Abstract

Introduction

It is estimated that approximately 35% of the female population (one in three women) worldwide have already suffered violence from a partner or third parties during their lives, either physical or sexual. Violence against women is not only a serious public health problem, but also a violation of human rights. Among the forms of violence, the intimate partner violence (IPV), i.e. domestic violence that is committed by the partner (or ex-partner), is characterized mainly by physical aggression, sexual coercion, mental abuse, and control over the partner, which can lead to physical, sexual, and psychological harm¹1 Organização Pan-Americana de Saúde. Organização Mundial da Saúde. Folha informativa - Violência contra as mulheres [Internet]. Washington: OPAS; 2017 [citado 20 Jul 2021]. Disponível em: https://www.paho.org/bra/index.php?option=com_content&view=article&id=5669:folha-informativa-violencia-contra-as-mulheres&Itemid=820
https://www.paho.org/bra/index.php?optio... . The stress generated in situations of violence is capable of causing serious psychological damage to these women, such as depression, anxiety, and behavioral disorders that can affect financial management, resulting in fewer resources for food planning and other necessities, thus increasing the family’s food insecurity (FI)²2 Melchior M, Caspi A, Howard LM, Ambler AP, Bolton H, Mountain N, et al. Mental health context of food insecurity: a representative cohort of families with young children. Pediatrics. 2009; 124(4):564-72..

Violence against women is one of the main problems responsible for damaging the health of this population³3 World Health Organization. Strengthening the role of the health system in addressing violence, in particular against women and girls, and against children [Internet]. Geneva: WHO; 2014 [citado 20 Jul 2021]. Disponível em: https://apps.who.int/iris/handle/10665/162855
https://apps.who.int/iris/handle/10665/1... . In Brazil, every four minutes, a woman is assaulted - in 2018 more than 145,000 women were assaulted by their partner⁴4 Flaeschen H. Epidemia invisível: o papel do SUS no combate à violência contra as mulheres? [Internet]. Rio de Janeiro: ABRASCO; 2020 [citado 20 Jul 2021]. Disponível em: https://www.abrasco.org.br/site/noticias/saude-da-populacao/epidemia-invisivel-qual-o-papel-do-sus-no-combate-a-violencia-contra-as-mulheres/45504/
https://www.abrasco.org.br/site/noticias... . A study conducted in João Pessoa showed that domestic violence against women directly and negatively affects the quality of life of the victims, since it interferes with their physical and psychological health, as well as their social relationships. Furthermore, the recurrence of violence has consequences that impact the lives of these women, ending their autonomy and directly influencing their well-being⁵5 Lucena KDT, Deninger LSC, Coelho HFC, Monteiro ACC, Vianna RPT, Nascimento JA. Analysis of the cycle of domestic violence against women. J Hum Growth Dev. 2016; 26(2):139-46..

Gender inequality has been considered a central issue in this type of violence, and it is to this inequity that behaviors of oppression and control by the partner are attributed that lead to the submission of the victim⁵5 Lucena KDT, Deninger LSC, Coelho HFC, Monteiro ACC, Vianna RPT, Nascimento JA. Analysis of the cycle of domestic violence against women. J Hum Growth Dev. 2016; 26(2):139-46.. Although scarcely studied, violence against women is a psychosocial element that has recently been introduced by researchers as a major risk factor for FI in developing countrie²2 Melchior M, Caspi A, Howard LM, Ambler AP, Bolton H, Mountain N, et al. Mental health context of food insecurity: a representative cohort of families with young children. Pediatrics. 2009; 124(4):564-72.^,66 Ellsberg M, Jansen HA, Heise L, Watts CH, Garcia-Moreno C. Intimate partner violence and women’s physical and mental health in the WHO multi-country study on women’s health and domestic violence: an observational study. Lancet. 2008; 371(9619):1165-72.^,77 Leddy AM, Zakaras JM, Shieh J, Conroy AA, Ofotokun I, Tien PC, et al. Intersections of food insecurity, violence, poor mental health and substance use among US women living with and at risk for HIV: evidence of a syndemic in need of attention. PLoS One. 2021; 16(5):e0252338..

FI is the lack of regular and permanent access to quality food in sufficient quantity for an active and healthy life, due to economic and social circumstances⁸8 Sistema Nacional de Segurança Alimentar e Nutricional - SISAN. Diagnóstico de implantação no âmbito estadual. Brasília: Coordenação Geral de Apoio a Implantação do SISAN, Ministério do Desenvolvimento Social e Combate à Fome; 2010.^,99 Coleman-Jensen A, Nord M, Andrews M, Carlson S. Household food security in the United States in 2010. Washington: United States Department of Agriculture; 2011.. In Brazil, according to the 2017-2018 Household Budget Survey (POF), 36.7% of the population, that is, 84.9 million people lived with hunger or some degree of FI with 10.3 million living with severe FI. Alarmingly, this number increased in the year 2020¹⁰10 Instituto Brasileiro de Geografia e Estatística - IBGE. Pesquisa de Orçamentos Familiares 2017-2018 – POF. Rio de Janeiro: IBGE; 2020.. According to the National Survey on FI in the Context of the Covid-19 Pandemic in Brazil, the number of Brazilians living with some type of FI jumped to 117 million. Thus, the total rose from 36.7% of households in 2018 to 55.2% by the end of 2020¹¹11 Rede Brasileira de Pesquisa em Soberania e Segurança Alimentar - Rede Penssan. VIGISAN: inquérito nacional sobre insegurança alimentar no contexto da pandemia da Covid-19 no Brasil. Rio de Janeiro: Rede Penssan; 2021.. As mentioned earlier, there is already evidence that violence against women and FI are associated. Studies that have linked domestic violence to FI have found that exposure to this trauma can be a significant factor in experiences of hunger¹²12 Breiding MJ, Chen J, Black MC. Intimate partner violence in the United States - 2010. Atlanta: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2014.^,1313 Chilton MM, Rabinowich JR, Woolf NH. Very low food security in the USA is linked with exposure to violence. Public Health Nutr. 2014; 17(1):73-82..

