Lockdown has had myriad consequences, including an increase in crimes against women in South Africa and the world. As 16 Days of Activism for No Violence against Women and Children is being commemorated, researchers from the University of Cape Town (UCT) are working collaboratively with national entities invested in the alleviation of this abuse.
The study, Impact of COVID-19 and lockdown on mental health and gender-based violence in South African women, is a collaboration between the Institute of Infectious Disease and Molecular Medicine (IDM) at the UCT Faculty of Health Sciences (FHS), the Centre for the AIDS Programme of Research in South Africa (CAPRISA), the Desmond Tutu Health Foundation (DTHF), the Seattle Children’s Research Institute in the United States and the Burnet Institute in Australia.
At a national address in August, President Cyril Ramaphosa said: “As we mark Women’s Day this year, South Africa is in the grip of two pandemics – the coronavirus pandemic and the scourge of gender-based violence and femicide.”
According to the South African Police Service, 87 000 cases of gender-based violence (GBV) were reported during the first week of lockdown. The spike in GBV over recent months is attributable to, among other complex contributing factors, the many survivors of violence who were left confined to sharing spaces with their abusers, which often compromise and constrain their access to support services.
This research is associated with the ongoing clinical study on mucosal injury from sexual contact (MISC) being conducted through a partnership between these research institutes, with Associate Professor Heather Jaspan as co-principal investigator (co PI) and Seattle Children’s Research Institute PI; Associate Professor Jo-Ann Passmore as co-PI and CAPRISA PI; and Dr Lindi Masson as co-PI and UCT PI. All have appointments through the FHS and are members of the IDM.
The MISC study aims to evaluate the behavioural and biological differences between adolescent and adult South African women in order to understand the extremely high HIV incidence in young women in this country. Among other factors, the study is investigating the impact of the use of vaginal insertion practices and/or sexual trauma on genital inflammation in young women.
The face-to-face clinical activities of this study were halted in March 2020, like almost all observational research projects at UCT, following guidance from the UCT Human Research Ethics Committee as a result of the national lockdown. The researchers instead implemented a telephonic survey study to assess the physical and emotional well-being of adolescent and young women living in Philippi, Cape Town, and Vulindlela in rural KwaZulu-Natal.
Economic vulnerability contributes to abuse
Between 2018 and 2019 black African women were recognised as the most economically vulnerable population group in South Africa, with an unemployment rate of over 30%. Many of these women also experienced violence, with almost 50% of assaults committed by someone such as a friend or acquaintance (22%), a spouse or intimate partner (15%), or a relative or other household member (13%). This is according to a Statistics South Africa report.
Concerned that the participants of the MISC study were particularly vulnerable, the researchers sought to offer them support.
A primary goal of the survey was to determine whether any of the study participants were confined in an unsafe environment during lockdown, with the aim of referring them to nearby shelters or social services. At the same time, the United Nations issued a call for data on the impact of COVID-19 on violence against women, and the team recognised the importance of collecting this data locally to contribute to this much larger body of work.
A total of 54 telephonic interviews were conducted during the various stages of lockdown. Of the 28 participants in Philippi, three experienced GBV and/or explicit threats of violence.
“One participant was murdered, another verbally threatened by an intoxicated man and the third reported attempted rape. These events highlight the extreme vulnerability of these women and the need for continued support,” said Dr Masson.
Ten women in Philippi (36%) and two women in rural KwaZulu-Natal (8%) were scored as having mild depression on the PHQ-9 scale, an evaluation tool with nine questions commonly used to assess depression.
Masson conceptualised this sub-study, the COVID-19 GBV and depression survey, and implemented it together with project coordinator Celia Mehou-Loko from the FHS, and Dr Hilton Humphries at CAPRISA. They found that concerns surrounding employment, education and the future were the main stressors for most participants.
According to Mehou-Loko, the study consistently considered three essential components: confidentiality, safety and beneficence.
“Operating outside the confines of the clinic caused a threat to all three of these key tenets,” she said.
Mehou-Loko explained that an additional concern was that participants would be overheard while speaking on the phone with the data collection team, thus potentially compromising their social standing further and putting them in even more danger – a consideration which led to the questionnaire being designed to ensure participants could provide simple responses while still allowing for sufficient data collection.
“Participants could also send us a ‘Please call me’ when they felt comfortable, safe and ready to speak freely … It was also very important that the referral channels, in case of emergency, were tested – that the social workers and the NGOs were available to see our participants despite the lockdown,” she said.
Evidence to advocate for change
The study highlights some of the unintentional and indirect impacts of lockdown strategies used to mitigate transmission risk in epidemics.
“These unintended consequences must be quantified so that in the future more accurate risk and benefit equations can be appreciated ahead of any decisions of this magnitude. In addition, this work may point out opportunities to reduce the risks of violence or better protect women and others, including children,” said Professor Linda-Gail Bekker, the chief operating officer at the DTHF and a member of the IDM.
“In the future it would be critical to comprehensively evaluate the availability of the support services these young women can access.”
The research team intends to use these findings to inform the development of more accurate risk and benefit equations that can be applied before implementing a lockdown in both rural (CAPRISA site) and urban settings (UCT site). This evidence can be used to advocate for continued availability of support services that are critical to ensure the well-being of young women during emergency situations like COVID-19, but also more generally.
“Emergency services currently prioritise crisis situations; however, the team has identified a high incidence of lower-grade depression that is important to defuse before it escalates to a more critical point. With simple counselling techniques, follow-up calls and referrals, most participants reporting depression improved their scores to absent or minimal depression,” Mehou-Loko said.
Masson echoed this sentiment: “In the future it would be critical to comprehensively evaluate the availability of the support services these young women can access and whether these services are adequate.”
Crucial in curbing this pandemic is creating awareness about the support services, including the NGOs and hotlines that are available to assist young women. The development of informed campaigns to encourage women to reach out and seek help when they experience emotional difficulties, violence or threats of violence remains key.
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