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How general practice can respond to violence against women and girls

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.

At a UK national policy level, this started to change with mandatory reporting policies on female genital mutilation, the Royal College of General Practitioners (RCGP) safeguarding standards and toolkit, and the National Institute for Health and Care Excellence (NICE) domestic abuse guidelines. However, evidence-based guidance is not yet systematically implemented in clinical education and practice.

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 download: Violence against women and girls: how can general practice respond?

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

For further information, please contact Gene at gene.feder@bristol.ac.uk

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Schools play important role in prevention and early identification of adolescent toxic relationships

VISION researchers, Dr Polina Obolenskaya, Dr Annie Bunce and Dr Ruth Weir, recently published a blog for the London School of Economics (LSE). Breaking the cycle of harm in adolescent relationships looks at the Netflix series, Adolescence, and the portrayal of the reality of teenage violence, and the complex causes behind it.

The researchers draw on their research into adolescent toxic relationships to highlight the sources of such behaviour, and argue that schools can play an important role in prevention and early identification of harmful relationships between peers.

To read or download the blog: Breaking the cycle of harm in adolescent relationships

For further information, please contact Polina at polina.obolenskaya@citystgeorges.ac.uk

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Examining the differing trends of violence between Wales and England

Violence is a public health problem, with significant individual, economic, health and social care costs. Monitoring violence trends and distribution is a key step of a public health approach to violence prevention.

Health service data in England and Wales are used to monitor temporal change in violence prevalence. However, administrative data relies on service contact and recording practices, while nationally representative surveys, such as the Crime Survey for England and Wales (CSEW), record information on violence even when services were not sought. The Office for National Statistics (ONS) uses CSEW to estimate prevalence of violent crime and changes over time, publishing these for England and Wales combined. Therefore, there is a need to examine whether trends in violence in Wales differ from trends in England, which is the aim of this report.

Dr Polina Obolenskaya led the study, Temporal trends in prevalence of violence in Wales: analysis of a national victimisation survey, with VISION colleagues Dr Anastasia Fadeeva, Emma Barton, Dr Alex Walker, Lara Snowdon and Professor Sally McManus. Using CSEW data, for years 2002–2020, they compared trends in prevalence of violence victimisation between Wales and England, for all adults and by gender.

Country-disaggregated data shows that the prevalence of violence was generally lower in Wales than in England for the first decade of the century. Analyses by gender shows further disparities between countries. Males in Wales and England and females in England experienced a decline in violence victimisation between 2002 and 2015 but there was no decline in violence for females in Wales until after 2016. This decline in violence for females in Wales differed for females in England who experienced an upturn in prevalence of violence from 2015.

Different patterns of violence in England and Wales indicate that relying on combined estimates of violence for England and Wales in strategy development and planning in Wales should be avoided. Further work is required to understand why trends differ between England and Wales, including analyses accounting for socioeconomic and demographic characteristics of each population, as well as thorough considerations of potential policy drivers.

Recommendation

Given differences in prevalence and trends in violence between Wales and England, relying on estimates based on the countries combined to inform strategic planning in Wales is problematic. Using Wales-specific estimates and trends in violence is therefore recommended.

To download: Temporal trends in prevalence of violence in Wales: analysis of a national victimisation survey

To cite: P. Obolenskaya, A. Fadeeva, E.R. Barton, A. Walker, L.C. Snowdon, S. McManus, Temporal trends in prevalence of violence in Wales: analysis of a national victimisation survey,
Public Health, Volume 245, 2025,105775, ISSN 0033-3506, https://doi.org/10.1016/j.puhe.2025.105775.

For further information, please contact Polina at polina.obolenskaya@citystgeorges.ac.uk

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Perpetrators of domestic abuse against older adults: A rapid evidence assessment

Despite increased research on issues related to aging and older age, abuse of older adults (defined as 60 or over in this study) is a neglected area of academic study. Most of the available evidence is currently found within the elder abuse field; although there is no agreed definition of elder abuse, most incorporate abuse by perpetrators outside of the family (such as carers, people in positions of trust and in some cases strangers) meaning evidence on intimate partner and family member perpetrators is subsumed within these studies. Most studies on domestic abuse have paid limited attention to older age, and in many cases restrict the focus to intimate partner violence among young adults.

