The event brought together around a hundred survivor advocates, academics, frontline practitioners, and policymakers to critically examine urgent responses to HBA in today’s rapidly evolving world.
The conference featured three panels examining the flagship “Crime, Not Culture” campaign, the growing role of technology and media in shaping harm, and the resilience and leadership of survivors and community advocates. Throughout the day, speakers and attendees returned to a central question: How do we ensure HBA is recognised and treated as a serious crime rather than dismissed or misunderstood as ‘culture’?
Narratives, Evidence, and the Power of Speaking Out
The day opened with powerful survivor testimonies – deeply personal accounts of control, coercion and systemic failures. These stories underscored the need for meaningful training across policing, healthcare and the family courts. As one panel chair reflected, “It’s not that the government lacks the budget. It’s about priorities. Women from ethnic minorities are not a priority.” The consequences of this neglect, she noted, echo across public services, placing a substantial and avoidable burden on institutions such as the NHS and the police.
Scholars challenged common assumptions about “culture” and emphasised the importance of evidence-informed policy. Their discussions invited the audience to interrogate the ways colonial narratives have shaped understandings of honour, family, and gender norms.
Technology, Media, and Emerging Threats
The second panel explored the fast-changing digital landscape. Speakers examined how technology-facilitated abuse, sextortion, online misogyny, and surveillance increasingly interact with HBA. The panel highlighted that marginalised women and girls often face compounded risks: gendered, racialised, and technologically amplified.
Two short animations produced by the Women’s Research Hub team in collaboration with VISION, on HBA and sextortion were screened during the session. These visual narratives helped ground the discussion in the lived realities of young people navigating online harms – showing not just the risks, but also how digital tools can be used to educate, empower, and support.
One speaker captured the spirit of the day: “It seems it wasn’t enough to be oppressed by patriarchal systems; now we also face the same inequalities reflected back at us through AI and social media.”
Collective Action and Pathways to Change
The final panel focused on resilience and community action. Speakers discussed the importance of survivor leadership, culturally informed practice, and training that centres real voices rather than “death by PowerPoint.” Their reflections highlighted that effective change relies on collaboration between organisations, communities, and those with lived experience.
The conference closed with remarks from Jess Phillips MP, who reinforced the urgent need to strengthen protections and ensure survivors are heard and believed. Her contribution was a fitting conclusion to a day centred on solidarity, listening, and the collective responsibility to challenge harmful practices and support those affected.
One of the quilts created by survivors of ‘honour’-based abuse and IKWRO
A Day of Reflection and Resolve
The event showcased what happens when survivors, activists, academics, and practitioners come together with a shared purpose. Across panels, one message was clear: understanding and preventing ‘Honour‘-Based Abuse requires research, policy attention, resources, and above all, a commitment to centring the voices of those most affected.
VISION was proud to support this important gathering for a second time sparking further conversations about how evidence and collaboration can drive meaningful, long-lasting change.
Key to the event was the organisation and support of VISION’s Knowledge Exchange Manager, Kimberly Cullen and the IKWRO conference organising committee.
By Ladan Hashemi, Senior Lecturer in Sociology of Health and Health Policy at City St George’s University of London
A new animation created by the Women’s Research Hubin collaboration with VISION aims to shed light on ‘Honour’-Based Abuse (HBA), a pervasive form of violence targeting women and girls. Informed by research and survey data on violence against women in Iran, this is the fifth animation in the Hub’s series on gender-based violence (GBV).The survey underpinning this work was designed by Fatima Babakhani, CEO of the safe house Mehre Shams Afarid in Iran.
HBA is widespread both in Iran and globally. Studies indicate that thousands of women and girls in Iran experience coercion, forced marriage, and other forms of abuse in the name of “honour.” Globally, HBA affects communities across the Middle East, South Asia, North Africa, and diaspora populations worldwide, often remaining hidden due to social stigma and cultural justifications. While reliable statistics are difficult to obtain because of underreporting, research shows that the consequences are severe: psychological trauma, physical violence, and, in extreme cases, death. The Centre for Human Rights in Iran reported that in 2024 at least 179 women in Iran were killed — roughly a woman every two days — a significant proportion of them as a result of so-called ‘honour’ killings.
