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 to access essential health services, including services 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 how women sought help following 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 shifting services online or to telehealth platforms, raising concerns about digital access and safety, particularly when women accessed services from spaces shared with a violent partner. Some other adaptations included the use of community volunteers and the provision of cash assistance for survivors. Help-seeking varied, with some healthcare settings reporting increases and others decreases in the number of survivors presenting, likely reflecting fluctuating restrictions. Women experiencing violence often sought help from informal sources such as community leaders and family. Help-seeking was further constrained by the economic crisis accompanying COVID-19, including food insecurity and transportation challenges. To prepare for future outbreaks, research is needed to identify which services can be safely and equitably delivered online, and which require in-person provision, as well as to understand a broader range of emerging practices for adapting services to physical distancing, movement restrictions, and economic stress.