Given the high rates of domestic violence against women, it is necessary to review the literature on the influence of this event on their food security and that of their families. Therefore, this study aims to review the literature about the relationship between intimate partner violence (IPV) against women and FI.

Methods

A narrative review was conducted in the Pubmed, SciELO, Lilacs, and Medline databases in February and March 2021. The review strategy was developed by associating the terms on FI: “food insecurity”, “food security”, “food supply”, “human right to adequate food”, to terms about violence against women: “intimate partner violence”, “intimate partner abuse”, “domestic violence”, “battered woman”, “spouse violence”, as well as other keywords to refine the search, such as “woman”, and “association”, and the corresponding terms in Portuguese. The list of terms was developed by reading previously published articles and based on the search for terms Decs/MeSH.

No restriction was imposed on the year of publication of the selected studies and language of the publications. As for the study design, cross-sectional studies, cohort studies, and case-control studies were included, while qualitative studies and commentaries on the theme were excluded.

In a first step, the titles and abstracts of the articles identified in the search were evaluated by one of the authors of the review. The inclusion criteria comprised studies that related IPV against women to FI. Articles were excluded when the audience was only men, and when the study included only one of the related subjects or there was no relationship of one to the other.

The full articles were assessed by one of the study authors to verify inclusion criteria and data extraction. When there was uncertainty about the eligibility of the study, it was evaluated by a second author. For data extraction and interpretation, a spreadsheet containing the items in Table 1 was organized.

Results

Of the 58 studies initially found in the databases, 22 were selected by reading the title and abstract, of which six were excluded after reading the entire article (Figure 1).

Sixteen articles were identified relating IPV against women to FI and all found a strong and robust association between the topics. The included studies were all in English and spanned the years 2016 to 2020. They were conducted in 18 countries, being 7/16 (43,8%)¹⁴14 Hatcher AM, Weiser SD, Cohen CR, Hagey J, Weke E, Burger R, et al. Food insecurity and intimate partner violence among HIV-positive individuals in rural Kenya. Am J Prev Med. 2020; 60(4):563-8.

15 Fong S, Gupta J, Kpebo D, Falb K. Food insecurity associated with intimate partner violence among women in Abidjan, Cote d’Ivoire. Int J Gynaecol Obstet. 2016; 134(3):341-2.

16 Willie TC, Kershaw TS, Callands TA. Examining relationships of intimate partner violence and food insecurity with HIV-related risk factors among young pregnant women in Liberia. AIDS Care. 2018; 30(9):1156-60.

17 Barnett W, Pellowski J, Kuo C, Koen N, Donald KA, Zar HJ, et al. Food-insecure pregnant women in South Africa: a cross-sectional exploration of maternal depression as a mediator of violence and trauma risk factors. BMJ Open. 2019; 9(3):e018277.

18 Field S, Onah M, van Heyningen T, Honikman S. Domestic and intimate partner violence among pregnant women in a resource-poor setting in South Africa: a facility-based mixed methods study. BMC Womens Health. 2018; 18(1):119.

19 Andarge E, Shiferaw Y. Disparities in intimate partner violence among currently married women from food secure and insecure urban households in south ethiopia: a community based comparative cross-sectional study. Biomed Res Int. 2018; 2018:4738527.^-2020 Woldetensay YK, Belachew T, Biesalski HK, Ghosh S, Lacruz ME, Scherbaum V, et al. The role of nutrition, intimate partner violence and social support in prenatal depressive symptoms in rural Ethiopia: community-based birth cohort study. BMC Pregnancy Childbirth. 2018; 18(1):374. conducted on the African continent, 4/16 (25%)²¹21 Conroy AA, Cohen MH, Frongillo EA, Tsai AC, Wilson TE, Wentz EL, et al. Food insecurity and violence in a prospective cohort of women at risk for or living with HIV in the U.S. PLoS One. 2019; 14(3):e0213365.

22 Breiding MJ, Basile KC, Klevens J, Smith SG. Economic Insecurity and Intimate Partner and Sexual Violence Victimization. Am J Prev Med. 2017; 53(4):457-64.

23 Ricks JL, Cochran SD, Arah OA, Williams JK, Seeman TE. Food insecurity and intimate partner violence against women: results from the California Women’s Health Survey. Public Health Nutr. 2016; 19(5):914-23.^-2424 Hernandez DC, Marshall A, Mineo C. Maternal depression mediates the association between intimate partner violence and food insecurity. J Womens Health (Larchmt). 2014; 23(1):29-37. in North America, 2/16 (12,5%)²⁵25 Moraes CL, Marques ES, Reichenheim ME, Ferreira MF, Salles-Costa R. Intimate partner violence, common mental disorders and household food insecurity: an analysis using path analysis. Public Health Nutr. 2016; 19(16):2965-74.^,2626 Ribeiro-Silva RC, Fiaccone RL, Barreto ML, Santana ML, Santos SM, Conceição-Machado ME, et al. The association between intimate partner domestic violence and the food security status of poor families in Brazil. Public Health Nutr. 2016; 19(7):1305-11. in South America, 2/16 (12,5%)²⁷27 Falb KL, Blackwell A, Stennes J, Hussein M, Annan J. Depressive symptoms among women in Raqqa Governorate, Syria: associations with intimate partner violence, food insecurity, and perceived needs. Glob Ment Health (Camb). 2019; 6:e22.^,2828 Diamond-Smith N, Conroy AA, Tsai AC, Nekkanti M, Weiser SD. Food insecurity and intimate partner violence among married women in Nepal. J Glob Health. 2019; 9(1):010412. in the Asian continent, and 1/16 (6,3%)²⁹29 Jansen E, Lachman JM, Heinrichs N, Hutchings J, Baban A, Foran HM. Hunger in Vulnerable Families in Southeastern Europe: associations with mental health and violence. Front Public Health. 2020; 8:115. conducted in three different countries in southeastern Europe.

