Introduction

In 2020, the World Health Organization (WHO) declared the novel 2019-nCoV (Coronavirus Disease 2019) a global pandemic [1, 2]. Parallel to this visible COVID-19 pandemic exists a shadow pandemic of Gender-Based Violence (GBV) [3]. As early as 2014, UN Women used the term ‘pandemic’ to encapsulate the global pervasiveness of GBV [4]. Thus, there are two global pandemics occurring simultaneously where the one (GBV pandemic) is exacerbated by the other (COVID-19 pandemic) [3]. Early reports from countries first affected by COVID-19 (e.g., China), warned the rest of the world that these pandemics not only co-exist but also interact [5]. From the global start of the implementation of pandemic control measures, Intimate Partner Violence (IPV) has largely increased in a shadow pandemic [6]. Administrative and reporting data on GBV is not readily available and communicated within South Africa. Reliable service level data is yet to emerge on possible GBV increases during the COVID-19 period. However, many reports from newspapers and GBV service providers (NGOs) have reported an increase in GBV cases [7–10]. The head of South African Police Services released a media statement reporting on a general decrease in violent crime overall in the country for the 1^st seven days of the lockdown but warned that the same was not found for GBV, with more than 2300 calls registered in this period. As a comparison, the same report indicated that the number of GBV calls (received through the GBV Command Centre, a National, 24hr/7days-a-week Call Centre facility, operating under The Department of Social Development) registered per day during the first 90 days of the year (1 January– 31 March 2020) was 177 calls per day, which is a clear indication of the increased need for assistance sought by women in distress related to GBV during the lockdown [9]. This is not surprising given that South Africa is known to have high levels of GBV. For example, the country’s intimate partner femicide rates are amongst the highest in the world [11].

Similarly, reports from China, the United States of America, and several European countries have also shown an increase in IPV during the COVID-19 pandemic [12–16]. Thus, although pandemic response measures are essential, they do not adequately integrate gender protections to address morbidity and mortality from GBV (i.e., there is a lack of gender-sensitive pandemic control measures) [17].

For example, in South Africa, restrictive measures were taken, and a state of disaster was announced alongside a five phased lockdown approach (refer to Table 1 for more information), which was adopted and implemented on 27 March 2020. This lockdown severely restricted movement and limited people to only leaving home for the purchasing of essential items such as food and medical supplies [18]. The South African lockdown is considered as amongst the most restrictive globally: non-essential shops, businesses and restaurants were temporarily closed, schools were closed, all social and sport activities were banned, and there was a complete ban on the sale of alcohol and cigarettes [19]. In addition, President Cyril Ramaphosa deployed the army to assist the South African Police Services to ensure adherence to the COVID-19 regulations, specifically the restriction of movement [20]. Therefore, whilst the lockdown is arguably crucial, the restrictions implemented to reduce transmission as well as the pressure on the health care system, likely resulted in unanticipated consequences for women, as a few factors connect IPV and the COVID-19 pandemic [21].

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Table 1. South Africa’s COVID-19 lockdown levels, period and summary of restrictions.

https://doi.org/10.1371/journal.pone.0259275.t001

South Africa’s legacy of multiple inequalities may also arguably generate a setting ripe for the pandemic restrictions to exacerbate IPV. Thus, managing the relationship between COVID-19 and IPV, requires a careful response to the context and the intersectionalities that magnify the harmful impact of the pandemic restrictions among women in South Africa [17]. The primary lockdown requirement is confinement to the home, which minimizes opportunities for women to report violence and leave abusers [21]. Home isolation orders for women in abusive relationships often means being trapped (frequently without the means to access support) with a violent perpetrator who may become even more abusive as alternative outlets are minimized, such as social activities. Quarantine also presents abusers with an increased opportunity to inflict harm as they know that women and children have significantly reduced access to their support networks [22]. In fact, the COVID-19 lockdown is subjecting abused women to a compounded, veiled and unspoken lockdown as such women tend to already be exposed to controlling behaviours, which involve, for example, the prevention of seeing friends and family; while some women are not allowed to work, or to leave the house, suffering the risk of being abused if they do [23]. Indeed, lockdown is a crucial aspect of the COVID-19 public health emergency response, yet it magnifies the risk for increased IPV [21], which may further challenge an already fragile South African health care system.

Earlier literature has revealed that factors such as parenting stress [24], economic hardship [25], and food insecurity [26], increase the risk of violence, such as IPV. Indeed, many South Africans are experiencing food shortages and financial hardship during the pandemic as a result of job loss or reduced hours worked, which can worsen already stressful household situations. Simultaneously, we are reminded that many abused women tend to already be financially dependent on their abusers, making an attempt to leave quite difficult [19, 27]. There is also the presence of children and adolescents at home due to school closures, which may mean added parental stress [22]. Add these aforementioned factors, and the stress is intensified [28]. These factors may contribute to a perfect storm, a perfect recipe for perpetration and vulnerability [29].

