Theme 1: Impacts of SLEs on health and well-being of survivors of IPV and the increased risk of IPV.

During SLEs, Survivors of IPV often faced a notable decline in their health and well-being, influenced by various factors, such as increased severity and frequency of IPV, social isolation, and limited access to formal and informal support networks While most literature in this review focuses on the COVID-19 pandemic, Enarson (1999) previously showed how disasters, like floods, can diminish Survivors’ emotional and physical health due to isolation and lack of support [41]. This study further emphasized how environmental disasters place considerable strain on relationships by compounding the difficulties of replacing lost possessions, securing housing, and finding employment, all of which heighten the risk of intimate partner violence (IPV). Three other studies focused on recessions and environmental disasters, predominantly from the perspective of service providers [38, 80, 92].

Survivors encountered increased mental and physiological stressors throughout the pandemic, particularly during lockdown periods. As described in multiple studies, lockdown measures precipitated lifestyle changes (i.e., increased caregiving responsibilities, cooking, cleaning, virtual schooling, workplace transitions, employment loss/change) marked by physical and social isolation [40, 43, 45, 61, 67, 71, 72, 74, 77–79, 84, 87, 88, 100, 102, 107, 110].

Many Survivors found themselves isolated at home with their perpetrator, lacking formal or informal support for themselves and their children. These changes, in turn, contributed to a decline in mental health, heightened anxiety, increased economic stress, increased alcohol consumption by perpetrators, increased instances and severity of abuse, and diminished motivation to seek help, exacerbating pre-existing trauma [67, 72, 75, 99]. Consequently, coping mechanisms such as alcohol or illicit substance use, engaging in sex work, or remaining in abusive relationships due to loneliness became more prevalent during the COVID-19 pandemic [77, 91].

Leigh (2022) revealed how limited access to services and reduced help-seeking behaviors stemmed from the need to juggle competing survival priorities such as job loss, childcare responsibilities, and caring for loved ones affected by COVID-19 [53]. Several studies reported observing an increase in violence, or the risk of violence and decreased mental health [45, 49, 60, 77, 79, 82, 83, 86, 99]. Elliott (2022) noted the heightened risk of violence, stating even Survivors not currently experiencing abuse feared pandemic-related stay-at-home mandates and associated stressors (e.g., COVID-19 infection, job loss) would precipitate new abuse [40]. Moreover, researchers in the United Kingdom observed the dynamics of how merging families to care for children and elderly relatives heightened stress and the risk of multi-perpetrator domestic violence and abuse (i.e., additional abuse from a perpetrator’s family members), with racialized women being disproportionately affected [79, 87].

Various studies have detailed how survivors exhibited a decline in psychological well-being, including PTSD and depression, as well as symptoms such as flashbacks, nightmares, disturbed sleep patterns, anxiety, reduced self-esteem, neglect of personal care, and suicidal thoughts [84, 87, 99]. Haag (2022) emphasized the overlooked health concerns when virtual diagnosis and access to healthcare were not feasible during lockdowns, leading some to forego seeking health services [48]. Safar et al. (2023) and McKinlay et al. (2023) described how Survivors used physical or action-based coping strategies to manage stress and declining mental health, including cooking, baking, strategically avoiding the partner, taking on additional work, exercising, meditating and engaging in outdoor walks [67, 91]. From a service provider perspective, several authors illustrated how staff supported the well-being of clients by distributing care packages containing personal care and relaxation items during stressful periods, organizing distanced walking groups, and having 24-hour phone support to maintain client well-being contact during lockdowns [39, 99].

Mantler et al. (2024) discussed the inner strength and resilience of IPV Survivors during the pandemic, while Fothergill (1999) noted the personal growth and resilience that results from an SLE, in this case a flood [44]. They emphasized the importance of maintaining a positive mindset and resisting self-doubt to foster resilience, especially when supported by a close-knit community. Support helped mitigate mental health decline and isolation. The use of affirmations taught as a practical tool in counseling, reinforced survivors’ self-worth and value [56].

Theme 2: Considerations in the VAW sector during SLEs.

The VAW sector–A neglected priority in emergency preparedness and SLEs. The VAW sector has long grappled with challenges in delivering adequate support and resources to Survivors, even preceding the onset of events such as pandemics, economic downturns, or environmental catastrophes. Houghton et al. (2010) note that the VAW sector often faces a shortage of resources and limited capacity to adapt to climate crises [106]. Brown (2010) explained this struggle within the context of Hurricane Katrina in New Orleans, while Williams (2021) and Michaelsen (2022) expanded on how the already fragile infrastructure was exacerbated by the pandemic [38, 58, 74]. Pfitzner and McGowen (2023) noted that during the lockdowns, domestic and family violence services were not classified as ’essential’ services, which prevented them from remaining open for face-to-face consultations [110]. Stanley et al. (2022) investigated the development and use of community touch-points in the UK, such as pharmacies and banks, as potential frontline response sites for IPV survivors during COVID-19. They found that while these venues could offer necessary support, the significant training and resources needed by an already resource-strained sector present a substantial challenge [98].

Additionally, Enarson (1999) suggested an existing insensitivity towards domestic violence, which diminishes motivation and initiatives to include the sector in preparedness planning [41]. Governments across all levels have consistently neglected to acknowledge the pivotal role of VAW sectors in emergency preparedness planning, resulting in a dearth of recognition and support for these indispensable services during crises. This may be explained by the lack of recognition of shelters as priority facilities for housing and aiding a vulnerable population [41]. Briones-Vozmediano (2014) highlighted the relegation of IPV policy to a non-priority status during economic crises, subject to the whims of inconsistent political parties [80]. Consequently, economic downturns precipitate austerity measures, budget cuts, and diminished resources for IPV support, particularly for marginalized groups such as immigrant women. Otero-Garcia (2018) further illustrated how complementary resources to clinics, including shelters, social housing, criminal courts, and NGOs, are curtailed during periods of economic turmoil [92].