Regarding the study population, only two included both men and women and fourteen included only women. The studies included women ranging in age from 15 years to 60 years or older, with a higher prevalence of ages between 18 and 35 years.

Regarding the way to evaluate the incidence of FI, the following methods stood out: five articles (31.3%) applied the Household Food Insecurity Access Scale, three (18.8%) used the Household Food Security Survey Module, and two (12.5%) used the US Department of Agriculture Short Form Household Food Security Scale. Two other articles (12.5%), used the Brazilian Food Insecurity Scale (EBIA).

IPV against women was evaluated through different tools. In most of the studies (n=6; 37.5%), IPV was measured through its own methodology, with questionnaires and questions that had the objective of identifying its occurrence and the types of violence (physical, psychological and sexual).

Discussion

This narrative literature review set out to investigate the evidence about the association between food insecurity (FI) and intimate partner violence (IPV) against women. Of the 16 studies selected, all showed a positive association between FI and IPV. Among those studies that corrected their results, the most commonly used factors were age, income, marital status, educational level, mental health, and race/ethnicity.

The Landscape of FI

In the studies analyzed, most of the authors found an FI situation among the analyzed public. Among those conducted in the African continent, only the study by Fong S, Gupta J, Kpebo D, Falb K¹⁵15 Fong S, Gupta J, Kpebo D, Falb K. Food insecurity associated with intimate partner violence among women in Abidjan, Cote d’Ivoire. Int J Gynaecol Obstet. 2016; 134(3):341-2. found FI prevalence below 30%, two¹⁷17 Barnett W, Pellowski J, Kuo C, Koen N, Donald KA, Zar HJ, et al. Food-insecure pregnant women in South Africa: a cross-sectional exploration of maternal depression as a mediator of violence and trauma risk factors. BMJ Open. 2019; 9(3):e018277.^,2020 Woldetensay YK, Belachew T, Biesalski HK, Ghosh S, Lacruz ME, Scherbaum V, et al. The role of nutrition, intimate partner violence and social support in prenatal depressive symptoms in rural Ethiopia: community-based birth cohort study. BMC Pregnancy Childbirth. 2018; 18(1):374. obtained results of 30.9% and 39.4%, while the other four articles¹⁴14 Hatcher AM, Weiser SD, Cohen CR, Hagey J, Weke E, Burger R, et al. Food insecurity and intimate partner violence among HIV-positive individuals in rural Kenya. Am J Prev Med. 2020; 60(4):563-8.^,1616 Willie TC, Kershaw TS, Callands TA. Examining relationships of intimate partner violence and food insecurity with HIV-related risk factors among young pregnant women in Liberia. AIDS Care. 2018; 30(9):1156-60.^,1818 Field S, Onah M, van Heyningen T, Honikman S. Domestic and intimate partner violence among pregnant women in a resource-poor setting in South Africa: a facility-based mixed methods study. BMC Womens Health. 2018; 18(1):119.^,1919 Andarge E, Shiferaw Y. Disparities in intimate partner violence among currently married women from food secure and insecure urban households in south ethiopia: a community based comparative cross-sectional study. Biomed Res Int. 2018; 2018:4738527. found a percentage above 40%. These results reinforce data from the 2019 UN annual report that the number of hungry people in Africa is 257 million (1 in 5 people), with 38% of women of reproductive age affected by anemia as a result of FI. Of this total, 237 million are in Sub-Saharan Africa, the region where the studies included in this review were conducted³⁰30 Organização das Nações Unidas para a Alimentação e Agricultura. Novo relatório da ONU revela que a fome na África continua aumentando [Internet]. Brasília: FAO no Brasil; 2019 [citado 20 Jul 2021]. Disponível em: http://www.fao.org/brasil/noticias/detail-events/pt/c/1180521/
http://www.fao.org/brasil/noticias/detai... . The two studies conducted on the Asian continent²⁷27 Falb KL, Blackwell A, Stennes J, Hussein M, Annan J. Depressive symptoms among women in Raqqa Governorate, Syria: associations with intimate partner violence, food insecurity, and perceived needs. Glob Ment Health (Camb). 2019; 6:e22.^,2828 Diamond-Smith N, Conroy AA, Tsai AC, Nekkanti M, Weiser SD. Food insecurity and intimate partner violence among married women in Nepal. J Glob Health. 2019; 9(1):010412. identified similar results to the African continent, with 67.8% reporting suffering some form of severe FI in Syria and almost half (49.4%) of women living in households with FI in Nepal. According to a qualitative study conducted in South Asia, the high rates of FI reported by participants can be explained by the position in which women are placed in these cultures. Generally, women eat last and in smaller quantities than the rest of the family³¹31 Lentz EC, Narayanan S, De A. Last and least: findings on intrahousehold undernutrition from participatory research in South Asia. Soc Sci Med. 2019; 232:316-323. Doi: https://doi.org/10.1016/j.socscimed.2019.05.024.
https://doi.org/10.1016/j.socscimed.2019... .

