COVID-19 & Violence Against Womxn: The Role of Contraception
In order to reduce the harms associated with the COVID-19 pandemic, Canada and other countries worldwide have relied heavily upon physical distancing restrictions as a key public health strategy. However, physical distancing mandates, namely reducing time spent outside of the home, have created a variety of unintended secondary impacts beyond disruption of COVID-19 transmission.
The World Health Organization and other authorities are now turning their attention to these secondary consequences of restricting peoples’ daily routines to private domains (1). In particular, United Nations documents have raised concerns that worldwide COVID-19 physical distancing restrictions might dramatically amplify global patterns of domestic violence against women and girls. Global patterns in trans and non-binary populations are not as well studied but are estimated to be similar (2–5).
This concern is grounded in crime theory in that isolation breeds an environment where there is less opportunity for a crime to be observed, and therefore could increase the risk of its occurence (6–8). Increases in patterns of both male violent crime perpetration and female violent crime victimization (comprised primarily of intimate partner violence episodes) in private settings following physical distancing restrictions have been suggested in a number of recent scientific publications and media stories (9–14).
Although the majority of reported cases of intimate partner violence involve a male perpetrator and female victim, intimate partner violence can be experienced or perpetrated by any person regardless of how they identify.
Physical distancing and isolating in place are not safe practices for those who experience intimate partner violence or other forms of violence at home (15,16). Violence against womxn, especially intimate partner violence, has significant impacts on health; it can result in severe physical, mental, sexual, and reproductive health problems, including sexually transmitted infections and unplanned pregnancies (17).
The United Nations Population Fund has reported that for every three months that physical distancing measures continue, it is expected that there will be an additional 15 million cases of gender-based violence and 13 million womxn will not be able to access contraception, thus resulting in 325,000 unintended pregnancies globally (16).
Access to contraception during COVID-19 has been limited due to a number of factors including reduced capacity and hours of walk-in clinics, physician offices, and pharmacies, fear of visiting medical facilities, reduced access to or perceived safety of public transportation, a reliance on technology to be seen by providers only offering telemedicine appointments, depleted contraception stock at pharmacies, and financial stresses.
For the many people who are facing unemployment, loss of health insurance, and reduced income, affording contraception is now weighed against the costs of other basic needs like food and shelter. Additionally, changes in pharmacy dispensing procedures from 90-day to 30-day supplies due to dwindling stock could mean tripling of the usual dispensing fee (18). The impacts of the COVID-19-related increase in violent crime against womxn and additional barriers to accessing contraception are heightened in British Columbia where there is an existing lack of universal access to contraception.
Although access to contraception is deemed a basic human right, contraception for many individuals in British Columbia is not accessible (19).
In 2016, one in five Canadian womxn had an unplanned pregnancy (20), and as many as 61% of Canadian womxn report having had an unplanned pregnancy in their lifetime (21). Prior to COVID-19, cost of contraception was a significant barrier inhibiting access, and cost is playing an even larger role now (22). Intra-uterine devices (IUDs) can cost as much as $380, hormone injections $180 per year, and oral contraceptive pills upwards of $20 monthly (23). Furthermore, the most reliable contraceptive methods, IUDs and other long-acting reversible contraceptives, have the highest upfront costs, which acts as an additional barrier and results in reliance on less effective methods (20).
While it is not believed that the costs associated with the contraceptive products themselves have increased during COVID-19, current economic stresses make contraception inaccessible for many. While this can be said for all womxn, trans men, and non-binary individuals with uteruses, it is of particular relevance for those experiencing violence. Both violence against womxn and pregnancy rates have been observed to increase with crisis isolation, and intimate partner violence is known to increase when womxn are pregnant (24–27).
COVID-19 physical distancing restrictions have led to a shift in daily activities from the public to the private sphere thus increasing the opportunity for violence and decreasing the potential for intervention by others. The rise in violent crime against womxn is associated with an elevated risk of unintended pregnancy, especially in light of challenges accessing contraception.
Financial hardships as a result of the pandemic is just one of the barriers being faced, but one that could be diminished by universal access to contraception. In addition to limiting access to contraceptives, COVID-19 has impacted access to services including abortion care and sexually transmitted infection testing as a result of physical distancing and other public health protocols, business closures, changing hospital priorities, lab capacity, and condom shortages (28,29).
When taken together, all of these factors combine to have significant impacts on health. Ultimately, recognizing the unintended secondary impacts of public health physical distancing protocols, including shifts in the volume and distribution of crime and criminal victimization, is critically important to guide evidence-based public health and public safety interventions to mitigate harms, especially if such crime and victimization burdens fall upon already vulnerable populations and have significant implications on health.
A special thanks to Erin Slade for their help in the creation of this article.
World Health Organization. A Coordinated Global Research Roadmap: 2019 Novel Coronavirus. Geneva, Switzerland; 2020. https://www.who.int/blueprint/priority-diseases/key-action/Coronavirus_Roadmap_V9.pdf.
United Nations Population Fund. Coronavirus Disease (COVID-19) Pandemic UNFPA Global Reponse Plan. New York, NY; 2020. https://www.unfpa.org/resources/coronavirus-disease-covid-19-pandemic-unfpa-global-response-plan.
United Nations Population Fund. COVID-19: A Gender Lens. New York, NY; 2020. https://www.unfpa.org/resources/covid-19-gender-lens.
United Nations Population Fund. Impact of the COVID-19 Pandemic on Family Planning and Ending Gender-Based Violence, Female Genital Mutilation and Child Marriage. New York, NY; 2020. https://www.unfpa.org/resources/impact-covid-19-pandemic-family-planning-and-ending-gender-based-violence-female-genital.
