Virtual Roundtable: Gender Inequality and Domestic Violence During the COVID-19 Pandemic

Tuesday, September 15, 2020
Victoria Razo/Getty Images
Felicia Marie Knaul

Director, Institute for Advanced Study of the Americas, and Professor, Miller School of Medicine, University of Miami; Chair, Lancet Commission on Gender-Based Violence and Maltreatment of Young People

Shawna Wilson

Executive Director, International Association of Women Judges


Adjunct Senior Fellow for Women and Foreign Policy, Council on Foreign Relations

Women and Foreign Policy Roundtable Series

Governments worldwide have imposed lockdowns and implored residents to stay home to contain the spread of COVID-19. But for some, home is a dangerous place. Emerging data from around the world indicate a rise in domestic and gender-based violence since the start of the pandemic. Our panelists discuss gender inequality, and the risks associated with domestic violence, during the COVID-19 pandemic.


Caroline Bettinger-Lopez: Good afternoon. My name is Carrie Bettinger-Lopez, and I am an adjunct senior fellow at the Council on Foreign Relations. I’m so pleased to be here to present this roundtable today—to preside over a roundtable with two excellent speakers—and the topic is domestic violence and gender inequality in the age of COVID-19.


As COVID-19 has swept across the world, it has exacerbated pre-existing gender inequalities. And we can also already see the different and disproportionate effects of, that the pandemic has had on women and girls. For example, women are more likely to hold informal and lower-paying jobs, and they make up most of the world's nurses, as well as shouldering most of unpaid care work in the world. As governments have imposed lockdowns to contain the coronavirus, these same restrictions have increased the risks associated with domestic violence and especially as they apply to women, children, and LGBTQ individuals.


Secretary General of the United Nations Antonio Guterres has called for measures to address what he calls a horrifying global surge in domestic violence that’s been directed toward women and girls. It’s important to remember, however, that domestic violence was a global pandemic, long before the COVID-19 outbreak. And so, our two speakers today will share important information and data on the magnitude of the problem as well as responses to it globally. So, I’m very pleased to introduce our two speakers.


First, we have Shawna Wilson, and Shawna is a lawyer and the current executive director of the International Association of Women Judges (IAWJ). She previously worked as a rule of law advisor and as deputy director for the Office of Multilateral Affairs for the State Department’s Bureau of Counterterrorism. She’s also worked for the State Department’s Bureau of International Narcotics and Law Enforcement Affairs. She participated in the U.S. Supreme Court fellows program and worked at the international judicial relations office as an international judicial relations officer at the Federal Judicial Center.


And our second presenter will be Felicia Marie Knaul. And Felicia is my colleague at the University of Miami. She’s a professor at the University of Miami School of Medicine and director of the Institute for the Advanced Study of the Americas. She's also a full member of the cancer control program at the Sylvester Comprehensive Cancer Center. She’s a chair of the Lancet Commission on Gender-based Violence and Maltreatment of Young People, on which I happen to sit as well. And previously, Dr. Knaul served as associate professor at Harvard Medical School and as director of the Harvard Global Equity Initiative. She founded Cáncer de Mama: Tómatelo a Pecho, which is a Mexican nonprofit agency that is dedicated to the health of women and focuses on the detection of breast cancer. Dr. Knaul has dedicated more than three decades to academic advocacy and policy work in global health that’s focused on reducing inequities and improving the condition of vulnerable groups, primarily in Latin America and the Caribbean.


And so, how we’re going to structure this roundtable today is that, first, we’d like our speakers to give some introductory remarks that help us to frame the nature of the problem as well as potential directions for addressing the problem. And then we’re going to go into a Q&A between myself and our panelists. And finally, we’ll open it up in the last twenty-five minutes of the program, to questions and answers from all of you who are attending this meeting virtually. So, we welcome—we warmly welcome our speakers as well as our attendees, and we’re looking forward to hearing from you. Why don’t we start first with Dr. Knaul with some introductory remarks?


Felicia Marie Knaul: Thank you so much. It’s a pleasure to be sharing this roundtable discussion with you and with Shawna and to be with the CFR. It’s a tremendous honor. And I’m so glad that things to, really to your dedication on this issue, we’re able to be discussing this today.


I thought I would start a little bit having reviewed—I took a review of the literature right up to the most current, particularly focusing on some of the global health literature, and to share some of the numbers as they’re coming up. You know, really focusing on domestic violence during the pandemic, but as I’ll share in a minute, I’m not so sure that’s the point that we should actually be focusing on in terms of timing.


What the UNFPA is saying is that if the lockdown continues for six months, which it has, thirty-one million additional gender-based violence cases can be expected and that for every three months the lockdown continues, we’re going to see an additional fifteen million additional cases. And then the COVID-19 pandemic is likely to cause a one-third reduction in progress towards the Sustainable Development Goals.


That said, I don’t think we really know these numbers at all. There’s a recent, and very good, note that comes out of the Center for Global Development (CGD) that really took a look at a lot of the literature up to about a month ago. And some of the literature shows an increase in cases, and some of the literature shows a decrease in cases, and some shows that it’s—there’s an insignificant change. But what’s really going on there is that there’s a change in the likelihood of reporting in and in women and children’s abilities to access services. We also know that the data from high-income countries are better than the data from low-income countries.