All studies conducted in North America²¹21 Conroy AA, Cohen MH, Frongillo EA, Tsai AC, Wilson TE, Wentz EL, et al. Food insecurity and violence in a prospective cohort of women at risk for or living with HIV in the U.S. PLoS One. 2019; 14(3):e0213365.

22 Breiding MJ, Basile KC, Klevens J, Smith SG. Economic Insecurity and Intimate Partner and Sexual Violence Victimization. Am J Prev Med. 2017; 53(4):457-64.

23 Ricks JL, Cochran SD, Arah OA, Williams JK, Seeman TE. Food insecurity and intimate partner violence against women: results from the California Women’s Health Survey. Public Health Nutr. 2016; 19(5):914-23.^-2424 Hernandez DC, Marshall A, Mineo C. Maternal depression mediates the association between intimate partner violence and food insecurity. J Womens Health (Larchmt). 2014; 23(1):29-37. were in the United States and did not identify as high a prevalence of FI as the African and Asian continents. The only study that surveyed men and women together identified the highest prevalence of FI in the women surveyed, being 28.2% versus 24.6% exposure by men. These findings reinforce current statistics that of the 821 million people suffering from FI in the world today, 60 percent are women, and in almost two-thirds of countries, women are more likely than men to report FI³²32 World Food Program USA. Infographic: how and why women face higher rates of hunger [Internet]. Washington: WFP; 2019 [citado 20 Jul 2021]. Disponível em: https://www.wfpusa.org/women-are-hungrier-infographic/
https://www.wfpusa.org/women-are-hungrie... . Also, the prevalence of FI identified in the studies included in this review are in line with the Household Food Security in the United States 2018 report, which found that 88.9% of U.S. households had food security³³33 Coleman-Jensen A, Rabbitt MP, Gregory CA, Singh A. Household Food Security in the United States in 2018. Washington: United States Department of Agriculture; 2019..

The two South American Studies²⁵25 Moraes CL, Marques ES, Reichenheim ME, Ferreira MF, Salles-Costa R. Intimate partner violence, common mental disorders and household food insecurity: an analysis using path analysis. Public Health Nutr. 2016; 19(16):2965-74.^,2626 Ribeiro-Silva RC, Fiaccone RL, Barreto ML, Santana ML, Santos SM, Conceição-Machado ME, et al. The association between intimate partner domestic violence and the food security status of poor families in Brazil. Public Health Nutr. 2016; 19(7):1305-11., both from Brazil (Rio de Janeiro and Salvador) have analyzed the family FI and the severity of this condition. The prevalence of FI in the Rio de Janeiro study was 39.4%, with more than a quarter being moderate or severe²⁵25 Moraes CL, Marques ES, Reichenheim ME, Ferreira MF, Salles-Costa R. Intimate partner violence, common mental disorders and household food insecurity: an analysis using path analysis. Public Health Nutr. 2016; 19(16):2965-74. and 62.5% in Salvador, with almost 20% moderate²⁶26 Ribeiro-Silva RC, Fiaccone RL, Barreto ML, Santana ML, Santos SM, Conceição-Machado ME, et al. The association between intimate partner domestic violence and the food security status of poor families in Brazil. Public Health Nutr. 2016; 19(7):1305-11.. The prevalence of food security that had been growing since 2004, dropped from 77.4% in 2013 to 63.3% in the 2017-2018 POF analysis¹⁰10 Instituto Brasileiro de Geografia e Estatística - IBGE. Pesquisa de Orçamentos Familiares 2017-2018 – POF. Rio de Janeiro: IBGE; 2020.. The pandemic experienced in the years 2020 and 2021 caused a new rise in poverty and extreme poverty in the country, and the welfare programs created in this context were not enough to ensure healthy food on a regular and permanent basis to the Brazilian population¹¹11 Rede Brasileira de Pesquisa em Soberania e Segurança Alimentar - Rede Penssan. VIGISAN: inquérito nacional sobre insegurança alimentar no contexto da pandemia da Covid-19 no Brasil. Rio de Janeiro: Rede Penssan; 2021..

Only one study was conducted in Europe looking at three middle/low income countries in southeastern Europe and found an average prevalence of 31% FI. According to Grimaccia, et al.³⁴34 Grimaccia E, Naccarato A. Food insecurity in europe: a gender perspective. Soc Indic Res. 2020; 21:1-19., which assessed factors related to food security from gender differences in Europe, for women, estimates suggest a higher risk of FI in the south and east of the continent, and education level, household composition, and number of children in the family have a significant impact on the risk of FI.

