Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697640364448.pdf (Australia)
INQUIRY INTO FAMILY, DOMESTIC, AND SEXUAL VIOLENCE SUBMISSION BY THE AUSTRALIAN RESEARCH ALLIANCE FOR CHILDREN AND YOUTH JULY 2020 WHO WE ARE The Australian Research Alliance for Children and Youth is a national body which strives to improve the lives of all Australian children aged 0-14 by promoting evidence-based strategies for improving wellbeing, with a focus on prevention and early intervention.
According to our surveys of children and young people themselves, wellbeing means: having access to material basics, feeling loved and safe, being healthy, learning, participating, and having a positive sense of identity and culture.

Domestic and family violence is a pervasive problem that impacts on a child’s ability to obtain wellbeing in all of these domains.

ARACY would therefore like to make the following contribution to help in the evidence-based eradication of domestic and family violence.
TERMS OF REFERENCE ADDRESSED IN THIS SUBMISSION a) Immediate and long-term measures to prevent violence against women and their children, and improve gender equality.

b) Best practice and lessons learnt from international experience, ranging from prevention to early intervention and response that could be considered in an Australian context.

TERMINOLOGY There is variability in the literature regarding the terminology used to describe violence against women.
The terminology used in this submission reflects that used by Australia’s National Research Organisation for Women’s Safety (ANROWS), where: Intimate partner violence is used to describe violence occurring between people currently or previously in an intimate relationship.

The literature variably includes current or previous cohabitation as part of the definition, which can affect statistical information.
Family violence includes violence between intimate partners, as well as violence between other family members such as between siblings or violence directed at parents from children.

Domestic violence is used interchangeably with intimate partner violence, with intimate partner violence being the preferred terminology.

Domestic violence is used when citing literature using this term.

Violence against women encompasses intimate partner violence, sexual assault, sexual harassment and stalking.
(Politoff, et al., 2019) Inquiry into family, domestic and sexual violenceSubmission 203 INTRODUCTION Intimate partner violence is the largest contributing risk factor to the burden of disease in women, exceeding other risk factors such as cigarette smoking, alcohol use, physical inactivity and obesity (Webster, 2016).

In 2019, 30% of all homicides in Australia were attributable to family and domestic violence, with 64% of victims being female (Australian Bureau of Statistics, 2020).
Exposure to family violence, including intimate partner violence, has a significant negative effect on the wellbeing and development of children, and is associated with an increased likelihood of both perpetration and victimisation of violence (Campo, 2015a).

Strategies that aim to prevent family violence as well as strategies aimed to reduce the negative impacts of violence are necessary to address this burden of disease for women and the flow-on effects to their children.
THE IMPACT OF DOMESTIC AND FAMILY VIOLENCE ON CHILDREN AND YOUNG PEOPLE One in four Australian children will be exposed to domestic violence, and of all women who experience domestic violence, more than 50% have children in their care (NSW Government, 2019).

Domestic and family violence has a profound negative impact on children and young people.

This is true irrespective of whether they witness the violence and even when they are not direct victims of the violence themselves.
For example:  Family violence is the leading cause of child homelessness, accounting for one third of presentations to accommodation assistance programs in Australia (Campo, 2015a).

 Domestic and family violence is associated with poorer educational outcomes, behavioural problems, mental health disorders, and increased victimisation and perpetration of bullying in children (Campo, 2015a).
 Domestic and family violence can impair a child’s ability to form secure attachments to their  primary caregivers, which can have lasting implications on their ability to build future relationships (Campo, 2015a).

Even in utero, unborn children exposed to domestic and family violence can have lifelong negative consequences, for example through associations with low birthweight, preterm birth, maternal substance use, and maternal depression (Campo, 2015b).
Furthermore, exposure to domestic violence in the context of additional risk factors (such as parental mental illness, substance abuse, poverty) is associated with increased risk of future perpetration, contributing to the intergenerational transmission of violence (Campo, 2015a).