Articles focused on the pandemic also underscored the absence of established emergency preparedness plans or protocols to mount swift and effective responses [62, 74]. Findings from these articles recognized the importance of disaster readiness and emergency preparedness in addressing IPV during the pandemic, which encompassed factors such as regional subcultures of preparedness, prior disaster knowledge, governmental mandates, and personal networks [41, 49, 62, 110]. Furthermore, Enarson (1999) emphasized the imperative of survivor resilience and community integration into disaster planning to ensure the presence of structural support before crises occur [41]. Post-pandemic, Yakobovich et al. (2023) stressed the importance of the inclusion of VAW Survivor voices in policy planning [78].

Precarious funding is an issue. The chronic issue of unstable funding within the VAW sector has persistently hindered its capacity to deliver consistent and comprehensive support to Survivors of IPV. Multiple articles emphasize this challenge, particularly highlighting the vulnerability of the sector during SLEs. Specifically, in the aftermath of climate disasters such as hurricanes or earthquakes, physical infrastructures are often decimated, leading to the perception of services no longer existing which results in the cessation of funding [38]. Economic recessions exacerbate this predicament as austerity measures redirect funds away from social support programs, precipitating budget cuts and resource shortages [80, 92]. More recently, the onset of COVID-19 further compounded funding challenges, as the mechanisms and constraints surrounding service provider funding significantly affected stability, sustainability, and service provision. Insufficient and inconsistent funding impeded the transition to virtual services, and the short-term nature of COVID-19 funding failed to offer sustainable solutions [39, 59, 88, 103]. Consequently, the loss of funding precipitated staff layoffs, voluntary attrition, and a reduction in services [59, 61, 72]. Disparities emerged in accessing emergency funding during the pandemic, leading to competition among providers for limited resources, often with unsuccessful outcomes [68, 78]. Furthermore, inflexibility in funding allocation posed another challenge, as providers were mandated to allocate funds for specific purposes, such as personal protective equipment (PPE), at the expense of essential services, while some funds were inaccessible or difficult to obtain [42, 68]. Fundraising activities, typically relied upon to supplement core funding, were either suspended, delayed, or insufficient during emergencies [41, 59].

Several articles highlighted the importance of both governmental and private funding, as well as the need for flexibility in funding and service delivery to accommodate the increased severity and number of cases during SLEs. This included extending hours, hiring/training additional staff, enhancing advertising to raise awareness and provide education, transitioning to virtual services during the pandemic, providing hazard pay, additional mental health services, and adopting innovative programming [37, 61, 65, 78, 95]. Burd et al. (2023) further noted that community support through donations was vital in sustaining agency operations and facilitating the expansion of services [39].

Coordination and collaboration are important. The literature surrounding the pandemic highlighted the difficulty in or lack of coordination and collaboration within the VAW sector and across related systems (i.e., healthcare, social housing, legal services, and criminal justice), suggesting systemic hurdles to effectively address the diverse needs of IPV Survivors amidst crises.

The collegial partnerships among service providers dissipated as services transitioned online and service providers were busy adapting to the pandemic [104]. For example, Gregory (2021) discussed the challenges faced by service providers in coordinating support with friends and family to aid in safety planning in a virtual and locked-down environment [89]. At a broader sector level, Bomsta and Kerr (2023), Burd (2023), Garcia (2022), and Vives-Cases (2021) detailed the challenges service providers faced in collaborating with other agencies and support services during the pandemic. Limited interactions, mandated by public health measures and changes in service delivery, significantly impeded this fundamental aspect of their work. [37, 39, 46, 100]. Randell et al. (2023) addressed the challenges of maintaining connections with rural agencies that relied on travel, after travel had halted during the pandemic. This disruption harmed the partnerships essential for supporting survivors in rural areas [65]. Ghidei et al. (2022) addressed the dearth of coordination, collaboration, and transparency among VAW sector agencies during the pandemic, attributed to competition for funding [47]. In terms of coordination with other sectors, the COVID-19 pandemic disrupted the coordination along the housing continuum from emergency shelters to transitional housing and then social housing; there was increased demand for and reduced availability of housing, leading to difficulties in coordination in transitioning Survivors from emergency shelters [79]. Even if housing was available, Cunha et al. (2023) identified challenges in the coordination of processes for reintegration into society, such as setting up water service, acquiring furniture, or accessing social security [83]. Yakubovich et al. (2023) discussed the development of a continuum in housing support, ranging from emergency shelters to long-term supportive housing, and investment in transitional housing to provide stable environments for survivors [78]. In the context of climate crisis, Houghton et al., (2010) described the lack of communication and co-ordination between agencies to respond to IPV during the snow storm in New Zealand [106].

Facilitators included integration of IPV screening and support services with other essential services (general practice clinics, childcare services) to enhance continuity of care for consistent support and understanding of the Survivor experience [86, 108, 109]. Fuchsel (2024) emphasized the importance of supporting the overall well-being of Survivors through comprehensive wrap-around services, such as food, financial assistance, and counseling [45]. Similarly, Thiara and Roy (2022) stressed the necessity of enhancing wrap-around support for women with no recourse or access to public funds (i.e., not yet a citizen and have access to social welfare supports) including the provision of basic practical help with living essentials, to address their critical needs effectively [99]. Additionally, the necessity of interdisciplinary collaboration within the sector (i.e., community-based VAW organizations) and partnerships with other services (police, transportation, taxis, groceries, rideshares, landlords/housing, schools, healthcare professionals) was highlighted [37, 51, 60, 72, 78, 83, 86, 87, 90, 98, 100, 108]. Cunha et al. (2024) detailed how shelters collaborated with key organizations to ensure children had necessary resources for online schooling, while also securing essential supplies like PPE and food for shelters. This partnership provided comprehensive support, addressing both the educational needs of children and the operational requirements of the shelters [83].

