The review, led by Mandu Stephen Ekpenyong at Manchester Metropolitan University alongside Khatidja Chantler and Gillian Janes at Anglia Ruskin University, synthesised evidence from twenty-one qualitative and mixed-methods studies conducted across the United Kingdom, Australia, the United States, Italy, Norway, Sweden, and Pakistan between 2000 and 2023. The researchers searched five major databases, including MEDLINE, Embase, CINAHL, PsycINFO, and Scopus, following PRISMA 2020 reporting guidelines and using the SPIDER framework to define eligibility. Methodological quality was appraised with the Critical Appraisal Skills Programme checklist, and findings were interpreted through a socio-ecological model, a public health framework that situates behaviour within nested systems spanning individual, interpersonal, institutional, and societal levels. This analytical choice proved crucial, because it allowed the team to move beyond listing barriers and facilitators towards understanding how these factors interact and reinforce one another across multiple domains.

The scale of the problem these findings address is staggering. The World Health Organization estimates that roughly one in three women aged fifteen and over have experienced physical or sexual intimate partner violence, or non-partner sexual violence, in their lifetime. In England and Wales, five percent of adults aged sixteen and over reported experiencing domestic abuse in the year ending March 2022, equating to approximately 2.4 million adults. In the United States, lifetime estimates suggest one in four women have experienced sexual violence, physical violence, or stalking by an intimate partner. The health consequences are equally severe: women who experience abuse report higher rates of depression, self-harm, suicide attempts, anxiety disorders, miscarriage, pregnancy complications, and chronic physical injuries. When abuse involves multiple forms simultaneously, such as physical violence combined with coercive control, the effects compound and intensify over time.

Against this backdrop, the review’s central finding is both elegant and sobering: disclosure emerged as a relational process, not a discrete event. Women’s willingness to share their experiences depended on trust, perceived safety, validation, confidentiality, and continuity of care. Trust, in this context, was not a singular construct but a multidimensional process comprising relational safety, perceived competence, emotional validation, and the expectation that the healthcare professional would act in the woman’s best interests. Seemingly small interpersonal behaviours, such as sitting down, maintaining eye contact, speaking calmly, and allowing time, were interpreted by women as signals of attentiveness and legitimacy. These behaviours reduced perceived risk and enabled incremental disclosure, often unfolding gradually across repeated encounters rather than emerging in a single consultation.

One of the most conceptually rich findings is the notion of borrowed trust. The review found that women’s willingness to engage with healthcare professionals was sometimes mediated through social networks, institutional legitimacy, or prior social endorsement rather than through direct personal experience. In other words, trust could be borrowed from community endorsement, professional authority, or the expectations associated with healthcare settings themselves. This extends the understanding of trust beyond an individual interpersonal bond, positioning it as both relational and socially mediated. At the same time, trust proved remarkably fragile: where women encountered impatience, disbelief, judgement, or subtle emotional distancing, it deteriorated rapidly, and women who experienced dismissal or disbelief were significantly less likely to re-disclose in future consultations.

Validation emerged as another critical mechanism, operating at multiple levels. Emotional validation acknowledged feelings; epistemic validation treated women’s accounts as truthful; and moral validation clearly named abuse as unacceptable. Failure in any of these domains undermined relational safety and frequently resulted in withdrawal from further help-seeking. The review also found that non-disclosure should not be conceptualised as a straightforward failure of courage. In some contexts, silence represented a rational and protective strategy, shaped by economic dependency, housing insecurity, childcare concerns, and fear of triggering child protection procedures. For some women, the possibility that disclosure could lead to statutory intervention acted as a deterrent, particularly where professionals did not communicate safeguarding responsibilities clearly or sensitively. Moreover, leaving or separating from an abusive partner does not necessarily restore safety; research shows that separation can intensify risk and produce further instability.

On the professional side, the review revealed that preparedness is a multidimensional construct encompassing competence, confidence, emotional readiness, and perceived role legitimacy. Competence refers to knowledge and skill, including understanding indicators of abuse, safeguarding procedures, and referral pathways. Confidence reflects the perceived capability to initiate enquiry. Readiness encompasses both cognitive preparedness and emotional willingness to engage with the complexity of abuse disclosures. Crucially, the findings showed that knowledge alone was insufficient. Even where training had improved theoretical understanding, practitioners described hesitation rooted in uncertainty about managing disclosure consequences, fear of causing harm, unclear role boundaries, and concern about lacking appropriate follow-up resources. The absence of enquiry, the authors argue, cannot be interpreted solely as lack of competence; it may reflect a rational appraisal of structural constraints.