Addressing domestic and family violence is therefore paramount to improving the wellbeing of Australian children and youth.
Key Points:  Domestic and family violence has a profoundly negative impact on children and young people, contributing to homelessness, academic performance, behavioural and mental disorders, ability to form relationships, and an increased risk of future perpetration.
2 Inquiry into family, domestic and sexual violenceSubmission 203 VIOLENCE AMONG ADOLESCENTS AND YOUNG ADULTS Young women (aged 18-24) are significantly more likely to experience intimate partner violence and/or sexual violence than any other age group.

A recent report by ANROWS indicates that women aged 18-24 have a higher rate of recent1 violence than any other age group (Politoff, et al., 2019).
The same report showed that rates of recent sexual violence were two times higher than average for women in the 18-24 age group, and 4 in every 10 young women had had a recent experience of sexual harassment.

Young people overall, and especially young men, are more likely to have a lower level of knowledge of violence against women and hold beliefs supportive of violence against women.
A report by ANROWS (Politoff, et al., 2019) indicated that young people demonstrated a lower level of knowledge about violence against women than any other age group, and young men had significantly lower levels of understanding than young women of non-physical violence.

Young men also had a poorer understanding of the prevalence of violence compared to young women, with just 57% of young men agreeing with the statement “violence against women is common” compared to 78% of young women.
Young men, and in some instances young women, demonstrated concerning attitudes about gender equality.

For example, twice as many young men than women (17% vs 8%) believed that men make more capable bosses than women.

A striking 52% of young men agreed that “many women exaggerate how unequally women are treated in Australia”, and 43% of both young men and women agreed that “it’s natural for a man to want to appear in control of his partner in front of his male friends”.
A high proportion of young people mistrusted women’s reports of violence and disregard women’s right to consent.

For example, almost half of young men agreed that “It is common for sexual assault accusations to be used as a way of getting back at men” and more than one quarter of young men and women agreed that “if a woman sends a nude image to her partner, then she is partly responsible if he shares it without her permission”.
Young people and adolescents constitute a significant proportion of perpetrators of family violence.

For example, the Victorian Royal Commission into Family Violence (State of Victoria, 2016) found that 1 in 10 police reports of family violence involved a young person as the perpetrator of violence.

They also found that the number of family violence intervention order applications against adolescents aged 0-17 years has increased in Victoria since 2009 (912 to 1325).
Male adolescents were the most common perpetrators of adolescent family violence, with prevalence of perpetration increasing with age.

Sole mothers were the most common victim of adolescent family violence.

Risk factors for perpetration included previous experience of family violence (59% of perpetrators) and history of childhood trauma (46%).
Other risk factors included learning difficulties, disability (including acquired brain injury), mental health conditions, and substance use disorders (State of Victoria, 2016).

Notably, this data does not include dating violence i.e.

the perpetration of violence against women amongst adolescents in intimate relationships.

IMMEDIATE AND LONG-TERM MEASURES TO PREVENT VIOLENCE AGAINST WOMEN AND THEIR CHILDREN, AND IMPROVE GENDER EQUALITY.
1 Within the last 12 months 3 Inquiry into family, domestic and sexual violenceSubmission 203 PREVENTION AND EARLY INTERVENTION: AN OVERVIEW Primary prevention strategies involve the prevention of violence before it takes place (Campo, Kaspiew, Moore, & Tayton, 2014).

They are measures which reduce the incidence of violence within a population by addressing the root causes, such as gender inequality, stereotyped gender norms, and factors affecting individuals, communities, and society (Webster, 2016).
They can be universal or targeted at groups at higher risk of experiencing or perpetrating violence.

Primary prevention strategies are often cost-effective (Vos, et al., 2010), and are also compelling from an ethical standpoint by preventing violence before it occurs.
A report by Webster (2016) argues that because the root causes of family violence also contribute to repeated violence and associated harms, addressing the root causes can additionally reduce the recurrence of violence and aid in recovery (Webster, 2016).

The idea that primary prevention measures can also function as secondary and even tertiary prevention strategies is also considered in other literature (Campo et al., 2014).
Secondary prevention measures, also referred to as early interventions, are targeted measures which are aimed at people at high risk of violence, or experiencing violence in the early stages (Campo, Kaspiew, Moore, & Tayton, 2014).