Inadequate communication and lack of public awareness. Several studies examining the COVID-19 context highlighted issues of inadequate communication and insufficient public awareness, areas that were not specifically addressed in the research on other SLEs (environmental disasters and economic recessions). The absence of transparent communication regarding avenues for seeking assistance and ambiguity surrounding the availability of support services present obstacles for Survivors of IPV, compounding their already precarious situation during the pandemic [40]. Studies described the confusion stemming from inconsistent messaging regarding the closure of shelters and services despite many remaining operational during COVID-19; this was coupled with unclear guidelines, which impeded trust in available information [43, 51, 53, 54, 60, 65, 74, 75, 88]. In terms of public awareness, Mantler et al. (2024) highlighted service providers’ concerns about systemic barriers stemming from a widespread lack of understanding of intimate partner violence (IPV) and the failure of systems like the police and criminal justice to adequately prioritize survivor safety [57]. Similarly, Yakubovich et al. (2023) addressed the insufficient awareness about IPV, including unclear definitions of what constitutes violence [78].

In the context of the COVID-19 pandemic, the continuously changing nature of public health regulations necessitated frequent revisions to institutional policies and procedures, rendering it challenging for Survivors to grasp the evolving situation and access necessary services [51, 74, 97], while also demanding daily adaptations from service providers to comply with these mandates [59]. McKinley et al. (2023) highlighted significant gaps in communication during the lockdowns concerning the ability to leave an abusive relationship; survivors were unclear about mandates and whether they could leave to access safe spaces [91]. In another example, Speed (2020) highlighted inadequate communication regarding case delays within legal systems and criminal trials, particularly concerning divorce and custody matters [97].

Scholars discussed the need to access clear information about options in the aftermath of SLEs, advocating for leveraging diverse media platforms to publicly disseminate information about support services [43, 49, 51, 53, 72, 86, 88, 97, 98, 100]. These initiatives include various media channels through local community and state-led campaigns (rather than general national level), collaborations with other entities, and innovative approaches to enhance public awareness. Authors underscored the criticality of providing Survivors of IPV with clear guidance on available options during lockdowns (or emergencies), advocating for media campaigns and establishing accessible helplines within safe environments [51, 97]. Stanley et al. (2022) suggested leveraging relationships with large public-facing companies, like Royal Mail in the U.K., to raise awareness about available support services for survivors IPV during emergencies [98].

Pedersen et al. (2023b) illustrate how Violence Against Women Programs actively maintain visibility through social media and local press, coordinating with police and media to ensure those at risk understand their options for seeking shelter [94]. However, the literature also pointed to challenges of communication and media campaigns in including or reaching racialized communities, often resulting in these groups being less likely to seek care, thereby exacerbating health and social inequities [99].

Theme 3: Capacity to provide and access support services following SLEs.

Following the implementation of public health measures or emergency protocols, such as COVID-19 lockdowns or responses to disasters or climate events, a significant reduction in the capacity of support services inevitably occurred in the aftermath of SLEs. As discussed by Enarson (1999), Houghton (2010), Fothergill (1999) disasters disrupt the resources used by shelters to help Survivors, including local hotels, safe homes, public transportation, legal/law enforcement, and social/health services [41, 106, 111]. Much of the literature in this scoping review focuses on the COVID-19 pandemic, highlighting how resources were redirected from social and health services to directly combat COVID-19 infection and prevention. This redirection led to the suspension or delay of in-person services and reduced support services, and led to the transition of many services to virtual platforms, with some, like support groups, being canceled due to challenges in maintaining a safe online modality [40, 42, 54, 83]. Consequently, stay-at-home orders and lockdowns not only reduced referrals to support services, limiting survivors’ access to assistance, but also posed challenges for both survivors and service providers in accessing in-person sessions during the COVID-19 pandemic. Factors such as physical distancing precautions, decrease in scope of services, limited access to personal protective equipment (PPE), fear of contracting the disease or infecting family members if essential workers, and safety concerns in communal living spaces all contributed to these challenges [39, 42, 47, 48, 52, 58, 60, 62, 68, 72–77, 82, 86, 89, 91, 93–95, 97, 99, 100, 103, 107, 110].

Additionally, reduced screenings in emergency rooms, referrals to support services, and decreased availability of mental and medical health services were reported due to resources being diverted to COVID-19 infection control [49, 55, 78, 85, 91, 93, 94, 101]. As Hendrix (2021) describes, the use of PPE (i.e., masks, goggles, and gowns) during the COVID-19 pandemic posed a significant barrier to making personal connections with patients, leading to a sense of isolation, and negatively impacting the quality of the service provision [49].

Lockdown measures and reduced social support also affected key services, leading to delayed family court proceedings, custody hearings, and extended waiting times for legal processes related to custody, separation, and divorce [37, 47, 60, 88, 93, 101, 102]. These reductions in services and accessibility left individuals compromised, unable to access necessary support, continue therapeutic work, or progress with legal proceedings [93, 97, 102, 107].

