Exploring Intimate Partner Violence (IPV) Health Inequities During COVID-19 Lockdowns in Ontario

Abstract

Background: Intimate partner violence (IPV) is a critical public health issue that affects millions globally. During the COVID-19 pandemic, public health mandates including lockdowns and social distancing requirements created conditions that amplified risks for IPV survivors while simultaneously disrupting access to formal and informal support systems. The overarching aim of this dissertation was to explore how COVID-19 lockdown measures in Ontario shaped experiences of IPV, access to formal and informal supports, and perceived health outcomes. Specifically, the research sought to determine whether, and in what ways, survivors of IPV faced disproportionate health inequities during the pandemic compared to the general population. Methods: This dissertation employed a multi-method design comprising four interconnected studies grounded in Heise’s Ecological Framework, Berkman and Krishna’s Model of Social Networks and Health, and Peterson et al.’s Health Equity Framework. Article 1 was a scoping review of 72 studies examining IPV survivors’ access to supports during stressful life events (pandemics, natural disasters, and economic recessions) in high-income countries. Article 2 was a cross-sectional survey of 1,344 Ontario adults assessing IPV experiences, barriers to formal and informal supports, and health outcomes during COVID-19 lockdowns (March 2020–June 2021). Article 3 analyzed qualitative interviews with 14 women IPV survivors and 10 violence against women (VAW) service providers to explore lived experiences and multilevel barriers and facilitators to care. Article 4 integrated quantitative and qualitative data through a concurrent mixed-methods analysis to examine health pathways among women IPV survivors, investigating how behavioural, psychological, and physiological mechanisms shaped health outcomes during lockdowns. Results: The scoping review identified systemic barriers that intensify during crises, including service disruptions, economic instability, and isolation. The survey found that 23.4% of respondents experienced IPV during lockdowns. IPV survivors were 3.4 times more likely to face barriers to formal supports and reported significantly reduced communication with friends and family compared to non-IPV respondents. Qualitative findings from interview with women survivors and VAW service providers revealed eight major themes across individual, organizational, and structural levels, including: escalating violence and isolation; technology as both lifeline and weapon; strain and resilience; knowledge gaps in recognition and public education; systems failures and service disruptions; stigma and cultural barriers; structural inequities in housing, employment, and funding; and facilitators for access and continuity of care. The mixed-methods integration demonstrated that women IPV survivors experienced significantly worse mental and physical health outcomes compared to the general population. Specifically, survivors were 2.5 times more likely to report poor mental health and nearly twice as likely to report poor physical health compared to those who did not experience IPV. Reduced access to both formal and informal supports served as key pathways to these health inequities. Conclusions: This dissertation demonstrates that IPV survivors faced heightened health inequities during COVID-19 lockdowns, experiencing compounded barriers to support services and worse health outcomes than the general population. Findings reveal critical gaps in emergency preparedness frameworks, which currently fail to address gender-based violence as a core component of crisis response. The research was conducted through authentic community partnership with the Ontario Association of Interval and Transition Houses (OAITH), embodying engaged scholarship principles and ensuring findings remained grounded in frontline realities. Results underscore the urgent need for sustained funding for the VAW sector, integration of IPV considerations into emergency and disaster management strategies, intersectional approaches to service design, and survivor-informed policies that prioritize equity and accessibility during crises. These insights extend beyond COVID-19 to inform preparedness for future pandemics, natural disasters, and large-scale emergencies, with implications for research, policy, and practice in population and public health.