But I went through the Lancet and found a very recent paper—it’s from the end of August—that I think, actually, is probably the best of what I’ve seen in terms of what the data can show us. It’s Jena—and I may butcher her last name—Derakhshani Hamadani. And she’s looking at rural Bangladeshi women and their families, and she has an interrupted time series. So again, this is, I think, some of the best that we’ve seen in terms of the data. It’s a sample, randomized control. And she compares what was analyzed a year and two years ago to data from May 19 to June 18 of 2020. And so, she definitely finds a serious increase. So, she looks among women who have experienced emotional or moderate physical violence, and over half reported an increase since the lockdown. The data are really pretty astonishing. And she says of the 2,200 or so women living with their husbands who shared information about intimate partner violence during the lockdown, and she looks at all forms, emotional, physical and sexual violence, and all forms increase.


For emotional violence, insults increased 68 percent. Intimidation 69 percent. Ohysical violence, thinking about being slapped, or having something thrown at these women were reported initially by 6.5 percent of women, and there was a 56 percent increase. Sexual violence numbers, it’s a much smaller proportion—probably because of stigma and other reasons in reporting—but that also showed a 50 percent increase. And although this isn’t the topic of today, if you look at that paper in Lancet Global Health, the data on food security are just horrific in terms of the increases in food insecurity.


Now, but that’s really looking at the lockdown. And what I want to do is I’m not actually sure we should even be looking that way. And we’re spending a lot of resources trying to do so. Because we really know that the risk factors are increasing. We know that unemployment is increasing tremendously. We know that poverty is increasing tremendously. And we know that the food and security data, as I said, are just tremendous.


So, if we look not so much at the current issues around the lockdown, but the way we’re beginning to think about this in terms of health data is to look at the longer term. We’re looking at excess mortality. We’re looking at excess mortality going in the future. So, if you look at women’s cancer data recently, and there’s some data from Mexico, you’ll see a 25 precent decrease. That isn’t because there’s less cancer among women; it’s just because women aren’t able to get access to the services that would allow them to effectively diagnose whether or not they do or don’t have cancer. What it also means is when we do get to them, they’re going to be later diagnosed, the situation is going to be worse, and we will expect more, what we call, excess mortality—so, above the norm of what we’ve seen in many years in the past. And that’s what we’re going to see on all sorts of health-related issues. For something like diabetes, we’re going to see a lot more morbidity in the future because people have not been able to get care.


And I think that leads us to the idea of what we might think of as a “cost of inaction” approach, which is a lot of how we’re focusing the work of the Lancet commission. And I’m really so pleased that Carrie and I are able to work together on that commission. And I think that fits into the dilemma of build back better. And that includes thinking of reducing violence against women, violence against children, and gender-based violence, not only in terms of the immediate benefits, but the longer term because of this huge cost of inaction. The cost figures that we have on domestic violence and violence in general are very poor. They range from 1.2 percent to 3.7 percent of GDP. They compare to what most governments spend on education, and that sounds bad enough, but as far as I can see, as someone who’s worked on costing for a long time, that it’s totally the tip of the iceberg. It doesn’t take into account any of the long-run implications. So, it’s just a current estimate. It isn’t a current estimate of what we’re losing going into the future. So, it doesn’t take account of the costs of lack of educational attainment, losses in productivity and health, or at all the intergenerational transfer of violence.


And we need to do is think about this as a structural cost that affects economic as well as human and social development. When we look at it that way, it can explain because so prevalent, one in three women, one in five adults report abuse as children. It’s so prevalent that this can explain things, I think, in large part, like the gender wage gap.


Now, I think broadly just from it, and this will be the last point, I think a lot of health economists, like myself, have spent the last decades trying to demonstrate that there’s a very strong link between health and the economy. And it’s bi-directional. And we’ve tried to demonstrate that investing in health is key to attaining economic growth. That’s as absolutely essential. And there's been a lot of effort over the years to try and help health sector people, i.e., ministers and secretaries, to be able to speak more effectively to finance ministers, because those conversations tend to not work in the same way. Help people speak a health language, finance ministers and others speak in economics language, and they’ll they sort of brush the health minister out of the way.


But finally, and this is like the only good thing I can say about COVID, we finally can say that everybody has to recognize that there’s a very, very strong link between health and the economy. We’ve never seen the kind of economic crisis that we’re seeing now: a 5.2 percent contraction in global GDP, plunging most countries into recession. We’ve never seen this. Data say that we haven’t seen anything like this since around 1870 $1 trillion U.S. dollar debt. It’s huge, and it’s all because of a health problem that could have been prevented, in large part, had we done the right preparedness and had we undertaken the right policies. So, what is sort of that final message is I think we have the opportunity to be able to say that there are these strong, strong links between issues related to health and well-being of human beings and economic outcomes to people who doubted it in the past, and say it is time to truly invest. And that’s, I think, the idea of build back better. Thanks so much.