Shutdowns decreased in-person services, and remote work arrangements heightened the risk for Survivors, resulting in increased violence and negative mental and physical health outcomes [40, 43, 71, 72, 107]. Physical access to healthcare providers was limited by public health restrictions and physical distancing mandates. This was further complicated by reduced public transportation and thus, impacted Survivors’ ability to travel for appointments [42, 49, 51, 52, 60, 63, 66, 74, 75, 102]. Mantler (2024) revealed that inadequate access to essential services, such as transportation in rural areas, significantly hindered the resilience of women attempting to leave abusive relationships, further compounding their isolation in these regions [57].

Clarke (2023) discussed how vulnerable clients were particularly affected by the reduction of services, as the usual avenues for leaving the house, such as grocery shopping, were eliminated due to COVID-19 restrictions [102]. Additionally, childcare became a challenge for many, as isolation measures resulted in children being home due to school closures, while essential workers were required to be at work [61, 112]. Concerns in custody contexts also arose, as there were no safe spaces for exchanging children due to the closure of public spaces [102]. School closures further diminished children’s support networks, reducing opportunities for disclosure or confiding in a safe person [90]. Fear of COVID-19 infection also deterred individuals from seeking accommodation in shelters or emergency rooms, with some older women avoiding shelters altogether due to infection fears [49, 51]. The delay or suspension of services further discouraged individuals from seeking help during this period [42] Leat (2024) noted that the unpredictability of public health mandates and policies during the pandemic (i.e., continuously changing) complicated the ability to effectively manage service provision, occupancy, and staffing.

The role of bystanders and informal support networks is crucial in the lives of IPV Survivors. Restrictions, be it emergency protocols or lockdowns, prevented advocates and informal sources of support from accompanying Survivors to appointments or providing emotional support [40, 44, 46, 53, 55, 58, 76, 107].

Authors acknowledged the remarkable commitment, motivation, resilience, creativity, and self-sacrifice demonstrated by service providers and sector leaders during SLEs [39, 41, 80, 86, 89, 100, 104]. Garcia (2022) and Thiara and Roy (2022) discussed how resilience was acknowledged by advocates, communities, and Survivors despite the formidable challenges encountered [46, 99]. Several authors stressed the importance of addressing the needs of support service providers, including provisions for sick leave, flexibility around family responsibilities, flexible working arrangements, training, compensation for extra workload, and support for mental health and well-being [46, 49, 51, 60, 65, 78, 83, 94, 98, 101, 105]. Cunha et al. (2024) highlighted that shelter leadership prioritized the well-being of staff and professionals by regularly checking in and utilizing online platforms for team meetings. This approach allowed for open discussions on professional practices and personal concerns, which fostered a supportive work environment.

Theme 4: Service providers workload and stress during SLEs.

Across various contexts including the pandemic, economic recessions or climate disasters increased workload for staff in addition to budget cuts, which required them to "do more with less" and take on additional responsibilities (i.e., get involved in homeschooling for children at shelters) [41, 43, 44, 61, 80, 83, 90, 92, 104, 106]. During the pandemic, service provision became more demanding due to ever-changing public health measures like disinfection protocols and PPE requirements, combined with a reduced workforce, all of which contributed to pandemic fatigue. [51, 56, 60, 65, 68, 71, 91, 99, 101–103, 105]. The majority of literature (94%) in this scoping review was pandemic-focused, and delved into the constantly evolving public policy responses, leading to profound exhaustion and burnout within the VAW sector. This exhaustion significantly impacted the stability and sustainability of service providers and their efficacy in delivering support.

Service providers talked about the mental and emotional toll of service provision during the pandemic, and reported increased anxiety, stress, depression, and feelings of isolation for themselves, alongside concerns for their clients and children [39, 42, 65, 82, 93, 94, 100–102, 107]. Additionally, providers were overworked, overloaded, and became sick and stressed, and needed to balance virtual shelter operations with childcare responsibilities while home-schooling [52, 56, 59–61, 69, 83, 89, 95, 99–102, 109]. Service providers, particularly in rural areas, faced additional stress due to limited resources and the challenges of conducting secure virtual sessions, especially when Survivors were isolated with their abusers [47, 97]. As Voth Schrag (2023) discussed, ensuring technology safety became an integral aspect of the job for virtual service providers, adding complexity to the delivery of safety plans as virtual service provision evolved [73]. This often meant prioritizing urgent matters, such as immediate service provision, at the expense of advocacy and group sessions [51]. Moreover, lack of mentorship and institutional support and difficulties in contacting their own organizations/colleague networks for assistance or guidance during crises were reported, shifting emotional support from addressing Survivors’ trauma to dealing with pandemic-related challenges and virtual work, which necessitated additional training [42, 60, 93, 94, 100, 110]. Front-line staff, who typically face more challenging working conditions with fewer resources and lower pay, felt a pronounced disconnect with top management, who were often physically separated from the shelters and seemingly unaware of the daily risks and exposures frontline staff endured [37]. Of note, Burd (2023) found that the implementation of public health restrictions during the COVID-19 pandemic challenged the principle of choice, leading to the disempowerment of women and contradicting the feminist principles that underpin their work. Staff struggled with prioritizing COVID-19 public health mandates over providing their core VAW services.

Several authors highlighted the significance of funding and financial support [37, 39, 44, 61, 65, 87, 95, 105, 106]. They emphasized the necessity for adaptable sustainable funding mechanisms, especially when adjusting service delivery in response to SLEs. In the context of the COVID-19 pandemic, funding flexibility was required to transition to virtual modalities or invest in innovative strategies to reach isolated Survivors. This flexibility is crucial for creative and adaptable services that effectively address the changing severity and fluctuations in IPV case numbers amidst the dynamic and continuously changing characteristics of SLEs [37, 65, 86, 90, 91, 93, 100, 103].

