Data collection

The interviews were conducted by three female researchers from the research team with training and experience in qualitative research methodology.

The interview guide (S2 Table) was based on the study objectives and was piloted and adapted in the first phases of the field work. The final structure of the guide was focused on perceptions related to: 1) context and needs of the women; 2) strategies adopted for the services and working conditions; and 3) lived work experience (obstacles, positive aspects and proposals for improvement. Interviews were conducted in Spanish and adapted to the professional profiles of the participants. Discussions within the research team were held to promote use verbal and non-verbal communication strategies to minimize possible language barriers related to the distance interviews. We carried out our interviews by telephone and video call, due to the COVID-19 context, which made physical meetings and in-person interactions difficult. The participants decided their preferred method: 22 were carried out by telephone and 21 by video call. The duration of the calls was from 50 to 70 minutes. Calls were audio recorded digitally and later transcribed. Participation was voluntary, and an information sheet was sent prior to recording, providing information about confidentiality and the policy of anonymity. Also, the participants’ consent for the processing of data for research purposes was orally collected and recorded at the beginning of the interview. The study was approved by the Ethical Committee of the University of Alicante (UA-2020-07-08).

Analysis

A qualitative content analysis was carried out using predefined tree codes that were agreed upon by the research team, based on the study objectives and a preliminary analysis of information from the interviews. After using this initial tree of codes, new codes that emerged were added during the process of analysis. The tree of codes was adapted during the coding process, by unifying codes related to similar discourses and later grouping codes to create different categories, as described in the Results section. To prevent possible bias in coding we carried out the following measures: double coding of interviews, contrasting the usefulness of emerging codes among the analysts and engaging in debate with the rest of the research team (The coding tree is shown in S3 Table). Atlas.ti (version 9) was used for this process.

Impact of the COVID-19 pandemic on women affected by IPV and their children

During the confinement, the professionals perceived a reduction in the number of deaths and reports of physical aggression. They attributed this primarily to the fact that, in being in constant contact with their aggressors, women developed strategies for mitigation through submission and conflict avoidance. They also signaled a possible increase in psychological and sexual violence, given that aggressors had more intense control of households and could commit abuse with greater impunity. They pointed out that it was not only women who were more exposed to this type of violence, it was also minors and other household members.

An increase in intensity, actually, total isolation and an intense control over women, in the intensity and frequency of the exposure of minors who were in the household. In the end it was school that prevented them from seeing many things, wasn’t it? Worse violence, and furthermore, the children seeing it. TS-19

The type of violence, for example, there was a resurgence in sexual aggression in the couple…That is to say, there were cases of women who weren’t able to report it and get out of the situation. We were able to do follow-up, both psychological and social, to support them in their efforts to report it, and these sexual aggressions occurred because they were confined, because the aggressor had greater control. GBVOS-08

Also related to the COVID-19 lockdown, the interviewees described how it may have helped women to increase their consciousness about their own IPV situation.

It allowed them to see that their situation was tremendously unsustainable, and that they couldn’t be there. Many of these women told me,’ if I hadn’t been confined at home with this man for so long I wouldn’t have taken this step.’ GBVOS-17

I knew that…, I knew she wasn’t doing well, that there had been suicide intents, I knew that something was happening to her, but I didn’t know why. (….) Then, well, maybe this is a case in which the confinement helped bring it to light, you know? Who knows. The confinement could also have helped a bit in this way. HEALTH-30

According to those interviewed, women who continued to live with their aggressors during confinement were more exposed to abuse (greater intensity, more frequent). This situation, linked to the aggressors’ extreme supervision and control, made social interaction more difficult for these women, and therefore it was more difficult to share their fears and look for help. They felt more alone, which led them to develop strategies of conflict avoidance to contain the increase in violence.

I think that women who are abused or who are victims of violence have tried to become invisible, in other words, tried to avoid conflict at all costs. HEALTH-42

Those women who did not live with their aggressors also had varied experiences. The professionals interviewed described how some women could have felt safer during the confinement thanks to the lower probability of seeing their ex-partners and/or suffering abuse outside the home, which implied a reduction in their fear.

In fact, one woman told me that she was more relaxed because she knew they were at home, that nothing could happen and that she was with her children. And, well, since they were accustomed to not going out often because of the fear they felt about going out, well, it was actually going well. GBVOS-12

However, according to the professionals, even when they were separated, aggressors continued to try to maintain a presence in the lives of their ex-partners, by threatening them or using minors and/or food pensions as blackmail mechanisms.

