Global Outbreaks Amplify Violence Against Women: A Hidden Crisis in Public Health

Infectious disease outbreaks, from Ebola to COVID-19, have long been recognized as public health crises, but their intersection with violence against women and girls (VAWG) remains a critically understudied and underreported dimension. A recent systematic review published in BMJ Global Health by researchers at Washington University in St. Louis, led by Lindsay Stark and Ilana Seff, underscores a glaring evidence gap: while qualitative reports and anecdotal evidence suggest a surge in VAWG during outbreaks, quantitative data is almost exclusively limited to the COVID-19 pandemic. This absence of broader data across other major outbreaks—such as the 2014-2016 Ebola crisis in West Africa or the 2009 H1N1 pandemic—means that public health responses are often blind to the gendered impacts of these crises, leaving women and girls disproportionately vulnerable.

The review, which analyzed 112 studies from nearly 2,900 screened publications, identifies five key mechanisms driving VAWG during outbreaks: income loss, social isolation, disrupted services, increased caregiving burdens, and heightened community tensions. These factors are exacerbated in low- and middle-income countries (LMICs), where economic fragility and limited access to protective services amplify risks. However, the original coverage in Medical Xpress misses a crucial historical context: similar patterns of increased VAWG were documented during the Ebola outbreak in Sierra Leone and Liberia, where school closures led to a reported spike in teenage pregnancies and child marriages, often as coping mechanisms for economic hardship. This pattern, unaddressed in the review's quantitative scope, suggests a recurring cycle that demands longitudinal research beyond single-event studies like COVID-19.

Moreover, the original article underplays the role of structural inequalities—such as patriarchal norms and weak legal protections—that predate outbreaks but are intensified by them. For instance, during the COVID-19 lockdowns, UN Women reported a 30% increase in domestic violence calls in some regions, yet these figures likely underestimate the true scale due to barriers in reporting, a point the review acknowledges but does not fully explore. A deeper issue lies in the methodological limitations of existing studies: reliance on proxy indicators like hotline data fails to capture unreported cases, especially among adolescent girls, who are often overlooked in favor of adult women. This gap obscures the full spectrum of violence, including forced early marriage and sexual exploitation, which are uniquely tied to economic desperation during crises.

Drawing on related research, a 2015 study in The Lancet on the Ebola outbreak (sample size: N/A, observational) highlighted how disrupted health services led to reduced access to reproductive care, indirectly fueling gender-based violence—a connection absent from the BMJ review’s focus. Similarly, a 2021 UN Women report on COVID-19 (sample size: N/A, mixed methods) emphasized that women in informal economies, common in LMICs, faced heightened risks of economic coercion and abuse during lockdowns. Synthesizing these sources reveals a systemic failure: outbreak response frameworks rarely integrate gender-specific protections, despite evidence of recurring harm. No conflicts of interest were disclosed in these studies, though funding from global health bodies like UNICEF in the BMJ review raises questions about potential bias toward policy-aligned findings.

What’s missing from the original coverage is a call for intersectional policy reform. Public health responses must move beyond infection control to embed VAWG prevention, such as funding community-based shelters and ensuring continuity of gender-based violence services during crises. The ‘shadow pandemic’ of VAWG during COVID-19 was a wake-up call, but without preemptive measures, future outbreaks will replicate this harm. Climate change, driving more frequent zoonotic diseases, adds urgency to this integration—outbreaks are not just health events but social catalysts that expose and worsen gendered inequalities. The evidence gap is not merely academic; it’s a policy failure that costs lives.