Theme 5: Issues of isolation, power dynamics and control during SLEs for IPV survivors.

Amidst the unprecedented challenges precipitated by SLEs, both IPV Survivors and service providers found themselves grappling with isolation, exacerbating existing vulnerabilities, and complicating access to vital formal and informal support services. As Enarson (1999) describes, “subject to a vicious cycle of power and control, battered women live in a world of increasingly narrow social networks with abusers who keep them isolated, restrict their transportation and employment opportunities, and control household resources” (p. 748). Women living in daily fear and intimidation and who experience emotional crises before a disaster already face enough hardship, and when compounded with having to navigate evacuation or lockdown warnings, face even more difficulty [41].

Survivors experienced isolation from family, friends, and broader social networks [109]. Pandemic lockdown mandates left many Survivors isolated and disconnected from their usual informal support when at home with their abusers [39, 45, 47, 52, 58, 67, 71, 75–78, 82, 83, 91, 97, 99, 102, 108, 110]. Numerous articles delved into the concept of social isolation [15, 58, 68, 72, 74, 109]. For example, perpetrators of violence employed deliberate tactics to cut off Survivors from external support networks, rendering them without access to assistance or resources, and heightened their dependency on the abusive partner with decreasing motivation to seek help. This led to an increased risk of experiencing further violence. Notably, Gregory & Williamson (2021), Holt et al. (2022), and McKinley et al. (2023) investigated the isolation felt by informal support providers, who were overwhelmed themselves and depended on their networks to assist the survivors in their lives [89–91]. Similarly, service providers felt isolated from their work networks and community during the pandemic [60].

Survivors encountered increased isolation from formal services due to reduced, suspended, unavailable, or virtualized services [57, 91, 101, 105]. Many found themselves unable to access or engage with services virtually due to their confinement at home with their perpetrator, as there was a heightened risk of violence if the Survivor was discovered seeking support. The presence of other family members also hindered Survivors’ ability to seek help [43, 46, 51, 53, 57, 63, 66, 67, 74, 79, 95, 104]. Furthermore, the COVID-19 lockdowns prolonged the cycle of violence by confining Survivors with their abusers and eliminating opportunities for respite or safety planning, such as commuting to work or running errands [53, 87]. Concerns about custody arrangements during the pandemic and fear of retaliation by the abuser further deterred Survivors from seeking help or leaving abusive situations. Those who accessed shelters were isolated upon entrance to the facility due to lockdown measures [73].

The pandemic-induced isolation, enforced through lockdown mandates, served as a tool for perpetrators of IPV to assert control and manipulate Survivors through power dynamics. Several articles delineated instances of "exerting power and control" and "weaponizing the pandemic" to restrict movements, coerce Survivors into cohabitation, or instill fear about the virus, alongside instances of financial abuse and withholding essential resources [40, 45, 48, 51, 53, 58, 63, 74, 77, 78, 84, 86–88, 90, 91, 93, 95, 99, 100, 109]. Examples include preventing them from going to work, preventing child contact with mother in custody cases, using food pensions, limiting access to PPE, and limiting access to social medical appointments (i.e., hiding insurance cards).

Moreover, the isolation mandates inadvertently re-traumatized IPV Survivors by mirroring control and manipulation tactics employed by their perpetrators, exacerbating feelings of powerlessness and entrapment within a confined environment [39, 40, 48, 63, 66, 72, 73]. Survivors detailed how wearing masks brought on feelings of being suffocated, strangled, and sexually abused with obstructed breath [63, 73]. Others discussed being “retraumatized” by the pandemic lockdown restrictions and when restrictions were implemented at the shelters, it mimicked the situation of being isolated and restricted by a controlling and abusive partner (i.e., no communal/congregate living, isolation and quarantine in the rooms/homes, controlling of movements, and enforcing infectious disease control and safety precautions) [40, 48, 57, 63, 66]. Toccalino et al. (2022) described how continuously changing physicians during the pandemic meant Survivors repeated their stories, resulting in re-victimization, which was an aversion to seeking help [72].

To assist Survivors in navigating various systems and fostering resilience, peer support groups, domestic violence advocates, liaison roles and system navigators emerged as necessary components [45, 49, 72]. In some cases, the pandemic-induced isolation provided an unexpected opportunity for introspection and healing, with Survivors finding refuge in shelters that facilitated a focus on personal safety and learning about IPV tactics [66]. Additionally, the public health restrictions (i.e., visitor policies in healthcare settings) facilitated disclosures of abuse to healthcare providers when in person, as perpetrators were unable to accompany Survivors to medical appointments, allowing for a safer space for disclosure [49, 102]. Due to restrictions, youth IPV Survivors, experienced a sense of safety due to lessened encounters with perpetrators whom they did not live with, highlighting the unintended positive outcomes of pandemic-induced isolation [100].

To maintain personal connections and support during the isolating lockdown pandemic periods, staff implemented safety measures beyond the use of PPE, including holding meetings in open, non-traditional spaces such as parking lots [39]. In some instances, shelters provided transportation services to facilitate safe movements during lockdowns [52]. Additionally, maintaining connections with informal support systems (i.e., support bubbles of family and friends) was identified as critical in supporting survivors with emotional and practical support during challenging times [56, 67, 91].

Theme 6: Navigating the transition to virtual service amidst the pandemic: Challenges and Innovations.

The literature on transitioning to virtual service provision was only in the context of the pandemic; the papers on economic recessions and natural disasters did not include virtual support services. Navigating the transition to virtual platforms for formal IPV support services amidst the COVID-19 pandemic presented several challenges, disrupting traditional modes of assistance and requiring innovative approaches to ensure continued care for Survivors.