(…) they’re already separated, they don’t live with the aggressor. Then, evidently, with a lot of fear, they continue to use mechanisms of control, even without living with them. So they had fear of possible reprisals, and that there would be continued abuse, attacks, that he would get the kids or show up unannounced. The level of threat continued. GBVOS-21

In terms of the aggressors, the truth is that the breakdowns were very few (…) But I’m telling you, there were many attempts, for example, insisting on seeing the kids, when they knew that they couldn’t, well, it’s still a way of being visible. And women had many doubts about this as well. We’re in a situation, but…can I leave him with the child? Or not? He is insisting and saying that he’s going to report me. Well, this is also real violence. GBVOS-14

They also mentioned that, for some already separated women, the conditions of confinement and the limitations of movement made them relive the trauma of when they lived with their aggressors.

One important thing that the women communicated to us was, for example, being shut in indoors or semi-shut in, it brought back past memories of when the aggressor would refuse to let them out of the house or shut them in. Thus, it provoked a great deal of discomfort because they had to relive these past moments. TS-27

Care needs during and after the COVID-19 lockdown from women exposed to IPV

Those interviewed also highlighted the women’s most basic and material needs, even above the problems related to partner violence. They identified an increasing worry about feeding the children. Access to these types of resources was another of the principal petitions received by the professionals of the public administration and the non-profit sector.

[During the pandemic] we received a ton of calls from women who couldn’t pay for basic services or rent. This increased a lot, because beforehand there were few of these calls, otherwise it would have been the same. TS-04

At first, above all they were social, later things went back to normal daily functioning a little. But there was an increase in social demand, both in the state of alarm and later in the return to opening. GBVOS-23

More specifically, the service professionals that offered supports related to housing also described an increase in the need for this support, especially in the first few weeks of the confinement.

These petitions could be a little more than what I’ve described, the demands for rooms, right? I have to run away and need a place to stay, I need some resource that’s going to cover that. As I told you, it was those first 15 days. GBVOS-21

The interviewees also reported that during the confinement there was an increase in the demand for psychological support, primarily related to the need to speak and be listened to, and sometimes, the need for strategies for cohabitating with the aggressors. These petitions were attended to primarily by telephone.

I didn’t receive any specific petition except for women wanting to be heard, wanting support. The great majority of them were at home alone, maybe after a divorce, and because the measures that were implemented were new, they wanted to be heard. GBVOS-03

Now I am noticing it. During the confinement there was an extreme increase in new patients who called to get support, to vent, or because they needed psychological support. GBVOS-09

The professionals working in the third sector during the confinement detected certain health needs, the majority of which were referred to the health system, above all, cases of anxiety and pain. Health services also reported that women in situations of IPV that had been identified specifically asked for mediation to confront the confinement living situation, and consequently they were prescribed more anti-anxiety medications.

Well, there is more than that issue of health, of course… Yes, it has increased much more. Yes, there was a notable increase in health needs. I believe that now almost all of the women we are attending, they all come for health problems, like body pains, insomnia, anxiety… Before, there was around 60% or 70%, now it’s all of them. All of the women who come to us ask to be seen by a doctor. I don’t know if this has to do with the confinement, the situation of uncertainty, whether economic or social. TS-11

The need is, well, to give them something to support the situation. In the end that’s what all women ask for when they’re in such difficult situations; they ask, is there something that could help me tolerate this? All the anguish that this relationship is causing me. HEALTH-41

Aspects that made the response capacity of IPV services more difficult during the confinement due to COVID-19

The interviewees reported having to work in constant intensification and reorganization of activities (carrying out non-habitual work and functions), combined with insufficient personnel and infrastructure, which resulted in professionals having to lengthen their workdays, work on weekends and establish shift work in order to deliver care. Other factors added to the high workload, including the pressure to care for women’s needs and the increase in individual responsibilities in the resolution of urgent cases.

I’ve worked like never before in my life, and meanwhile, all of a sudden, my mother was admitted to the ICU. She was 61 years old and in 12 hours she was in critical condition. GBVOS-01

The social worker and the psychologist worked together to combine telework with in-person work. I went two days per week and the social worker went another two days per week, and that’s how we covered four days per week. In this way, at least we were available by phone 24 hours per day, because it’s true that we increased our normal workload. Our work hours usually last from 8 am to 4 pm more or less, but during the pandemic we were available, morning, afternoon and night, because the situation was exceptional for everyone. GBVOS-17

Nor did we have a predetermined procedure for a situation of this type. Someone would arrive all of a sudden and need help fast, and sometimes there was only one person available. It depended a lot on who was there. TS-19

A negative aspect was the lack of experience in delivering telecare using technology. Households had to improvise to make room for work as well as reorganizing in order to attend both to work and the needs of minors and dependents that, from one day to the next, stopped being able to attend sports and educational activities, senior centres, etc. that were essential for the conciliation of work and home life.