IPV and related factors

The articles included in this review also addressed other factors, seeking to identify their role in the relationship with IPV and FI. In three of them¹⁴14 Hatcher AM, Weiser SD, Cohen CR, Hagey J, Weke E, Burger R, et al. Food insecurity and intimate partner violence among HIV-positive individuals in rural Kenya. Am J Prev Med. 2020; 60(4):563-8.^,1616 Willie TC, Kershaw TS, Callands TA. Examining relationships of intimate partner violence and food insecurity with HIV-related risk factors among young pregnant women in Liberia. AIDS Care. 2018; 30(9):1156-60.^,2121 Conroy AA, Cohen MH, Frongillo EA, Tsai AC, Wilson TE, Wentz EL, et al. Food insecurity and violence in a prospective cohort of women at risk for or living with HIV in the U.S. PLoS One. 2019; 14(3):e0213365., that related to risk factors for HIV, percentages ranging from 4.5% to 58% in the incidence of IPV were found. Seven studies evaluated depression as a mediator for IPV¹⁷17 Barnett W, Pellowski J, Kuo C, Koen N, Donald KA, Zar HJ, et al. Food-insecure pregnant women in South Africa: a cross-sectional exploration of maternal depression as a mediator of violence and trauma risk factors. BMJ Open. 2019; 9(3):e018277.^,1818 Field S, Onah M, van Heyningen T, Honikman S. Domestic and intimate partner violence among pregnant women in a resource-poor setting in South Africa: a facility-based mixed methods study. BMC Womens Health. 2018; 18(1):119.^,2020 Woldetensay YK, Belachew T, Biesalski HK, Ghosh S, Lacruz ME, Scherbaum V, et al. The role of nutrition, intimate partner violence and social support in prenatal depressive symptoms in rural Ethiopia: community-based birth cohort study. BMC Pregnancy Childbirth. 2018; 18(1):374.^,2424 Hernandez DC, Marshall A, Mineo C. Maternal depression mediates the association between intimate partner violence and food insecurity. J Womens Health (Larchmt). 2014; 23(1):29-37.^,2525 Moraes CL, Marques ES, Reichenheim ME, Ferreira MF, Salles-Costa R. Intimate partner violence, common mental disorders and household food insecurity: an analysis using path analysis. Public Health Nutr. 2016; 19(16):2965-74.^,2727 Falb KL, Blackwell A, Stennes J, Hussein M, Annan J. Depressive symptoms among women in Raqqa Governorate, Syria: associations with intimate partner violence, food insecurity, and perceived needs. Glob Ment Health (Camb). 2019; 6:e22.^,2929 Jansen E, Lachman JM, Heinrichs N, Hutchings J, Baban A, Foran HM. Hunger in Vulnerable Families in Southeastern Europe: associations with mental health and violence. Front Public Health. 2020; 8:115., of which five investigated the types of IPV, with psychological violence being the most present among participants, followed by physical violence and sexual violence. Also, out of the six studies¹⁵15 Fong S, Gupta J, Kpebo D, Falb K. Food insecurity associated with intimate partner violence among women in Abidjan, Cote d’Ivoire. Int J Gynaecol Obstet. 2016; 134(3):341-2.^,1919 Andarge E, Shiferaw Y. Disparities in intimate partner violence among currently married women from food secure and insecure urban households in south ethiopia: a community based comparative cross-sectional study. Biomed Res Int. 2018; 2018:4738527.^,2222 Breiding MJ, Basile KC, Klevens J, Smith SG. Economic Insecurity and Intimate Partner and Sexual Violence Victimization. Am J Prev Med. 2017; 53(4):457-64.^,2323 Ricks JL, Cochran SD, Arah OA, Williams JK, Seeman TE. Food insecurity and intimate partner violence against women: results from the California Women’s Health Survey. Public Health Nutr. 2016; 19(5):914-23.^,2626 Ribeiro-Silva RC, Fiaccone RL, Barreto ML, Santana ML, Santos SM, Conceição-Machado ME, et al. The association between intimate partner domestic violence and the food security status of poor families in Brazil. Public Health Nutr. 2016; 19(7):1305-11.^,2828 Diamond-Smith N, Conroy AA, Tsai AC, Nekkanti M, Weiser SD. Food insecurity and intimate partner violence among married women in Nepal. J Glob Health. 2019; 9(1):010412. that evaluated only the relationship between IPV and FI, four¹⁵15 Fong S, Gupta J, Kpebo D, Falb K. Food insecurity associated with intimate partner violence among women in Abidjan, Cote d’Ivoire. Int J Gynaecol Obstet. 2016; 134(3):341-2.^,1919 Andarge E, Shiferaw Y. Disparities in intimate partner violence among currently married women from food secure and insecure urban households in south ethiopia: a community based comparative cross-sectional study. Biomed Res Int. 2018; 2018:4738527.^,2626 Ribeiro-Silva RC, Fiaccone RL, Barreto ML, Santana ML, Santos SM, Conceição-Machado ME, et al. The association between intimate partner domestic violence and the food security status of poor families in Brazil. Public Health Nutr. 2016; 19(7):1305-11.^,2828 Diamond-Smith N, Conroy AA, Tsai AC, Nekkanti M, Weiser SD. Food insecurity and intimate partner violence among married women in Nepal. J Glob Health. 2019; 9(1):010412. found a prevalence of more than 50% of participants who had suffered any type of violence at some point in their lives and two²²22 Breiding MJ, Basile KC, Klevens J, Smith SG. Economic Insecurity and Intimate Partner and Sexual Violence Victimization. Am J Prev Med. 2017; 53(4):457-64.^,2323 Ricks JL, Cochran SD, Arah OA, Williams JK, Seeman TE. Food insecurity and intimate partner violence against women: results from the California Women’s Health Survey. Public Health Nutr. 2016; 19(5):914-23. showed an association, but not the prevalence of violence.

These findings are in line with an analysis conducted by the WHO based on data from 80 countries, in which it was identified that about 30% of women worldwide who were in a relationship were victims of physical, psychological, and/or sexual violence. Also, according to the WHO, in some regions women who suffered physical or sexual abuse were 1.5 times more likely to have HIV compared to those who did not suffer any violence¹1 Organização Pan-Americana de Saúde. Organização Mundial da Saúde. Folha informativa - Violência contra as mulheres [Internet]. Washington: OPAS; 2017 [citado 20 Jul 2021]. Disponível em: https://www.paho.org/bra/index.php?option=com_content&view=article&id=5669:folha-informativa-violencia-contra-as-mulheres&Itemid=820
https://www.paho.org/bra/index.php?optio... .