Several authors discussed the issue of the digital divide, exacerbating disparities in accessing virtual care for IPV Survivors during the pandemic, underscoring the unequal distribution of technological resources (i.e., ability to afford or have digital platforms) and skills (i.e., older adults) reducing their ability to seek or access support online [39, 40, 48, 60, 67–69, 71, 81–83, 88, 91, 93, 94, 97, 98, 100, 101, 104, 109, 110]. The transition also emphasized service providers’ lack of experience and training in delivering telecare, along with issues such as access to devices and reliable connectivity, posing significant hurdles in providing effective support [42, 46, 58, 59, 65, 69, 72–74, 89, 90, 93, 94, 101–105, 109]. Concerns regarding the sustainability of technology emerged, with authors noting service providers (and their clients) were experiencing screen fatigue. They found it challenging to complete complex online forms, highlighting the limited capacity of both Survivors and service providers to navigate online systems beyond care provision [59, 61, 63, 69, 73, 75, 90, 101, 104].

Technology emerged as a double-edged sword. On one hand, it provided a venue for accessibility, on the other, it was evident that perpetrators increasingly weaponized it for surveillance, digital violence, and monitoring purposes during the pandemic, exacerbating fears of privacy invasion and further threatening survivor safety [61, 81, 82, 84, 108, 109]. The transition to virtual and telephone platforms also raised concerns about the efficacy of risk assessment and remote counseling with some Survivors and service providers expressing difficulties in establishing trust, rapport, interpreting visual cues and emotional connections, crucial for therapeutic relationships, healing trauma, and IPV disclosure [39, 40, 46, 48, 59, 60, 65, 67–69, 73, 74, 79, 82, 84, 86, 89–91, 93, 94, 99, 101, 104, 105, 110]. In post-separation contexts, Desai (2022) explained how perpetrators of abuse adaptively and persistently use technology-facilitated methods to stalk and harass their former partners, leading to heightened anxiety about safety for the Survivors and their children.

Innovative strategies emerged to enhance services through virtual modalities, ensuring survivor safety. The utilization and positive impact of virtual platforms have been explored and implemented in various studies [37, 39, 40, 51, 53, 55, 60, 61, 65, 67, 71, 75, 82, 83, 85, 93, 94, 98–101, 105, 107, 109, 110]. These studies underscored the significance of expanding broadband internet services to ensure seamless connectivity [62, 69, 103] and highlighted the advantages of virtual meetings for support staff including reducing the need for physical transport, minimizing exposure risks, and saving time [60, 109].

Fogarty et al. (2022) discussed the favorable aspects of online telehealth, while Golenko & Rittossa (2022) described the increased usage of online and telephonic communication for support services [88, 105]. Additionally, discreet digital communication platforms observed or proposed [53, 76, 104], alongside initiatives to counter digital exclusion by providing devices and internet access to Survivors and service providers [94, 103]. Oswald et al. (2022) proposed that broadening access to broadband internet services would not only enhance telehealth and IPV resource accessibility but also help IPV survivors preserve essential social connections [62]. Gregory (2021) touched on the resourcefulness of informal support providers in communicating with Survivors to offer assistance [51, 89]. According to Bomsta and Kerr (2023), telehealth proved not just a substitute but an enhancement over in-person services, offering clients significant benefits that reduced the need for travel and related expenses, enhanced privacy, and convenience. This led to fewer missed appointments and high attendance in support groups conducted via telehealth [37]. Similarly, as Desai et al. (2022) described, some Survivors felt more comfortable and safer engaging in telephone counseling as it reduced self-consciousness and provided a sense of security and privacy [84].

Fogarty (2022) emphasized the need for adaptability, particularly in tailoring therapeutic approaches to help effectively engage with clients online [105]. This involves establishing rapport with women and devising innovative methods to involve children in the therapeutic process [110]. Coram (2021) explored innovative strategies to sustain client engagement, such as offering footpath drop-offs and food parcels as part of service provisions [103]. Some studies recommended extending helpline hours to accommodate the times when clients most need support and suggested that proactive service delivery in convenient off-site locations, rather than traditional drop-in centers [79, 99].

Leigh (2022) recommended leveraging local media, virtual town halls, and live feeds on Facebook to raise awareness about ongoing services [53]. Yakobovich et al. (2023) recommended the implementation of educational curricula and public awareness campaigns focused on healthy relationships, gender expression, and the dynamics of violence, with targeted outreach to educate men and boys on issues of gender-based violence [78]. In the context of perinatal health, Krishnaumuti (2021) developed a mobile application with an IPV assessment tool for pregnant women, providing a means to reach individuals hesitant to disclose directly to their care provider [50]. Additionally, Rahman (2022) emphasized the necessity of mandatory pediatric primary care visits, irrespective of emergency orders, as an avenue for Survivors to access support services [64].

Overall, the transition to and utilization of virtual services underscored both the resilience of Survivors and an imperative for ongoing innovation and adaptation to meet the evolving challenges of IPV support amidst the pandemic, or any SLEs. As highlighted by Clarke (2023), this opportunity compelled certain organizations to carefully evaluate their operational procedures, fostering enhancements and prompting fresh perspectives on virtual administrative work, as well as the optimization of services for Survivors and their children in shelters [102].

Theme 7: Privacy, confidentiality, and safety.

