The Public Health Approach to Femicide Prevention
The prevention of femicide is the overall goal of the Canadian Femicide Observatory for Justice and Accountability.
For the past several decades, there have been increasing efforts internationally to prevent violence against women, including femicide. It is recognized that key and ongoing challenges are the need to address gender inequalities as well as entrenched negative attitudes and stereotypes about women and girls. In addition, it is also recognized that dominant attitudes and beliefs accepting of, or tolerant towards, such violence perpetuate and maintain these types of violence overall and, specifically, against women and girls who are already marginalized and vulnerable (e.g. Indigenous women and girls, poor women, immigrant/refugee women). Therefore, preventing the ultimate form of violence against women – femicide – requires knowledge of the broader contextual and underlying causes of female victimization (e.g., gender inequality, power imbalances, misogynistic attitudes, patriarchal social structures, and structural/systemic discrimination).
More generally, the prevention of femicide, and violence against women and girls, faces other practical challenges, particularly at the national level, including a lack of systemic evidence on what works in terms of prevention, services, legal responses, and early and long-term intervention. While there is a growing body of literature on what works, the lack of recognition about the importance of systematically monitoring the processes and outcomes of implementation and the ongoing impact of a variety of initiatives hinders a fulsome understanding of prevention efforts.
In a report by the World Health Organization (WHO), the importance of taking a public health approach to mitigate the risks of violence against women and girls was and continues to be recognized as key to prevention. A public health approach aims to improve care and safety for the general population.[1] In taking a multidisciplinary, evidence-based approach to violence prevention, the public health model emphasizes the benefits of multi-sector collaboration to address issues that were originally seen as largely a medical or criminal problem.[2] The importance of involving multiple sectors is premised on the view that violence is a multifaceted problem that cannot be addressed with a single-factor solution.
Taking a public health approach to addressing violence against women and girls has a general mandate for prevention.[3] To prevent a phenomenon as complex as violence against women and girls, including femicide, involves a four-step process: (1) defining the scope of the problem; (2) identifying the risk factors associated with violent victimization/perpetration; (3) evaluating potential prevention tactics based on the above information; and (4) sharing the knowledge widely.[4]
The public health approach utilizes the ecological framework (see Figure 1) to further the understanding of the risk of violent victimization faced by women and girls. This framework was developed with the knowledge that no single factor accounts for risk but rather that the interaction among many factors at four levels – individual, relationship, community and societal – contributes to the outcome of violence and, ultimately, femicide. Brief descriptions of the four levels are provided here and expanded upon below:
- Individual-level factors include personal history and biological factors (e.g. experiencing childhood maltreatment, alcohol or substance abuse histories).
- Relationship-level factors include family, friends, intimate partners, and peers who may increase or protect against risk of violence.
- Community-level factors refers to those contexts in which social interactions occur (e.g. schools, workplaces, neighborhoods).
- Societal-level factors refer to social and cultural norms that may influence acceptance or rejection of violence as well as social structures, and institutional policies and practices that produce harmful or preventive outcomes in relation to violence.
Numerous academics, policymakers, community groups and advocates alike have recognized that risk at the societal level permeates and influences the degree of risk at the subsequent levels.[5] There is an interplay of factors among the four ecological levels that may either increase or decrease the risk women and girls face. The model provides insights on why certain communities have higher rates of violence, why violence occurs in some settings but not others, and why certain individuals are at an increased likelihood of perpetrating or being victims of violence.[6]
It follows, then, that when developing femicide prevention initiatives, the identification of risk and protective factors, and how they work in isolation as well as together, plays a critical guiding role.
Multiple risk factors have been identified at the societal, community, relationship, and individual level – each of which carries specific preventative measures.
Figure 1. Ecological model for prevention of gender-based violence
Below, at each level, we describe briefly, what prevention initiatives might look like with a few select examples. One of the long-term goals of the Observatory will be to generate more detailed and systematic knowledge about what is occurring across the country at each of the levels discussed. This review should be considered introductory only.