Caroline Bettinger-Lopez: Thank you so much, Dr. Knaul. That was a great way to kick us off to make these vital connections between health, economics, and gender violence and gender equality. So, now I’d like to turn it over to Shawna Wilson for some introductory remarks.


Shawna Wilson: Thank you Carrie, and thank you so much for this opportunity to speak with you and other members of CFR on this important topic.


I’m just going to take a few minutes to introduce the attendees to the IAWJ, so that it puts sort of some of the work that we have done and will continue to do in context a little bit. IAWJ is a global network of women judges. Our work started about thirty years ago. We were created by a group of fifty, dynamic and visionary women judges from around the world. And they sort of had two core objectives. The first was to increase the number of women judges, but, and also to push for more women in leadership positions within the profession. And in addition, this sort of second objective was that they felt that women judges are in a unique position to really impact the rights of women and to dismantle some of the barriers that women and girls face to justice. And those are the two main objectives the IAWJ still strives for today. And from those fifty core women, we’ve grown to a membership of 6,150 judges around the world. We are in over one hundred countries and territories. We have members from Argentina to Zambia. And so, the IAWJ, through our members, implement a number of programs designed to address, as I said, some of the issues that disproportionately impact women and girls, and domestic violence has been and continues to be a very important topic for our members.


And just to give you a little bit of context of how important it is and how enduring our work has been, back in 1992, when the IAWJ had its first international conference, the association voted to have domestic violence be the priority topic for IAWJ. And since that time members have worked to get domestic violence laws on the books in their countries. They’ve created specialized domestic violence courts, which I hope we’ll get to talk about a little bit this afternoon, and provide training to others in the justice sector and outside the justice sector to address how gender bias impacts the way that they handle DV cases.


In May of this year, we hosted a series of webinars in French, English, and Spanish. We had about five hundred participants for those three webinars. And we had our members share with all of us sort of the issues that they’re seeing in dealing with domestic violence during the pandemic, and a lot of the points that were highlighted by Dr. Knaul were very similar to the points raised by our members. And I’d like to be able to share with you some of the insights and innovations that our members have come up with to sort of continue to do the important work that they’re doing even during the pandemic


Caroline Bettinger-Lopez: Wonderful, thank you so much, Shawna. And, and in full disclosure, I also am a member of the board of managerial trustees of the IAWJ and have gotten to see this extraordinary organization in action. So, we look forward to hearing more from you about the results of these of these webinars and surveys.


So, the way we’d like to break this conversation down is in roughly three parts. The first part focusing on the nature of the problem, which, which both of you have touched upon. The second on global and national responses to the domestic violence crisis during COVID-19—before, during, and what may come after. And third on recommendations, your thoughts on how our countries and our international entities should be addressing this pandemic within a pandemic.


So, let’s first turn to the nature of the problem. Felicia, you’ve spoken very eloquently about this already. We’ve seen that domestic violence in times of COVID has been characterized as this double pandemic, and can you talk a little bit more? You’ve already touched on a few. Can you talk about more how the COVID pandemic has affected rates of and responses to domestic violence around the world?


Felicia Marie Knaul: Sure, and I was going to say please don’t call me Dr. Knaul. Call me Felicia. So, I'm glad that switch, Shawna too, please for many reasons.


So, I was thinking how to build on that. And, you know, I think maybe we should talk a little bit about what does lockdown mean, when is lockdown appropriate, and when and why it works, thinking more on the health side. Because the basic argument has been that lockdown means keeping people shut in a home under difficult conditions of duress, and that puts those who are vulnerable within the family—typically, but not only women and children, often the elderly, the infirm, the ill—at great risk, especially in heightened situations of violence and when people are living in very close quarters. But lockdown is only phase one of an appropriate public health response to this pandemic. And luckily, we’ve learned some things over time.


For example, we have learned about the importance of using masks and of learning how to appropriately use masks, right. We’ve also learned that the poor typically don’t stay in lockdown because they can’t. We saw it in New York. We see it all over the world. We see it in slums. They need to go to work, and they typically do go to work. The question is, under what conditions? Typically, in the informal sector, under conditions of poverty, and so the question is, do they have access to running water? Are they using masks? Those sorts of questions to help effectively protect themselves and significantly reduce risk.


But let’s turn then to what is phase two. Phase two—and there’s a recent article in The New York Times that I think is very good on this—it talks about hammer and dance. And so, what you want to achieve in phase two is that you’re actually functioning according—you’re looking at outbreaks. And what you’re trying to do, instead of doing a mass lockdown, is use contact tracing and effective testing to be able to identify where is an outbreak and then lock own only in very small geographic areas, like the smaller, the better. And when you achieve that, what you can do theoretically, if your R stays down—your rate of transmission stays down—then you can begin to think about what we need, which is opening the economy and helping people to get back on their feet so that we can think about reducing the unemployment, reducing the impact on poverty, increasing the food security. And I think that's when we can get at what’s so important, which is things like the social protection program, the income generation programs for women, getting women back to being able to access primary care services and sexual reproductive health services. So that’s what we need to be able to get, get this going.


And flattening the curve in phase two is about being able to open up these services to women. So, I think the more we can focus on what the phase two can look like and encourage countries and leaders that they have to give the right information about using a mask, about contact tracing, and about testing on a large scale, the sooner we can think about what are going to be the macro, upstream policies that we need to help to reduce the risks associated with domestic violence.