PhD student, Merili Pullerits at the Violence and Society Centre at City St George’s University of London, collaborated with colleagues Hannah Bows (Durham University), who led the study, and Natalie Quinn-Walker (University of Wolverhampton), to examine the existing, published research on the demographic and health characteristics, and the offending behaviours and histories of perpetrators of domestic violence and abuse against adults aged 60 and over. 

Using a systematic methodology, searches were conducted in five databases: MEDLINE Complete, APA PsychInfo, CINAHL Complete, SociINDEX with Full Text, Criminal Justice Abstracts with Full Text, and Web of Science (Core Collection), resulting in 75 papers being included in the review.

Their rapid review found that much of the available evidence comes from the elder abuse field, with only a fifth of the included studies taking a specific domestic abuse perspective. Because elder abuse studies often group together all abuse types across varied relationship contexts, such studies make  becomes difficult to extract findings on domestic abuse, potentially hiding important differences. Additionally, the review found that non-intimate partners, that is (adult) children or other family members, tend to be the most frequently reported perpetrator group, although this varied according to the design and methodology of the studies. Most perpetrators tend to be male, and, where information is available, poor health, and drug and alcohol problems are often reported.

The research team concluded that more evidence is required on perpetrators of domestic violence and abuse using a broader range of data sources and research methods.

Recommendation

Evidence on those that use domestic violence and abuse on older people should be situated within the conceptual lens of domestic abuse. Policy and practice should urgently review whether existing risk assessment tools and perpetrator programmes are suitable given that a substantial proportion of domestic abuse against older adults is perpetrated by younger sons, daughters or other family members.

To download: Perpetrators of domestic abuse against older adults – a rapid evidence assessment

To cite: Hannah Bows, Merili Pullerits, Natalie Quinn-Walker, Perpetrators of domestic abuse against older adults – a rapid evidence assessment, Aggression and Violent Behavior, Volume 82, 2025, 102056, ISSN 1359-1789, https://doi.org/10.1016/j.avb.2025.102056.

For further information, please contact Hannah at hannah.bows@durham.ac.uk

Funding: This study was funded by a Home Office (Domestic Abuse Perpetrators) grant.

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Challenges for evidence syntheses on homicide in a global context

Data and evidence on violence are a few of the many core elements necessary for prevention. They inform decision-making by policy makers, provide corroboration for claims-makers, and exist as a means of empowerment for advocates and activists. However, evidence required for prevention is currently fragmented across different systems of knowledge production, creating challenges in the form of missing data.

Viewed through the sociology of quantification and knowledge production, VISION Co-Investigator Dr Elizabeth Cook, provides methodological and ethical reflections on conducting a global systematic review of sex/gender-disaggregated homicide data. In doing so, she highlights epistemological and ontological differences that risk becoming obscured in global, comparative work on violence. 

The systematic review she draws on in her critique, Conflating the map with the territory: Challenges for evidence syntheses on homicide in a global context, consisted of a four-step search strategy: electronic database searches, hand searches of statistics, ministry, and police websites, citation tracking, and email survey of statistics offices.

Studies were included if they reported prevalence data on homicide which was sex/gender-disaggregated (by victim/offender relationship, sexual aspects, and/or motivation) by both women and men. From 194 WHO-recognised countries, data were available for just under half (n = 84). However, there were pronounced differences between countries and regions regarding the availability of data.

Evidence syntheses are just one way of trying to make sense of this vast body of evidence in a transnational context. Viewed through sociological work on quantification and epistemic communities, Lizzie has provided reflections on a global systematic review to establish the prevalence of sex/gender disaggregated homicide by country, region, and globally. 

Recommendation

To avoid conflating the ‘map with the territory’ as others argue, moving towards critical knowledge synthesis as a way to build in contestation and to decenter assumptions of objectivity in the global systematic review of sex/gender-disaggregated homicide data.

To download: Conflating the map with the territory: Challenges for evidence syntheses on homicide in a global context

To cite: Cook, E. A. (2025). Conflating the map with the territory: Challenges for evidence syntheses on homicide in a global context. International Sociology, 0(0). https://doi.org/10.1177/02685809251336694

For further information, please contact Lizzie at elizabeth.cook@citystgeorges.ac.uk

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Confronting violence against vulnerable groups: Insights from a Pint of Social Sciences

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.

