Gender-based violence (GBV) is a public health, social policy, and human rights concern ¹ . Globally, over one out of three women experience physical or sexual violence in their lifetime, usually perpetrated by their intimate partner ² . 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 victims ^{3– 5} . Contradictory, GBV research remained underfunded, and GBV provisions became scarce with increased GBV inequities for underserved groups ⁶ .

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 violence ⁷ . 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 GBV ⁸ . 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-harm ⁹ . In some low-middle income countries, GBV skyrocketed during the lockdowns and curfews compared to the pre-pandemic years ^{10– 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 assaulted ¹⁴ . Consequently, in a country with high social tolerance (59%) towards gender-based violence ¹⁵ , 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.

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 syndemic ²⁴ . 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 provisions ²⁵ . 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 violence ²⁶ . 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 victims ²⁸ . 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 worldwide ³⁰ . Such is the case of Peru, which before the pandemic shifted their femicides incidence from decreasing ^{31, 32} to increasing ³³ , 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 aggressor ³⁴ . 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 GBV ³⁵ . 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 factors ³⁶ . 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 areas ³⁷ . Previous studies reported that over their life, 45% of Peruvian women experience some form of GBV, with rates as high as 69% in rural areas ³⁸ . Cities do not generate GBV, but they certainly offer more opportunities for reducing it than those provided in rural areas ³⁹ . 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 individual ³⁸ . 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 Peru ³⁸ . 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 partner ⁴¹ . 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 mothers ⁴² . 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.

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.