Health service responses and help-seeking for women experiencing violence during outbreaks in low- and middle-income settings: a scoping review

During outbreaks women struggle with access to essential health services, including for violence. Services may be disrupted or deprioritised, or women may avoid clinical settings. We conducted a scoping review to understand how health services for violence against women (VAW) were affected in low- and middle-income (LMIC) settings during recent outbreaks, and womens help-seeking for violence. We reviewed published academic literature reporting on primary research from LMIC settings during recent outbreaks (Ebola, Zika and COVID-19). Four databases were searched: Medline, Embase, Global Health, and Global Index Medicus. Thirty two papers met the inclusion criteria. Data were extracted using a thematic framework focusing on both the supply and demand for services. Experiences during COVID-19 were overrepresented, with no studies identified from other outbreaks. Research spanned 20 countries including a range of services and populations. In the face of lockdowns and reorientation of the health system towards COVID-19, VAW services were restricted or closed despite being essential. Many settings reported that they moved services online or to telehealth, raising digital access issues and safety concerns for women using services from spaces that might be shared with a violent partner or others. Some in-person programme modalities were also adapted, with community volunteers used, or cash assistance provided to survivors. Help-seeking varied, with greater or fewer numbers of survivors presenting at clinical settings, likely indicating fluctuating restrictions. Women experiencing violence often sought help from informal sources (such as community leaders and family). Survivors help-seeking was affected by the economic crisis accompanying COVID-19, including food insecurity and transportation challenges. To prepare for future outbreaks research is needed to identify what services are or are not safe and accessible to deliver online, as well as a understanding a broader range of emerging practices for adapting to social distancing, movement and transport restrictions and economic stress.