For further information, please contact VISION_Management_Team@citystgeorges.ac.uk

Photographs: Top – Dr Anastasia Fadeeva; Above – Dr Ladan Hashemi

Workplace violence and fear of workplace violence: An assessment of prevalence in the UK by industrial sector

Workplace violence is a significant problem with underexamined productivity effects. In a global survey, just under 1 in 5 workers reported exposure to psychological violence and harassment at work, and 1 in 10 reported exposure to physical violence during their working-lives. In the United Kingdom (UK), the Health and Safety Executive (the regulator for workplace health and safety) found 1% of all adults of working age, in the 12 months prior, experienced a physical assault or threat of assault at work.

Workplace violence covers a broad range of adverse social interactions and behaviours committed by or towards employees. It includes encounters between colleagues and between workers and service users. It can also include incidents of domestic abuse experienced at work, with abusers known to pursue victims in the workplace.

Direct and indirect exposure to violent acts or threats of violence at work can be anticipated to lead to anxiety and fear of further victimization. Workplace violence, especially when persistent, may cause psychological disorders including common mental disorders (CMD) of generalized anxiety and depression.

VISION researchers Dr Vanessa Gash (City St George’s University of London) and Dr Niels Blom (University of Manchester) used the United Kingdom Household Panel Study, a nationally representative survey with mental health indicators to examine the prevalence of violence and fear of violence by sector and the effect of violence on common mental disorders (CMD) risk. They also supplemented the analyses with the views of those with lived experience.

Their study, Workplace violence and fear of violence: an assessment of prevalence across industrial sectors and its mental health effects, examined variance in the prevalence of workplace violence and fear of violence in the UK by industrial sector and determined the mental health effects thereof using longitudinal data.

Results showed that a high prevalence of workplace violence and fear of workplace violence was found in multiple different UK industrial sectors – >1 in 10 workers were exposed to violence in the last 12 months in 30% of sectors and >1 in 20 workers were exposed in 70% of sectors. Workers employed in public administration and facilities had the highest risks of workplace violence. The second highest sector was health, residential care, and social work. Workplace violence increased CMD risk as did fear of violence at work. Also, the effect of violence and fear of violence on CMD remained when the researchers investigated CMD one year later. 

Recommendation

The researchers recommend better recognition of the extent to which workplace violence is experienced across multiple sectors and call for better systems wide interventions to mitigate the associated harms.

To download: Workplace violence and fear of violence: an assessment of prevalence across industrial sectors and its mental health effects

To cite: Gash, V, Blom, N. ‘Workplace violence and fear of violence: an assessment of prevalence across industrial sectors and its mental health effects’. Scandinavian Journal of Work, Environment & Health. https://doi.org/10.5271/sjweh.4230

For further information, please contact Vanessa at vanessa.gash.1@citystgeorges.ac.uk

Illustrations from Geisa D’Avo and copyright owned by UKPRP VISION research consortium

A personal view on the Netflix hit, Adolescence

A Warning for Parents, a Teaching Moment, or Just a Drama?

by City St George’s UoL doctoral researcher Sylwia Wypyska-Kieran

I finally got around to watching the show. I braced myself for it. I work in this field, and when I sit down to watch TV, I want an escape. And more importantly, I have a son the same age as the main character. I was scared—I know how dramas can pull the right emotional strings to shake you to your core. And this show does exactly that.

It grips the audience, tapping into their deepest emotions to climb the charts. It spreads fear about youth violence, fueling the anxieties of parents who are already overwhelmed by the mysteries of the online world. At the school gates, friends tell me how upsetting it was. Online, acquaintances share tips on how to ‘better control’ our children, while colleagues publish their expert opinions. Following the discourse surrounding the show is fascinating. But let’s start from the beginning.

Katie was murdered. In a typical narrative about crime, the show’s focus is on the perpetrator – a 13-year-old boy. This compelling drama has done an amazing job of avoiding the othering of the boy who killed, a common and widely criticised practice in the media. Jamie looks young and innocent. His child-looking face shatters the stereotype of a perpetrator, which is so important for society’s understanding of the reality of everyday violence. We feel for him. We see a child whose life has crumbled. We feel for his parents, we feel their pain, self-blame and disbelief. Together with the detectives, we seek the answers. Why?

