Fediša Modikologo : breaking the intergenerational cycle of violence against women and children. Theoretical framework and protocol for a prospective cohort study

Abstract

In South Africa, after two decades of national femicide surveillance, we know comparatively little about what places women who experience intimate partner violence (IPV) at risk of intimate partner femicide. Further we have not mapped the multi-generational health, social and economic impact of severe IPV on women subjected to it, and their children, nor the consequences of help-seeking, nor described what helps, STET recovery trajectories. This study aims to deepen understanding of risk factors for femicide and the health, social and economic impacts of severe IPV on women and their families, including understanding risk and resilience to intergenerational cycling of violence. It further aims to describe how statutory and community measures operate to enable recovery and safety. Following pilot research, we developed a prospective questionnaire-based cohort study with three components, and plan for nested qualitative research. The primary cohort will enrol 12,000 women experiencing severe IPV, recruited using non-probabilistic methods (mostly referral from services and community members, and chain-recruitment). Following a baseline interview, participants will complete annual on-line surveys to track key outcomes for five years. The main questionnaire will measure exposure to range of different forms of IPV in the past year, lifetime trauma exposure history, childhood background, health, social and economic circumstances and help-seeking practices. A sub-cohort of the women (a 20% sub-sample), will be followed more intensively over 3 years. Among these, the children aged 6 years and over, of consenting mothers, will also be followed for three years. Deaths in the cohorts will be tracked through the National Population Register through participants’ national identity numbers. Mixed-methods verbal autopsies will be conducted with friends or family members of deceased participants. Results will guide femicide prevention nationally, and will build understanding of what is needed to prevent intergenerational cycling of violence and enable recovery of exposed women and children.

PLAIN LANGUAGE SUMMARY ‘Fediša Modikologo: breaking the intergenerational cycle of violence against women and children. Theoretical framework and protocol for a prospective cohort study’ describes the plans for research that will be conducted by the South African Medical Research Council and partners in four diverse sites in South Africa with women who have experienced severe intimate partner violence and their children. This study aims to help us to understand what places women at risk of the most severe impacts of intimate partner violence, including loss of life, and to describe the myriad of ways in which their experiences, and attempts to protect themselves and their families, impact their health, social circumstances and finances. It also aims to help us understand how children are impacted by growing up in a home with violence and what may influence whether they go on to use violence themselves in their lives. We are recruiting 12,000 women who have recently experienced severe intimate partner violence into the study and we will interview them with a questionnaire, and provide counselling, over 5 years. We will as k a sub-group of these women to come for more intensive interviews, and if they agree, to invite their children, aged 6 years and over, as well. We will identify and investigate any deaths. The results will guide femicide prevention nationally, and will build understanding of what is needed to prevent the worst outcomes and enable recovery among exposed women and children.