Caroline Bettinger-Lopez: Thank you so much. So, Shawna, picking up on some of those streams of ideas, can you speak specifically about how systems of protection for domestic violence survivors, whether they be legal health, social services, education, or housing, how have those services been affected during COVID times?


Shawna Wilson: Well, the first thing that sticks out is shelters, right. You have issues with social distancing and the virus spreading. So, the number of people who can go to shelters is limited. And so, a number of countries had to think, “How do we work with this?” And I know France and a few other countries have provided hotels for individuals for areas of protection.


I’m picking up on Felicia’s thread about the cost of inaction and delay in seeking care. That’s a huge issue with domestic violence because you have your sort of health services all focused on containing and mitigating and dealing with COVID-19. You’re not seeing people getting help for other injuries or medical assistance. And so, you’re pushing even those with domestic violence injuries even further, sort of, off the grid.


The other sort of issue that really came across from a number of our members was the digital divide, right. So as everything goes online, what about those who don’t have access? And it was interesting, we had a number of roundtable discussions with UN Women about this. And not only is it a digital divide with internet, but even just mobile devices. So, they’re still—I think the number was about 430 million women who are just unconnected. And so, it’s really forcing all of us to sort of think differently. And how can we connect and support individuals?


And the other sort of issue on, sort of, service that really came to the forefront was relayed to us by a member in the United Kingdom. And it’s this sort of tension between protecting individuals. So, there’s a huge push not to detain individuals because of the spread of COVID in detentions or centers or jails. But at the same time, you have an individual who is causing harm to another individual, and you need to separate them. So where does the “perpetrator” go? If you’re not going to hold them in detention, do you find another place for that individual to go? Do you move the victim? And if there are children, do you move them? How long do you move them? Who pays for this? Where do they go? So, these are sort of new issues that have come to the forefront that judges are trying to work with a range of actors, primarily civil society actors, to try to figure this out and, sort of, dealing with these, sort of, dual tensions of, sort of, public health and, sort of, public safety versus an individual’s safety and protecting victims of domestic violence.


Caroline Bettinger-Lopez: Thanks so much. So, you both have underscored the problems that pre-existed this crisis, the ways in which we have experienced new problems during this crisis, and the ways in which pre-existing problems have surfaced in new ways that are both potentially exacerbations of what existed before or new manifestations. And so, we really are dealing with such complex and deep systemic problems.


And so, now I want to move on to think about, well, how we respond to that. And both of you are deeply engaged with various systems that are involved with responses. Felicia, you’ve been deeply involved with data analysis in so many different areas as a health economist, and I was wondering if you could please speak about the role of data in efforts to address public health crises, such as domestic violence, in times of COVID? Is domestic violence adequately tracked around the world, for example, before and during this crisis? And what about the need for tracking data on integrated policy frameworks and data on strategies at both national and subnational levels?


Felicia Marie Knaul: So, I think one almost obvious point, again, is that the data we have is very high-income country focused. And the few grants that are going out have tended to be for U.S. or high-income country research. There’s really very few that are targeting and focused on low- and middle-income countries, where what can be produced may not be of the same quality, but is so very important because we’re starting from a much lower base, and we know much less. And there are a couple of examples that I think are really great of grants that are going out. There’s one where we look at Innovations for Poverty Action. Again, this is some of the work of CGD and highlighting how important it is to try and get those data in low- and middle-income countries.


The other piece I wanted to highlight, and it picks up on some of what Shawna was saying, is that we know very, very little about the cyber violence part of this. And since we have kids, girls, boys, people of all genders on screen so much more—and both in the school setting and just in what they do with their time—and we know that cyber violence is such a great threat, we know so little about what to do about this. I think that’s an area we need to think about collecting much better data. And again, we’re, you know, very, very grateful to have a world expert on this; Mary Anne Frank’s working at this at the University of Miami. But I think that’s an area where we need to concentrate a lot of our efforts. Our Lancet commission is going to focus quite a bit on this, for that reason.


For more of a programmatic point of view, I’m concerned—we just don't have the evaluations we need. The work that was done in what works, it gives us an incredible base on which to look at, but they’re largely small scale. And we’ve seen you know very few evaluations that look at either subnational or national programs, and what the impact is. And so, we don’t have that base information that would help us to know what works and what doesn’t work in the longer term in the face of the pandemic. And thinking about some of the programs that Shawna was mentioning, we really don’t know what the impact is. You know, we ask a set of questions. Was it a good idea to use pharmacies as a place to go to be able to get access or grocery stores? We don’t know. What if people then said, “Oh, I can’t go to the grocery store anymore, because someone’s going to see in the grocery store that I’m going to get access to care.” And then, that affects food access. And we have this series of questions that we can’t really answer about the impact of programs.