Interface: FI and IPV

Of the included studies (n=16), five of them¹⁵15 Fong S, Gupta J, Kpebo D, Falb K. Food insecurity associated with intimate partner violence among women in Abidjan, Cote d’Ivoire. Int J Gynaecol Obstet. 2016; 134(3):341-2.^,1919 Andarge E, Shiferaw Y. Disparities in intimate partner violence among currently married women from food secure and insecure urban households in south ethiopia: a community based comparative cross-sectional study. Biomed Res Int. 2018; 2018:4738527.^,2222 Breiding MJ, Basile KC, Klevens J, Smith SG. Economic Insecurity and Intimate Partner and Sexual Violence Victimization. Am J Prev Med. 2017; 53(4):457-64.^,2323 Ricks JL, Cochran SD, Arah OA, Williams JK, Seeman TE. Food insecurity and intimate partner violence against women: results from the California Women’s Health Survey. Public Health Nutr. 2016; 19(5):914-23.^,2828 Diamond-Smith N, Conroy AA, Tsai AC, Nekkanti M, Weiser SD. Food insecurity and intimate partner violence among married women in Nepal. J Glob Health. 2019; 9(1):010412., focused on the relationship between FI and IPV, without presenting a relationship other than sociodemographic and economic characteristics. Women who reported high and moderate levels of FI were significantly more likely to have experienced one or all forms of IPV. In the study conducted in Ethiopia¹⁹19 Andarge E, Shiferaw Y. Disparities in intimate partner violence among currently married women from food secure and insecure urban households in south ethiopia: a community based comparative cross-sectional study. Biomed Res Int. 2018; 2018:4738527. FI intensity and types of IPV were measured, and it was found that 66.4% of women who experienced violence were from families with FI. Another study¹⁵15 Fong S, Gupta J, Kpebo D, Falb K. Food insecurity associated with intimate partner violence among women in Abidjan, Cote d’Ivoire. Int J Gynaecol Obstet. 2016; 134(3):341-2. concluded that women who experienced severe FI were eight times more likely to have experienced IPV in the previous year. The other studies found that participants who experienced FI were more likely to experience emotional and physical IPV, and identified that the more severe the level of FI the more likely they were to experience IPV ²²22 Breiding MJ, Basile KC, Klevens J, Smith SG. Economic Insecurity and Intimate Partner and Sexual Violence Victimization. Am J Prev Med. 2017; 53(4):457-64.^,2323 Ricks JL, Cochran SD, Arah OA, Williams JK, Seeman TE. Food insecurity and intimate partner violence against women: results from the California Women’s Health Survey. Public Health Nutr. 2016; 19(5):914-23.^,2828 Diamond-Smith N, Conroy AA, Tsai AC, Nekkanti M, Weiser SD. Food insecurity and intimate partner violence among married women in Nepal. J Glob Health. 2019; 9(1):010412..

The relationship between IPV and FI is related to socioeconomic and cultural factors, such as low income, lower education, lower employability of women, marital status, fertile age, and gender inequality¹⁹19 Andarge E, Shiferaw Y. Disparities in intimate partner violence among currently married women from food secure and insecure urban households in south ethiopia: a community based comparative cross-sectional study. Biomed Res Int. 2018; 2018:4738527.^,2323 Ricks JL, Cochran SD, Arah OA, Williams JK, Seeman TE. Food insecurity and intimate partner violence against women: results from the California Women’s Health Survey. Public Health Nutr. 2016; 19(5):914-23.^,2828 Diamond-Smith N, Conroy AA, Tsai AC, Nekkanti M, Weiser SD. Food insecurity and intimate partner violence among married women in Nepal. J Glob Health. 2019; 9(1):010412.. Besides these factors, the association can also occur in other ways, one of them being the economic abuse practiced by the partner, characterized by the deprivation of adequate financial resources. This fact can also occur to women when they leave these abusive relationships, being forced to rely on some kind of social assistance or low-paid jobs³⁵35 Power EM. Economic abuse and intra-household inequities in food security. Can J Public Health. 2006; 97(3):258-60.. Experiences of sexual violence were described as linked to physical and mental health problems, inability to sleep, eat, feel safe, and develop trusting relationships. These problems have been put forward as reasons behind the inability to maintain stable employment and complete studies, thus increasing the risk of FI⁷7 Leddy AM, Zakaras JM, Shieh J, Conroy AA, Ofotokun I, Tien PC, et al. Intersections of food insecurity, violence, poor mental health and substance use among US women living with and at risk for HIV: evidence of a syndemic in need of attention. PLoS One. 2021; 16(5):e0252338.. Arguably the most prominent factor of all is gender inequality, as indicated by the World Food Program USA. According to the program, women perform 2.6 times more unpaid care and domestic work than men and earn 23% less for paid work, and on average have only three-quarters of the legal protections afforded compared to men. It is noteworthy that in 18 countries husbands can legally prevent their wives from working. Furthermore, in 49 countries there are no laws protecting women from domestic violence, which further increases the rates of this problem³²32 World Food Program USA. Infographic: how and why women face higher rates of hunger [Internet]. Washington: WFP; 2019 [citado 20 Jul 2021]. Disponível em: https://www.wfpusa.org/women-are-hungrier-infographic/
https://www.wfpusa.org/women-are-hungrie... .

