Samantha Willan

Purpose: Women often do not recognize when they experience attempted femicide, so another way of measuring it is needed for research. We examined narrative accounts of femicide attempts, and analysed data to determine whether we could systematically expand the definition of attempted femicide, for the purposes of research. Methods: We recruited a non-probability sample of 3742 women into the Fedisa ModikologoStudy. They were 18–45 years and had experienced severe intimate partner violence in the previous year. They completed an interview with two closed and one open question about attempted femicide experiences. Results: Strangulation, suffocation, stabbing, bludgeoning, gun shots, fire, mocked suicides and accidents were all used in attempted femicides, which 32.4% (1211/3742) of women said they had experienced. These were significantly more common among this sub-group of women. Gunshot injuries and loss of consciousness due to strangulation were the most strongly associated with a recognized femicide attempt, however other injuries were also associated. Assuming unrecognized femicide attempts were broadly similar, we conducted an analysis with recognized femicide attempts as a putative gold standard, and examined change in the sensitivity, specificity and ROC AUC of including different elements in the attempted femicide definition. After incrementally adding elements, we optimized the model with a sensitivity to 85.0%, specificity of 52.7% and ROC AUC of 67.1. Conclusions: Our findings point to a working definition of attempted femicide as having a recognized femicide attempt, or injuries leading to loss of consciousness, acts of strangulation, suffocation, gunshots, burns, or stabbing to the neck, torso or genitals.

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.

In contexts of extreme adversity and oppression, trauma exists as an open-ended ongoing threat, requiring us to recognise the ways people cope as adaptive survival mechanisms shaped by external hardship. Through a Black feminist lens, we explored the narratives of 17 young people in KwaZulu-Natal, South Africa, detailing their day-to-day experiences navigating hardship and potentially traumatic events, collected as part of a co-produced community-based initiative. Using grounded thematic network analysis, we offer an understanding of the young people’s emotional experiences and the spectrum of strategies they use to cope. Feeling through Survival consists of five themes representing emotion experience of trauma, ranging from heaviness and fear to joy and pride. Coping as an Act of Resistance encompasses eight themes depicting young people’s efforts and subtle agentic acts to persevere; including collective patterns, sacrifices, adaptive efforts to create a sense of safety, escapism, breaking free and boundary-setting, support systems, sense-making, and for some, meaning-making. Our analyses provide insight into the complex experience of trauma and survival, where multiple, at times, seemingly conflicting, realities co-exist. By adopting a non-judgemental approach to coping, we move beyond simplistic dichotomies of risk or resilience, deepening our understanding of what it means to live and cope amidst persistent adversity. Our findings highlight the importance of contextualising individuals’ emotional and behavioural functioning within the circumstances that drive their efforts to cope. This understanding necessitates a shift in approaches to therapeutic interventions with individuals and communities facing open-ended trauma, particularly in resource-constrained settings. Recognising the risks of assuming safety or closure from trauma, interventions should be re-oriented towards supporting navigation of ongoing traumatic contexts, addressing barriers to accessing safety, and facilitating community empowerment.

Marginalised young women and men in South Africa experience and perpetrate high rates of intimate partner violence (IPV), shaped by their contexts and life histories. To address this, we co-developed Stepping Stones and Creating Futures Plus (SSCF+) with young women and men living in marginalised communities to reduce IPV, strengthen livelihoods and improve mental health. We assessed the intervention’s feasibility, acceptability and potential impact, when delivered to small single-gender friendship groups, through a mixed-methods study. We had 30 groups for men and women, and randomly allocated groups to receive the intervention or not. In-depth interviews were conducted post-intervention with n=23 women and n=22 men. Participants were aged 18–30 living in selected communities. We assessed the acceptability of the intervention (participant attendance, overall views) and evidence of change in IPV perpetration (men) and experience (women), livelihoods and mental health 5–6 months post-baseline, and hypothesised mechanisms of change. N=163 men and N=162 women were recruited and we followed up 96.9% men and 100% women at endline. 81% women and 53% men attended at least 70% of sessions, but 3 clusters (10%) ended early. Participants reported the intervention was relevant and enjoyable for them, although they raised some areas for strengthening. At endline, women reported non-significant reductions in physical IPV (aOR0.64, 0.27, 1.53), sexual IPV (aOR0.59, 0.21, 1.65) and severe IPV (aOR0.73, 0.30, 1.75), and significant improvements in livelihoods and mental health. Men reported significantly less physical IPV perpetration (aOR0.38, 0.17, 0.81) and non-significant reductions in sexual IPV (aOR0.77, 0.39, 1.51) and severe IPV (aOR0.86, 0.47, 1.56), as well as improved livelihoods, but no change in mental health. The co-developed SSCF+ intervention was acceptable and showed promise in reducing IPV and strengthening livelihoods, as well as addressing overlapping risk factors. Further research is required to determine its effectiveness. The study was pre-registered at clinicaltrials.gov (NCT05783336).

Introduction: Gender-based violence (GBV) is a threat to the health and well-being of women globally, and a key barrier to the achievement of the Sustainable Development Goals 3.3 and 5.2. Harmful alcohol use is a recognised risk factor for the perpetration and experience of GBV, particularly, intimate partner violence, and for the severity of intimate partner violence. This paper seeks to explore the role of alcohol in women’s experience of severe intimate partner violence (SIPV) in South Africa. Methods: We conducted a qualitative study, using six focus group discussions and 20 in-depth interviews with 62 demographically diverse adult women from three provinces in South Africa (Gauteng, KwaZulu-Natal, and the Western Cape) who sought help for SIPV. Findings: Women reported alcohol-related SIPV, frequently describing that her partner intentionally started arguments after he had been drinking. Their abuse included controlling and coercive behavior that restricted their movement and ability to participate in daily activities, economic abuse, and instances of severe physical and sexual intimate partner violence and attempted femicide. They viewed men's alcohol use as a ‘right’ associated with masculinity, that often intersected with expressions of masculinity, including controlling behavior, dominance, and aggression, and performing a provider role, especially among friends in taverns and bars. Conclusions: Planning for effective prevention, providing services and policy efforts requires an understanding of the complexity of the interaction between men's alcohol abuse and their perpetration of SIPV particularly in a context like South Africa, where both harmful alcohol use and GBV are prevalent.

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.