And then a last thing is, while I was just saying we need those national evaluations, I also think that we need to do the labor-intensive work of tracking policies at the subnational or state, provincial, or municipal level. We spend a lot of time either on the community programs, which are very important, or they give out national policies, which I think on the financing side is really important. But a lot of what needs to be done and is going on has to happen at the subnational, municipal level. And maybe that sounds obvious if we think about, say, a U.S. or Canadian scenario. But it’s not obvious when we’re talking about low- and middle-income countries. What we’ve learned from Kerala state in India has been huge. What we need to figure out in Brazil and Mexico in the face of very poorly thought-out national policies, to say the least, around COVID on the health side is: what’s going to happen at the state level? And some of these states are the size of many countries around the world. So, it’s much more labor intensive, but I would love to have much more information on what municipalities cities are doing, and what states are doing, and see what works in that sense. Maybe I’ll stop there.


Caroline Bettinger-Lopez: Thanks. That’s so helpful. So, Shawna, taking it kind of back to IAWJ, the International Association of Women Judges, can you talk about the work that IAWJ is doing to promote women’s access to the courts and to advance women’s rights to equal justice, and specifically, I’m interested in hearing about some of the main barriers to women’s equal access to the justice system before and after the COVID crisis. And also, you know, we’re having a very interdisciplinary conversation right now, which I think is generative of so many interesting and important ideas. Can you talk about how other disciplines—economics, public health, or otherwise—can help us as lawyers to better understand the problem and adequate responses to it?


Shawna Wilson: I think the answer to that question, you’ve sort of laid the groundwork when you talked about how this is just really sort of an exacerbation of existing issues and things that we already knew, and they’ve just really come to the forefront. So, we all know that it’s sort of legal and policy frameworks that really impact women negatively, and some are discriminatory. So, you’ve got issues with property, inheritance, divorce. So, things that are sort of outside what you would really think of, sort of, the pandemic, but they’re all sort of intertwined, because then it goes into, sort of, resources and economic dependence or economic instability and, sort of, the wage gap and the digital divide, and all of those things rolled together, sort of, really create these difficult obstacles. And so, you know, our members are looking to work with a range of different actors, and I, sort of, definitely appreciate Felicia’s point about an evaluation. Like, we don’t know about the pharmacies or groceries or postal workers, but we’ve had to rely on, sort of, different actors now. So, it definitely—we always knew it took a village, but now we’ve just added more people to our village. I don’t know if I would have thought about including, you know, bus drivers and postal delivery individuals into, sort of, the fight, but it really does—it does point to the fact that you really do need to get the community involved, and there’s so many different touch points.


And another point or issue here that was important was one country has now changed who can file a complaint. So, before you would have to have the victim be the individual who would start any sort of protection order, but now if anyone is seeing signs of abuse, they can relay that information, and a case can start. So, you don’t always need the complaining witness, which I thought was, it’s an interesting way to go to try to again provide the short-term, immediate protection.


And the other thing is that it really has strengthened, I think, the bond and the need to work outside of the bubble of the justice sector. And our members and judges have always known the importance of civil society, but it has just really come to the forefront during this pandemic. And, for instance, we had one jurisdiction where they were—they realized that they were doing everything virtually, but there were a number of communities that just didn’t have access. So, then they were able to partner with an NGO that brought the individual to a secure location so that they could have video access, they could do the hearing for the protection order in it. And then the NGO also provided additional support and services.


And so, for us, there’s nothing, sort of, again, I think, like rocket science, or anything sort of very new, but it just reiterated a lot of the points and efforts that we do already. So, besides, sort of, it takes a village, the other thing is sort of keep it local. And I think this is something, Felicia that you were hitting on and for domestic violence issues, it’s really important to look at, sort of, the local response—like at a municipal level or something comparable. Because that’s, sort of, where the first sort of touch point will be. It’s sort of where the community can rally and provide the support needed. And so, we’ve always focused on local solutions. And this just sort of reiterates the need for continuing to do so.


Caroline Bettinger-Lopez: Great, thank you. Yeah. And I can, I can echo that as well, in my capacity as a law professor at University of Miami and directing the human rights clinic there, we’ve been deeply engaged at the local level with stakeholders who are involved in serving domestic violence victims. And one thing that we’ve learned is that the right hand and the left hand oftentimes don’t speak with one another. But now that has been magnified many folds.


And so, we’re now at a at a place in our own community where shelters or legal service providers or counseling centers or other folks within the criminal legal system don’t necessarily know who’s open, who’s not, who’s virtual, who’s not, how services are being provided, what contingency plans are being made, if survivors don’t have access to technology, etc. And, and so we’re in the process of trying to develop a database that can be updated on a real time basis by community members to just try to, kind of, keep in touch with one another through those frameworks. So, it’s so essential, I think, that the local point that both of you are making about both kind of local communication as well as local data collection.


So, just finally, we’re wrapping up, and I want to give our attendees a heads up that we will shortly be opening it up for Q&A, and we look forward to your questions. So, please start to prepare your questions. But as we wrap it up, I’d like to ask Shawna and Felicia, if you could talk about your recommendations—any recommendations that you haven’t touched on already—or any closing thoughts about where we go from here. You know, there’s a report from Women, Business, and the Law from the World Bank that found that thirty-five countries still lacked laws that specifically address domestic violence. And then we have other countries with highly developed legal systems in the area of domestic violence, but that were, that had major problems before the pandemic, which, as you’ve said, has been exacerbated. So, how do we go about, kind of, moving forward given these very diverse regimes and circumstances across high-, middle-, and low-income countries? What recommendations do you see both for the international community, national governments, the private sector, and, of course, the local and state, municipal levels. So, Shawna, do you want to kick us off?