In contrast, tertiary prevention aims to prevent violence recurring in people already experiencing violence, and minimise the health impacts of domestic and family violence (Webster, 2007).
Tertiary prevention is also known as interventions or response measures (Campo, Kaspiew, Moore, & Tayton, 2014).

Unfortunately, evidence for the effectiveness of primary prevention strategies for domestic and family violence is limited, and current primary prevention strategies are largely theory driven (Campo, Kaspiew, Moore, & Tayton, 2014).
A report by the Australian Institute of Family Studies notes that: “There is widespread acknowledgement in policy frameworks that primary prevention of [domestic and family violence] should address the underlying causes contributing to violence, yet evidence regarding both the causes of DFV, and the effectiveness of various prevention strategies, is limited and very few prevention programs have been adequately evaluated”.
(Campo et al., 2014, p. 30) A review of reviews conducted by the World Bank Group identified 58 interventions globally that had been evaluated for effectiveness to reduce intimate partner violence; of these, only 15 were demonstrated to be effective and only four of the effective interventions were a primary prevention strategy (see Figure 1 of Appendix) (Arango et al., 2014).
The same review found that: “The interventions with the most positive findings used multiple, well-integrated approaches and engaged with multiple stakeholders over time.

They also addressed underlying risk factors for violence, including social norms regarding gender dynamics and the acceptability of violence.
These examples point to the imperative of greatly increasing investment both in innovative programming in primary prevention, as well as in high-quality experimental and quasi-experimental evaluations” (Arango, Morton, Gennari, Kiplesund, & Ellsberg, 2014, p. 2) Given the lack of current evidence, many primary prevention programs target factors associated with perpetration.

Campo et al.
(2014) identifies the following factors associated with perpetration:  Traditional/normative beliefs about gender  Community sanctions for gendered violence 4 Inquiry into family, domestic and sexual violenceSubmission 203 Idealised masculinity   Attitudes supportive of violence    Childhood history of multiple forms of child abuse/maltreatment Low education Substance abuse Based on existing literature and theoretical models of domestic and family violence, primary prevention strategies should (summarised from Campo et al., 2014): Target multiple levels of risk Emphasise attitudinal change Include the local community context     Be implemented at various stages across the lifespan  Be tailored to the appropriate cultural context  Specifically target children and young people, particularly before they reach high school before rigorous ideas around gender and violence are formed  Be evaluated for effectiveness Key Points:  Investment in primary prevention strategies to reduce domestic and family violence are likely to have a significant impact on the disease burden for women and children.
 There is a limited evidence base about what primary prevention strategies are effective.

 Based on theoretical knowledge of factors associated with perpetration, interventions that address beliefs about gender, masculinity, and violence, as well as substance use, education, and childhood trauma, are appropriate targets for primary prevention strategies.
 Primary prevention interventions should be tailored to meets the needs of the target audience, factoring in age, cultural context, and the local community context.

 It is imperative that these primary prevention strategies are evaluated for effectiveness, especially given the lack of current evidence base.
PRIMARY PREVENTION: SCHOOL-BASED INTERVENTIONS The impact of violence on children and young people, the prevalence and attitudes of adolescents and young people about violence make compelling arguments for primary interventions in childhood and adolescence.

Interventions that occur in childhood and adolescence are largely limited to school-based programs.

The evidence for this is discussed below.


There is reasonable evidence that school-based interventions are effective in changing students’ attitudes towards domestic violence, gender roles, and respectful relationships in Australia (Campo et 5 Inquiry into family, domestic and sexual violenceSubmission 203 al., 2014).

Examples of these include LoveBites and Respectful Relationships.
Two evaluated interventions conducted in Canada also found a reduction in dating violence following a group training program for male and female adolescents (Arango et al., 2014).

However, school based interventions in high-income countries on a global scale have not demonstrated promising results (Ellsberg, et al., 2015).
Some Australian studies have also demonstrated mixed results, for example interventions that demonstrate attitudinal shifts toward domestic violence but not coercive behaviours or dating violence (Campo et al., 2014).

Other issues include lack of longer-term follow-up to determine whether these attitudinal and behavioural shifts are sustained over time.