The animation presents real-life narratives, capturing the lived experiences of women subjected to HBA. Through carefully constructed scenes, it depicts situations such as family-imposed restrictions on women’s clothing and mobility, threats, humiliation, forced and child marriage, and the devastating consequences of upholding “honour” through coercion, including physical violence and ‘honour’-based killings.
Some of the impactful transcripts featured in the animation include:
Forced marriage: “They said there had been too many rumours about her, so her family forced her to marry.”
‘Honour’– Based Killing:“His brothers came, one by one, saying: ‘You’ve protected your honour. You’ve spared us all the shame.”
The animation brings these testimonies to life with a sensitive and empathetic approach, allowing viewers to understand the psychological and social dynamics of HBA, as well as its human impact. It emphasises that ‘honour’ is never a justification for violence:“No one is another person’s ‘honour’.‘Honour’ is lost when we turn to violence — not when a woman chooses to live her life on her own terms.”
The campaign also provides clear guidance for bystanders and communities on how to respond:
Avoid judging others’ private lives — everyone has the right to make choices about their body, relationships, and lifestyle.
Support victims of HBA without blame, and do not leave them isolated.
Be mindful of language: words like “honour,” “shame,” and “purity” can reinforce harmful norms.
Do not share private information or images that could endanger someone.
Speak up if you believe someone is at risk and contact trusted organisations.
The animation was produced in collaboration with animators in Iran, experts supporting women affected by HBA in Iran, Fatima Babakhani, and the UK-based NGO IKWRO, which supports victims of HBA in the UK.
The animation will be officially launched on the Women’s Research Hub Instagram page during the 16 Days of Activism Against GBV, providing an important opportunity to reach a global audience and raise awareness of HBA. Ladan and colleagues will also be discussing the campaign at a free lunchtime webinar on Monday, 8 December. For further information and to register for the Teams link, please see Webinar: Using animation to campaign against VAWG.
Previous animations in the series have been viewed hundreds of thousands of times, narrated in multiple languages as well as subtitled, and it has been used in classrooms and at other events. We encourage its widespread use to improve awareness, and one animation in the series provides bystanders with potential strategies for safe intervention.
By combining rigorous research, authentic survivor narratives, and creative storytelling, this animation series offers a powerful tool for raising awareness and driving action against GBV. It is a vital reminder that combating GBV requires both evidence-informed strategies and a commitment to amplifying the voices of those most affected.
Blog by Dr Polina Obolenskaya, Merili Pullerits and Dr Niels Blom
The UK government is expected to publish its new Violence Against Women and Girls (VAWG) strategy later this year. The strategy is part of a broader ambitious commitment to halve VAWG within a decade. A new combined measure of domestic abuse, sexual assault, and stalking, developed by the Office for National Statistics (ONS), has been proposed to serve as the main benchmark for evaluating progress toward this commitment.
Here we outline three main concerns the VISION consortium has with the proposed approach.
Lack of historical continuity
To assess the effectiveness of the VAWG strategy, historical continuity is crucial. Rates of domestic abuse in England and Wales have declined in recent years (Figure 1). Therefore, any assessment of a decline or rise in VAWG needs to be placed in the context of broader declining violence rates. Without this historical continuity, the government cannot distinguish between improvements driven by their strategy and those resulting from long-term social changes that were already underway.
Figure 1 Prevalence of domestic abuse in the last year among people aged 16 to 59 in England and Wales, 2004/05 to 2023/24
However, the new combined measure disrupts this continuity. This is due to changes to the question wording and structure of its composite measures. The new combined measure of VAWG consists of self-completion data from a newly developed Domestic Abuse module (piloted in 2022/23 and 2024/25, and fully implemented from 2025/26), as well as a combination of the old and new Sexual Victimisation module (piloted in 2025/26 and planned for full implementation from 2026/27).