Shawna Wilson: Yes. So, I think the key—one of the key things is really still to tackle sort of the stigma and the cultural norms and stereotypes, right. And that is one of IAWJ’s sort of bread and butter. And the thing that gives me hope is, I looked at an evaluation of a project—a training program that we did for judges a number of years ago—and it was in a country where rape was legal, and the practice was you had to marry your rapist, right. Because you were no longer a virgin. And so, we were do doing training to help judges, sort of, identify their own, sort of, gender bias, implicit and explicit. And going through this sort of evaluation, this one judge said, “I went through this training, and it really did make me take a step back and think how I handled these cases, and I asked myself some really important questions.” And based on that he started to approach rape cases differently at the time, but after some time, the cases, rape became a criminal offense, and he said, after going through this training that then he had found people guilty of rape.


And so, it gave me hope that there it takes time, but that you’re able to really change attitudes. And judges are humans, and they’re bringing, sort of, the bias and their attitudes to their work. And so, if we can continue to, sort of, tackle the stigma, and you know, think about just, sort of, how domestic violence was handled here in the United States just thirty years ago, and how far we’ve come and how far we have to continue to go, I think those are sort of critical. And that’s going to stay the same, sort of, regardless of what the operating context is. And then I think the, sort of, those key things that we’ve talked about already this afternoon, it’s like keeping it local and really trying to dismantle, sort of, the stove pipes among the various sectors. Because it’s a very complicated problem that requires a lot of input from all of us.


And one of the things that I liked, and I highlighted at the beginning, are these domestic violence courts. They’re sort of problem-solving courts that are much more comprehensive and holistic, and they’re looking both at the victims but also the perpetrator to try to address some of the outside and target root issues, and looking to offer not only protection and safety for the victim, but trying to really reduce and eliminate the violence altogether. And so, I think we’ve got a wealth of, sort of, material, and we’ve got some anecdotal evidence of things that can work, and we just need to continue to fight the fight.


Caroline Bettinger-Lopez: Thanks so much. Felicia.


Felicia Marie Knaul: I want to say that that the point you brought up in the last set of questions about the opportunity to have others who are not the survivor come forward and declare—I think that’s huge. You know, anyone, any of us who’ve been close to someone who’s had to stand up and share would know how incredibly important it is.


And the other is that we’re doing things, as I think Shawna mentioned, we’re doing we would never been able to try before. I mean, that’s the one thing that’s good about an emergency in a crisis is that you’re forced to try things. So, we’re going to have lessons, knowledge, learning that will come out of this that I don’t think we could have had under any other circumstances. We never could have risked, and rightly so, to have done some of the things that the world has had to do.


So, what can we learn from this? What can we learn about pharmacies, grocery stores, and post offices that we could never thought of doing before? And really think out of the box? You know, it’s like the idea of using hairdressers as places where you can share information. You have to really think out of the box. I think that that's one point.


But the other in a more general kind of a policy framework, I think, you know, all of the evidence that we have to date on the policy side, and a lot of it comes from the “what works” literature, which again, is so strong, is that they’re talking about a three-pronged approach, right. Tackling women’s health needs, supporting economic empowerment, and challenging inequitable gender norms and power dynamics in society as well as in the household, and, I would add, with a very strong focus on the most vulnerable and using an equity lens, which is what we’re, you know, over and overall learning in this other emergency that we’re seeing around something like Black Lives Matter. But we have this situation where health systems were weak before the pandemic, and they were particularly weak on issues like mental health support and, of course, violence. And so, we need a continuum of care approach that's intersectoral.


But the other is that I think there’s a lot of learning to be had from social protection programs. There were like literally decades of evidence around the effectiveness of programs like conditional cash transfers, so called “CCT” programs, but the bigger point there is what we’ve called a diagonal approach, usually to health system strengthening. It’s the idea that you can layer programs.


So, if you have a strong state or national program that’s a conditional cash transfer—there’s one in New York, there are some all over the world—layer into that. Because with very little extra investment, you get a lot of spread. And I think that’s what we should be thinking about when we’re thinking about domestic violence related responses. That’s where you get that strong income generation opportunity. That’s where you can reach schools, as well as clinics, on a large scale without having to recreate what we’re going to think of is parallel programs, which is what you generally want to avoid.


Now, that said, I just I have to signal that some countries really, you know, I think went the wrong direction, unfortunately, just before the pandemic—shutting down major reforms, shutting down CCT programs. And the country I know best is Mexico—shutting down a very successful conditional cash transfer social protection program just months before the pandemic. They didn’t know a pandemic was going to hit, but now we don’t have those platforms. So, what I would say is for countries that still do have those platforms, keep them, strengthen them, maintain them so we can use them going forward. For countries that don’t, start them. For countries that had them, get them back up and running because all of our evidence is that they can really change a lot of things on health and education. And I think also, it’s where we can do some of the most innovative important work on preventing domestic violence.