Additionally, evaluated programs have largely occurred in secondary school.
Insights from practitioners indicate that these interventions must start earlier i.e.

in early primary school, and must take a gendered approach to domestic and family violence (despite a preference by some schools to take a gender-neutral approach) (Campo et al., 2014).

The rationale for this is that views about gender are already fairly well-established by adolescence.
Finally, a review of evaluated programs found that no school-based programs specifically aimed at culturally or linguistically diverse children.

School based-interventions are therefore a promising avenue for primary prevention strategies, but must specifically address gendered violence, start in the early primary schools years, consider cultural context, and be evaluated for effectiveness.
Key Points:  Children and young people are an ideal target for primary prevention strategies that address attitudinal shifts.

School based-interventions are a promising avenue, but must specifically address gendered violence, start in the early primary schools years, consider cultural context, and be evaluated for effectiveness.
SECONDARY PREVENTION: PERINATAL HOME VISITATION Home visitation programs involve regular antenatal and post-natal visitation with women with the aim of improving pregnancy outcomes and infant development.

Home visitation that has a focus on intimate partner violence would generally be considered a secondary prevention measure, as the intervention would be targeted at high risk families or families already experiencing violence.
However, some nurse home visitation programs have been shown to improve maternal mental health (Centre for Community Child Health, The Royal Children's Hospital Melbourne), and such programs may have the potential to reduced intergenerational transmission of violence (not evaluated).

This would mean nurse home visitation would also function as both a primary and tertiary measure.
A home visitation program in Hawaii (Hawaii’s Healthy Starts Program, HSP) that actively aimed to reduce family violence demonstrated a reduction in intimate partner violence over the three year implementation (Duggen et al., 1999 in Arango et al., 2014).

Similar outcomes have also been noted in other countries including Australia.
For example, a small trial conducted in Melbourne evaluated non- professional mentor visitation to women experiencing intimate partner violence, and showed a significant reduction in Composite Abuse Scale after 12 months of the intervention (Taft, et al., 2011).

Of note however, only home visitation programs that specifically aimed to reduce intimate partner violence were effective in doing so (Prosman, Lo Fo Wong, van der Wouden, & Lagro-Janssen, 2015).
A 6 Inquiry into family, domestic and sexual violenceSubmission 203 report by the World Health Organisation also notes the need for trials of home visitation that “focus on women experiencing intimate partner violence” and measure this as a “primary outcome” (World Health Organization, 2013).
Key Points:  Perinatal home visitation programs are a promising avenue to reducing intimate partner violence, and should be evaluated via rigorous, large scale trials for efficacy and cost- effectiveness in Australia.

Current evidence indicates that such programs must be specifically dedicated to the reduction of intimate partner violence with intimate partner violence measured as a primary outcome in order to be effective.
BEST PRACTICE AND LESSONS LEARNT FROM INTERNATIONAL EXPERIENCE, RANGING FROM PREVENTION TO EARLY INTERVENTION AND RESPONSE THAT COULD BE CONSIDERED IN AN AUSTRALIAN CONTEXT.

VIOLENCE IN AUSTRALIA: A GLOBAL CONTEXT One in four women in Australia experience physical and/or sexual violence from an intimate partner at some time in their life.

On an international scale, 44 out of 103 surveyed countries have lower rates of lifetime prevalence than Australia (OECD, 2014).
Australia performs below expected on laws protecting women against violence.

The OECD (OECD, 2014) classifies Australian legislation around sexual harassment as being “in place” but that “the law is inadequate”.

Legislation around domestic violence was slightly better, with the law being “adequate overall” but with “reported problems of implementation”.
More than half of 160 surveyed countries scored equal or better to Australia on a scale rating the legal framework protecting women from domestic violence.

This is consistent with laws around coercive control2.
Coercive control has been made a criminal offence throughout the United Kingdom since 2015, but not taken up in Australia in any state or territory aside from Tasmania despite a recommendation by the Victorian Law Reform Commission to criminalise such behaviour (It’s time ‘coercive control’ was made illegal in Australia, 2019).

