White House Releases U.S. National Plan to End Gender-Based Violence

Gender-based violence remains a severe threat in the United States. It can have far-reaching effects that persist throughout the lifespan, including

Physical: Sexually transmitted diseases and infections (abuse and trauma are among the top drivers of HIV/AIDS among women); chronic diseases such as cancer (including cervical cancer, which develops from sexually-transmitted human papillomavirus infections), diabetes, and heart disease; injuries such as traumatic brain injury from blunt force trauma and attempted strangulation, fractures, and burns; and maternal health issues such as unintended pregnancy, pregnancy complications, fetal death, and maternal mortality. In a 2020 Tulane study, homicide is the leading cause of pregnancy-associated death in Louisiana.

Mental: Depression, anxiety, post-traumatic stress disorder (PTSD), and suicidal ideation.

Behavioral: Risky behaviors such as substance use (often used as a coping mechanism) and unsafe sex, as well as missed opportunities such as education, absenteeism at work/reduced workplace productivity, lost earnings, and homelessness.

A recent webinar titled Preventing Gender-Based & Intimate Partner Violence from the Health Resources and Services Administration’s Office of Women’s Health explored this topic and outlined the federal government’s most recent strategies for action to address this issue.

Lynn Rosenthal, U.S. Department of Health and Human Services (HHS) director of Sexual and Gender-Based Violence, summarized the U.S. National Plan to End Gender-Based Violence released by the White House in May 2023. The Plan is the first government-wide interagency framework developed to prevent and address multiple forms of gender-based violence (GBV), including domestic violence (DV), intimate partner violence (IPV), sexual violence, sexual assault, stalking, and human trafficking.

Previous U.S. violence prevention bills have included the 1984 Family Violence Prevention and Services Act, which, for the first time, provided federal funds dedicated directly to domestic violence shelters and services such as hotlines. The 1994 Violence Against Women Act (VAWA), modeled on the Civil Rights Act of 1964, was built on the foundation that gender-based crimes violate a woman’s civil rights. Before VAWA, domestic abusers could cross state lines to avoid prosecution for beating their spouses or partners; passage of the 1994 legislation mandated law enforcement to honor restraining orders filed in other states. Some experts credit VAWA for a decrease in the domestic violence rate in the U.S. According to a 2012 Department of Justice report, the overall rate of intimate partner violence dropped 64% from 1993 to 2010.

However, the world is a different place in 2024 than it was in 2010. The coronavirus pandemic lockdowns exacerbated already dangerous situations for those experiencing violence at home, and the rise of technology, mobile devices, and social media as part of daily life has led women, girls, and LGBTQI+ to face increased targeted violence.

Therefore, in 2021, the Biden Administration issued Executive Order 14020, creating the Gender Policy Council tasked with developing the U.S. National Plan to End Gender-Based Violence. The National Plan is significant because it is the first to provide an all-of-government approach that directs federal agencies on how to proceed and provides a blueprint that states, local communities, and nonprofit organizations can utilize to address and respond to gender-based violence.

The National Plan vision statement says, “The U.S. will be a place where all people live free from gender-based violence in all aspects of their lives” – and “all” applies to everyone, regardless of gender, sex, race, ethnicity, religion, age, ability, geographic location, socioeconomic level, or immigration or citizenship status. Rosenthal stated, “We’re embracing a human rights approach. We’re saying that freedom from violence and abuse is a human right.”

7 Pillars of the National Plan

The National Plan is an interagency effort encompassing, but not inclusive of, the White House, Health and Human Services (HHS), Department of Justice (DOJ), Department of Labor (DOL), Housing and Urban Development (HUD), Federal Emergency Management Agency (FEMA), and the Department of Commerce. The Plan will focus on seven strategic pillars:

Prevention: Gender and social norms change.
Healing, safety, and wellbeing: Trauma-informed care and trauma-responsive services integrated throughout all federal levels.
Economic security & housing stability: HUD will address housing options, as domestic violence remains one of the leading causes of homelessness. Survivors are also affected in the workplace and may face job or wage discrimination. The blueprint will address appropriate employer responses.
Online safety: The White House Task Force will lead the work in this area, including preventing online harassment, such as the nonconsensual distribution of intimate images.
Legal and justice systems: Department of Justice bureaus such as the Office of Victims of Crime, Office of Violence Against Women, Civil Rights division, etc., will look at the role of restorative justice in addressing gender-based violence.
Emergency preparedness & crisis response: It has been known since Hurricane Katrina in 2005 that gender-based violence increases during times of natural disasters and national or global events such as COVID-19, as well as victims becoming more isolated. Meta-analysis showed at least a 10% increase in domestic violence around the country during the pandemic.
Research & data: Rosenthal stated, “Research and data are increasingly important in guiding our work, so we’re looking at coordinating those efforts across federal agencies.”

