An Integrative Review of Safety Strategies for Women Experiencing Intimate Partner Violence in Low- and Middle-Income Countries

Abstract

Intimate partner violence (IPV) is prevalent and a leading source of morbidity and mortality to women worldwide. Safety planning is a cornerstone of harm reduction and violence support in many upper income countries. Far less is known about safety strategies used by women in low- and middle-income countries (LMICs) where the IPV support service infrastructure may be more limited. This study aimed to review the literature regarding safety strategies in LMICs. A PubMed search was conducted using search terms “safety,” “coping,” “harm reduction,” and “intimate partner violence.” Inclusion criteria comprised IPV studies mentioning characterization and utilization of safety strategies that were written in English and conducted in an LMIC. Our search yielded 16 studies (in-depth interviews, n = 5; focus group discussions, n = 2; case study, n = 2; mixed qualitative methods, n = 4; mixed methods, n = 1; and semi-structured quantitative survey, n = 2). Four distinct themes of strategies emerged: engaging informal networks, removing the stressor/avoidance, minimizing the damage to self and family through enduring violence, and building personal resources. IPV-related safety strategies literature primarily emerged from site-specific qualitative work. No studies provided effectiveness data for utilized strategies. Across geoculturally diverse studies, results indicate that women are engaging in strategic planning to minimize abuse and maximize safety. Women highlighted that safety planning strategies were feasible and acceptable within their communities. Further research is needed to test the effectiveness of these strategies in decreasing revictimization and increasing health and well-being. Further adoption of safety strategies into violence programming could increase monitoring and evaluation efforts.

Safety decision-making and planning mobile app for intimate partner violence prevention and response: randomised controlled trial in Kenya

“…10 11 In LMICs, limited available research shows that IPV survivors engage in active, intentional harm reduction and safety strategising, including engaging informal networks, removing stressors/avoidance, minimising damage to the self and family, and building personal resources. 12 In Nairobi's informal settlements, IPV survivors face a host of barriers to safety, yet often take action steps in securing financial resources and personal property. 13 Women often face multiple, competing priorities such as privacy, children and financial security in considering how to respond to IPV.…”

“Being Married Doesn’t Mean You Have to Reach the End of the World”: Safety Planning With Intimate Partner Violence Survivors and Service Providers in Three Urban Informal Settlements in Nairobi, Kenya

“…These challenges became evident throughout participant discussions, as women emphasized that short-term safety strategies were sometimes their only option due to the lack of community or macrosocial support in addressing these issues more sustainably. Given these constraints, they opted for temporary harm reduction strategies to maximize safety and mitigate harm while working to identify longer-term solutions; this preference for straight-forward, temporary solutions over formal helpseeking, particularly from justice services, is consistent with safety strategy literature in other LMICs (Wood et al, 2021). Some strategies recommended by survivors, particularly those surrounding removing stressors and avoidance, are not durable solutions.…”

Resilience: Safety in the Aftermath of Traumatic Stressor Experiences

“…Relatedly, from a resilience perspective, the physiological (and subsequent behavioral) impacts that occur in humans can be influenced by previous experiences with controllable stressors. If women who experience abuse have learned safety strategies for contending with mild interpersonal challenges in their current or previous relationships (e.g., possibly confronting the insults, or by turning to others who re-affirm her self-esteem), they might be able to manage or terminate the relationship if the abuse continues (Wood et al, 2019). Ordinarily, when a challenge first occurs, in the absence of previous relevant experiences, it may be unclear whether the stressor is controllable or uncontrollable, or whether it will be a brief insult or one that will be prolonged or repeated.…”