Of the three studies that evaluated the relationship between IPV and FI in participants with, or at risk for HIV¹⁴14 Hatcher AM, Weiser SD, Cohen CR, Hagey J, Weke E, Burger R, et al. Food insecurity and intimate partner violence among HIV-positive individuals in rural Kenya. Am J Prev Med. 2020; 60(4):563-8.^,1616 Willie TC, Kershaw TS, Callands TA. Examining relationships of intimate partner violence and food insecurity with HIV-related risk factors among young pregnant women in Liberia. AIDS Care. 2018; 30(9):1156-60.^,2121 Conroy AA, Cohen MH, Frongillo EA, Tsai AC, Wilson TE, Wentz EL, et al. Food insecurity and violence in a prospective cohort of women at risk for or living with HIV in the U.S. PLoS One. 2019; 14(3):e0213365., two found a high prevalence in this association¹⁴14 Hatcher AM, Weiser SD, Cohen CR, Hagey J, Weke E, Burger R, et al. Food insecurity and intimate partner violence among HIV-positive individuals in rural Kenya. Am J Prev Med. 2020; 60(4):563-8.^,1616 Willie TC, Kershaw TS, Callands TA. Examining relationships of intimate partner violence and food insecurity with HIV-related risk factors among young pregnant women in Liberia. AIDS Care. 2018; 30(9):1156-60.. One of the studies¹⁴14 Hatcher AM, Weiser SD, Cohen CR, Hagey J, Weke E, Burger R, et al. Food insecurity and intimate partner violence among HIV-positive individuals in rural Kenya. Am J Prev Med. 2020; 60(4):563-8. identified that each 1 point increase in FI was associated with a 6% greater risk of victimization by violence among HIV-positive women. FI and violence are associated with risky sexual behaviors such as rape, forced marital sex, transactional sex, and anal sex that led to increased vulnerability to STIs, including HIV, since they usually occur without the use of condoms. Also, that women who are victims of IPV are more likely to have an HIV-infected partner and be infected³⁶36 Decker MR, Seage 3rd GR, Hemenway D, Raj A, Saggurti N, Balaiah D, et al. Intimate partner violence functions as both a marker and risk factor for women’s HIV infection: findings from Indian husband–wife dyads. J Acquir Immune Defic Syndr. 2009; 51(5):593-600.^,3737 Justman J, Befus M, Hughes J, Wang J, Golin CE, Adimora AA, et al. Sexual behaviors of us women at risk of hiv acquisition: a longitudinal analysis of findings from hptn 064. AIDS Behav. 2015; 19(7):1327-37.. The third study, meanwhile²¹21 Conroy AA, Cohen MH, Frongillo EA, Tsai AC, Wilson TE, Wentz EL, et al. Food insecurity and violence in a prospective cohort of women at risk for or living with HIV in the U.S. PLoS One. 2019; 14(3):e0213365., although it found a relationship between violence and FI (women with FI were 7.05 times more likely to suffer sexual or physical violence), it did not find an association between HIV and FI in violence after adjustment, contrary to the results of previous studies in this area³⁶36 Decker MR, Seage 3rd GR, Hemenway D, Raj A, Saggurti N, Balaiah D, et al. Intimate partner violence functions as both a marker and risk factor for women’s HIV infection: findings from Indian husband–wife dyads. J Acquir Immune Defic Syndr. 2009; 51(5):593-600.^,3737 Justman J, Befus M, Hughes J, Wang J, Golin CE, Adimora AA, et al. Sexual behaviors of us women at risk of hiv acquisition: a longitudinal analysis of findings from hptn 064. AIDS Behav. 2015; 19(7):1327-37..

Among the six studies that analyzed the relationship between IPV and FI and depression¹⁷17 Barnett W, Pellowski J, Kuo C, Koen N, Donald KA, Zar HJ, et al. Food-insecure pregnant women in South Africa: a cross-sectional exploration of maternal depression as a mediator of violence and trauma risk factors. BMJ Open. 2019; 9(3):e018277.^,1818 Field S, Onah M, van Heyningen T, Honikman S. Domestic and intimate partner violence among pregnant women in a resource-poor setting in South Africa: a facility-based mixed methods study. BMC Womens Health. 2018; 18(1):119.^,2020 Woldetensay YK, Belachew T, Biesalski HK, Ghosh S, Lacruz ME, Scherbaum V, et al. The role of nutrition, intimate partner violence and social support in prenatal depressive symptoms in rural Ethiopia: community-based birth cohort study. BMC Pregnancy Childbirth. 2018; 18(1):374.^,2222 Breiding MJ, Basile KC, Klevens J, Smith SG. Economic Insecurity and Intimate Partner and Sexual Violence Victimization. Am J Prev Med. 2017; 53(4):457-64.^,2525 Moraes CL, Marques ES, Reichenheim ME, Ferreira MF, Salles-Costa R. Intimate partner violence, common mental disorders and household food insecurity: an analysis using path analysis. Public Health Nutr. 2016; 19(16):2965-74.^,2727 Falb KL, Blackwell A, Stennes J, Hussein M, Annan J. Depressive symptoms among women in Raqqa Governorate, Syria: associations with intimate partner violence, food insecurity, and perceived needs. Glob Ment Health (Camb). 2019; 6:e22. only two were not conducted with mothers or pregnant women, which found a higher prevalence of psychological IPV for women who reported FI²⁵25 Moraes CL, Marques ES, Reichenheim ME, Ferreira MF, Salles-Costa R. Intimate partner violence, common mental disorders and household food insecurity: an analysis using path analysis. Public Health Nutr. 2016; 19(16):2965-74.^,2727 Falb KL, Blackwell A, Stennes J, Hussein M, Annan J. Depressive symptoms among women in Raqqa Governorate, Syria: associations with intimate partner violence, food insecurity, and perceived needs. Glob Ment Health (Camb). 2019; 6:e22.. One of these studies²⁵25 Moraes CL, Marques ES, Reichenheim ME, Ferreira MF, Salles-Costa R. Intimate partner violence, common mental disorders and household food insecurity: an analysis using path analysis. Public Health Nutr. 2016; 19(16):2965-74. identified that psychological violence is directly linked to FI and that in this relationship there are other variables involved, in addition to mental disorders and physical violence. The author suggests that in relationships where psychological violence occurs, the partner usually exercises control over the family budget to establish power over the woman, thus decreasing the priority of buying food. The findings reinforce previous research that identified that mothers in families who experienced persistent FI, experienced mental health problems or domestic violence. They also indicated that during pregnancy, psychological aggression was more closely linked to depression and that women who experienced any level of physical aggression or sexual coercion, by their intimate partners (before or during pregnancy), had higher levels of depressive symptoms compared to non-victims²2 Melchior M, Caspi A, Howard LM, Ambler AP, Bolton H, Mountain N, et al. Mental health context of food insecurity: a representative cohort of families with young children. Pediatrics. 2009; 124(4):564-72.^,3838 Martin SL, Li Y, Casanueva C, Harris-Britt A, Kupper LL, Cloutier S. Intimate partner violence and women’s depression before and during pregnancy. Violence Against Women. 2006; 12(3):221-39..