In two days, more or less here in the Region of Madrid, schools were closed. We are nearly 50 workers, all women, there is one man, and there was a high percentage of us caring for children. TS-19

These factors added to the uncertainty brought about by the global pandemic and generated a negative emotional impact among professionals (frustration, powerlessness, overwhelm, fear, burnout…) that had a negative effect on the capacity to manage work.

Well, first, we’re very overworked. Like it or not, this also plays a role […]. I feel like I’m a person who is conscientious and I try to always take that perspective, but there are times when I just don’t have the energy. Times when I stay superficial and I say, ‘look, there it is,’ you know. No, now I don’t have time or energy to take on anything more. And this obviously has an impact, because you need time to get through it. HEALTH-30

I’m sure that many women have had a really complicated time of it, because any patient has a hard time contacting the center. The help lines were overwhelmed, the internet visits were blocked. There were waitlists to get a call back. Sometimes so many people signed up that you couldn’t call back for up to 10 days, because it was totally impossible. HEALTH-22

In this context of adverse circumstances, another series of difficulties was mentioned in the interviews related to the care for IPV cases related to the characteristics of the resources, the barriers to women’s access and the professionals themselves. In terms of the resources, the limited capacity of the public administration to adapt to the new situation is worth highlighting.

There were difficulties in the petitions for subventions, the SEPE, all of the telematic procedures that were generated, but with difficulty and with barriers…The electronic DNI, the digital certificate…for many women there was a lack of knowledge about how to manage this. GBVOS-24

The non-profit sector professionals reported a lack of support from institutions and the difficulties they found in contacting them. On some occasions, this was an important obstacle to attending to women’s needs.

I understand that the bureaucracy responds to the needs of the administration and so on, but we would have needed, at minimum and in the moment of maximum urgency, that it had been easier to carry out the paperwork. TS-20

They also mentioned the problems in coordinating with other services and sectors, both those that had not been sufficiently developed prior and those in which it simply was not possible in the context of the pandemic.

I’ll give you an example from my area. The psychosocial teams from the courts have been working from home. Therefore, we could not coordinate with them. Everything has been done in the sense of, I’ll leave a note with my colleague and he’ll call you at home. This has made it all more difficult. GBVOS-21

I can tell you that we don’t count on support from the administrations. In fact, what they showed us during these months is that they have been more of a hassle than a support, on various occasions. We feel pretty ignored, and of course there are basic things that we lack that they’re not offering us. TS-02

Among the barriers to access to services, they mentioned the heightened bureaucracy on which various supports depended and that were disrupted by the confinement, the weight of telework that made in-person contact difficult and the collapse of different services including social services. Many of these bureaucratic procedures switched to an online format and in the process became more complex for both the professionals and users, given the lack of training on how to use the new systems.

The public services were not prepared to provide a rapid and emerging response to the needs of the women. Everything required reports, a process and a protocol that we, with better coordination and response that I told you about, have improved upon. However, I still think that the administrations are a significant barrier for the women. GBVOS-08

It’s not that there wasn’t anyone on the other side, but the bureaucracy, the level of density of the system, it didn’t have the capacity that we did as grassroots organizations. In the end, in my case, if there’s nothing I can do…well, I’ll start calling and activating volunteers. A social services worker has her hands tied and is totally absorbed by the bureaucracy. TS-20

Furthermore, they mentioned barriers to access imposed by the women’s own situation of IPV, which was amplified during the pandemic.

There were women that were impossible to reach by any means, because they were in lockdown with their aggressor. And this is the most frustrating thing in the world. Because even when there is no confinement, the aggressor has to go to work, and there are spaces in which you can reach women. But it’s that here there were many women who were impossible to reach, and there was tremendous frustration. TS-19

According to the interviewees, the break with care services was not only a barrier to access, but it was also the loss of a source of trust between the women and the supports, or between the women and each other, which are basic tools for working on their processes. This is particularly relevant in the case of new users of the services, with whom there was no prior relationship, and also in relation to minors.

New users entered during the pandemic process, that is, during the state of alarm. And well, it was strange because we were accustomed to seeing them, and when you see someone in front of you, there’s empathy, there’s a connection. Well, it’s that emotional part, right? Contact is so human, even when it’s visual. Now we can’t offer any type of contact, by phone…GBVOS-18

Intervening with minors is very complicated…there was the issue, though it was very ordinary, that they could stay on screen. It’s not the same thing for them to stay on the screen to play as it is to stay on the screen for an intervention…TS-10

Mainly during the confinement, but also in the months that followed, the focus was put on a type of personalized and individualized care (psychological and emotional care and individual juridical advice) in detriment to the collective work with the women (group therapy, support groups and leisure groups, multi-topic groups: labour orientation, training in online tools), whose focus was the promotion of women’s autonomy.

It was almost summer when we started to be able to do a little bit, for example, spaces for yoga and other activities, we activated them in the summer. And they lasted very little time, because here in Catalonia we’ve been confined again from time to time, although it seems like now we’ll be able to go out again. Imagine that this has meant reinventing projects all the time and spaces where we can carry them out, because all of sudden it was ok to do yoga, but we had to do it at another site because we needed more than two square meters, plus who knows what else, or two groups, or more hours. In the end, changes and the administration of these details has been brutal as well. TS-20

Aspects that facilitated the response capacity of the IPV services during the COVID-19 lockdown

Despite the difficulties already mentioned, the overall evaluation of the professionals was related to having been able to respond quickly and efficiently. Some of the factors that, in their opinions, facilitated this result were flexibility in adapting and the capacity to rapidly identify and offer solutions to the affected women, even in situations of institutional barriers and uncertainty.

Reinventing oneself, adaptation to new situations and being there, always with the intention to collaborate for the good of the people. And above all, with lots of flexibility to adapt to new ways and to the response, demand and solutions from the perspective of accompaniment. GBVOS-17

Well, what we have gained in terms of rapidity and effectiveness under circumstances of extreme pressure… I think we knew how to provide a response to the stress. And I think we were able to adapt to using the new technologies, and I think in these times that is something really important…having that flexibility, knowing how to adapt, being able to provide service, even at a distance… TS-02

I also think that we reacted quickly in terms of making information available. TS-35

They also signaled the motivation and commitment to this area of work, the availability of entities, professionals and voluntary personnel to provide care for and accompany these women in times of need. According to the interviewees, this guaranteed continuity of the care even in the most difficult times of the pandemic.

We believe that we went above and beyond many times in our functions, as though they were our family. I think it shouldn’t be that way, but well, I simply tried because of empathy, because we know these are very difficult times… GBVOS-12

There is a vocation and implication in the personnel that I think is what differentiates this from other jobs. It is what makes it different or what gives the possibility for professionals, in this type of situation, to be involved…and they have greater capacity for adaptation. GBVOS-15

Another key factor according to the professionals interviewed was the development of formal support networks for coordination and collaboration with other entities and resources to provide services with greater efficiency, but also in the prior work carried out with women to support informal support networks (among the women and/or con key community agents).

The issue of coordination was fundamental for me, and it really served us. It was a big help to be able to coordinate with social services or with all of the operators to be working together towards the same goals. Even though it is true that these coordinations are habitual, perhaps in this time they were even more necessary… GBVOS-23

The interviewees also reported another facilitating factor, the implementation of specific measures carried out by institutions for addressing IPV and the increase in public resources during the pandemic. These ranged from macro-level measures, such as state campaigns or specific legislation, to more concrete measures such as adaptation of tourist housing to shelter women victims of abuse who wanted to leave their homes, or the establishment of financial support. Particularly important was the recognition of those working to provide these services as essential workers.

It is difficult, but I believe it was done well, because there was a state campaign that all establishments could take in any woman that needed help. This campaign was very positive, because everyone knew about it. TS-11

Well look, I’m positive, it’s the collective provision of a series of measures. They reinforced and bolstered those institutions that have to attend to women. For me that was the most important of all… We devised a series of public policies in record time to save lives, and that was really an historic achievement. GBVOS-01

Finally, it is also worth highlighting the incorporation of new telematic tools such as WhatsApp, videoconferences, and email to solve the problem of accessibility during the confinement, which are considered relevant for continuing to maintain.

You could provide services during the first part by telephone, or by videoconference, through WhatsApp or email, you know? There were many possibilities to get access if you wanted it. And they were easy. GBVOS-09

We are already offering, in our next projects, the option to do a videoconference. We have to determine how, when and in which cases. TS-19