However, to date, there is an absence of research that seeks to understand women’s experiences of being in abusive relationships during the COVID-19 pandemic. Thus, given that globally, we know little about the virus and its impacts, it is crucial that research is done to begin to understand the extent and depth of the impact that the COVID-19 restrictions have had on IPV in South Africa.

Methods

A sample of 16 women (see Table 2) were recruited using purposive sampling. These 16 women were recruited from five shelters, based within both rural and urban areas within three South African Provinces. Six women were recruited from Western Cape shelters, six from a Gauteng shelter, and four women from a Kwa-Zulu Natal shelter. These shelters were selected as we wanted a racially diverse sample as well as women geographically dispersed within South Africa, and from both urban and rural areas. All five shelters provide residential shelter and refuge to abused woman and their children, along with counselling and skills training, in order to find healing, and to learn skills that will empower them to cope as self-reliant members of society. Recruitment occurred through each shelter’s social worker. The social workers spoke to each woman who met the inclusion criteria and asked each woman whether she would be willing to participate. If she agreed, a suitable date and time would be organized for the telephonic interview.

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Table 2. Participant characteristics.

https://doi.org/10.1371/journal.pone.0259275.t002

Further, telephonic interviews (due to COVID-19 restrictions) were conducted in English in June 2020 with women housed at shelters for abused women and their children. The inclusion criteria was: Women (over the age of 18 at the time of interviews); who have experienced IPV from a male partner. Also, the abusive male partner could either be the participants’ former or current boyfriend/husband.

Throughout the data collection process, the first author engaged in reflexivity. This entailed writing notes to keep a record of thoughts, ideas, and observations. It was also a way to articulate beliefs and judgements, which was important to reflect on in terms of how these may have influenced the research process, in order to promote validity [30].

The first author conducted individual, semi-structured interviews, and each interview was on average, one hour in length. Repeat interviews were done with participants as two interviews were conducted per participant, which was based on a scope of enquiry, which was developed based on the literature reviewed, and used to guide the interviews. This allowed the agenda to be flexible although partially directed by the interview schedule. The first interview briefly explored their background and demographic information and then moved into the beginning of their intimate relationships. The second interview delved deeper into their relationships with partners, and also explored the eventual leaving of the abusive relationship.

Ethical approval was obtained from the South African Medical Research Council’s Human Research Ethics Committee. Approval to conduct research within each shelter was provided prior to the interviews by the Social Worker at each organization. Written informed consent procedures were followed and the aim of the study as well as all ethical procedures (risks and benefits, anonymity, confidentiality) and the recording of the interviews were explained to participants. To maintain anonymity, we use pseudonyms in the paper. We recognized that support for participants was vital and thus, prior to each interview we asked each social worker whether he/she would be willing to meet with the women after the interview, if she felt this was needed. This would have been followed up by the first author to ensure that all participants requesting this service, received it, however, no participants requested additional therapy. Psychological support was also arranged for the first author, who conducted the interviews. After the interviews were conducted, the first author transcribed some of the interviews and a transcriber assisted with the remaining interviews. All interviews were transcribed verbatim. Quality checks were done by the first author who conducted crosschecking of all the recorded interviews against the transcribed interviews.

Data analysis was performed according to the principles of grounded theory. During open coding, audio-recordings and interview transcripts were reviewed with the aim of examining the text for thoughts, ideas, and meaning and consequently assigning them codes, and consequently a codebook was developed. Emphasis was placed on allowing concepts to emerge naturally without forcing them into predefined categories. Categories were then divided into sub-categories. Trimming down of the codes was done with the assistance of the second author, thereby concluding the first stage with 21 codes. Together, a single category was identified (axial coding) as the central phenomenon of interest. This selection was made based on the categories most extensively discussed by participants (i.e., the codes with the highest frequency), which were then positioned as central features, around which, other categories were related, and a storyline was constructed. To illustrate this storyline, discriminate sampling was used, which refers to selecting certain participant quotes, which are able to maximize opportunities for verifying the storyline. The storyline was further validated by searching for relevant literature pertaining to categories. Member checking was performed with participants to iron out ideas and reach consensus. Lastly, core categories were then organized into the research paper. Quotes used herein are illustrative of the codes selected.

Discussion

Nationwide stay-at-home policies following the introduction of the COVID-19 pandemic, abruptly interrupted daily life across South Africa and the globe. In this paper we show how lockdown restrictions introduced new stressors and exacerbated existing strains, thereby escalating violence within already abusive relationships within South Africa (Fig 1). It is, however, worth bearing in mind that a limitation of this study is that the participants represent a specific group of abused women, who arguably have greater agency and access to resources, as they were able to leave their abusive partners during the pandemic. Thus, the voices of those women who were unable to leave their abusers, are not included. Future research is needed to understand IPV experiences amongst those women who were unable to leave during the pandemic.