Additional guiding principles of the Plan include:

Most importantly, making the voices of survivors and their lived experiences the centerpiece of the policy recommendations.
Expanding the perspective of gender-based violence beyond the criminal/legal framework to addressing it as a public health and safety issue, an approach The Centers for Disease Control and Prevention (CDC) has employed for a while, but the 2023 National Plan expands that mindset across the entire federal government system.
Recognizing that gender-based violence is a form of gender discrimination that disproportionately affects women and girls as well as people of diverse gender identities.
Grounding the plan to end gender-based violence in evidenced-based approaches using 20 years of collected research and data.
Providing behavioral health support for people committing the violence.
Promoting workplace safety for health care workers and creating trauma-responsive health care facilities.
Developing tools that screen for all forms of gender-based violence.
Ensuring that work on gender-based violence in the health equity setting is linked with work on social determinants of health (SDOH) and violence prevention.

Who experiences IPV?

Stephen Hayes, MPH, Public Health Analyst, HRSA Office of Women’s Health, shared statistical evidence of those affected by intimate-partner violence, noting that the majority experience their first instance of violence before age 25. The most affected group is bisexual women ages 16-18 (61%), followed by trans/non-binary people (54%), women (nearly half), and men (44%). Other communities disproportionately affected include disabled people, rural residents, teenagers (ages 12-18), LGBTQ, those who are HIV positive, those who abuse substances (40% – 60% of intimate partner violence incidents include substance abuse), and pregnant people. Hayes notes that the risk of homicide is 35% greater during pregnancy and the postpartum period; additionally, nearly half of pregnancy-related homicides are the result of intimate partner violence.

Barriers to care

Violence victims may not seek care for many reasons: A fear for their own or their children’s safety; shame, stigma, or fear of judgment; limited availability of gender-based violence services; lack of awareness about available resources; and lack of privacy. Hayes notes, “I want to emphasize how important it is to always prioritize individual safety, confidentiality, and autonomy when we’re documenting any sensitive data, but especially things like IPV disclosure.”

As violence is a mitigating factor to accessing care, HRSA has oriented its strategy of addressing and responding to gender-based violence around the health care system and its workers, who are often the front-line contact with victims. The framework emphasizes the need to train staff on what IPV is, how to recognize the signs, and how to engage diverse voices in program planning, stressing the importance of including individuals with lived experience with IPV in the decision-making process.

Sexual Assault Nurse Examiners

Another critical resource in the health care realm is specially trained nurses who provide medical, mental, and emotional care to sexual assault survivors in the emergency room setting. Sexual Assault Nurse Examiners (SANE) are registered nurses who evaluate and address survivors’ health concerns, minimize trauma during and after the exam, and detect, collect, preserve, and document physical evidence related to the assault for potential use by the legal system.

Michael Clark, MBA, RN, and Aroona Toor, MPH, DrPH(C), co-project officers of the Advanced Nursing Education Sexual Assault Nurse Examiner (ANE-SANE) program through the HRSA Bureau of Health Workforce, spoke about the existing shortage of SANE nurses, citing reasons such as low retention rates due to dissatisfaction with compensation, long work hours and burnout (SANEs typically work on-call in addition to their full-time shifts), and a lack of stakeholder support from hospitals and law enforcement. Toor, referencing a 2016 GAO report, stated, “Some officials stated that hospitals might be reluctant to support examiners and examiner programs due to a low number of sexual assault cases treated each year.”

Limited training availability is also a barrier, as programs may only be offered once a year in some states. To address this issue, educational institutions may apply for federal grant funding to implement SANE training programs to increase the number of SANEs and the number of communities they serve and to expand access to sexual assault forensic exams, especially in rural and underserved areas.

It appears to be working, as training sites funded by ANE-SANE grants increased from 169 in 2021 to 214 in 2022; 18% of these sites are community-based. “That’s important because you need to be in the community you serve. The farther away you are, the less likely people are going to be to seek out these services,” said Clark. To date, there have been 580 SANE graduates of grant-funded programs, with 29% of those employed in medically underserved communities

Need help?

If you or someone you know needs help, the following resources are available 24/7, always free, and always confidential.

National Domestic Violence Hotline

Call: 800-799-SAFE (7233) or 800-787-3224 (TTY)

Chat: www.thehotline.org

Text: START to 88788

National Sexual Assault Hotline

Call: 1-800-656-HOPE (4673)
Chat:
English: https://hotline.rainn.org/online

Spanish: https://hotline.rainn.org/es?_ga=2.262612492.1444806690.1703719585-1046642814.1703719584

National Human Trafficking Hotline:

Call: 888-373-7888

Chat: HumanTraffickingHotline.org/en/chat