Societal Level
The societal level refers “to the overarching institutional patterns of the culture or subculture, such as the economic, social, educational, legal, and political systems” of which community, relationship, and individual characteristics are concrete manifestations.[7] Because femicide is a global concern, the United Nations has created a model policy for states to use as a guiding framework for eradicating gender-based violence. Building off international human rights’ law—which guarantees fundamental rights for women—the protocol is now focused on rectifying the structural inequalities, gender stereotypes, and discrimination that affect women and girls which, in turn, create an atmosphere that is tolerant of violence toward women.[8] One area of the protocol specifically focuses on addressing and rectifying cultural definitions of masculinity that promote a patriarchal society, the reinforcement of traditional gender roles, and the sense of male entitlement over women.[9]
Without addressing the structural inequalities and entrenched stereotypes that justify the subordination of women, men who perpetrate violence against them will experience impunity, not accountability. Under international law, states are now obliged to prevent acts of violence against women and, when they do occur, to investigate and punish perpetrators with due diligence.[10]
In addition to international law, national legislation is required to denounce all forms of violence against women which, in turn, can contribute to a disruption of the cycles of abuse and mistreatment which can result in femicide.[11] [12] Various legislative and policy frameworks exist at the provincial and territorial levels in Canada, although none specifically target violence against women, instead adopting the terms ‘family violence’ and ‘domestic violence.’ There is no national legislation other than the Criminal Code of Canada which was amended in 1996 to allow for some forms of violence to be viewed as an aggravating factor, including violence that occurs within the context of intimacy such as against a spouse or child.
Currently, in Canada, when considering larger societal efforts at prevention, two national initiatives that would encompass prevention efforts targeting femicide, as a form of violence against women, are of note. First, the Canadian Family Violence Initiative has been the federal government’s primary strategy for addressing family violence since 1988.[13] This national initiative brings together 15 partner departments and agencies to prevent and respond to family violence, led and coordinated by the Public Health Agency of Canada. Second, and more recently, the Canadian government launched its Strategy to Prevent and Address Gender-Based Violence, which builds on current federal initiatives and proposes to lead to greater action for gender-based violence which would include femicide.[14]
While ongoing work continues to address larger social structural and practical issues, prevention efforts are ongoing at various levels of society and governments and they continue to evolve. To complement national legislation and action, prevention requires the development and implementation of related action plans, public policies and programs. It will be the goal of the Observatory to identify existing initiatives over the long-term that exist across the country as one way to understand what Canada, and its provinces and territories, are doing to prevent femicide, as one form of violence against women and girls, and to locate these efforts internationally.
With some exceptions, the emphasis on prevention of femicide has focused largely on intimate femicide which is the killing of women by their current or former male partners. This is also true in Canada. The one exception is the recent focus on missing and murdered Indigenous women which highlights the varying other contexts in which women and girls are killed.[15]
Given the emphasis on intimate femicide, many prevention efforts have focused on this subtype of femicide, but continuing work of the Observatory will identify other more broadly-focused femicide prevention initiatives. Below, we discuss efforts targeting intimate femicide.
The emphasis on intimate femicide
In their report on femicide,[16] the World Health Organization recognized that a large proportion of femicides occur within intimate partner relationships, largely perpetrated by current or former male partners. Therefore, to prevent femicide generally, WHO argues that it is necessary to (a) reduce intimate partner violence; (b) implement intervention strategies to mitigate harms associated with leaving a relationship; (c) implement stronger gun laws, especially for males with a documented history of intimate partner violence; and (d) raise awareness of violence against women broadly and specifically within various social and cultural contexts.
In Western countries, targeting what are largely intimate femicides, several countries have established domestic violence death review committees that examine domestic homicide cases retrospectively to identify potential improvements in systems as one mechanism for preventing future similar deaths. These initiatives are in operation at a national- or provincial/state-level basis in Australia, Canada, New Zealand, United Kingdom, the United States and, most recently, Portugal. [Further information on these initiatives in the Canadian context will provided in the various provincial/territorial prevention profiles as they are generated.]
In addition, several of these countries have national networks that link researchers, policymakers, and community partners and organizations who share a concern with, or an emphasis on, the prevention of such killings. In Australia, there is the Australian Domestic and Family Violence Death Review Network. In Canada, the Canadian Domestic Homicide Prevention Initiative was recently established (www.cdhpi.ca) and, in the United States, the National Domestic Fatality Review Initiative (http://ndvfri.org/) continues to coordinate such efforts there. While most of these prevention initiatives use the gender-neutral language of family violence, domestic violence, and so on, it is acknowledged that the bulk of the killings reviewed are women killed by intimate male partners or ‘intimate femicide’.
Community/Relational Levels
Women and girls are at an increased risk of femicide when the community in which they live is tolerant of these forms of violence against women. In this context, community refers to the environments in which social interactions occur and relationships develop such as educational settings, employment or workplaces, leisure activities or groups, and neighbourhoods. Based on this view, risk at the community level also accounts for relationship factors—or how ties to peers, intimate partners, and family members can increase or mitigate the risk of violent victimization or perpetration.[17] These relationships have the power to influence an individual’s behaviour and their experiences.
