What works to prevent violence among women with disabilities?

Challenge #1: There are numerous drivers and stressors triggering risk of violence among women and girls.

• Women and girls with disabilities face multiple layers of discrimination resulting from gender inequalities, their disability status, and social norms, attitudes, and stereotypes that make them very prone to experiencing violence. Structural factors that can increase risk of violence for women with disabilities include patriarchal privilege (power imbalance between women and men), normalisation and acceptability of violence in social relationships, and poverty that can either individually or collectively influence men to perpetrate violence against women.
• Data from a World Health Organisation (WHO) multi-country study on domestic violence indicates that among women of reproductive age (with and without disabilities), the risk of experiencing IPV increases if they have experienced factors such as witnessing violence against their mother during childhood, their first sexual experience was unwanted or forced, or they report that their partner has behaviour issues (e.g. alcohol use, frequent fights, controlling behaviour).
• Furthermore, women with disabilities on average are less likely to have had access to secondary education compared to those without disabilities. As a result, they often have limited employment opportunities and when employed can face several barriers including discrimination. This can have a big impact on mental health, which further exposes them to sub-standard livelihoods, financial dependence on family members and risk of violence perpetrated against them.
• Unprecedented events like the current COVID pandemic can further directly or indirectly have an adverse effect on individuals and families, causing poor mental health, increased dependencies and loss of housing or livelihoods, which are additional risk factors for IPV that will also affect women with disabilities.

Challenge #2: Women with disabilities do not enjoy their rights to full and effective participation and inclusion in society on an equal basis with others.

• Despite ratifying the United Nations convention on the rights of persons with disabilities, many countries’ legislative laws do not adequately recognise the multiple layers of barriers experienced by women with disabilities. As a result, women with disabilities continue to experience discriminatory attitudes and practices that may manifest in violence.
• Data from a multi-country qualitative study conducted with women and men with disabilities in the context of IPV prevention programmes in four LMICs confirmed the existence of disability-related stigma and discrimination; manifested as being blamed and devalued for having a disability, denied access to employment opportunities, and excluded from community interactions. Women with physical impairment frequently experienced stigma due to the visibility of their impairment.
• Women with disabilities experience internalised stigma and discrimination such as feeling of failure for not conforming to the gender norms and social obligations in their communities. This can introduce additional stress in the households, through care and support needs, which in turn can increase their increase of experiencing IPV.
• Stigma and discrimination can lead to underreporting of IPV, with common reasons such as: failure of law enforcement, silencing by communities, fear of repercussions from perpetrators, financial dependence on violent partners, or survivors’ empathy for abusive partners. In some situations, stigma enactors in the community can include law enforcement professionals such as police and judiciary staff, meaning that perpetrators of violence escape punishments and women with disabilities’ accounts are disregarded4. This further discourages women with disabilities from reporting crimes perpetrated against them.

Challenge #3: Violence is a complex event that needs a multi-sectoral and collaborative approach.

• One review reported that the prevalence of violence was highest among people with mental illness. Another multi-country study reported that although women with disabilities were at increased risk of both physical and emotional types of violence, emotional violence caused mental health issues including anxiety, depression, and suicidal thoughts. Furthermore, the study reported increased risk of IPV with increased severity of disability.
• Evaluation of a social and economic empowerment programme – ‘Stepping Stones and Creating Futures,’ conducted in South Africa found that the programme had led to a significant reduction in severe physical IPV among women without disabilities, but reported an increase among women with disabilities.  The authors explain that women with disabilities may have found it challenging to translate the learnings and experiences from the programme into action in their home lives, particularly those around building respect and authority. This suggests that targeted programmes need to consider wider social dimensions and take a multi-system approach, to avoid further marginalising women with disabilities and adding to their vulnerability.
• In general, programmes that support women experiencing IPV do not fully accommodate the access needs of women with disabilities, further contributing to their exclusion and isolation. Future programmes should be more inclusive and consider accessibility needs related to communication channels, venues, programmes materials and activities.
• Women with disabilities experiencing sexual violence often need several multidisciplinary services such as health, social care, and legal support that may be scattered in different locations. They frequently need to retell their stories of trauma each time they engage with a different service/sector which can contribute to secondary victimisation. One review identified the following barriers to the implementation of a one-stop care model for IPV and sexual violence for women experiencing violence in LMICs: harmful staff attitudes towards women experiencing violence; mistreatment by police; lack of services on night and weekends, out-of-pocket user costs, lack of community awareness; lack of resources including financial constraints; privacy issues and maintaining confidentiality, poor data management system and lack of monitoring and evaluation mechanisms; and weak multi-sectoral networks.

Challenge #4: There are methodological problems in the way that violence data is captured and measured.

• It is recognised that the nature of victimisation and abuse experienced by women with disabilities may be distinct from that experienced by women without disabilities. A recent study reported that among the research participants almost half of the women with disability experienced sexual form of IPV compared to a quarter of the women without a disability. As a first step towards developing an effective violence prevention strategy, it is necessary to define the nature of the problem by identifying the prevalence and risk of violence among women with disabilities specifically. However, available violence data does not adequately capture and measure violence against women with disabilities. For example, prevalence data from cross-sectional studies does not routinely measure or report whether violence or disability occurred first, and large studies on violence do not regularly disaggregate outputs by disability status.
• Prevalence data on disability from household surveys can also underestimate the true prevalence of both disability and of violence. If surveys do not include institutional settings (in which women with disabilities may live), allow for proxy-report (otherwise excluding those who cannot communicate independently) or use stigmatising tools to measure disability (leading to non-disclosure), they may under-estimate disability prevalence. If they do not protect anonymity and safety, women (with and without disabilities) who are dependent on an abuser may also be unlikely to disclose violence, leading to underestimates of violence prevalence.
• Few studies used accepted and validated measurement tools for IPV like the Conflict Tactics Scale or the Women’s Experience with Battering Scale. A recent study used a shortened version of the Conflict Tactics Scale (CTS). Although the CTS can capture all types of IPV including physical, sexual, and emotional type of violence it can overlook disability-specific forms of violence experienced by women with disabilities, such as withholding care or assistive devices, and forced sterilisation.
• Although Washington Group Short Set of Disability Questions (WG-SS) is a recommended questionnaire to capture functional difficulties they are limited in their ability to capture disabilities resulting from mental health conditions or chronic illness. Moreover, they do not measure the implications of social contexts and built environments on disability. It is therefore necessary to complement the WG-SS questions with additional mental health questions such as those in the Short-Set Enhanced.

Challenge #5: The evidence base on what works to prevent violence among women with disabilities is sparse.

• The evidence base around effective violence prevention interventions specifically developed for women with disabilities is very limited. One recent study compared the effectiveness of a multi-component IPV prevention intervention related to economic and social empowerment between women with and without disabilities, finding similar benefits between the groups. However, the relative change in some outcomes such as physical violence was quite small among women with disabilities suggesting high rates of violence even after receiving the intervention. The intervention was generic, but there is a need to develop and evaluate violence prevention interventions taking into consideration specific disability issues.
• Further, research participants in violence prevention interventions may not represent all women with disabilities as those with severe disabilities can face exclusion from participation due to barriers in the recruitment and intervention delivery phases. Lack of specific accommodations strategies have been cited as one of the barriers.