United Nations Population Fund. Gender Equality and Addressing Gender-Based Violence (GBV) and Coronavirus Disease (COVID-19) Prevention, Protection and Response. New York, NY; 2020. https://www.unfpa.org/resources/gender-equality-and-addressing-gender-based-violence-gbv-and-coronavirus-disease-covid-19.
Cohen LE, Felson M. Social change and crime rate trends: A routine activity approach. Am Sociol Rev. 1979;44(4):588-608.
Hollis-Peel ME, Reynald DM, van Bavel M, Elffers H, Welsh BC. Guardianship for crime prevention: A critical review of the literature. Crime, Law Soc Chang. 2011;56(1):53-70. doi:10.1007/s10611-011-9309-2
Reynald DM. Translating CPTED into Crime Preventive Action: A Critical Examination of CPTED as a Tool for Active Guardianship. Eur J Crim Policy Res. 2011;17:69-81. doi:10.1007/s10610-010-9135-6
Gillis W. Forced to stay home with their abusers, Canadian victims of domestic violence must ‘choose between two pandemics.’ The Star. https://www.thestar.com/news/canada/2020/04/20/forced-to-stay-home-with-their-abusers-canadian-victims-of-domestic-violence-must-choose-between-two-pandemics.html. Published April 20, 2020.
Mohler G, Bertozzi AL, Carter J, et al. Impact of social distancing during COVID-19 pandemic on crime in Indianapolis. 2020. https://www.researchgate.net/publication/340414800_Impact_of_social_distancing_during_COVID-19_pandemic_on_crime_in_Indianapolis.
Campbell AM. An increasing risk of family violence during the Covid-19 pandemic: Strengthening community collaborations to save lives. Forensic Sci Int Reports. 2020;2:100089. doi:10.1016/j.fsir.2020.100089
Nair R. Domestic violence organizations prepare for possible surge due to COVID-19 isolation. CBC News. April 28, 2020.
Usher K, Bhullar N, Durkin J, Gyamfi N, Jackson D. Family violence and COVID‐19: Increased vulnerability and reduced options for support. Int J Ment Health Nurs. 2020. doi:10.1111/inm.12735
Bradley NL, DiPasquale AM, Dillabough K, Schneider PS. Health care practitioners’ responsibility to address intimate partner violence related to the COVID-19 pandemic. Can Med Assoc J. 2020.
Patel R. Minister says COVID-19 is empowering domestic violence abusers as rates rise in parts of Canada. CBC News. https://www.cbc.ca/news/politics/domestic-violence-rates-rising-due-to-covid19-1.5545851. Published April 27, 2020.
Kaur J. COVID-19 lockdowns leading to a rise in violence against women and girls. FIGO Global Women’s Health News. https://www.figo.org/covid-19-lockdowns-leading-rise-violence-against-women-and-girls. Published May 14, 2020.
World Health Organization Human Reproduction Programme. COVID-19 and Violence against Women: What the Health Sector/System Can Do.; 2020. https://www.who.int/reproductivehealth/publications/emergencies/COVID-19-VAW-full-text.pdf.
Canadian Pharmacists Association. COVID-19 and the responsible allocation of medications to patients. https://www.pharmacists.ca/news-events/news/covid-19-and-the-responsible-allocation-of-medications-to-patients/. Published 2020. Accessed November 28, 2020.
United Nations Population Fund. By Choice, Not by Chance: Family Planning, Human Rights and Development. New York, NY; 2012. https://www.unfpa.org/sites/default/files/pub-pdf/EN_SWOP2012_Report.pdf.
Vogel L. Canadian women opting for less effective birth control. C Can Med Assoc J. 2017;189(27):E921-E922. doi:10.1503/cmaj.1095446
Laucius J. Oops! 61 per cent of Canadian women have had an “unintended” pregnancy, says survey. Ottawa Citizen. June 19, 2017.
Black A, Guilbert E. The road to contraceptive consensus: New recommendations for contraceptive use in Canada. J Obstet Gynaecol Canada. 2015;37(11):P953-P954. doi:10.1016/S1701-2163(16)30043-3
AccessBC. Universal Access to No-Cost Prescription Contraception in BC. https://www.accessbc.org/background. Published 2020. Accessed November 28, 2020.
Evans RW, Hu Y, Zhao Z. The fertility effect of catastrophe: U.S. hurricane births. J Popul Econ. 2009;23(1). doi:10.1007/s00148-008-0219-2
Drew LB, Mittal M, Thoma ME, Harper CC, Steinberg JR. Intimate partner violence and effectiveness level of contraceptive selection post-abortion. J Women’s Heal. 2020;29(8):1142-1149. doi:10.1089/jwh.2018.7612
Long A, Golfar A, Olson D. Screening in the prenatal period for intimate partner violence and history of abuse: A survey of Edmonton obstetrician/gynaecologists. J Obstet Gynaecol Canada. 2019;41(1):38-45.
Pallitto CC, García-Moreno C, Jansen HAFM, Heise L, Ellsberg M, Watts C. Intimate partner violence, abortion, and unintended pregnancy: Results from the WHO Multi-Country Study on Women’s Health and Domestic Violence. Int J Gynecol Obstet. 2013;120(1):3-9. doi:10.1016/j.ijgo.2012.07.003
Osman L. Advocates sound alarm over COVID-19 limiting access to contraceptives, abortion. The Globe and Mail. https://www.theglobeandmail.com/canada/article-advocates-sound-alarm-over-covid-19-limiting-access-to-contraceptives/. Published April 2, 2020.
Couto M. Experts say women shouldn’t put off sexual health care during coronavirus pandemic. Global News. https://globalnews.ca/news/6905605/coronavirus-womens-sexual-health/. Published May 5, 2020.