I was expecting the answer to be the manosphere. The trailer and discourse surrounding the show heavily focused on that. The online world of incels and Andrew Tates. I was surprised and rather confused to see that the manosphere was not a direct effect on Jamie’s behaviour. Katie was bullying Jamie, calling him an incel and telling him that no one will ever go out with him.

How did a drama about a boy who murdered a girl manage to make her seem responsible for his crime? Whilst I pondered whether I misunderstood the implication, I saw a comment online ‘What the boy did was definitely wrong but didn’t it start from the bullying by the girl!!!’.

The detective’s son pulls his Dad aside and tells him about the secret language of teenagers. I work with some amazing people whose work is all about young people’s participation. Teenagers don’t live on The Planet of the Adolescents, to which we have no access. Yes, adolescence is a distinctive period in people’s lives and we do have to understand the psychosocial challenges young people face. But let’s not align adolescence with violence and let’s not separate ourselves from them. It is harmful to them, to us, and to society as a whole.

‘Adolescence made free for schools as Keir Starmer meets creators’, the BBC reports, alongside calls to introduce anti-misogyny lessons. But we can’t teach our way out of misogyny. It seems like a reactive decision made without consultation with experts or young people. The context, complexities and consequences of this decision could be immense.  

The boys I have spoken to, as part of my research exploring responses to harmful sexual behaviours, have told me that they feel shut down in conversations about relationships and sex. It is consistent with other studies around the topic. They already feel they do not have a space where they can explore and learn about relationships or their identities as men. Will showing this series to them open up a conversation or prove them right? My bet is on the latter. We risk pushing them further into a corner—driving them toward the very spaces where they do feel heard. 

References

Youngs, I. (2025) ‘Adolescence hard to watch as a dad, Starmer tells creators ‘, BBC News, 31 March. Available at: https://www.bbc.co.uk/news/articles/cx28neprdppo (Accessed: 02 April 2025).

Gooch, B., Cooke, M. (2025) ‘Schools to run anti-misogyny classes for boys in bid to tackle toxic masculinity’, The Independent, 25 March. Available at: https://www.independent.co.uk/news/uk/home-news/school-misogyny-classes-boys-toxic-masculinity-adolescence-b2718706.html (Accessed: 04 April 2025)

King-Hill, S (2025) ‘Adolescence in schools: TV show’s portrayal of one boyhood may do more harm than good when used as a teaching tool’, The Conversation, 02 April. Available at: https://theconversation.com/adolescence-in-schools-tv-shows-portrayal-of-one-boyhood-may-do-more-harm-than-good-when-used-as-a-teaching-tool-253158 (Accessed: 02 April 2025).

For further information, please contact Sylwia at sylwia.wypyska-kieran@citystgeorges.ac.uk

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Researching the impact of Black and Asian women leadership within East of England domestic abuse services

The East of England is a region with minimal presence of ‘by and for’ (BFR) domestic abuse (DA) specialist services despite being home to Black and Asian communities. A VISION-funded research project, ‘Nothing about us without us’: Investigating the impact of the leadership of ethnic minority women on domestic abuse service provision in East England’, is exploring the impact of the leadership of Black and Asian women within DA service provision in the region.

As part of the work, researchers Dr Mirna Guha (Anglia Ruskin University) and Dr Katherine Allen (University of Suffolk), hosted a leadership event on 3 April 2025 for racially and culturally diverse women. Held at a venue provided by the City of London police, the event was part of a leadership programme implemented through the HUM (‘Us) : A Place-based Emerging-Leaders Model designed and piloted by Mirna and Katherine to diversify leadership in domestic abuse and sexual violence services. Research aims include ensuring culturally responsive and representative support for minoritised victims-survivors in East England.

Prior to the April event, Mirna and Katherine researched the leadership needs of 19 overstretched frontline practitioners i.e. ‘emerging leaders’ from racialised communities working within White-majority and at times professionally isolating generalist services across Bedfordshire, Suffolk and Cambridgeshire. East England is home to scattered racialised and diasporic communities where women’s leadership in local politics and policymaking is low. Based on this, three events on trauma-informed, culturally responsive and diverse styles of leadership have been co-produced with national DASV experts. Participants were invited to also join a regionally pioneering Community of Practice (CoP).