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Fig 1. How COVID-19 restrictions influenced household dynamics and increased IPV.

https://doi.org/10.1371/journal.pone.0259275.g001

Evidence of escalation and increase in severity of violence experienced by women was also reported in a study of trauma patients in South Africa, where all other forms of injury admissions decreased but female trauma admissions increased to levels higher than before lockdown [40]. Similarly, a recent study conducted by Jetelina, Knell, and Molsberry [41] in the USA found that 17% of female respondents reported that physical IPV worsened during the early stages of lockdown. This should not be surprising as pandemics tend to have accompanying risk factors such as, intense stress, financial difficulties, and decreased social support (as evidenced in this paper), which are also risk factors for IPV and therefore abuse in relationships may worsen during times of crises [17].

Indeed, due to the restrictions implemented during the COVID-19 lockdown period, this period emerged as an opportunity for abusers to tighten their controlling grip on their female partners. This study has shown that the fear and stress associated with pandemics may provide an enabling environment that may exacerbate IPV. Government regulations such as social distancing, inadvertently increased the risk of IPV. Travel restrictions could amplify this dynamic, as many South Africans found themselves in situations in which public transportation and travel by car were limited. Thus, this study has shown that within an isolated setting, some male partners used coercion and control to keep women at home during the lockdown period. Although, intimidation, manipulation, and control are long-standing hallmarks of abusive relationships [42, 43], this discovery is in line with preliminary findings from the USA where concerns have been raised that abusers have been utilizing COVID-19 to instil fear and compliance in female partners as a means of further isolating them [44, 45]. It is possible that this type of coercion might also have resulted in fewer victims reporting IPV and/or seeking medical care for IPV-related injuries [44, 46, 47].

Tied to this, is the paradox highlighted in this study, which many of the women faced, that is, to either stay in the abusive relationship at home thereby adhering to Government regulations to possibly avoid contracting the disease, yet running the risk of enduring or escalating violence; or to leave the home and risk exposure to the coronavirus. The women in this study chose the latter, despite facing a paradoxical risk of dying. Thus, there are two global pandemics occurring simultaneously where the one (GBV pandemic: less visible and efforts to address it significantly under-resourced and overlooked) is exacerbated by the other (COVID-19 pandemic: highly visible, receiving significant public attention and resources) [3].

Overall, this study has reminded us that being ordered to stay at home is not always the safest option for women and that pandemic response measures must include local vulnerabilities [48]. In fact, the home is often the space where abuse occurs as the home is frequently a place where power dynamics can be undermined by those who abuse, often without scrutiny from anyone ‘outside’ the couple, or the family, especially during lockdown restrictions where mobility is restricted and visits from friends and family are prohibited. Thus, during the COVID-19 pandemic, the order to ‘stay at home’ has huge and potentially, deadly consequences for women who are living with a violent partner. Strict movement restrictions minimize opportunities for escaping or for seeking help for victims. As this study has shown, these restrictive measures tend to play into the hands of people who abuse through tactics of control, manipulation and coercion. Unintentionally, these lockdown measures grant abusers greater freedom to act without scrutiny or consequence [49].

Therefore, in a country where 42% of men have reported IPV perpetration [34] and between 43% and 56% of women have experienced IPV [35, 36], it becomes imperative to think critically about orders to stay home. It is understood that it has been essential to alter social behaviours to stop the spread of the virus so as to save lives and to protect our fragile health care systems. However, this study raises concerns surrounding abused women as a way of highlighting some of the paradoxes of such measures. Thus, highlighting the absence of imperative gendered considerations and voices in South African pandemic control measures, which are facilitating a context where IPV tends to increase during the COVID-19 pandemic. Important to note is that we are not opposing such measures, but instead are bringing attention to the voices and needs of abused women, which tend to be slightly forgotten within some policy and political spheres, evident in the lack of gender-sensitive pandemic control measures.

Conclusion

The South African Government has requested all South Africans to contribute towards fighting this pandemic, yet a critical reflection as to what this entails for many women is key. This is especially important as we prepare for multiple waves of the virus and thus, there needs to be a strong effort to ensure IPV safeguards are integrated into COVID-19 measures [57]. The United Nations Secretary-General highlighted the need to integrate protections for women during COVID-19. Specifically, all COVID-19 response plans need to address the impact of this pandemic on women and placing women at the heart of the response effort will ensure better and more sustainable development outcomes and support a faster recovery. Thus, given South Africa is a member state, this is a call to action for the South African Government [58]. In sum, this paper attempts to expose that which has been made invisible and render audible what has been silenced—the abused women’s experiences under COVID-19—in order to assist all women during the COVID-19 and any other emerging pandemics.

Supporting information