Survivors of domestic violence and abuse have been at increased risk of COVID-19, study finds

Women with general practitioner recorded exposure to domestic abuse or violence were at an increased risk of contracting COVID-19 during the first two waves of the pandemic in the UK, finds a new study led by the University of Birmingham.

Public health policies put in place to prevent the spread and transmission of Sars-CoV-2 appear to have led to a widely recognised “shadow pandemic” of domestic violence and abuse, previously highlighted by the team of researchers at the University of Birmingham. In response, the UK government among many others rightly allowed freedoms in movement for survivors of domestic violence.

The increased freedom of travel and coercive behaviour seen by abusive partners during the pandemic, in addition to the greater prevalence of COVID-19 risk factors among survivors, are thought to be responsible for increasing survivors’ risk of contracting COVID-19, say the researchers.

The researchers are now calling for changes to public health policy to improve domestic violence and abuse surveillance and to ensure promotion and prioritisation COVID-19 vaccination to the survivors.

The study, published today in BMC Medicine, was carried out by a cross disciplinary team of researchers from the University of Birmingham, spanning the Institute of Applied Health Research, the School of Nursing and Department of Economics and the University of Warwick Medical School. It used pseudo-anonymised data from GP records, examined the risk of contracting COVID-19 during the first wave of the pandemic in 10,462 female domestic violence and abuse survivors aged over 16 compared to a matched ‘control’ group of 41,467 women not exposed to domestic violence or abuse. 

The findings* showed that women with a recorded history of domestic violence and/or abuse were at an increased risk of suspected or confirmed COVID-19 compared to unexposed women, a finding that was more pronounced when examining only those women who had recorded domestic abuse in the one year proceeding the start of the pandemic

First author Dr Joht Singh Chandan, NIHR Clinical Lecturer in Public Health at the University of Birmingham, explained: “Public health measures, such as restrictions on movement, put in place to prevent the spread of infection, has previously seen increased rates of violence against women in other recent epidemics such as the Ebola outbreak in West Africa, Cholera outbreaks in Haiti and Yemen, and the Zika outbreak.

“Consequently, during the COVID-19 pandemic, many countries have implemented policies to allow the free movement of domestic violence and abuse survivors in an attempt to minimise their exposure to abusive environments and to facilitate access to support.”

Senior author Krish Nirantharakumar, Professor in Health Data Science and Public Health at the University of Birmingham’s Institute of Applied Health Research, added: “Although these policies are well received, the risk of transmission and exposure to the virus is compounded in this vulnerable group owing to the early evidence suggesting an upsurge in coercive behaviour of the perpetrators to control survivors. These include behaviours such as preventing access to healthcare services or treatment, and threatening or enacting purposeful exposure to COVID-19 within the household”

The researchers said the situation was further compounded by the fact that domestic violence and abuse survivors also have an increased prevalence of ‘comorbidities’, such as type 2 diabetes or cardiovascular disease, which can make them more at risk of COVID-19.

Author Anuradhaa Subramanian, also of the University of Birmingham’s IAHR, added: “Our findings demonstrate that despite accounting for known risk factors, individuals exposed to domestic violence or abuse were at an increased risk of suspected or confirmed Covid-19.”

The researchers recommend that countries globally adopt the evidence-based recommendations to increase vaccination rates in vulnerable groups - focused on reducing physical barriers to vaccine access. These include setting up pop-up clinics in the community to minimise the need to travel, or where survivors have already been displaced, and creating clinics within domestic violence shelters. Lastly, the researchers recommend that countries reconsider their views on COVID-19 vaccine prioritisation to take into consider the additional risk seen in this vulnerable group. 

*During the study period there were 190 (1.8%) new diagnoses of suspected or confirmed COVID-19 in the exposed cohort (an incidence rate of 20.2 per 1,000 person years), compared to 324 (0.8%) new diagnoses (an incidence rate of 8.6 per 1,000 person years) in the unexposed cohort.