When the world shut down due to the COVID-19 pandemic in early 2020, another crisis quietly grew behind closed doors. Reports from around the globe suggested that violence against women and girls was increasing. Governments, nongovernmental organizations and advocates began referring to the phenomenon as a “shadow pandemic.”
To determine whether these headlines and informal reports reflected reality, we led the first-ever comprehensive review of studies tracking violence against women and girls during infectious disease outbreaks across low- and middle-income countries. We focused on those regions because less research on the topic has been done there, and women and girls face specific risks, such as child marriage, that are less prevalent in wealthier nations.
Our findings, published in BMJ Global Health and co-authored with UNICEF, are both clear and concerning: Violence against women and girls tends to increase during outbreaks, and the very measures used to control disease spread can lead to that rise.
Across 53 studies measuring changes in violence against women and girls in the first year of the COVID-19 pandemic, the majority found increases, with some studies showing no change and relatively few showing declines. This pattern held across different types of violence – for example, physical domestic violence, sexual domestic violence, psychological violence or online violence – particularly committed within the home.
But even more striking was how little evidence there was from other infectious disease outbreaks. Despite the growing frequency of global health emergencies, only one study examined violence against women and girls during an outbreak other than COVID-19, specifically examining violence in Sierra Leone during both Ebola and COVID-19.
How outbreaks contribute to gender-based violence
Infectious disease outbreaks do more than spread illness. They can disrupt economies, burden health systems and reshape daily life. These shifts can amplify existing inequalities and, in many cases, increase the risk of violence.
Our research identified five key pathways through which outbreaks contribute to violence against women and girls.
First, job loss, reduced income and financial stress were the most consistently identified contributors to violence. When households experience economic strain, tensions rise – and women and girls often bear the consequences. In some contexts, economic stress was linked not only to intimate partner violence but also to harmful practices like child marriage.
Second, movement restrictions like lockdowns and quarantines can trap women and girls with abusive partners or family members. While these outbreak response measures are designed to reduce disease transmission, they can also isolate women from social networks and limit opportunities to seek both formal and informal help.
Third, deeming certain services as nonessential reduces people’s access to support. During COVID-19, many health, social and legal services were scaled back or became harder to access. School closures also meant that girls in some contexts faced increased risks of exploitation, early pregnancy or forced marriage.
Fourth, perpetrators may use women’s and girls’ fear of infection to control or manipulate them. For example, men sometimes discouraged their partners from leaving the home or seeking care in order to avoid disease risk.
Finally, women’s and girls’ past experiences with health systems can influence their intention to seek services in the future. In settings affected by earlier outbreaks, such as the 2014 Ebola outbreak, mistrust of health services discouraged some survivors from seeking care after experiencing violence, especially if doing so might lead to quarantine or mistreatment.
These pathways are not isolated. They often interact and reinforce one another, creating conditions in which violence becomes more likely during crises.
Building better evidence
Public health emergencies are becoming more frequent, and measures like lockdowns and limiting access to schools, clinics and other services can have unintended consequences.
Our findings show that protecting women and girls needs to be part of how public health experts respond to outbreaks from the start and not something to address only after violence has already increased.
Tracking the issue in different types of outbreaks – such as cholera, influenza or Ebola – could help determine which policy responses are most protective.
But even within COVID-19 research, we uncovered important limitations. First, most studies focused on adult women, with far less attention to girls. And second, many studies relied on metrics such as the number of hotline calls or clinic visits, which can be misleading. A drop in reports does not necessarily mean a drop in violence; it may reflect reduced access to services or greater barriers to reporting.
Despite the data gaps we uncovered, our study already points to targeted strategies that can protect women and girls: reducing households’ financial stress, making services safe and easy to reach, ensuring girls’ continued access to school, and building stronger community support.
