percent of Brazilian women had suffered from sexual or physical violence at some moment in their lives. Among those who had ever had a partner, 27.2 percent said they had suffered physical violence committed by a partner at least once (Garcia-Moreno et al. 2005).<sup>7</sup> More recent research completed by the Foundation Perseu Abramo (2010) finds similar rates of violence against women: two out of five (40 percent) women suffered some type of domestic violence at least once in their lifetime; 24 percent reported experiencing control or restrictive behaviors; 23 percent psychological or verbal violence; and 24 percent physical threat or violence.<sup>8</sup> Data from DataSenado’s 2017 survey on domestic violence found an 11 percentage-point increase in women reporting they suffered some type of domestic violence between 2005 and 2017 – from 18 percent to 29 percent, respectively – and an increase in the percentage of women who knew a woman who had suffered domestic violence (56 percent in 2015 to 71 percent in 2017).

Since the enactment of the MdP law, services for support of VAW survivors have expanded, and measures to strengthen their quality have been established. These services encompass several areas - social assistance, justice, public safety and health – and include specialized and non-specialized services. Non-specialized services units include those that serve the population in general, including regular family courts; shelters; and health providers,<sup>9</sup> which can be trained to properly attend to cases of domestic violence. The main specialized services are: Specialized Police Stations for Women (DEAM – _Delegacia Especializada de Atendimento à Mulher_ ); Specialized Courts for dealing with domestic violence cases; and Integrated Centers for Special Attention to Women ( _Centro Integrado de Atendimento a Mulher -_ CIAM/CEAM/CRAM).<sup>10</sup> CIAMs, the service from which research participants for this study were recruited, provide various services including psychological support, legal assistance and referral to other services. While the responsibility for the instrumentation and implementation of MdP is decentralized to States and Municipalities, there are no built-in federal enforcement mechanisms or conditionality.

As stated above, critics of the MdP law defend that its implementation has led to a greater emphasis on punitive mechanisms and institutions (DEAMS, courts) to the detriment of protective and preventive ones (e.g. CIAMs) (Avila 2017; Machado et al. 2017). Some argue that the strong punitive emphasis of the law can alienate survivors, and point to the fact that, after cases are reported, the aggressor can be punished with or without a survivor’s consent (Machado et al. 2014).

In Brazil as in other countries, the issue of low uptake of services for women in situations of violence is often connected to the availability and quality of services, women’s awareness of their rights and knowledge of where they can go for help, and social norms, attitudes and support among family and friends (PAHO 2012, WHO 2019). Better understanding where, how, and from whom

> 7 The population-based research with a representative sample was conducted in Brazil in 2000-2001, as part of the WHO Multicountry Study on Women’s Health and Domestic Violence Against Women. The Brazilian part of the study interviewed 2,645 women of reproductive age in the city of São Paulo and the Forest Zone of the State of Pernambuco. Much of this information was reiterated in research conducted by the Perseu Abramo Foundation (2010), relating to women in public and private spheres, even though the questions for measuring physical or sexual violence were slightly different for the acts investigated. Husbands, exhusbands, boyfriends and sons were the main aggressors.

> 8 The survey “Brazilian women and gender research in public and private spaces,” carried out by the Perseu Abramo Foundation in August 2010 heard the views of 2,365 women and 1,181 men over 15 years of age, in 25 states.

> 9 Concerning health services, it is important to highlight that the National Disease Notification System (SINAN) requires mandatory notification for cases of domestic or sexual violence.

> 10Different denominations have been used to designate these specialized centers: _Centro Especializado de Atendimento à Mulher (CEAM), Centros de Referencia de Atendimento a Mulher (CRAM), Centros Integrados de Atendimento a Mulher (CIAM)._ In Rio de Janeiro, the most commonly adopted denomination is “CIAM,” which will also be used throughout the text.

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