Community groups/neighbourhoods: Communities with high rates of violence against women are often those with high degrees of social isolation and where intimate relationships, and the problems that occur within, are seen to be private matters, making intervention more difficult.[18] Research has also recognized the importance of women having strong ties to friends, family members, and neighbours because such bonds can act as a protective factor and reduce the likelihood of violent victimization.[19] However, living in a neighbourhood with high rates of unemployment or few resources can also act to increase the likelihood of intimate partner violence and violence against women and girls more generally.[20]
Schools: Gender norms are often reinforced in schools, at all levels, and can act to validate gender inequalities and negative attitudes toward women and girls. This can be seen with higher rates of sexual violence among college-aged males who associate with peers who condone and encourage such behaviour.[21] Prevention practices at this level seek to educate grade school youth on the importance of healthy family relationships, gender equity and dating violence as well as to reduce the stigma surrounding mental illness to encourage individuals to seek treatment.
Employment and Workplaces: Prevention initiatives focused on employment and workplaces can have one of two objectives. Within this context, it is recognized that to prevent femicide, the gender wage gap must be addressed, including increases in employment opportunities for women to build a better future through training and investment programs. In addition, women often experience violence at work and, increasingly, it is being recognized that workplaces have a role to play in the prevention of femicide and other forms of violence against women.
Part II of the Canada Labour Code requires that employers act with due diligence to prevent workplace violence, provide access to resources or assistance for employees dealing with violence, and acquire a full understanding of the circumstances in which the violence occurred to reduce the risk of future incidents.[22] Within the past decade, further amendments have been made to other provincial/territorial workplace legislation that enhances protections for victims, including employer obligations to help protect workers from domestic violence as well as time off from work for victims which affords them time to deal with issues arising from their victimization. Workplace domestic violence action plans appear to be in their infancy, but the Occupational Health and Safety Council of Canada has provided educational resources and guidelines to encourage employers to develop anti-violence policies.[23]
Other settings: It is increasingly being recognized that the healthcare setting is a crucial point of intervention for women experiencing violence, including those at risk of femicide. Research has shown that femicide victims have often been in contact with healthcare professionals prior to the killing and many women had previously been admitted to an emergency department for treatment of physical violence.[24] Given what appears to be high numbers of femicide victims’ medical treatment prior to death, there has been some movement to use screening or risk assessment tools when dealing with female patients, especially those who exhibit even minor signs of abuse. The effectiveness and impact of such prevention efforts is still being examined.
Individual/Relational Levels
At the individual level, certain biological and biographical factors can influence how an individual behaves within his/her interpersonal relationships. Certain characteristics (e.g., impulsivity, substance abuse, exposure to prior violence, etc.) can increase the likelihood of individuals perpetrating or becoming victims of violence.[25] It follows that individual-level prevention often focuses on risk factors that are commonly associated with femicide and its various subtypes. For example, some women are more at risk than others – those who are younger, have lower education levels, have experienced childhood victimization, and/or have substance abuse histories. Similar factors increase the risk of femicide perpetration, such as witnessing domestic violence or experiencing physical and/or sexual abuse as a child.[26] Various prevention programs are in place to increase education, intervene in cases of child maltreatment, and provide substance abuse treatment.
With respect to intimate femicide, more specifically, two of the most common risk factors are prior history of domestic violence and actual/pending separation. One avenue for preventing femicide, therefore, requires intervention in cases of domestic abuse and the implementation of safety plans for women planning to separate from an abusive partner.
Summary
Preventing violence against women, including femicide, requires attention to the root causes, not just the symptoms. National legislation can lay the foundation for achieving gender equality and providing justice for victims of violence. Denouncing violence against women nationally can also work to dismantle the climate of tolerance of violence against women, particularly some groups of victims, such as Indigenous women and girls. In this way, all individuals and community members have the knowledge and power to identify and assist women at risk of femicide. With the increasing availability of education programs and public awareness campaigns, women are increasingly being empowered which can help both in the short- and long-term to improve their lives, break the cycle of intergenerational abuse, and to educate men about the damage produced by entrenched and negative social norms and notions of masculinity both for themselves and for women and girls.
References
Baker, L., Etherington, N., Pietsch, N., Straatman, A., Ansems, A., Barreto, E., & Campbell, M. (2015). Femicide. Learning Network Brief (Issue 14). London, ON: Learning Network, Centre for Research and Education on Violence Against Women and Children.