Caroline Bettinger-Lopez: Thank you, Felicia. We will now open it up to question and answer, so our events team will now share instructions for how you can participate.


Event Manager: Hello, as a reminder, today’s discussion is on-the-record. To ask a question, please click on the raise hand icon on your Zoom window. When you are called on please accept the “unmute now” prompt, then proceed with your name and affiliation, followed by your question. If you’d like to view the roster of registered participants for this meeting, please click the link in the Zoom chat. Thank you.


Caroline Bettinger-Lopez: Thanks so much. So, I’d like to kick off the Q&A by giving the floor to Tom Bollyky, who is the director of the Global Health program here at the Council on Foreign Relations, which is cosponsoring this roundtable. So, Tom, would you like to ask the first question, please?


Thomas J. Bollyky: Sure. Well, let me start by congratulating you, Carrie, for this great event and its timeliness and to the panelists for a very provocative and informative set of remarks. So, thank you both for being here.


It does seem like there may be an opportunity, through our preparation for future pandemics and future waves of this pandemic, to address this and other challenges and inequities that have been revealed by the pandemic. A lot of that seems likely to be led, at least initially, at the national level—how do we better protect countries against pandemics? So, what is the role of—and you’ve mentioned here that this is a problem that needs to be addressed at the local level, fundamentally—what is the role of national governments in enabling a local response? Which countries are doing that well should we look at? And of course, we’re in the midst of a hot debate about the United States, both because it’s an election year and because it’s been a little bit anomalous, in some ways, in this pandemic. How is the United States doing in supporting localities on domestic violence? Anybody can go.


Felicia Marie Knaul. Tom, it’s nice to hear your voice, and thank you for all the things you’ve been writing and sharing with the global health community on this pandemic.


You know, I’m a little biased because I’m Canadian. So, I often turn to Canada. And I’ll avoid, since I’m not a U.S. citizen, saying too much, and I’m not an expert on the U.S. system as much as I am on some other systems. But I can say, sort of, if you turn a little bit to the north and think about what a national policy has been, what speaking out appropriately and leadership looks like, and also then working at the provincial level, I think there are a lot of examples to be drawn. You know, I have to speak out strongly about leaders that don’t wear masks and don’t speak according to what I think is gender-norm appropriate, and they somehow tend to coincide in the same individuals. And a lot of the messaging, a lot of what we need is strong leadership, strong messaging. Now, what we are seeing in, I think, what we’ve been studying in depth, is in places like Mexico and Brazil, where sort of, a total lack of a reasonable national policy on all fronts in the face of this pandemic has—we’ve been calling it punt politics—has sort of devolved everything and in a somewhat decentralized system to the state level, which wasn’t the way that I think it should have gone. But what we are seeing is pockets that are doing very well, and states that are not doing very well. And that’s what drew me to say we really also need to study what’s going on at the state level. We’re seeing actually some very innovative work on violence coming out of Mexico City, which is actually aligned with the with the national government, in terms of political parties, but we’re seeing some very innovative work in Mexico City. On the actual pandemic front, huge variation across the states in what and how strong they are and how effective their response has been to the pandemic overall, which will say something about how quickly they can go into a phase two.


Caroline Bettinger-Lopez: Shawna?


Shawna Wilson: I’m just quickly, just in looking at the time, I would say it is important, perhaps to have sort of a national framework, and then you allow, sort of, state and counties and, sort of, whatever the governance structure is to then implement and supplement that based on what their needs are. And, so you sort of saw that model a little bit with the United States and, I think, in how we started to tackle domestic violence when you had the federal legislation that came on high that really sort of set the tone for, sort of, state and municipal action. And so, I think, here we’re looking at, again, so many different issues that are so interwoven and that so you do need, sort of, a good government approach and the political will to address all of those. And then, sort of, that’s the framework, and then you can leave maybe the implementation, sort of, down to the local level so that it’s meeting the particular needs.


Caroline Bettinger-Lopez: And I would also just—


Felicia Marie Knaul: I’m sorry, go ahead, Carrie.


Caroline Bettinger-Lopez: Oh, finally, I was just going to add the importance of strong women’s movements and strong civil society in connecting the local with the national with the global. And, and so yeah, that’s just such an important piece because a government’s response that is not informed by the experiences of survivors will not be a good government response. It won’t be solid. It won’t be based on lived experience. Felicia you’re—?


Felicia Marie Knaul: No, I was just going to say that, you know, we earlier, we were trying to have this interdisciplinary conversation, and listening to Shawna, the way that we would say this in health systems jargon is you want—we call it—stewardship at the national level, and then delivery of services and financing of services at the local or state level, and then we want very fragmented human resource generation. So, it’s very interesting that it’s exact—it’s a very similar model.


Shawna Wilson: We just use different lingo, yeah?


Felicia Marie Knaul: But we got—we’re figuring it out. We’re talking to each other.


Caroline Bettinger-Lopez: Well, thanks. Those are great responses. I’d like to ask Alexandra Bro, who is our research associate at the Women in Foreign Policy program to call on the next question.


Alexandra Bro: Yeah, we have a question here from Louise Shelley.