The new Domestic Abuse module had undergone a complete redevelopment, with extensive negative repercussions for historical continuity, which we have outlined previously. While the sexual victimisation module is not being re-developed as considerably, the comparability of the new data to the previously collected data can only be assessed once the first round of results is available. This means a new stable and comparable measure will not be available in its final form until the 2026/27 data collection, despite the government’s strategy period beginning in 2025/26.
Without historical continuity, it will not be possible to produce long-term trends over time in the composite measure of VAWG for England and Wales for some years to come. Given the decline of some forms of violence in recent decades, it is important to examine whether any decline in VAWG is due to genuine policy success, or due to a continuation of pre-existing trends.
Incomplete scope of violence
While the government has indicated that it intends to supplement the new combined measure of domestic abuse, sexual victimisation and stalking with additional metrics, it is currently unclear what these supplementary measures will include or how they will be weighed against the main benchmark. In any case, the narrow scope of the new combined measure has been raised as a concern both among academics and others working in the sector.
Some of the limitations of the measure are due to the unavailability of certain measures in data it is based on – the Crime Survey for England and Wales. The End Violence Against Women coalition (EVAW) has highlighted that the new measure fails to reflect the full spectrum of violence experienced by women and girls, omitting online abuse, child abuse, ‘honour’-based abuse and sexual harassment (EVAW blog) as well as Female Genital Mutilation (EVAW briefing). These exclusions, as EVAW argues, risk distorting the true scale and impact of VAWG. Additionally, given alarming rates of teenage relationship abuse (e.g. Barter et al., 2009; Fox et al., 2013), we consider its exclusion to be a serious oversight in measuring VAWG – including girls – effectively. Since the combined measure excludes experiences of girls under the age of 16, its use as a main tool to measure government’s ambition to half ‘Violence against women and girls‘ may be misleading.
While the gaps outlined above stem from the limitations of the Crime Survey for England and Wales, we also have concerns about the scope of the measure which could be addressed with the data already available.
Firstly, the new combined measure excludes other offences which count within the CSEW as ‘violent crime’ or violence against a person. While men are more likely to be victims of such offences, disregarding women’s experiences of these risks undercounting their overall risks and impacts of violence (Cooper & Obolenskaya, 2021; Davies et al., 2025). For example, while a substantial amount of VAWG is covered by domestic abuse, sexual violence, and stalking, women also experience violence in other aspects of life, such as at work or in public spaces. Accounting for the above offences significantly increases the proportion of people experiencing violence and more accurately reflects the extent of violence experienced by women and girls.
Secondly, the new combined measure omits broader violence-related offences, for which data are available in the CSEW. This includes threats of violence and other criminal offences which are coded as ‘non-violent’ by the ONS (due to a methodological process involving priority ordering of offences), even though they involve the threat or use of force or violence (Davies et al., 2025; Pullerits & Phoenix, 2024). These offences should be included in any overall measure of VAWG regardless of who is most affected. However, their omission is especially problematic given that they disproportionately affect women (Davies et al., 2025; Pullerits & Phoenix, 2024), meaning the headline measure is likely to underestimate women’s experiences even further.
Although the government has suggested that other metrics are planned to be used, separately, to assess progress towards halving VAWG, having a narrow main measure risks reinforcing outdated gender norms where women are considered to be more affected by what happens at home rather than outside of it. Such a perspective fails to capture emerging forms of abuse and fails to reflect the full spectrum of women’s lived experiences with violence.
Collected new Domestic Abuse data had not undergone statistical validity and reliability checks and had not been subjected to wider scrutiny (as raised by VISION previously) before the decision to replace the old module with it was finalised.
Changes to the Domestic Abuse and Sexual Victimisation modules appear to have been made independently from each other, with limited coordination across the survey modules. Given the similarity in the phrasing of a few questions across the modules, this lack of foresight and integration appears to have resulted in overlapping content that could lead to confusion both for respondents and for those interpreting the data.
The development process has lacked transparency and consultation with external stakeholders, as raised by EVAW.
Recommendations for improvement
The ONS’s new combined measure of VAWG risks oversimplifying the complex realities of violence against women and girls. Even with supplementary metrics, relying on such a narrow primary benchmark – which lacks historical continuity and is limited in scope – will not adequately support evidence-based policy development or serve the needs of those most affected by violence and abuse.
To ensure more meaningful monitoring, we have three key recommendations to the ONS:
Prioritise historical continuity in Domestic Abuse data collection: We urge the ONS to revert to a Domestic Abuse module that aligns more closely with the previous version to ensure data continuity. While we welcome the inclusion of new questions on coercive control and family-related violence, we strongly believe these additions could be integrated into the long-standing existing framework without disrupting the historical comparability of the data. If a full reversion is not feasible, we recommend that theONS takes steps to ensure meaningful assessment of change and continuity using the new measure. These steps should involve: publishing clear comparability assessments between old and new measures; providing bridging data where methodologically possible; and maintaining transparency about limitations.
Broaden the scope of the ‘combined’ measure and make it explicit that it does not fully reflect the experience of girls: the definition of violence against women and girls should be expanded by using existing CSEW data to include “violence against the person” offences, as well as, possibly, other incidents where violence or threat of violence took place but that are not coded as “violent crime” by ONS. The CSEW currently provides insufficient coverage of technology-facilitated and online abuse, which should be a development priority going forward, given the increasing prevalence of these forms of violence both within domestic contexts but also outside of them. Additionally, since the combined measure does not capture violence experienced by girls under the age of 16, the government needs to make it clear that the headline measure, should it be used in the strategy, reflects only experiences of (young) women, not girls.
Enhance transparency and accountability in survey development: we call on the ONS to address technical and transparency concerns regarding their measures and commit to greater openness in their approach. Any new module should be subject to timely, transparent analysis and external scrutiny of it before it becomes a permanent change in the survey.
If the government is genuinely committed to halving violence against women and girls within a decade, it must first ensure its measurement approach is comprehensive, meaningful and methodologically sound. Relying overwhelmingly on a narrow headline measure risks presenting an incomplete picture of the problem of VAWG, and risks undermining both accountability and progress.
Cooper, K. & Obolenskaya, P. (2021). Hidden Victims: The Gendered Data Gap of Violent Crime, TheBritish Journal of Criminology, 61(4): 905–925. https://doi.org/10.1093/bjc/azaa100
Davies, E., Obolenskaya, P., Francis, B., Blom, B., Phoenix, J., Pullerits, M. & Walby, S. (2025). Definition and Measurement of Violence in the Crime Survey for England and Wales: Implications for the Amount and Gendering of Violence, The British Journal of Criminology, 65(2): 261–281. https://doi.org/10.1093/bjc/azae050
Fox, C. L., Corr, M. L., Gadd, D., & Butler, I. (2013). Young teenagers’ experiences of domestic abuse, Journal of Youth Studies, 17(4), 510–526. https://doi.org/10.1080/13676261.2013.780125
Pullerits, M. & Phoenix, J. (2024). How Priority Ordering of Offence Codes Undercounts Gendered Violence: An Analysis of the Crime Survey for England and Wales, The British Journal of Criminology, 64(2): 381–399. https://doi.org/10.1093/bjc/azad047
Fourteen researchers from across the UKPRP VISION research consortium attended the September 2025 European Conference on Domestic Violence (ECDV) in Barcelona, Spain. The team presented key findings from their VISION research and several also convened a symposium. It was a successful turnout from the team and a fantastic networking opportunity.
The ECDV conference aims to support and reflect the aims of the Council of Europe’s Convention on Preventing and Combating Violence against Women and Domestic Violence. It was developed to enhance the visibility and connection of individuals working to address domestic violence in Europe, while also benefitting from the contribution of colleagues from outside Europe.
Anastasia Fadeeva convened the symposium Health perspectives on addressing domestic violence and abuse
Ladan Hashemi, Anastasia Fadeeva and Sally McManus presented Gender Asymmetry in Physical Health Associations with Intimate Partner Violence (IPV)
Anastasia Fadeeva and Niels Blom presented Injuries and Seeking Healthcare following Violence: Inequalities by Victim-Perpetrator Relationship
Vanessa Gash presented Hounded Out? Measuring the Effect of Workplace Violence on Women and Men’s Employment Transitions
Natalia Lewis and Lizzie Cook participated in the workshop, Community of practice for evidence syntheses on gender-based violence: learning together to enable methodological developments and improve evidence for policy and practice.
Lizzie Cook presented Analysing sex/gender-related motives and indicators in England and Wales
Sally McManus presented Commercial Determinants of Health: Opportunities for domestic violence prevention from a public health framework analysis which was written with VISION colleagues Olumide Adisa and Mark Bellis.
Ruth Weir convened the symposium Violence and abuse in young people’s intimate relationships
Polina Obolenskaya and Annie Bunce presented Too soon, too late: experience of and professional responses to abuse in teenage relationships
Ruth Weir presented ADA and its consequences: a rapid systematic review
Annie Bunce convened the symposium, Exploring multiple vulnerabilities using specialist services’ administrative data: Challenges, opportunities and lessons for the future
Maddy Janickyj and Leonie Tanczer presented Understanding Technology-Facilitated Abuse: Exploring real-life experiences through Support Services’ data
Annie Bunce presented The role of vulnerability in the inequity of health outcomes for DVA survivors
Hannah Manzur presented Disclosure to Formal Agencies and Specialised Support Services among Victims of Intimate Partner Domestic Abuse: Comparing Inequality Patterns, Victim Profiles, and Harms by Disclosure, written with VISION colleagues Annie and Ravi
Ladan Hashemi and Hannah Manzur presented Ethnic Disparities in outcomes from contact with DVA support services
Gene Feder convened the symposium Adding to the evidence base that community-based perpetrator programmes work to reduce abuse: Positive findings from REPROVIDE, a UK randomised controlled trial
Photographs:
Top, left to right: Annie Bunce (VISION, City St George’s University of London), Ruth Weir (VISION, City St George’s University of London), Nicola Farrelly (University of Lancashire), Polina Obolenskaya (VISION, City St George’s University of London), Christine Barter (University of Lancashire), Aisling Barker (Islington City Council and City St George’s University of London), and Katrina Hadjimatheou (University of Essex)
Middle, left to right: Hannah Manzur (VISION, City St George’s University of London), Ladan Hashemi (VISION, City St George’s University of London), Maddy Janickyj (VISION, University College London), and Annie Bunce (VISION, City St George’s University of London)
Second from bottom: Vanessa Gash (VISION, City St George’s University of London)
Bottom, left to right: Angel Deng (Kings College London), and Ladan Hashemi, Anastasia Fadeeva and Sally McManus (VISION, City St George’s University of London)
One in four women and one in seven men in England and Wales have experienced domestic abuse. Coercive and controlling behaviours are core to domestic abuse. They result in loss of autonomy and independence and are intended to isolate and reduce self-worth. Such behaviours are common but hard for health professionals to detect.
If passed, the Terminally Ill Adults (End of Life) Bill will allow people who are terminally ill and expected to die within six months to request assistance to end their lives. VISION researchers Gene Feder, Elizabeth (Lizzie) Cook and Sally McManus have written an opinion published in The BMJ that calls for safeguards in the bill need to be strengthened to prevent coercion in the context of domestic abuse.
Assisted dying requires a careful consideration of the risks posed by domestic abuse and coercion. The current bill does not fully tackle specific safeguarding concerns for patients experiencing domestic abuse which can include economic, emotional, physical, and other forms of abuse from a partner or other family member. To safeguard against domestic abuse and associated coercion, Gene, Lizzie and Sally propose a set of principles that should be part of the UK bill.
For doctors responding to any request for assisted dying, training must be extensive, specialist, in person, and backed up by referral pathways. Independent domestic abuse advocates, with expertise in recognising coercive control, could contribute to assessment of assisted dying requests.
Commitments to confidentiality and data security must not obscure assisted dying decisions and the contexts in which they occur. The bill must ensure transparency.
The bill must establish accountability. Transparent data about each stage of the approval process would also enable monitoring and regular scrutiny of the processes and outcomes of assisted dying legislation.
Lawmakers must resist expansion. Dementia and mental health conditions are now being considered for eligibility. These are conditions prevalent in survivors of domestic abuse. The UK bill should include clauses that limit any expansion of scope to other conditions and situations.
Violence against women and girls (VAWG) is a global violation of human rights that damages health and wellbeing across the life course and across generations. Except in its most obvious manifestations as acute injury or distress, VAWG has been largely hidden from the awareness of health services.
National and local VAWG prevention policies are siloed, despite the overlap of different types of VAWG, often affecting the same families, and often part of intersectional vulnerability, amplifying other sources of inequality: class, deprivation, ethnicity, gender identity, disability, and poor mental health.
VISION Director and Professor of primary care at the University of Bristol, Gene Feder, and his Bristol colleagues, argue that the role of general practice needs to be based on the evidence for effective interventions. Despite the relatively recent recognition that violence prevention and mitigation is part of health care, that evidence has grown rapidly over the past two decades. It is strongest for the training of primary care teams linked to a referral pathway to the specialist domestic abuse sector in the UK as well as post-disclosure specialist support for survivors.
Experience of domestic violence and abuse is difficult to disclose and may endanger the patient if the abuser learns of disclosure. Disclosure may be even less likely with the increase of remote and digital access to general practice. Therefore, training for all clinicians should include how to ask about abuse, including in online or telephone consultations, how to appropriately and safely respond to disclosure, and to safely document in the medical record.
Although associated with inequality, VAWG is present in all communities. Prevention and mitigation needs to be across all sectors, with investment in interventions with individuals, families, communities, and tackling structural drivers of violence. General practice must be part of this societal response.
Key messages
There is overlap between different types of violence often affecting the same children, families, and households.
Intersections of deprivation, disability, poor mental health, and racism amplifies the effect of violence and trauma, also reducing access to general practice support.
Violence against women and girls (VAWG) requires a team-based general practice response underpinned by trauma-informed training and referral pathways to specialist services, often in the voluntary sector.
Effective responses to VAWG needs to be rooted in trauma-informed care, facilitated by relational continuity and enabled by face-to-face consultations.
Clinician experience of violence and abuse needs to be addressed in training and support.
To cite: Violence against women and girls: how can general practice respond? Gene Feder, Helen Cramer, Lucy Potter, Jessica Roy and Eszter Szilassy. British Journal of General Practice 2025; 75 (756): 297-299. DOI: https://doi.org/10.3399/BJGP.2025.0244
On a balmy May evening, VISION researchers Dr Anastasia Fadeeva and Dr Ladan Hashemi had the pleasure of presenting at Pint of Social Science, an engaging public event held at a local pub. The event, organised by Caroline (Cassie) Sipos, Business Development Manager for the School of Policy and Global Affairs, City St George’s University of London, was part of the broader Pint of Science movement.
This event, one of many on the same night, is an annual global festival bringing academic research into informal, accessible spaces such as pubs or cafes. The environment enables researchers and the public to connect over important social issues, drinks, and conversation.
Anastasia showcased her research on violence against older people, an often-overlooked area of abuse and harm. She spoke about different forms of violence in older age, including physical, emotional, and economic, and discussed the social and structural barriers that allow this violence to remain hidden. Anastasia also shared the findings from the recent study that measured the prevalence of violence in older age and the associations between violence and mental health in later life. The talk concluded with calls for stronger protective measures and greater public awareness to safeguard the dignity and wellbeing of older populations.
Ladan shared the Breaking the Silence campaign, which uses culturally sensitive animations to amplify the voices of women in Iran affected by violence. Grounded in a survey of 453 Iranian women, the campaign highlights the widespread and multifaceted nature of violence against women and girls, and the urgent need for greater awareness and legal reform. Through powerful storytelling, the animations address issues such as coercive control, economic abuse, and technology facilitated abuse, while promoting the role of active bystanders and signposting available support services. The campaign aims to break taboos, raise awareness, and foster dialogue about women’s rights and freedoms in Iran.
The evening provided a lively and welcoming space for thoughtful conversations and personal reflections. The audience was engaged with both talks, asking insightful questions—often the kind that don’t come up in professional or academic settings. Pint of Social Sciences was a reminder of the value of public engagement and the importance of making research accessible beyond academia. Events like this help to build understanding and inspire collective action towards a more just and informed society.
Domestic violence against women (DVAW) is a public health issue and a breach of human rights, yet evidence on effective interventions remains limited, particularly in low-income and middle-income countries. In Brazil, around one third of women have reported current or previous experiences of DVAW, especially perpetrated by intimate partners. Brazil has a comprehensive policy framework on DVAW, however, their implementation has been piecemeal and low priority.
The research team, led by VISION co-Deputy Director Dr Estela Capelas Barbosa, aimed to evaluate changes in identification and referral to specialist support associated with system-level strategies implemented within Brazilian primary healthcare (PHC) to strengthen the response to DVAW as part of the Healthcare Responding to Violence and Abuse (HERA) programme.
The HERA Programme was an international collaboration, involving research partners in the UK, Brazil, Sri Lanka, Nepal and Palestine, which aimed to strengthen the healthcare system response to DVAW, in order to ultimately ensure better outcomes for women and children.
The researchers explored before and aftereffects using difference-in-difference techniques in a quasi-experimental design, using observational data. HERA intervention in Brazil was implemented in eight PHC clinics, while 33 served as controls. Data on DVAW identification and referral were obtained from the national Epidemiological Surveillance System.
Results indicated that the HERA implementation strategies were effective in increasing identification and referral of women who experienced violence and presented at primary care clinics. By prioritising the needs and experiences of women, under a gender and human rights perspective, the strategies may also have enhanced the quality of interactions between healthcare providers and patients.
To the research team’s knowledge, this is the first Brazilian study using a quasi-experimental design to evaluate a system-level set of implementation strategies to DVAW. It provides compelling evidence for the effectiveness of culturally tailored strategies aimed at improving the response of PHC settings to DVAW. The findings reveal significant improvements in both identification and referral rates. The evidence not only underscores the intervention’s potential but offers a valuable framework for policymakers and healthcare providers seeking to implement effective strategies in similar contexts, particularly in low- and middle-income settings.
To cite: Estela Capelas Barbosa, Stephanie Pereira, Loraine J. Bacchus, Manuela Colombini, Gene Feder, Lilia Blima Schraiber, Ana Flávia Pires Lucas d’Oliveira, Healthcare responding to violence and abuse in Brazil: a quasi-experimental difference-in-differences analysis, The Lancet Regional Health – Americas, Volume 47, 2025, 101114, ISSN 2667-193X, https://doi.org/10.1016/j.lana.2025.101114.
Domestic violence (DV) is a violation of human rights and a major public health problem that damages the health of women and their families. In the occupied Palestinian territories, 29% of women have a lifetime exposure to intimate partner violence, the most prevalent form of DV.
Despite the existence of national policies to prevent and respond to DV, implementation within the Palestinian primary health care system has been weak. The research team, including VISION researcher Professor Gene Feder, developed, piloted, and evaluated a system-level intervention, including training for health care providers and care pathways for women patients. The aim of the evaluation was to determine the feasibility and acceptability of the HEalthcare Responding to violence and Abuse (HERA) intervention.
The adaptation of a previous (HERA) intervention was implemented in primary health care settings in Palestine, informed by stakeholder meetings, interviews with clinic managers and health care providers (HCP), facility-level readiness data, and findings of a previous pilot study. The training component of the intervention, delivered by the Palestinian Counseling Centre, included a train-the-trainer session, two clinic-based training sessions, and reinforcement sessions for front-line healthcare providers in four clinics.
Healthcare providers were trained to ask about DV, give immediate support, and offer a referral to a nurse case manager. The care pathway beyond the case manager was either referral to a primary-care based psychologist or social worker or to a gender-based violence focal point external to the clinic that coordinated referrals to appropriate external services (e.g. police, safe house, psychologist, social worker).
For the evaluation, the researchers employed a thematic analysis of post-intervention semi-structured interviews with HCP and trainers, and observations of training sessions and field notes. Provider Intervention Measure (PIM) data on changes in HCP attitudes and practice were analysed with descriptive statistics. Identification and referral rates for women disclosing DV 12 months before and 12 months after the intervention were obtained from clinic registries. The research team also developed a theory of change to triangulate the qualitative and quantitative data.
Results showed that the training proved acceptable to HCPs and there was evidence of positive change in attitudes and readiness to engage with women patients experiencing DV. Compared to the year before the intervention, there was a reduction in the number of patients disclosing DV during the intervention and of referrals in three of the four clinics. This reduction may be explained by the impact of the Covid 19 pandemic on clinic priorities, lack of time, persisting HCP fear about engaging with DV, and HCP rotation between clinics.
The delivery of the training component of the HERA intervention within the Palestinian primary healthcare system proved partly feasible and was acceptable to HCPs, but contextual factors limited HCP implementation of the training in practice.
Intimate partner violence (IPV) is a widespread global public health issue with serious and long-lasting consequences. While much research has focused on the mental health consequences of IPV, such as depression and PTSD, there is limited evidence on its association with physical health.
This study explored how different types and number of types of IPV are linked to specific physical health conditions, and whether these associations differ between men and women. VISION researchers Dr Ladan Hashemi, Dr Anastasia Fadeeva and Professor Sally McManus, with Nadia Khan, City St George’s UoL, examined this using data from the 2014 Adult Psychiatric Morbidity Survey.
Key findings include:
Women were more likely to experience IPV and a higher number of IPV types than men.
Women’s experience of lifetime and 12-month IPV were significantly associated with 12 and 11 different physical health conditions, respectively, while men’s experience of lifetime and 12-month IPV were significantly associated with 4 and 1 conditions, respectively.
Different types of IPV types were associated with different types of physical health condition, particularly among women.
A cumulative association between experiencing a greater number of IPV types and an increased risk of physical health conditions was evident for women but not for men.
The research concludes that IPV is a gendered issue, with stronger associations between IPV and physical health evident in this data for women than for men. This may be because women are more likely to experience more and multiple types of IPV, more frequently, and more often with injury. Healthcare systems must recognise IPV as a priority issue, ensuring support is tailored to those affected.
Recommendation
Healthcare systems need to address IPV as a priority health issue for the female population. Gender-informed approaches in IPV intervention strategies and healthcare provision are required. This means emphasising the development of IPV-responsive healthcare systems and comprehensive IPV curricula in medical and health training.
To cite: Hashemi L, Fadeeva A, Khan N, McManus S. Intimate partner violence and physical health in England: Gender stratified analyses of a probability sample survey. Women’s Health. 2025;21. doi:10.1177/17455057251326419