Australia performs well on a global scale in terms of women’s attitudes towards violence, but this is not the case for particular subpopulations within Australia.
3.2% of Australian women believe that a husband/partner is justified in beating his wife/partner under certain circumstances compared to a mean of 27% globally (OECD, 2014).

Two out of 152 countries had scores of 0% (Malta and Denmark), and 15/152 countries scored lower than Australia.

However, attitudes towards violence can vary significantly based on age and gender.
A recent report by ANROWS showed that a significant proportion of young people, and especially young men, held attitudes that were supportive of violence against women: for example, 23% of men aged 18-24 agreed that “domestic violence can be excused if, afterwards, the violent person genuinely regrets what they have done” (Politoff, et al., 2019).
2 “An act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim… designed to make a person dependent by isolating them from support, exploiting them, depriving them of independence and regulating their everyday behaviour” (Women's Aid, 2019) 7 Inquiry into family, domestic and sexual violenceSubmission 203 Australia has a high migrant population; overseas born residents constitute almost 30% of Australia’s population (Australian Bureau of Statistics, 2020).
Notably, the percentage of women who agreed that beating a wife/partner was justified in certain circumstances was extremely high in many countries, reaching upwards of 50% in 29 countries and as high as 92% in the highest country.

The top three countries from which residents emigrate from are England, China, and India.
10.2%, 32.7%, and 22.1% (respectively) of women surveyed in these countries agreed that a husband/partner was justified in beating his wife/partner under certain circumstances (OECD, 2014).

Although not definitive, it is possible that victims of intimate partner violence could be over-represented in migrant and refugee populations.

The evidence regarding this in Australia is mixed.


While prevalence data in the Australian Personal Safety Survey suggests lower rates of domestic violence among immigrants, multiple organisations have found that this is likely underestimated, while other studies have indicated a trend in the opposite direction e.g.

the overrepresentation of intimate partner homicide in culturally and linguistically diverse couples (Ghafournia & Easteal, 2018).
Key Points  Together, this data indicates that the vast majority of Australian women do not agree that violence against women is ever justifiable, but that these attitudes are not necessarily reflective of the wider community, that violence is still occurring at an unacceptably high rate, and that legal framework protecting women against domestic violence and sexual harassment could be improved.
LESSONS LEARNT FROM INTERNATIONAL EXPERIENCE International comparisons of violence prevalence is limited by comparability of data.

There are significant discrepancies in figures, largely due to differences in definitions.

For example, OECD data indicate that women in Canada have the lowest lifetime prevalence of physical and/or sexual violence from an intimate partner (6%) on a global scale (OECD, 2014).
This contrasts to data provided by the Canadian Government, which indicates that 30% of women experience intimate partner violence within their lifetime (Government of Canada, 2015).

Inconsistencies in Australian data are also evident, with OECD figures indicating that 25% of Australian women experience physical and/or sexual violence from an intimate partner in their lifetime (OECD, 2014), compared to ABS data which indicates that this figure is closer to 17% (Australian Bureau of Statistics, 2017).
This represents a significant barrier to potentially useful comparisons between countries.

Facilitating international collaboration around prevention and early intervention for domestic and family violence may facilitate greater gains in this area.

Fortunately, trends in violence within countries can still provide insights into potentially useful international practices.
For example, Canada has demonstrated a reduction in annual rates of intimate partner violence over the last decade, where Australian rates have plateaued.

In Canada, self-reported spousal violence within the past 5 years decreased by 41% (from 6.6% to 3.9%) between 2004 and 2014 (Burczycka, Section 1: Trends in self-reported spousal violence in Canada, 2014, 2016).
This is supported by police reports, which also declined between 2009 and 2014, although numbers have stagnated since this improvement (see Figure 2 of Appendix) (Burczycka, 2019).

Australian rates of partner violence that occurred in the last 12 months slightly increased between 2005 and 2016 from 1.5% to 1.7% (Australian 8 Inquiry into family, domestic and sexual violenceSubmission 203 Bureau of Statistics, 2017).
Again, these numbers are not directly comparable, but such trends may provide clues as to the efficacy of public health measures which may be adaptable to Australia.