Louise Shelley: I’m, I work on the issue of human trafficking, of which domestic violence is a key associate of it—that many women and young girls who are exposed to it are more likely to become victims of trafficking later in their lives. And I’m wondering if in some of your work on health or the judiciary, you are making these linkages?


Shawna Wilson: Yes. So, we also work quite intensely on human trafficking. And one of the areas that we are focused on is victim identification. And this is very true, I think, for domestic violence as well, is that often times individuals are in the system for different things, and they’re coming before the court. And it’s only then do judges realize that this individual is a victim, and how do we provide the services to that individual? How do we try to dismantle this trafficking ring? So, yes, we definitely see the correlation. You know, there’s the intimate partner violence. We’ve seen, and I'm sure you have, with trafficking victims who are trafficked by their partner, by their family, and violence is a way of keeping them in line. And so, it is very much part and parcel of the human trafficking work that many of our judges and member association see and do. And so, we do a lot of training of the judiciary, like I said, on victim identification and victim centered approaches so that you are not re-victimizing individuals who are going through the process, but again, making sure that they have access to a variety of support services.


Louise Shelley: Thank you. Such a good panel today.


Caroline Bettinger-Lopez: Thank you very much. And I think we have one final question from Sam Kiernan from the Council on Foreign Relations.


Samantha Kiernan: Hi, everyone. Thank you so much for this absolutely fantastic discussion. Like Carrie said, I’m a research associate here at the Council on Foreign Relations’ Global Health program. And earlier you discussed how a lack of shelters and safe places is a serious issue during this pandemic and then concerns over social distancing. Now, it may be premature, but I wanted to ask how you see that issue intersecting with the climate disasters occurring all across the country and the world, and how women and children’s health and safety can be supported during these multiple, intersecting crises? Thank you.


Felicia Marie Knaul: Shawna, do you want to start on the legal front?


Shawna Wilson: No, because I hadn’t actually thought about it. But that is an incredibly interesting and very forward thinking and timely question. And I would think, well, I’ll say know, but yes, that it’s all part and parcel, I guess, of displacement, right. And sort of what other sort of social safety nets would be available to victims and individuals. And I like the point that Felicia made that in this time of crisis, it allows us to do things that we had never thought possible, or we hadn’t even thought of before. So, it’s really pushing us to think differently. And it’s too bad that it often doesn’t happen until there’s a crisis that we’re not creative enough to deal with these types of issues. But I do think you’re onto something, and it could be something that I think we may want to do a deeper dive with our members and try to get some insights on that. I think there’s definitely a correlation.


Felicia Marie Knaul: Also, picking up on that. Unfortunately, this is also probably somewhere where we can learn a lot from low- and middle-income countries. Actually, Nigel Crisp has a great book on this: the idea that we keep thinking we, sort of, learn so-called north-to-south, but that there’s a very different way we can think, and some of, obviously, the most heinous and difficult displacement conditions are being seen in populations around the world in low- and middle-income countries. The huge fear around COVID-19 among the Rohingya and the displaced Rohingya is something to be incredibly worried about. You know, there’s, I think there’s been quite a bit of discussion and some very interesting papers suggesting that in situations of real poverty, we shouldn’t even talk about lockdown—that people are going to die of something else if we do the lockdown. And so that’s not the way to go. But when you think about displaced populations and that kind of mobility, you’re really up against both. So, my question is now, what can we learn from what's being done there? What’s being done in Colombia with the Venezuelans that are, have moved and continue to move in ways and to the extent they can? What can we learn that might be useful to think about what’s going on in this country—how layers of climate change are going to move people in ways that we really don’t know how to manage, with or without a pandemic?


Caroline Bettinger-Lopez: I would just add that Human Rights Watch has done some interesting work and is digging more deeply into this very question about the connection between climate change, women’s health, and violence against women. And so, they found, for example, in urban areas where there are no trees and the sun is much more intense, temperatures can be ten degrees higher than in other parts of the metropolitan area that have more trees, and the rates of miscarriage and the rates of women’s cancers are much higher in those areas. And so, they’re exploring those correlations, which could be the subject of many more roundtables about the causes and consequences of those are those climate change disasters in low-income communities, specifically for women. So, thank you.


Felicia Marie Knaul: One other thing that might just jump in on that is that I’ve been incredibly heartened to see how some communities that suffered tremendous displacement and hardship and were refugees as a community are standing up and trying to support communities now that are suffering displacement. One of them has been the Jewish community through an organization called HIAS. And if you really understand what it means to have been a displaced person and to have risked that to save lives, I think using that to think about the current situation and do something about it will generate, I hope, a stronger community response.


Caroline Bettinger-Lopez: Well, thanks so much to both of our panelists, Shawna Wilson and Felicia Marie Knaul, for your participation today. Thank you also to the Global Health program for cosponsoring this with the Women in Foreign Policy program at the Council on Foreign Relations. This has been a really wonderful roundtable. I’ve learned so much, and it’s always wonderful to connect with our community, even if it’s virtual. So, we look forward to seeing many of you in the future, both on Zoom and one day in person again, and we wish you all well. Thank you for attending today.

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