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Violence against women during covid-19 pandemic restrictions

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1712 (Published 07 May 2020) Cite this as: BMJ 2020;369:m1712

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Re: Violence against women during covid-19 pandemic restrictions

Dear Editor,

The increased levels of violence during the covid-19 pandemic are alarming indeed. Not only because of the lasting consequences for the physical and mental health of the women and the (unborn) children affected by the violence, but also because of the risk of intergenerational transmission.

The environment in which an individual develops, from the very earliest stages of life into childhood, has a fundamental influence on its growth and development and affects its behavior and susceptibility to disease (1). International studies performed before the COVID pandemic have shown that domestic and family violence in pregnancy is widespread and that violence often begins during pregnancy, or, if domestic violence already exists, its severity increases during pregnancy (2). Women who experience violence during pregnancy are more likely to deliver prematurely and have a baby with poorer neonatal outcomes (3). After birth, these children more often have internalizing problems and infants exposed to violence show insecure attachments, increased agressive behavior, reduced prosocial behavior, and poorer health (4,5). Adverse childhood experiences such as child maltreatment or domestic violence increase the risk of future disease, but also increase the risk of mental illness, substance abuse and violence, perpetuating a vicious circle of stress and adversity (6). Consequently, the current outbreak of violence does not only harm the health and wellbeing of those affected now, but also affects their future health and wellbeing, as well as the health of their future children.

Therefore, in addition to the authors call for more attention, protection and care for the women and children affected by the outbreak of violence during the COVID pandemic, I call for more upstream approaches to prevent violence. Although violence is a multifacetted and complex problem that cannot easily be solved, there are effective interventions that can help prevent domestic or intimate partner violence, such as the Grameen Bank project in Bangladesh, and the Nurse Family Partnership. If we do no take action now to seriously try to prevent any further escalation of violence, we will not only witness doubling numbers of traumatised individuals but also doubled numbers of individuals at risk of becoming future perpetrators of domestic violence.

There is a triple dividend of preventing further escalation of violence; it will have the potential to improve the current health and wellbeing of women and children, their future health as well as that of their future children. This is a promising way to break the intergenerational cycle of violence and improve the lives of generations to come. I believe preventing violence will address the sustainable development goal of reducing inequalities and I believe we have no time to waste and should start investing more in preventing violence.

Tessa Roseboom, professor of Early Development and Health, University of Amsterdam

1. Fleming TP, Watkins AJ, Velazquez MA, et al. Origins of lifetime health around the time of conception: causes and consequences. Lancet. 2018; 391(10132), 1842–1852.

2. Violence against women, UNICEF 2015. Retrieved from https://unstats.un.org/unsd/gender/downloads/WorldsWomen2015_chapter6_t.pdf

3. Shah PS, Shah J. Maternal exposure to domestic violence and pregnancy and birth outcomes: a systematic review and meta-analyses. J Womens Health. 2010; 19(11), 2017–2031.

4. Martinez-Torteya C, Bogat GA, Levendosky AA, von Eye A. The influence of prenatal intimate partner violence exposure on hypothalamic-pituitaryadrenal axis reactivity and childhood internalizing and externalizing symptoms. Dev Psychopathol. 2016; 28(1), 55–72.

5. Cameranesi M, Lix LM, Piotrowski CC. Linking a history of childhood abuse to adult health among Canadians: a structural equation modelling analysis. Int J Environ Res Public Health. 2019; 16(11). doi: 10.3390/ijerph16111942

6. Hughes K, Bellis MA, Hardcastle KA, Butchart A, Mikton C, Jones L, Dunne MP. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Global Health 2017:2:e356-66.

Competing interests: No competing interests

18 May 2020
Tessa J Roseboom
professor of early development and health
Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands