriers to reporting domestic abuse to the police

The Scottish Crime and Justice Survey (SCJS) finds that most incidents of partner abuse do not come to the attention of the police^[40]. The SCJS 2017/18 report^[41] found that a fifth (19%) of those who experienced partner abuse in the 12 months prior to interview stated that the police came to know about the most recent incident.

Further breakdowns indicate similar rates of reporting of partner abuse for men (19%) and women (20%) in the 12 months prior to interview according to SCJS 2016/18 data.

Based on 2016/18 SCJS data, when asked the reasons for not reporting the most recent incident of partner abuse to the police, some common reasons given by female respondents were:

• those involved had dealt with the matter themselves (34%)
• the abuse was too trivial/not worth reporting (28%)
• the abuse was a private, personal or family matter (25%)
• it would have been inconvenient or too much trouble (17%)

As reflected in the SCJS results, women’s perceptions of their relationships and/or incidents of abuse as personal, “nobody’s else’s business”, or private and confidential can also be reasons for not reporting abuse to the police. These SCJS results mirror the barriers that Fugate et al. (2005) highlight above. They also note that there can be a desire for individuals to preserve their relationship, or protect their partner by not reporting domestic abuse to the police (Fugate at al., 2005).

Sexual violence (SV)

Sexual violence^[42] is defined by the World Health Organisation (WHO) as:

Any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic or otherwise directed against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting, including but not limited to home and work (WHO, 2012b:2).

As Lundgren and Amin (2015: 543) note, SV can “occur at any age – including childhood – and can be perpetrated by parents, family members, teachers, peers, acquaintances and strangers, as well as intimate partners”. According to the SCJS 2016/18 results, women are more likely than men to have experienced both serious sexual assault^[43] and less serious sexual assault^[44]. Likewise, a higher proportion of women than men reported experiencing at least one type of serious sexual assault since the age of 16 (6.2% compared to 0.8%, respectively) (SCJS 2016/18). These results indicate the importance of using a gendered approach to understanding violence and the role of systemic gender inequality in sustaining violence.

According to DeGue et al. (2014), sexual violence is a complex topic with overlapping social, structural, cultural and individual dimensions. They argue that prevention approaches should be “equally complex, multifaceted, and embedded within our lives and environments” (DeGue et al, 2014:36). Sexual violence, as with other forms of violence against women and girls, can have a range of negative impacts, including for their reproductive health, mental health, behavioural impacts, and possibly fatal outcomes (see detailed list in Understanding and Addressing Violence Against Women: Sexual Violence, WHO 2012b).

The US Centers for Disease Control and Prevention provide details on sexual violence prevention strategies; understanding this form of violence as a public health issue – an approach that is central to the Scottish Government Equally Safe strategy.

Stalking and sexual harassment are not included within this report in detail due to limited available evidence. However, while they are not mutually exclusive, there are overlapping experiences with the forms of VAWG detailed in this report (see Annex E).

Overarching moderating factors for SV interventions

Potential facilitators

DeGue et al.’s (2014) systematic review outlines the following criteria, which can contribute to effective primary prevention strategies for sexual violence perpetration, suggesting that interventions should be:

• comprehensive
• appropriately-timed
• involve varied teaching methods
• include a sufficient ‘dose’
• foster positive relationships
• be relevant for particular sociocultural contexts
• have well-trained and equipped staff
• be theory and evidence driven

ScotPHN’s (2019) Violence Prevention Framework publication also provides details of potential facilitators for preventing sexual violence, some of which are drawn from a Scottish context (such as awareness campaigns).

Potential barriers: reporting sexual violence

As noted above in the DA summary, there are barriers that victims-survivorss face in receiving help and support and/or reporting SV to the police^[45]. These can include cultural and social attitudes, prior unsatisfactory experience with the justice system, concerns about the criminal justice process, and/or potential personal repercussions (see Prochuk 2018 for more detail).

This report will now consider interventions in turn, informed by the WHO (2019) RESPECT framework, to present evidence on what works to prevent VAWG.