Keywords
Violence, Gender-Based Violence, Intimate Partner Violence, Domestic Violence, Physical Abuse, Risk Factors
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Quispe AM, Vargas L, Sotelo M et al. The impact of the COVID-19 pandemic on gender-based violence and physical violence among women in Peru [version 1; peer review: 1 approved with reservations]. Gates Open Res 2022, 6:102 (https://doi.org/10.12688/gatesopenres.13749.1)
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Research Article
The impact of the COVID-19 pandemic on gender-based violence and physical violence among women in Peru
[version 1; peer review: 1 approved with reservations]
PUBLISHED 08 Aug 2022
This article is included in the Coronavirus (COVID-19) collection.
Abstract
Corresponding author:
Antonio M Quispe
Competing interests:
No competing interests were disclosed.
Grant information:
The author(s) declared that no grants were involved in supporting this work.
Copyright:
© 2022 Quispe AM et al.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Quispe AM, Vargas L, Sotelo M et al. The impact of the COVID-19 pandemic on gender-based violence and physical violence among women in Peru [version 1; peer review: 1 approved with reservations]. Gates Open Res 2022, 6:102 (https://doi.org/10.12688/gatesopenres.13749.1)
First published: 08 Aug 2022, 6:102 (https://doi.org/10.12688/gatesopenres.13749.1)
Latest published: 08 Aug 2022, 6:102 (https://doi.org/10.12688/gatesopenres.13749.1)
Introduction
Gender-based violence (GBV) is a public health, social policy, and human rights concern1. Globally, over one out of three women experience physical or sexual violence in their lifetime, usually perpetrated by their intimate partner2. At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, most countries implemented lockdowns as an initial response. This measure immediately raised alerts about the increase in GBV cases and decreased health service access for GBV victims3–5. Contradictory, GBV research remained underfunded, and GBV provisions became scarce with increased GBV inequities for underserved groups6.
GBV is a broad term encompassing different violence forms that share a common gender-based characteristic. Hence, GBV includes different general forms of violence such as domestic violence and intimate partner violence but also specific forms of violence such as verbal violence, physical violence, sexual violence, psychological abuse, and economic violence7. Regardless of which form of GBV you explore, the lockdowns and social distance imposed during the COVID-19 pandemic have had as an unintended consequence the exacerbation of GBV8. Furthermore, the risk of death or physical harm intensified under pandemic conditions because of the generated dependency and proximity to their aggressors. In contrast, health care, GBV provisions, and escape routes got limited, leading some survivors to contemplate self-harm9. In some low-middle income countries, GBV skyrocketed during the lockdowns and curfews compared to the pre-pandemic years10–12.
Before the COVID-19 pandemic, GBV was already endemic in Peru, with around three out of every five Peruvian women reporting being exposed to some form of GBV, including psychological abuse (53%) and physical violence (30%), and sexual abuse (7%)13. However, fewer than one-third of GBV victims seek help at any public institution after being physically assaulted14. Consequently, in a country with high social tolerance (59%) towards gender-based violence15, there was a genuine concern about the negative effect of the COVID-19 pandemic. In this study, we aim to assess the COVID-19 pandemic impact on GBV incidence and the changes in the characteristics of the GBV cases, victims, and aggressors. Additionally, we performed a cross-sectional analysis to assess the physical violence-associated factors among the GBV victims.
Methods
Ethics
We use exclusively open data for the study, downloading it from Peruvian government public domains. This data before its publication is masked and clear from any individual identifier. The study did not involve risks to people's health and integrity, so the Peruvian Institute of Legal Medicine IRB approved the study protocol under IRB exemption regulation.
Study design and population
We conducted a cross-sectional study to assess the impact of the COVID-19 pandemic on the weekly incidence of GBV among women residents in Peru and evaluated the associated factors of physical violence. First, we contrasted the trend of the weekly incidence of GBV cases reported in Peru during 2017–2021 against the weekly mortality from all causes. And second, we analyze the associated factors of physical violence among the women victims of GBV by contrasting the criminological characteristics of the cases, as well as the features of the victims and their aggressors, between the victims versus not victims of physical violence. To perform both analyses, we evaluated the open data from the surveillance system of GBV in Peru during 2017–2021.
Study outcome
In our first analysis, we used the weekly incidence rate of GBV as the study outcome. Hence, at the national and regional levels, we calculated the weekly incidence rate of GBV by multiplying the accumulated cases per epidemiological week by 100,000 women and dividing the product by the estimated annual women population. Likewise, we calculated the weekly mortality rate by multiplying the accumulated death counts per epidemiological week by 100,000 and dividing the product by the estimated annual population. In our second analysis, we modeled the prevalence of physical violence among the women victims of GBV and assessed its associate factor. We define as positive to physical violence every GBV case where the victim reported having been hurt by kicking, hitting, slapping, hair pulling, grabbing, pushing, beating, lashing, hanging, asphyxia/strangling, wounded by any weapon or object, rape, or hurt by any other form of physical violence (scratching, biting, headbutting, etc.). In this analysis, we assessed as potential associated factors the criminological characteristics of the GBV cases and the characteristics of the victims and the aggressors.
Data sources
We obtained the GBV data, death counts, population estimates, and region's geographical boundaries using open data curated from the Peruvian government. First, we got GBV from the Peruvian Ministry of Women and Vulnerable Populations16. Second, we obtained the women population estimates from the Peruvian National Institute of Statistics and Informatics17. Third, We got the death counts from all causes from the Peruvian National System of Deaths (SINADEF)18. And four, we obtained the Peru regional boundaries for our maps from the Peruvian Ministry of the Environment19.
Statistical analysis
We performed a descriptive analysis to characterize the GBV cases, victims, and aggressors, as well as its variability before (2017–2019) and during the COVID-19 pandemic (2020–2021). Then, we performed a graphical analysis of the weekly incidence of GBV cases and the weekly mortality rates at the national by using the "ggplot2" package20. After, we forecasted the 2017–2019 data to assess the hypothetical scenario without the pandemic effect by fitting an autoregressive integrated moving average (ARIMA) model21. As part of the forecasting modeling, we tested whether the time series was not stationary using the Phillips-Perron test and for white noise using the Portmanteau test. After completing the model parametrization, we selected an ARIMA (4,1,1) as the most suitable model for our GBV data using Akaike's Information Criterion (AIC). Complementary, we assessed the regional distribution of GBV by mapping the annual incidence of GBV cases during the years 2017–2021 using the QGIS program 3.22. Finally, we fit a Poisson regression model with a link log and robust variance to assess the associated physical violence factors using the prevalence ratio as a measure of interest. For the regression analysis, we used the packages "Epi," "foreign," "sandwich," "lmtest," and the procedures described by Espelt et al.22 We evaluated as a potentially associated factor the criminological characteristics of the GBV cases and the characteristics the victims and the aggressors as potential associated factors. The criminological features of the GBV cases included: regular violence (defined as daily, weekly or monthly violence), rural origin (versus urban area), victim direct report, aggressor's violence report, femicide attempt, physical violence (including kicking, hitting, slapping, hair pulling, grabbing, pushing, beating, lashing, hanging, asphyxia/strangling, wounded by any weapon or object, rape, or hurt by any other form of physical violence), verbal violence (including screaming/yelling, devaluating/humiliating, rejecting, swearing, harassment, other forms of verbal violence and threads of death, harm, eviction or suicide), sexual violence (sexual assault, touching/indecent assault, sexual harassment, sexual exploitation, threats or intimidation to perform sexual acts and other forms of sexual violence such as forcing prostitution, pornography, etc.), and economic violence including refusing/evading obligation to provide food support, basic needs, financial aid, possession's subtraction, destruction or appropriation, or any other for or economic violence such as salary control, reduction, or limitation. We used R 3.6.1 (R Foundation for Statistical Computing, Vienna, Austria) and R Studio 1.2.5001 (Free Software Foundation, Inc., Boston, MA) for the statistical analysis and the QGIS program 3.22 to elaborate the maps with the clustering analysis results.
Results
Gender-based violence at the national level
We analyzed 588,587 cases of women victims of GBV, reported by 450 reporting units across Peru. The annual average count of GBV cases reported by these centers was 276 (standard deviation [SD] =301; range: 4 to 3227) in 2017, 329 (S.D. =327; range: 4 to 2934) in 2018, 384 (SD =337; range: 5 to 2598) in 2019, 237 (SD =202; range: 1 to 1822) in 2020, and 328 (SD =242; range: 7 to 1778) in 2021. Based on these reports, we calculated an annual incidence of GBV of 518 cases per 100,000 women in 2017, 714 cases per 100,000 women in 2018, 958 cases per 100,000 women in 2019, 596 cases per 100,000 women in 2020, and 846 cases per 100,000 women in 2021. Compared to 2019, the latest pre-pandemic year, Peru recorded a reduction in its annual incidence of GBV of 37.7% in 2020 and 10.7% in 2021.
Gender-based violence at the regional level
At the regional level, the Peruvian regions that reported an annual incidence of GBV of over 1000 cases per 100,000 women increased from 1/25 in 2017 to 7/25 in 2018, and 14/25 in 2019. However, the count of these regions decreased to 6/25 in 2020 and rose again to 14/25 in 2021 (Figure 1). Overall, the regions with the highest annual incidence of GBV in Peru were Tumbes, Apurímac, Arequipa, Ayacucho, Cusco, and Tacna, all of which exceeded over 1000 cases per 100,000 women during 2019–2021. Conversely, Peru's regions with the lowest annual incidence of GBV were Ucayali and Cajamarca, with an annual incidence of GBV below 500 per 100,000 women consistently from 2017 to 2021 (Table 1).
Figure 1. Regional incidence of gender-based violence in Peru during 2017–2021.
Legend: The figure shows the evolution of the regional gender-based violence annual rates (cumulative cases counts per year/100,000 Peruvian women) in Peru during the years 2017 (Figure 2A), 2018 (Figure 2B), 2019 (Figure 2C), 2020 (Figure 2D), and 2021 (Figure 2E).
Table 1. Regional Incidence of GBV cases reported in Peru, 2017–2021.
Gender-based violence weekly incidence trend before and during the COVID-19 pandemic
From the first epidemiological week in 2017 to the 52nd epidemiological week in 2019, the GBV weekly incidence in Peru increased by around 0.06 GBV cases per 100,000 women per week (95% confidence interval [95% CI]: 0.02 to 0.10 GBV cases per 100,000 women) (Figure 2A). The increasing trend continued in 2020, reaching a peak of 22.7 GBV cases per 100,000 women per week in the epidemiological week 10–2021. However, the COVID-19 pandemic significantly impacted the registry of GBV once Peru implemented a national lockdown at the epidemiological week 12 in 2020. The lockdown ended at the epidemiological week 27–2020, three weeks after reaching the peak of Peru's first wave of the COVID-19 pandemic (Figure 2B). Since then, the reporting units began to operate progressively until they became fully operative in the epidemiological week 42 in 2020. In 2020, the GBV weekly incidence peaked at the epidemiological 46 with 20.5 cases per 100,000 women. And in 2021, the GBV weekly incidence started a plateau after the second epidemiological week.
Figure 2. Weekly incidence rates of gender-based violence and weekly mortality rates from all causes in Peru during 2017–2021.
Legend: The figure shows the evolution of the national GBV weekly rates (cumulative cases counts per week /100,000 Peruvian women) in Peru during the years 2017–2021 (Figure 2A) contrasted with the weekly mortality deaths (death counts per week /100,000 inhabitants of Peru) during the COVDI-19 pandemic in Peru (Figure 2B). Also, it shows the national quarantine period (blue shadow), which stops the cases reported from epidemiological weeks 10–26.
Impact of the COVID-19 pandemic on the gender-based violence weekly incidence
Our time series analysis observed a non-stationary positive trend in the weekly incidence during 2017–2019. We projected this trend to the years 2021–2022 to assess the impact of the COVID-19 pandemic by fitting an ARIMA (4,1,1) (Figure 3). This model turned to be the most suitable model for our GBV data compared to the ARIMA (2,1,1) ARIMA (3,1,1) ARIMA (2,2,1), ARIMA (2,3,1), and ARIMA (2,4,1) models. Besides the total collapse of the reporting system during the lockdown, we observed that only for six weeks (from the epidemiological weeks 42–49) the observed GBV weekly incidence was within the forecasted 95% confidence interval. Hence, we observed that during the COVID-19 pandemic, there was a significant reduction of the observed GBV weekly incidence, which seems to plateau since the epidemiological week 03 of 2021.
Figure 3. Forecasted versus the observed incidence of gender-based violence in Peru during 2017–2021.
Legend: The figure shows the national GBV (Gender-Based Violence) weekly incidence (cumulative cases counts per week /100,000 Peruvian women) in Peru as observed during the years 2017–2021 (Dashed line) contrasted 2020–2021 forecasted GBV weekly incidence (Figure 1B). The 2020–2021 GBV weekly incidence was forecasted using an ARIMA model using the 2017–2019 GBV weekly incidence.
Criminological characteristics of the gender-based violence in Peru
GBV cases are highly variable regarding their criminological characteristics (Table 2). According to the Risk of Death or Physical Integrity Peruvian score, most women victims of GBV were at the middle (50%) or high risk (21%). Most GBV cases reported regular violence (75%) and verbal violence (82%). Around 44% of victims also suffered physical violence, 11% sexual violence, 7% economic violence, and 0.3% a femicide attempt. During 2017–2021, the annual prevalence of high-risk violence (15.9% in 2017 to 23.8% in 2021) and violence regularity (69.0% in 2017 to 80.4% in 2021) increased significantly (p<0.05). On the contrary, the annual prevalence of verbal violence (from 84.0% in 2017 to 78.5% in 2021) and economic violence (from 7.2% in 2017 to 5.2% in 2021) decreased significantly (p<0.05).
Table 2. Criminological characteristics of the GBV cases reported in Peru, 2017–2021.
Characteristics of women victims of gender-based violence in Peru
The profile of the GBV victims also varied significantly during the COVID-19 pandemic (Table 3). The GBV victims´ age in Peru ranged from 1 to 104 years old, with a mean age of 30.6 years (SD = 16.5). Most victims were single (81%), from rural areas (75%), did not complete high school (54%), and have children (60%), with a median number of children of one (Interquartile range [IQR] = 3; range: 0 to 18). Around 3% of the victims were pregnant, and 1% were born outside Peru. In addition, most victims have a history of GBV previously reported (71%). Across the years 2017–2021, we observed a significant (p<0.05) increase in the GBV annual prevalence among victims with non-Peruvian citizenship (0.3% in 2017 to 1.6% in 2021), single status (79.4% in 2017 to 82.9% in 2021), and history of previous GBV reports (59.1% in 2017 to 76.8% in 2021). On the contrary, we observed a significant (p<0.05) decrease in the annual GBV prevalence among women from urban areas (from 82.1% in 2017 to 49.2% in 2021).
Table 3. Characteristics of the female GBV victims in Peru, 2017–2021.
Characteristics of the gender-based violence’ aggressors
Like the GBV victims, the profile of the GBV aggressors also varied significantly during the COVID-19 pandemic (Table 4). The age of the GBV aggressors in Peru is highly variable (range: 4 to 98 years old), with a mean age of 38.3 years old (SD = 12.1). Most aggressors were men (81%) with complete high school education (63%), a paid job (77%), and a partner history with their victims (58%). Around 45% of these aggressors cohabitate with their victims, 33% have a family bond, 27% use enablers (alcohol or drugs), and 0.9% were born outside Peru. Across the years 2017–2021, we observed a significant (p<0.05) increase in the annual GBV prevalence among foreign aggressors (0.2% in 2017 to 1.3% in 2021), enablers users (24.2% in 2017 to 27.2% in 2021), and those who cohabitate with their victims (44.1% in 2017 to 51.2% in 2021). On the contrary, we observed a significant (p<0.05) decrease in the annual prevalence of GBV among aggressors with paid jobs (from 78.5% in 2017 to 75.7% in 2021).
Table 4. Characteristics of the aggressors in the GBV cases reported in Peru, 2017–2021.
Physical violence associated factors among women victims’ gender-based violence
In our bivariate analysis, we observed that several characteristics of the GBV cases, victims, and aggressors might be associated with physical violence (Table 5). The list included the following: aggressor's school education, aggressor's age <40 years old, the aggressor's paid job, prior violence report, victim's <40 years old, foreigner victim, victim's single status, aggressor family bond, aggressor partner bond, number of children, aggressor enablers intake, help-seeking, urban area, aggressor's men, economic violence, year, verbal violence, victim's paid job, foreign aggressor, and victim's school education. However, in our multivariate linear regression analysis that the main physical violence associated factors among women victim GBV were: aggressor’s school education (adjusted prevalence ratio [aPR] = 0.89; 95% CI: 0.88 to 0.89), aggressor’s <40 years old (aPR = 1.30; 95% CI: 1.29-1.30), aggressor’s paid job (aPR = 0.99; 95% CI: 0.98-0.99), prior violence report (aPR = 1.27; 95% CI: 1.26-1.27), victim’s <40 years old (aPR = 1.23; 95% CI: 1.22-1.24), foreigner victim (aPR = 1.04; 95% CI: 1.01-1.07) (Table 6).
Table 5. Physical violence associated factors among the GBV victims in Peru, 2017–2021.
| Physical Violence Associated factors | Total n (%) | Physical violence | p-value | |
|---|---|---|---|---|
| Positive n (%) | Negative n (%) | |||
| Aggressor’s school education | 376,150 (63.9) | 216,994 (65.6) | 159,156 (61.8) | <0.001* |
| Aggressor’s <40 years old | 335,863 (57.1) | 168,965 (51.1) | 166,898 (64.8) | <0.001* |
| Aggressor’s paid job | 446,979 (77.1) | 252,745 (77.4) | 194,234 (76.7) | <0.001* |
| Prior violence report | 416,280 (70.7) | 222,805 (67.3) | 193,475 (75.1) | <0.001* |
| Victim’s <40 years old | 431,172 (73.3) | 227,641 (68.8) | 203,531 (79.0) | <0.001* |
| Foreigner victim | 6,560 (1.1) | 3,182 (1.0) | 3,378 (1.3) | <0.001* |
| Victim´s single status | 476,962 (81.0) | 259,187 (78.3) | 217,775 (84.5) | <0.001* |
| Aggressor family bond | 196,237 (33.3) | 119,043 (36.0) | 77,194 (30.0) | <0.001* |
| Aggressor partner bond | 342,287 (58.2) | 185,249 (56.0) | 157,038 (61.0) | <0.001* |
| Children, Median ± IQR | 1 ± 3 | 1 ± 2 | 1 ± 3 | <0.001* |
| Aggressor enablers intake | 156,077 (26.5) | 82,735 (25.0) | 73,342 (28.5) | <0.001* |
| Help-seeking | 238,697 (40.6) | 139,510 (42.2) | 99,187 (38.5) | <0.001* |
| Urban area | 443,252 (75.3) | 253,856 (76.7) | 189,396 (73.5) | <0.001* |
| Aggressor’s men | 530,294 (90.1) | 301,289 (91.0) | 229,005 (88.9) | <0.001* |
| Economic violence | 42,567 (7.2) | 26,394 (8.0) | 16,173 (6.3) | <0.001* |
| Year | ||||
| 2017 | 81,009 (13.8) | 44,269 (13.4) | 36,740 (14.3) | <0.001* |
| 2018 | 113,727 (19.3) | 61,462 (18.6) | 52,265 (20.3) | |
| 2019 | 155,092 (26.4) | 89,459 (27.0) | 65,633 (25.5) | |
| 2020 | 97,926 (16.6) | 56,610 (17.1) | 41,316 (16.0) | |
| 2021 | 140,833 (23.9) | 79,161 (23.9) | 61,672 (23.9) | |
| Verbal violence | 479,930 (81.5) | 273,151 (82.5) | 206,779 (80.3) | <0.001* |
| Victim´s paid job | 217,863 (37.0) | 125,578 (37.9) | 92,285 (35.8) | <0.001* |
| Foreign aggressor | 5,204 (0.9) | 2,658 (0.8) | 2,546 (1.0) | <0.001* |
| Victim´s school education | 269,794 (45.8) | 153,727 (46.5) | 116,067 (45.1) | <0.001* |
Table 6. Regression analysis of physical violence among GBV victims in Peru, 2017–2021.
| Factors associated | PR (95% CI) | p-value | aPR (95%CI) | p-value |
|---|---|---|---|---|
| Aggressor’s school education | 0.91 (0.91 – 0.92) | <0.001* | 0.89 (0.88 – 0.89) | <0.001* |
| Aggressor’s <40 years old | 1.38 (1.38 – 1.39) | <0.001* | 1.30 (1.29 – 1.30) | <0.001* |
| Aggressor’s paid job | 0.98 (0.97 – 0.98) | <0.001* | 0.99 (0.98 – 0.99) | <0.001* |
| Prior violence report | 1.25 (1.24 – 1.26) | <0.001* | 1.27 (1.26 – 1.27) | <0.001* |
| Victim’s <40 years old | 1.37 (1.36 – 1.38) | <0.001* | 1.23 (1.22 – 1.24) | <0.001* |
| Foreigner victim | 1.17 (1.15 – 1.21) | <0.001* | 1.04 (1.01 – 1.07) | <0.001* |
| Victim´s single status | 1.27 (1.27 – 1.29) | <0.001* | --- | --- |
| Aggressor family bond | 0.86 (0.85 – 0.86) | <0.001* | --- | --- |
| Aggressor partner bond | 1.12 (1.12 – 1.13) | <0.001* | --- | --- |
| Number of children | 0.97 (0.97 – 0.98) | <0.001* | --- | --- |
| Aggressor enablers intake | 1.10 (1.10 – 1.11) | <0.001* | --- | --- |
| Help-seeking | 0.92 (0.91 – 0.92) | <0.001* | --- | --- |
| Urban area | 0.91 (0.90 – 0.92) | <0.001* | --- | --- |
| Aggressor’s men | 0.88 (0.87 – 0.89) | <0.001* | --- | --- |
| Economic violence | 0.86 (0.85 – 0.87) | <0.001* | --- | --- |
| Year | ||||
| 2017 | Reference | |||
| 2018 | 1.01 (1.00 – 1.02) | 0.008* | --- | --- |
| 2019 | 0.93 (0.92 – 0.94) | <0.001* | --- | --- |
| 2020 | 0.93 (0.92 – 0.94) | <0.001* | --- | --- |
| 2021 | 0.97 (0.96 – 0.97) | <0.001* | --- | --- |
| Verbal violence | 0.92 (0.91 – 0.93) | <0.001* | --- | --- |
| Victim´s paid job | 0.95 (0.94 – 0.96) | <0.001* | --- | --- |
| Foreign victim | 1.12 (1.09 – 1.15) | <0.001* | --- | --- |
| Victim´s school education | 0.97 (0.96 – 0.97) | <0.001* | --- | --- |
Discussion
In the last five years, Peru registered over a half million GBV cases, reaching the highest annual incidence in 2019 with 958 GBV cases per 100,000 women. Since the COVI-19 pandemic hit Peru, we observed a significant decrease in the incidence of GBV across Peru. Compared to 2019, the latest pre-pandemic year, Peru recorded a reduction in its annual incidence of GBV of 37.7% in 2020 and 10.7% in 2021. Despite this reduction, Peru sustained a high GBV incidence with over 846 GBV cases per 100,000 women in 2021. Furthermore, at the regional level, in 2021, the count of regions with GBV incidence over 1000 per 100,000 women rose again to the exact count observed in 2019 (14/25), soon after decreased substantially in 2020 (6/25). More specifically, before the COVID-19 pandemic, Peru experienced a significant and sustained increment in its GBV weekly incidence since 2017 until reaching a peak of 22.7 GBV cases per 100,000 women per week in the epidemiological week 10 of 2021. However, as soon as the pandemic started, countries entered a national lockdown, shutting down GBV registries, which will recover gradually upon countries reopening their economic activities since the epidemiological week 27 of 2020. After, Peru never registered GBV weekly incidences as high as the ones observed in the weeks before the COVID-19 pandemic, starting a plateau in the epidemiological week 2 of 2021.
Globally, GBV and its forms spiked dramatically during the COVID-19 pandemic, to the point that global leaders labeled it as a “shadow pandemic,” “pandemic within a pandemic,”23 or more accurately as a perfect syndemic24. Regardless, most countries entered national lockdowns and practically abandoned GBV victims to their luck by shutting down their most needed medical care, psychosocial support or counseling, access to shelters, and legal provisions25. Before the COVID-19 pandemic, Peru was already experiencing an increasing burden of GBV, with nearly 1000 GBV cases per 100,000 women per year. In our study, we observed that upon entering the national lockdown due to the COVID-19 pandemic, the Peruvian government shut down the GBV surveillance system, the shelters, and legal services for over four months. Soon after, the United Nations Population Fund warned that national lockdowns severely disrupted the access to sexual and reproductive health services and hampered the ability of authorities to respond to gender-based violence26. In response to the increasing GBV reports, In April 2020, the Peruvian government published the legislative decree 1140, which partially amended this situation, reopening most of these services online and implementing the mobile response teams (Itinerant Emergency Teams)27. Additionally, upon the recommendation of the Social Scientist Task Force to address the increasing GBV incidence, the Peruvian government habilitated two large shelters for over 1000 GBV victims28. Regardless, when using the annual GBV incidence from 2019 as the baseline, we observed that Peru recorded a reduction of 37.7% in 2020 and 10.7% in 2021. However, Peru sustained a high annual GBV incidence with over 846 GBV cases per 100,000 women in 2021. Furthermore, our time series analysis confirmed that the COVID-19 pandemic significantly impacts the GBV weekly incidence, reducing its burden in 2020 and shifting its trend from increasing to a plateau that started on the second epidemiological week of 2021.
The profile of the GBV cases varied largely across countries, but in Latin America, it seems that physical violence has a high prevalence that ranges from 16% to 41%29. Furthermore, previous reports evidenced that the mortality associated with GBV appears to be very high in Latina American countries contrasted with the rest of the countries worldwide30. Such is the case of Peru, which before the pandemic shifted their femicides incidence from decreasing31,32 to increasing33, reaching its higher femicides incidence in 2019 with a yearly incidence of 1.01 femicides per 100,000 women. In our study, we observed that during 2017–2021 the GBV cases became more violent, increasing the annual prevalence of high-risk violence from 16% to 24% and the violence regularity from 69% to 80%. On the contrary, we observed that during the same period, the annual prevalence of verbal and economic violence decreased significantly, from 84% to 79% and from 7% to 5%, respectively.
The GBV risk factors include younger age, being unmarried, having lower education, personal and family history of GBV during childhood, having an intimate relationship with a partner who abuses alcohol/drugs, victims' unemployment, and having a history of being a GBV aggressor34. Furthermore, the GBV risk factors at the macro level include gender inequality, social spending, lack of police action after a GBV complaint, gender access inequity to education, and poor criminalization practice regarding GBV35. Understanding the impact of GBV risk factors at the macro level is essential to further understanding the COVID-19 pandemic impact on GBV incidence. It is particularly critical to understand further how the lockdowns and isolation increased the GBV risk and the barriers for the GBV victims to seek help and report their situation, independently of the individual risk factors36. In our study, we observed that most victims were single, from rural areas, did not complete high school and were mothers with children. On the other site, most aggressors were men with paid jobs, finished high school education, and had a partner history with their victims.
GBV varies widely across urban and rural areas, particularly in low-middle-income countries. In Eastern Africa, for example, the risks of experiencing intimate partner violence were significantly higher among women who resided in rural areas (RR = 1.13; CI 1.07–1.22) than those who lived in urban areas37. Previous studies reported that over their life, 45% of Peruvian women experience some form of GBV, with rates as high as 69% in rural areas38. Cities do not generate GBV, but they certainly offer more opportunities for reducing it than those provided in rural areas39. In Peruvian rural areas, family values play a crucial role in the decision for women to continue abusive relationships based on the belief that the needs of the family take precedence over the needs of the individual38. Other factors that may help to understand the relationship between rural origin and GBV are the economic and educational factors, which are proven with the direct association between illiteracy and poverty with GBV in rural communities in Peru38. In our study, we observed that most victims were women from rural areas and that the GBV incidence was consistently higher among the regions in the highlands of Peru. This difference is because the highland areas are not only more rural than the regions from the coast and the jungle but also higher in poverty and women without secondary education than the rest of the country's women.
Gender-based physical violence, which includes beating, burning, kicking, punching, biting, maiming, killing, or using objects or weapons, often escalates from milder forms of violence, including verbal and economic violence. Therefore, to prevent physical violence and ulterior femicides attempts is essential to study its risk factors, which seem to vary by country. For example, in African countries, the physical violence risk factors include having multiple intimate partners, income gap within couple households, and negative attitudes about sexual violence (for example, the belief that having non-consensual sex is not rape)40. In the United States, the risk factors for men perpetrating physical aggression against their partners included parental violence, dating before age 14, intermittent explosive disorder before and after age 20, dating aggression, and being victimized by the partner41. In India, the physical violence risk factors include husbands regularly consuming alcohol, dowry harassment (which is the attempt to obtain more money or goods from a wife's family after the marriage), personal history of harsh physical punishment during childhood, and having witnessed their fathers beat their mothers42. In our study, we observed that two of every five GBV victims suffered physical violence. We also observed that physical violence risk factors in Peru include the aggressor's age (below 40 years old), prior violence report, victim's age (below 40 years old), and foreign citizenship. In contrast, the physical violence protector factors were the aggressor's school education and the aggressor's paid job.
This study increases the knowledge about GBV and physical violence in one of the countries with a high GBV incidence worldwide; however, several study limitations need to be considered. First, our study used secondary data, so the study is prone to selection and information bias. Such restriction is standard in studies that use national registries. Regardless, GBV's secondary data analysis is of great value and generates evidence to highlight the importance of GBV as an increasing social problem. A second limitation is that our study lacks a proper comparison group, so we assess the physical violence risk factors among the women that were already GBV victims. Regardless, such evidence is of high value for decision-makers that aim to prevent femicides by early recognizing which women among the ones that file a GBV complaint are at higher risk of physical violence. Finally, the study does not include specific cultural or ethnic information, which may allow us to characterize the femicide victims and perpetrators further. Nevertheless, our results may help identify new opportunities to prevent femicide by using the data already available in the GBV surveillance system.
Conclusion
GBV is endemic in Peru, but the COVID-19 pandemic reduced its burden significantly in 2020–2021. Despite this reduction, Peru sustained a high GBV incidence with over 846 GBV cases per 100,000 women in 2021. In this scenario, we recognize several characteristics of the cases, victims, and aggressors that have changed over time, offering new opportunities for implementing interventions and policies that address this social problem. The victims' characteristics that significantly increased across 2017–2021 include non-Peruvian citizenship, single status, and history of previous GBV reports. The aggressors' characteristics that increased during 2017–2021 were: foreign citizenship, enablers users, and cohabitation with their victims. On the contrary, the victims' and aggressors' characteristics significantly decreased during the study time were victims from urban areas and aggressors with paid jobs. Additionally, we observed that over two of every GBV victims suffered physical violence. Furthermore, we observed that among the GBV victims, the risk of physical violence decreased when the aggressor had a paid job and had finished high school. However, the risk of physical violence increased when the aggressors were below 40 years old, or the victims had a history of priorly filing a GBV report, aged below 40 years old, and had foreign citizenship.
Data availability
Underlying data
We described the metadata and links from each source in Table 7. The data used in our study is open data curated by the Peruvian government and freely available at:
Table 7. Metadata for the datasets used in the research article.
| Name | Provider | Year | Format | Variable | Source |
|---|---|---|---|---|---|
| Number of cases attended by the urgent care service, according to sex, age group, type of violence, and department | Ministry of Women and Vulnerable Populations (MIMP) | 2017–2021 | Comma- separated values (CSV) | Continuous | https://portalestadistico.aurora.gob.pe/bases-de-datos-2021/ |
| National Deaths Informatics System (SINADEF) | Ministry of Health (MINSA) | 2017–2021 | Comma- separated values (CSV) | Continuous | https://www.datosabiertos.gob.pe/dataset/informaci%C3%B3n-de-fallecidos-del-sistema-inform%C3%A1tico-nacional-de-defunciones-sinadef-ministerio |
| Peruvian Population | National Institute of Statistics and Informatics (INEI) | 2017–2021 | Comma- separated values (CSV) | Continuous | https://www.datosabiertos.gob.pe/dataset/poblaci%C3%B3n-peru |
| Peru regional boundaries | Ministry of the Environment (MINAM) | 2007 | Shapefile | Continuous | https://geoservidorperu.minam.gob.pe/geoservidor/archivos/download/Limite_departamental.rar |
The official administrative boundaries for Peru regions are owned by the Ministry of Environment and can be accessed through the website https://www.geogpsperu.com.
Data are available under the terms of the Open Data Commons Attribution License (ODC-By).
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Quispe AM, Vargas L, Sotelo M et al. The impact of the COVID-19 pandemic on gender-based violence and physical violence among women in Peru [version 1; peer review: 1 approved with reservations]. Gates Open Res 2022, 6:102 (https://doi.org/10.12688/gatesopenres.13749.1)
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