At the April event in London, 15 emerging leaders from racialised backgrounds gained insights into the strategies, opportunities and challenges of practising culturally and racially representative leadership through an inspiring keynote by Superintendent Jasvinder Kaur, Domestic Abuse Lead at Suffolk Constabulary and co-founder of the National Women of Colour in Policing network. Furthermore, nine Black and racialised women speakers associated with statutory institutions viz. Cambridge City Council and the National Police Chief’s Council.

Voluntary organisations also spoke including Apna Haq in Rotherham, Asian Women’s Resource Centre in London, and Karim Foundation in Cambridge. Others also shared their experiences of navigating rural and predominantly White spaces, and their strategies for claiming space, giving voice to community members and creating opportunities for other culturally and racially diverse women leaders. One notable theme was the pathbreaking role each panellist had assumed during her career, opening (or at times creating) doors for herself and those who followed. Discussions across the day dwelled on temporality and the changing political landscapes as well as place-based challenges linked to rurality.

Overall, the leadership model, including this event and others and the growing leadership CoP, with a current membership of 25 emerging women leaders, aims to address these contextual and temporal challenges by bolstering and diversifying racialised women’s leadership in public services to ensure equity for minoritised victims-survivors.

By laying the groundwork for a regional advisory board through the CoP, the model challenges the epistemic erasure of racially and culturally minoritised women within the design of DASV, and broadly, public services which exacerbate the postcode lottery of services across England and Wales. Inspired by Pawson and Tilley’s (1997)[1] approach to realist evaluation (which seeks to understand what works for whom and in which circumstances) Mirna and Katherine aim to evaluate the impact of the leadership programme and CoP on how emerging leaders navigate specific challenges rooted in specific professional, relational and spatial contexts.

[1] Pawson, R. and Tilley, N., 1997. Realistic evaluation.

For further information, please contact Mirna at mirna.guha@aru.ac.uk

Photograph courtesy of Dr Mirna Guha and Dr Katherine Allen.

VISION/VASC Webinar Series: The intersection of a gendered economy and violence prevention

Mary-Ann Stephenson

This event is in the past.

We are pleased to announce our next webinar for the VISION and Violence & Society Centre (VASC) Webinar Series on Tuesday, 17 June, 11.00 – 11.50.

Mary-Ann Stephenson is the Director of Women’s Budget Group (WBG), a feminist think tank that works in research, advocacy and training to realise a gender equal economy in the UK. As an influential link between academia, the community and voluntary sector, and through their activities of government building and exchanging evidence, data, knowledge, and capacity, WBG’s work often interlinks with violence-prevention research and policy.

Examples include their 2019 report, Benefits or barriers? Making social security work for survivors of violence and abuse across the UK’s four nations, written with Surviving Economic Abuse and End Violence Against Women Coalition. Findings highlighted that the social security systems across the UK failed survivors of violence and abuse when they needed help most.

In 2024, WBG published Funding for violence against women and girls services: Briefing for a new government. Recommendations included:

  • A commitment to long-term grant funding for specialist women’s services, including ringfenced funding for services led ‘by and for’ Black and minoritised women, Deaf and disabled women and LGBT+ survivors.
  • More specialist training for police dealing with VAWG cases.
  • Reform social security (including uprating benefits and scrapping the benefits cap and two-child limit) to ensure women’s economic independence and their ability to leave abusive relationships.

In this webinar, Mary-Ann will highlight WBG’s programme of work demonstrating that a gender equal economy and the embedding of gender equality policymaking are necessary in the reduction of violence against women.

Please join the VISION research consortium and the Violence and Society Centre at City St George’s University of London for what will be a fascinating exploration of economic inequality through a gendered lens.

To register for the event and receive the Teams link, please contact: VISION_Management_Team@city.ac.uk

The purpose of the VISION/VASC webinar series is to provide a platform for academia, government and the voluntary and community sector that work to reduce and prevent violence to present their work / research to a wider audience. This is a multidisciplinary platform and we welcome speakers from across a variety of fields such as health, crime, policing, ethnicity, migration, sociology, social work, primary care, front line services, etc. If interested in presenting at a future Series webinar, please contact: VISION_Management_Team@city.ac.uk

This webinar series is sponsored by the UK Prevention and Research Partnership consortium, Violence, Health and Society (VISION; MR-V049879) and the Violence and Society Centre at City St George’s, University of London.