Bronfrenner, U. (1977). Toward an experimental ecology of human development. American Psychologist, 513-531.
Dawson, M. (2017). Domestic homicides and death reviews: An international perspective. London: Macmillan Publishers, Inc.
Etherington, N., & Baker, L. (June 2015). Forms of Femicide. Learning Network Brief (Issue 29). London, ON: Learning Network, Centre for Research and Education on Violence Against Women and Children.
Graffunder, C.M., Noonan, R.K., Coz, P., & Wheaton, J. (2004). Through a public health lens. Preventing violence against women: An update from the US Centers for Disease Control and Prevention. Journal of Women’s Health, 13(1), 5-14.
Heise, L.L. (1998). Violence against women: An integrated, ecological framework. Violence Against Women, 4 (3), 262-290.
Johnson, H., Kapoor, P., Durand, K., & Stinson, L.A. (2013, October). “The case for a national action plan on violence against women”. Canadian Network of Women’s Shelters and Transition Houses.
Laurent, C., Platzer, M., & Idomir, M. (2013). Femicide: A global issue that demands action. Academic Council on the United Nations System.
Mamo, C., Bianco, S., Dalmasso, M., Girotto, M., Mondo, L., & Penasso, M. (2015). Are emergency department admissions in the past two years predictors of femicide? Results from a case-control study in Italy. Journal of Family Violence, 30, 853-858.
Phillips, J., Vandenbroek, P. (2014). Domestic, family and sexual violence in Australia: an overview of the issues. Parliament of Australia. Domestic, Family And Sexual Violence In Australia: An Overview Of The Issues. Retrieved from
Sharps, P.W., Koziol-McLain, J., Campbell, J., McFarlane, J., Sachs, C., & Xu, X. (2001). Health care providers’ missed opportunities for preventing femicide. Preventative Medicine, 33, 373-380.
World Health Organization/London School of Hygiene and Tropical Medicine. (2010). Preventing intimate partner and sexual violence against women: Taking action and generating evidence. Geneva, World Health Organization.
World Health Organization. (2012). Understanding and addressing violence against women: Femicide.
[1] Dahlberg LL, Krug EG. (2002). “Violence-a global public health problem.” In: Krug E, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, eds. World Report on Violence and Health. Geneva, Switzerland: World Health Organization; 1–56.
[3] Graffunder, C.M., Noonan, R.K., Coz, P., & Wheaton, J. (2004). Through a public health lens. Preventing violence against women: An update from the US Centers for Disease Control and Prevention. Journal of Women’s Health, 13(1), 5-14.
[5] Heise, L.L. (1998). Violence against women: An integrated, ecological framework. Violence Against Women, 4 (3), 262-290.
[7] Bronfrenner, U. (1977). Toward an experimental ecology of human development. American Psychologist, 513-531.
[8] United Nations High Commissioner for Human rights. (n.d.). Latin American Model Protocol for the investigation of gender-related killings of women (femicide/feminicide).
[10] United Nations High Commissioner for Human Rights (n.d.)
[11] United Nations High Commissioner for Human Rights (n.d.)
[12] World Health Organization/London School of Hygiene and Tropical Medicine. (2010). Preventing intimate partner and sexual violence against women: Taking action and generating evidence. Geneva, World Health Organization.
[13] Include link to: https://www.canada.ca/en/public-health/services/health-promotion/stop-family-violence/initiative.html.
[14] Link to: http://www.swc-cfc.gc.ca/violence/strategy-strategie/index-en.html.
[15] Include link to interim report: http://www.mmiwg-ffada.ca/files/ni-mmiwg-interim-report-en.pdf
[16] The PDF for this public report will be included.
[17] Dahlberg LL, Krug EG. (2002).
[22] https://www.canada.ca/en/employment-social-development/programs/laws-regulations/labour/interpretations-policies/081.html
[23] Include link to: http://www.wsib.on.ca/cs/idcplg?IdcService=GET_FILE&dDocName=WSIB012070&RevisionSelectionMethod=LatestReleased
[24] Sharps, P.W., Koziol-McLain, J., Campbell, J., McFarlane, J., Sachs, C., & Xu, X. (2001). Health care providers’ missed opportunities for preventing femicide. Preventative Medicine, 33, 373-380.
[25] Dahlberg LL, Krug EG. (2002).
[26] Heise, L.L. (1998). Violence against women: An integrated, ecological framework. Violence Against Women, 4 (3), 262-290.