Evaluating housing interventions for women experiencing intimate partner violence
Authors: Rachel Jewkes
Journal: The Lancet Public Health (2021)

Over the past five decades, housing interventions have been a cornerstone of support globally for women experiencing intimate partner violence (IPV).1UN WomenVirtual Knowledge Centre to End Violence Against Women and GirlsThe history and origin of women's sheltering.https://www.endvawnow.org/en/articles/1368-the-history-and-origin-of-womens-sheltering.htmlDate accessed: October 31, 2021Google Scholar These interventions are crucial given that IPV is one of the most important causes of homelessness among women worldwide.2Daoud N Matheson FI Pedersen C et al.Pathways and trajectories linking housing instability and poor health among low-income women experiencing intimate partner violence (IPV): toward a conceptual framework.Women Health. 2016; 56: 208-225Crossref PubMed Scopus (52) Google Scholar Some women who have experienced IPV stay in shelters for months or years and use them to heal and move forward with their lives, whereas others stay for much shorter periods (ie, from days to weeks) to seek temporary respite and immediate safety.3Sullivan CM Virden T Interrelationships among length of stay in a domestic violence shelter, help received, and outcomes achieved.Am J Orthopsychiatry. 2017; 87: 434-442Crossref PubMed Scopus (12) Google Scholar All shelters aim to provide a safe space and many provide other programmes, including advocacy and counselling, with good effects, and income-generating opportunities.4Wathen CN MacMillan HL Interventions for violence against women: scientific review.JAMA. 2003; 289: 589-600Crossref PubMed Scopus (421) Google Scholar This variability enables housing interventions to potentially meet a range of women's needs; however, the intervention delivered differs considerably between settings, so evidence on their overall impact and what makes them more effective is unevenly understood. Alexa Yakubovich and colleagues5Yakubovich AR Bartsch A Metheny N Gesink D O'Campo P Housing interventions for women experiencing intimate partner violence: a systematic review.Lancet Public Health. 2021; (published online Nov 24.)https://doi.org/10.1016/S2468-2667(21)00234-6Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar systematically review the impact of housing interventions on women's health and experience of IPV in the first synthesis of quantitative global evidence. The authors found only 34 (mostly small) studies and just nine were from outside the USA. Although housing interventions are provided in diverse settings, no quantitative evaluation has been conducted in any low-income and middle-income country, and none from rural settings in high-income countries. Most studies (76%) evaluated shelters and assessed outcomes related to mental health, with fewer (65%) asking about perceived safety, readiness or decision to leave partner, and reoccurrence of IPV. Women who had experienced IPV generally reported improved mental health outcomes, as well as empowerment. Even though assessments were mostly positive, perhaps surprisingly, there was less evidence on the impact of interventions on IPV experiences, intention to leave, and perceived safety. Given the heterogeneity of interventions, settings, and patterns of use by women experiencing IPV, further research on housing outcomes would greatly benefit from the use of mixed methods and building a community of practice, among which there may be comparability of outcomes and a wider range of outcomes explored over an extended follow-up period. Given that women experiencing IPV have various needs at the point of accessing housing interventions, length of stay, and programmes provided, much larger samples are needed across different settings. Attention should be given to measuring health and violence outcomes, alongside measures of success identified as key by female service users, which might differ considerably, especially for short-term users. Although some women choose to stay for short periods, others choose to do so because of shelter factors, including restrictive policies and rules.6Fisher EM Stylianou AM To stay or to leave: factors influencing victims' decisions to stay or leave a domestic violence emergency shelter.J Interpers Violence. 2019; 34: 785-811Crossref PubMed Scopus (15) Google Scholar, 7Gregory K Nnawulezi N Sullivan CM Understanding how domestic violence shelter rules may influence survivor empowerment.J Interpers Violence. 2021; 36: np402-np423Crossref PubMed Scopus (14) Google Scholar This reality needs to be captured in research and considered in evaluation design, with clear value to be gained from intention-to-treat approaches. Research in other areas of prevention of violence against women is revealing how to effectively design and implement interventions, and how to map this on to success in achieving violence prevention outcomes.8Jewkes R Willan S Heise L et al.Effective design and implementation elements in interventions to prevent violence against women and girls.https://www.whatworks.co.za/documents/publications/373-intervention-report19-02-20/fileDate accessed: November 17, 2021Google Scholar It would be extremely valuable for researchers of housing interventions to make their components explicit because this would help to establish which ones are more effective and more highly valued by women who have experienced IPV. Additionally, this transparency might help to explain the diversity of outcomes achieved between studies, especially those with null findings. The systematic review did not assess studies that used qualitative methods.5Yakubovich AR Bartsch A Metheny N Gesink D O'Campo P Housing interventions for women experiencing intimate partner violence: a systematic review.Lancet Public Health. 2021; (published online Nov 24.)https://doi.org/10.1016/S2468-2667(21)00234-6Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar Reflection of the impact of housing interventions, quantitatively and qualitatively, is vital for preparing the investment case and to better understand how housing interventions in resource-constrained settings are positioned and prioritised against other interventions, including counselling and more general IPV-prevention approaches. Over the past decade, gender-based violence researchers have sought to evaluate and deepen understanding of measures to support women experiencing IPV, as well as interventions designed to prevent violence. Several interventions seek to address the structural drivers of violence and impediments to women's empowerment, particularly poverty, through cash transfers and other interventions combining economic empowerment and gender-transformative interventions, with considerable success.9Kerr-Wilson A Fraser E Gibbs A et al.What works to prevent violence against women and girls? Evidence review of interventions to prevent violence against women and girls 2000-19. South African Medical Research Council, Pretoria2020Google Scholar Housing interventions ideally provide both support for women and IPV prevention more generally, assisting women in crisis and enabling them to free themselves from the violence in their lives. The extent to which IPV prevention is achieved by these interventions has not been well evidenced by this systematic review and deserves further research. Furthermore, the question remains of whether and in what circumstances women's needs could be met by economic interventions instead of housing ones. The systematic review by Yakubovich and colleagues5Yakubovich AR Bartsch A Metheny N Gesink D O'Campo P Housing interventions for women experiencing intimate partner violence: a systematic review.Lancet Public Health. 2021; (published online Nov 24.)https://doi.org/10.1016/S2468-2667(21)00234-6Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar has shown that there are various outcomes for people who have experienced IPV that are generally met by housing interventions, particularly in providing a sense of safety and improvements in mental health. Additionally, the study has shown that, compared with the huge global breadth of the intervention, the quantitative evidence base is extremely narrow. More research is needed in a wider range of settings in high-income countries and low-income and middle-income countries to establish which aspects of housing interventions are important for which benefits. I declare no competing interests. Housing interventions for women experiencing intimate partner violence: a systematic reviewThere is promising evidence on the continuum of IPV-housing services for women, especially in terms of proximal outcomes, such as mental health, intent to leave partner, safety, and housing stress. However, more research of higher quality is needed, particularly on long-term housing solutions and from outside of the USA. Full-Text PDF Open Access