A systematic review of 58 impact evaluations found 15 that reduced intimate partner violence (Arango, Morton, Gennari, Kiplesund, & Ellsberg, 2014).

Of these, four demonstrated efficacy in high-income countries.
Two were based in Canada and focused on reducing dating violence, and two were based in the United States (Hawaii: a perinatal home visitation program that reduced intimate partner violence, and California: a clinic-based intervention that reduced reproductive coercion).

These also represent sources of potential international collaboration to build on the sparse evidence base of effective strategies in comparable countries.
Key Points  International comparisons of domestic and family violence rates are limited, impeding the ability to learn lessons from international experience.

Facilitating international collaboration around prevention and early intervention of domestic and family violence may facilitate greater gains in this area, especially given the lack of evidence around effective primary interventions.
 Canada could be a useful starting point for international collaboration given the cultural comparability to Australian and the declining incidence of violence against women over the past decade, which is in contrast to Australian figures.

 Both Canada and the United States have implemented interventions that effectively reduced intimate partner violence within the study.
Both countries have cultural overlaps with Australia, and are a source of potential international collaboration to build on the sparse evidence base of effective strategies.

SUMMARY OF KEY POINTS & RECOMMENDATIONS  Intimate partner violence is the number one contributing risk factor to disease burden in women, exceeding other risk factors such as substance use, obesity, and physical inactivity.
 Domestic and family violence has a profoundly negative impact on the wellbeing of children and young people, including significantly contributing to homelessness, educational outcomes, mental and behavioural issues, future relationships, and the risk of intergenerational transmission of violence.

 Adolescents and young adults are both victims and perpetrators of intimate partner and family violence.
They are also at greater risk of holding attitudes supportive of violence, of having a lower level of knowledge of what constitutes violence, and for young women, of experiencing violence.

Prevention and early intervention strategies should therefore include adolescents and young adults.
9 Inquiry into family, domestic and sexual violenceSubmission 203  Investment in primary prevention strategies to reduce domestic and family violence are likely to have a significant impact on the disease burden for women and children, but there is a limited evidence base about what primary prevention strategies are effective.
Based on theoretical knowledge of factors associated with perpetration, interventions that address beliefs about gender, masculinity, and violence, as well as substance use, education, and childhood trauma, are appropriate targets for primary prevention strategies.

 Primary prevention interventions should consider the age, cultural and the local community context of the target population, and must be evaluated for effectiveness given the lack of current evidence base.
 Children and young people are an ideal target for primary prevention strategies that address attitudinal shifts.
School based-interventions are a promising avenue, but must specifically address gendered violence, start in the early primary schools years, consider cultural context, and be evaluated for effectiveness  Perinatal home visitation programs are a promising avenue to reducing intimate partner violence, and should be evaluated via rigorous, large scale trials for efficacy and cost- effectiveness in Australia.
Current evidence indicates that such programs must be specifically dedicated to the reduction of intimate partner violence with intimate partner violence measured as a primary outcome in order to be effective.

 International comparisons of domestic and family violence rates are limited, impeding the ability to learn lessons from international experience.
Facilitating international collaboration around prevention and early intervention of domestic and family violence may facilitate greater gains in this area, especially given the lack of evidence around effective primary interventions.

 Both Canada and the United States could be useful starting points for international collaboration given they have cultural overlaps with Australia, and have made demonstrable gains in violence prevention.
 Australia underperforms on a global scale in terms of prevalence of violence and laws protecting women from violence.

 International data indicates that that victims of intimate partner violence may be over- represented in migrant and refugee populations and underrepresented in the literature.

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Retrieved from https://www.who.int/reproductivehealth/publications/violence/9789241548595/en/ 13 Inquiry into family, domestic and sexual violenceSubmission 203 APPENDIX Figure 1: Taken from Elsberg et al., 2015 in Arango et al., 2014.
VAWG = violence against women and girls; IVP = intimate partner violence; NPSA = non-partner sexual assault; FGM/C = female genital mutilation/cutting; CM = child marriage 14 Inquiry into family, domestic and sexual violenceSubmission 203 Figure 2: Adapted from Burczycka, 2019 15 Inquiry into family, domestic and sexual violenceSubmission 203