The two articles that evaluated the relationship between IPV and FI among families were conducted in three different countries in southeastern Europe²⁹29 Jansen E, Lachman JM, Heinrichs N, Hutchings J, Baban A, Foran HM. Hunger in Vulnerable Families in Southeastern Europe: associations with mental health and violence. Front Public Health. 2020; 8:115. and in Brazil²⁶26 Ribeiro-Silva RC, Fiaccone RL, Barreto ML, Santana ML, Santos SM, Conceição-Machado ME, et al. The association between intimate partner domestic violence and the food security status of poor families in Brazil. Public Health Nutr. 2016; 19(7):1305-11.. The European study analyzed this relationship through risk factors related to socioeconomic/demographic status, mental health, and social and family support set. This analysis identified that the chances of the family experiencing FI were higher if the parents did not have a college degree, could not or only read with difficulty, had more children residing in the home, had greater psychological distress, or had less emotional support. Furthermore, both female victimization of IPV and male perpetuation of IPV were more prevalent in families experiencing hunger (FI). The Brazilian study found that 62.5% of households lived with FI and that couples who reported reciprocal physical violence were more likely to suffer from domestic FI. It also identified that most of these individuals had lower economic conditions, had studied up to the 4th grade or less, and had a greater number of individuals living in the household. The risk factors for both IPV and FI are very similar and may explain these findings. Among these factors are: more children (especially very young), poor education, lower family income, female employment, and partner alcohol consumption³⁹39 Chernyak E. Intimate partner violence in tajikistan: risk and protective factors. Violence Vict. 2018; 33(6):1124-47..

A problem that already had alarming dimensions has become even bigger: violence against women has grown during the Covid-19 pandemic in Brazil. The Brazilian Public Safety Forum conducted the third edition of the survey “Visible and Invisible: Victimization of Women in Brazil” in which 24.4% of women said they had suffered physical, psychological, or sexual violence during the pandemic. Poorer living conditions were associated with violence. Among the women victims of violence 61.8% had a reduction in family income and 46.7% lost their jobs. When asked about the factors that had the most impact on the violence perpetrated against them, 25.1% of the women mentioned the loss of their job and the impossibility of ensuring their own livelihood. Denouncing the aggressor and breaking this perverse cycle has become more complicated due to social isolation⁴⁰40 Fórum Brasileiro de Segurança Pública. Visível e invisível: a vitimização de mulheres no Brasil. 3a ed. São Paulo: DataFolha/FBSP; 2021..

The present study is limited to a concentration of articles done in certain regions of the world and does not give a complete picture of the topic. Almost half of the studies were conducted in Africa, the continent most vulnerable to hunger. All of these studies were conducted in the sub-Saharan African region, the region with the highest FI rates on the African continent³⁰30 Organização das Nações Unidas para a Alimentação e Agricultura. Novo relatório da ONU revela que a fome na África continua aumentando [Internet]. Brasília: FAO no Brasil; 2019 [citado 20 Jul 2021]. Disponível em: http://www.fao.org/brasil/noticias/detail-events/pt/c/1180521/
http://www.fao.org/brasil/noticias/detai... . The sample analyzed presented studies from the same countries in North America and South America. This may be a limitation by not presenting variety in the sample from each continent. However, the total sample presented by the present review is considered to align with worldwide estimates that the relationship between IPV and FI is considerably high and that it can occur following different pathways.

Conclusion

The results of this study reinforce a strong bidirectional association between IPV and FI, owing to the fact that some of the factors that lead to IPV can lead to FI and vice versa. This relationship was mediated mainly by psychological and economic problems. It highlights the need for the creation of support networks and social structures, in addition to public policies, that guarantee the safety of these women, whether it be food, physical, sexual, or psychological, and that allow the break of the perverse cycle that relates such conditions. Moreover, in view of the increase in the number of cases of IPV and FI in recent years, there is a need for the expansion of studies in this area in order to bring to light this worrying and important issue.

References

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