The articles discussing safety concerns for Survivors of IPV were mostly in the context of the COVID-19 pandemic, particularly regarding confidentiality breaches, diminished physical safety, and challenges in safety planning within the context of heightened isolation and restricted resources. Enarson (1999) shed light on “second-order evacuation” in the context of environmental disasters requiring women to evacuate from their safe spaces (i.e., shelter, motel, family) and the inability of evacuation centres to protect privacy or ensure Survivor’s safety, especially in small communities [41].

Survivors faced reduced privacy while accessing services virtually or disclosing experiences of violence in person due to restrictions and the presence of perpetrators or family members in the home, leading to heightened safety concerns during pandemic lockdowns [39, 42, 46, 47, 51, 60, 69, 71, 72, 74, 75, 79, 81, 82, 93, 94, 97, 98, 102, 104, 105, 109, 110]. In some cases, small communities (i.e., rural, remote) reinforced privacy and confidentiality concerns among Survivors, deterring them from seeking or accessing help due to fears (i.e., stigma, shame) of their situations becoming public knowledge in their close community [54, 57, 93].

Similarly, service providers grappled with privacy and confidentiality issues in their own homes while providing services, navigating difficult stories with family members present as they transitioned to work at home during the pandemic [46, 47, 61, 62, 68, 81, 90, 104, 108]. Aligning public health measures with survivor and shelter confidentiality presented challenges, particularly regarding reporting positive cases while upholding confidentiality [61]. Additionally, interpretations of healthcare policy and legislation, particularly regarding data security and privacy, hindered the implementation of virtual care within organizations, with current privacy laws failing to adequately address the nuanced understanding of "privacy" and "safety" within the virtual environment [59]. Stanley et al. (2022) revealed the challenges of delivering confidential and safe services through community touchpoints in rural areas with small populations [98].

Navigating safety planning—plan that identifies methods to enhance the safety of victims and their children when confronted by family violence [113]—and accessing assistance for IPV Survivors became increasingly complex during the pandemic, necessitating innovative approaches to ensure protection within the constraints of social distancing measures and limited resources. Challenges included providing support for Survivors attempting to escape violence or safety plan amidst lockdowns, where finding excuses to leave without raising suspicion was difficult [40, 58, 61, 71, 89, 90, 108, 109]. Informal supports, such as bystanders, neighbors, friends, and family members, hesitated to intervene due to fear of reprisals or negative consequences, further isolating Survivors [96].

Measures to ensure security and privacy in virtual settings were prioritized through the adoption of encrypted web-based video call services [109]. Ghidei et al. (2022) and Ragavan et al. (2022) explored safety measures, including the incorporation of safe words to conclude virtual sessions or the use of code words via text messaging [47, 63]. Furthermore, Cortis (2022) emphasized the criticality of adjusting safety protocols to changing circumstances, such as conducting screenings in virtual environments when children were present [104].

Stanley et al. (2022) explored how banks, pharmacies, and online platforms served as ‘touchpoints,’ which are safe spaces providing discreet venues where survivors could seek assistance [98]. Additionally, several studies also highlighted various strategies of IPV Survivors using code words and phrases to seek supports discreetly. These tactics are vital for allowing Survivors to seek help without alerting their abuser [71, 98, 99, 110]. Pharmacies utilize the "Ask for ANI" code word system, providing survivors with a discreet method to signal their need for help [98]. Additionally, organizations have developed systems using words such as ’sunshine’ to indicate safety and ’cloudy’ to signal danger, enabling women to discreetly communicate their status and safely plan escapes [99]. Castellano-Torres et al. (2023) introduced the "mask 19" initiative from Spain during the COVID-19 lockdown, which allowed women at risk to discreetly request help at pharmacies using a code word, offering a confidential way to access support without alerting their abuser or attracting public attention. This initiative was part of broader efforts to ensure continued access to support services during the pandemic, catering to the heightened need for discreet assistance amidst increased isolation and the potential stigma or danger of discussing such issues publicly. [82].

Theme 8: Intersectionality and issues faced by racialized and marginalized communities.

The concept of intersectionality emerged in several of the papers, highlighting the disparities and barriers which intersect with race, ethnicity, substance use, mental health, and socioeconomic factors. This intersectionality often translates into greater challenges for marginalized and racialized communities in accessing support and resources for Survivors of IPV.

In the context of the climate emergency, Brown et la. (2010) highlighted the increasing number of women seeking shelters who grapple with multiple serious issues such as substance use, mental health concerns, and homelessness [38]. Moreover, austerity measures resulting from economic crises, as discussed by Briones-Vozmediano et al. (2014), exacerbate the structural violence experienced by immigrant women, limiting their employment opportunities, and impeding their ability to leave abusive partners [80]. These authors further explain how women without legal status or valid documentation often face additional barriers such as language barriers and lack of social support networks, further limiting their access to support services and resources Several papers have underscored the impact of the COVID-19 pandemic on oppressed, immigrant, migrant, and refugee communities, exacerbating existing challenges in accessing services (i.e., legal or social services assistance in applications following job loss). These challenges are compounded by factors such as language barriers, cultural norms about disclosure, lack of culturally safe care, food insecurity, age, and geographic isolation (i.e., rural, remote), leading to disparities in service utilization [46, 47, 57, 60, 67, 68, 72, 84, 98, 99]. Fuchsel (2024) found that perpetrators threaten immigrant women from seeking help, which leads to fears of deportation, uncertain immigration status, limited language proficiency, and cultural stigma/shame, thereby exacerbating their vulnerability and isolation during the pandemic [45]. In addition to the various inequities already faced by racialized and marginalized communities, Safar et al. (2023) highlighted a specific gap in the system: a lack of appropriate supports for older women, who often remain overlooked within these groups (63).

Additionally, pre-existing resource deficiencies for adults with disabilities, older women, youth, rural populations, and culturally diverse individuals were exacerbated during the pandemic and in the context of climate disasters [44, 46, 47, 67, 78, 94, 98, 99]. In their study, Shyrokonis et al. (2023) revealed that racialized individuals, essential workers, and those in financially intertwined marriages face heightened risks of inequities due to a lower likelihood of seeking support. Conversely, those who are young to middle-aged and pregnant are more likely to seek support [70]. Castellanos-Torres (2023) reported an increase in demand among women facing various forms of social vulnerability, such as unemployment, job insecurity, or belonging to an ethnic minority, factors that have facilitated the perpetration of sexual violence. Randell et al. (2023) noted that staff from marginalized communities encountered challenges arising from the intersection of COVID-19 and racism, affecting both their personal and professional lives [65].

Ghidei et al. (2022) highlighted how structural inequities compounded with IPV and the COVID-19 pandemic created unique challenges for marginalized groups of IPV Survivors [47]. More specifically, several of the papers investigated the structural inequities and barriers faced by racialized and immigrant populations experiencing IPV, along with associated intersecting issues such as substance use, homelessness and mental health. These barriers include xenophobia, racism, homophobia, transphobia and other forms of discrimination [43, 45, 49, 56, 63, 78, 91, 110]. Toccalino and colleagues (2022) emphasized the necessity of race- and culture-based data to demonstrate the structural inequities encountered by oppressed populations [72].

Anitha and Gill (2022) draw attention to the often-overlooked experiences of racially minoritized women during the COVID-19 pandemic, from the perspective of frontline practitioners of the same communities. The study showed how frontline workers adjusted their methods and used their authority to tackle the specific challenges and inequalities faced by racially minoritized women, highlighting important links between race, gender, and organizational actions. Similar findings from Thiara and Roy (2022) emphasized that racialized organizations serving racialized Survivors begin at a disadvantage, lacking initial resources and facing competition with larger mainstream organizations. They also confront systemic barriers while striving to provide culturally and racially relevant services [99].

From the perspectives of Survivors, Gill and Anitha (2023) discussed how racialized Survivors navigate the intersection of gendered and racialized disadvantages, which influence both the nature and extent of the abuse they endure and their opportunities for seeking formal and informal support. This is further complicated by a historical mistrust between police and racialized communities that often discourages them from seeking help [87]. Similarly, Luebke (2023) described how Indigenous Survivors often face compounded barriers due to distrust and discrimination, which manifest in their experiences of not being believed, listened to, or taken seriously within law enforcement and healthcare systems. These interactions, marked by racism and sexism, underscore the intersectional challenges of being Indigenous, female, and low-income, further exacerbated by a lack of culturally relevant care in the structures meant to provide protection and health services [54].

Numerous authors highlighted the significance of delivering community-based, trauma-based, trustworthy, language sensitive, and culturally safe supports to high-risk sub-groups of IPV Survivors [42, 45–47, 54, 72, 78, 79, 93], with some advocating for or implementing a harm reduction approach [39, 63]. Several authors discussed how service providers navigate the tension between adhering to public health mandates and understanding the unique risks to survivors in their communities. They emphasized the advocacy roles of these providers in mediating and influencing policies for more funding and to address structural inequalities affecting minoritized women, thereby enhancing their ability to provide culturally and contextually appropriate support [39, 65, 79, 87].

Theme 9: Financial strains and abuse.

Financial strains resulting from various crises—whether it be a pandemic, economic recession, or climate disaster—contribute significantly to the increase in IPV. The dimension of financial abuse during SLEs is crucial in empowering women, particularly in enabling them to leave abusive relationships. Vives Cases et al. (2021), Safar et al. (2023) and Randell et al. (2023) specified the need for financial support for Survivors [65, 67, 100]. Financial independence and access to resources are pivotal factors in the ability to leave without being financially dependent on the abuser. Several articles have highlighted that economic precariousness during any SLE makes it less likely for Survivors to leave abusive situations (e.g., loss of job), access services (e.g., due to associated costs, lack of health insurance, perpetrator control of personal documentation), and if financially dependent on the perpetrator of violence, they are also trapped in hostile environments which exacerbate IPV (stress, frustration) while decreasing their ability to seek support [40, 42–45, 58, 60, 63, 65, 72, 74, 75, 92, 95, 106, 107]. Housing insecurity exacerbates the risk of IPV, highlighting the complex interplay between socioeconomic instability and the heightened risk of remaining in abusive relationships. This insecurity, along with deteriorating living conditions, often forces women to endure abusive and stressful situations [37, 38, 53, 54, 56, 74, 78, 80, 86, 94] or rely on emergency shelters or insecure hotels for extended stays due to challenges in transitioning to housing [65, 83]. Healthcare professionals expressed concerns about discharging Survivors—who presented at emergency departments with severe injuries—to hotels, due to the lack of safe and secure community resources during COVID-19 [49].

Supplement 5 (S3 Table) presents the themes from the analyzed articles, detailing the barriers and facilitators identified in the literature for each of the included articles. To interpret Supplement 5, review the themes column, which synthesizes barriers and facilitators from the analyzed articles. Each row corresponds to an individual article, outlining the specific challenges and supports identified in the literature regarding access to services for IPV survivors during stressful life events. Figs 2 and 3 are an iteration of this supplement to provide a visual of the key themes and corresponding authors for barriers and facilitators, respectively.

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Fig 2. Barriers to accessing IPV supports during SLEs.

https://doi.org/10.1371/journal.pone.0313613.g002

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Fig 3. Facilitators to accessing IPV supports during SLEs.

https://doi.org/10.1371/journal.pone.0313613.g003