Structural factors proved equally decisive. Limited consultation time, workload pressures, staffing shortages, unclear reporting requirements, and fragmented referral pathways repeatedly constrained effective response. Time emerged in two distinct ways: as a practical resource within individual consultations, and as relational time accumulated through continuity of care. Brief appointment windows limited the opportunity for sensitive enquiry, while fragmented care reduced opportunities to build the rapport needed for safe disclosure. Where referral systems were unclear or community resources scarce, practitioners expressed moral distress and reluctance to initiate discussions that might not be adequately supported. In such contexts, identification without intervention risked being perceived as ethically problematic. Conversely, structured training combined with specialist support roles, such as domestic abuse nurse specialists, enhanced confidence and facilitated earlier identification, demonstrating that education operates on a continuum and must be supported by organisational structures to translate into practice.

The review’s most consequential insight is that disclosure alone did not ensure improved outcomes where system readiness was inadequate. Without clear referral pathways, protected time, and institutional backing, even well-informed practitioners may be constrained in their ability to respond effectively, and disclosure may expose women to additional risks, including procedural harm, unmet expectations, or unintended consequences associated with safeguarding processes. The authors therefore caution that efforts to promote disclosure must be accompanied by parallel investment in system capacity and trauma-informed care. The absence of overt structural barriers did not automatically function as a protective condition; disclosure required the active presence of relational safety and institutional support, highlighting the asymmetrical nature of barriers and enablers.

The implications extend far beyond individual training programmes. Sustainable progress, the review concludes, depends on organisational leadership, protected time, clear referral systems, and alignment across relational and structural domains. Relationally, healthcare encounters must prioritise trust, validation, confidentiality, and shared decision-making. Organisationally, services must provide continuity of care, clear protocols, and accessible referral systems. At the system level, leadership, policy alignment, and interagency collaboration are essential to support consistent and effective responses. The socio-ecological model proved especially useful here, revealing how interpersonal failures are often symptoms of wider structural misalignment rather than simply individual professional shortcomings. Future research, the authors suggest, should examine healthcare professionals’ own lived experiences of domestic abuse, a dimension absent from the included studies but potentially significant for understanding empathic engagement, emotional burden, and response behaviours. They also call for exploring disclosure processes in diverse healthcare and socio-cultural contexts, since most included studies were conducted in high-income settings with different healthcare infrastructures, legal frameworks, and safeguarding systems. Ultimately, meaningful improvement in healthcare responses to domestic abuse will depend on moving beyond individual-level interventions towards integrated, system-wide approaches that align relational practice with organisational and structural support, ensuring that when women finally find the courage to speak, the system is ready to listen.

Subject of Research: Health

Article Title: Factors affecting women's disclosure of domestic abuse and healthcare professionals’ preparedness to identify and respond: a systematic literature review

Article References: Ekpenyong, M. S., Chantler, K., & Janes, G. (2026). Factors affecting women's disclosure of domestic abuse and healthcare professionals’ preparedness to identify and respond: a systematic literature review. Frontiers in Global Women's Health, 7, Article 1702307. https://doi.org/10.3389/fgwh.2026.1702307

Image Credits: AI Generated

DOI: 10.3389/fgwh.2026.1702307

Keywords: domestic abuse, healthcare professionals, disclosure, systematic review, women's health, preparedness, socio-ecological model, Frontiers, Factors, affecting, women's, domestic

The researchers measured empowerment using the SWPER Global Index, a validated survey-based instrument that captures three distinct domains: attitudes towards violence, social independence, and decision-making. Rather than collapsing empowerment into a single proxy such as education or employment, the index distinguishes whether a woman rejects violence-supportive norms, where she stands in broader social terms including schooling, access to information, and timing of marriage and childbirth, and how much say she has over household choices. Each domain was classified into low, medium, and high levels using established cutoffs derived from 14 questions in the DHS women’s questionnaire.

The outcome was intimate partner violence experienced during the 12 months preceding each survey, constructed as a composite of physical, sexual, or emotional abuse reported by the woman herself. The pooled prevalence came to 12.4 percent, but the range across countries was dramatic, from just 2.0 percent in Mauritania to 30.8 percent in Sierra Leone, with Liberia close behind at 26.3 percent. South Africa, Malawi, and Burundi all sat below 8 percent. The authors note that such variation likely reflects differences in gender norms, economic conditions, legal protections, and disclosure patterns, although their analysis did not directly measure these contextual factors.

When the researchers ran survey-weighted multivariable logistic regression, adjusting for age, marital status, religion, education, occupation, parity, wealth, residence, and partner characteristics, the attitudes-towards-violence domain emerged as the strongest empowerment-related signal. Women with high empowerment in this domain had an adjusted odds ratio of 0.59 for past-year IPV compared with women with low empowerment, a 95 percent confidence interval of 0.55 to 0.63. High social independence was also protective, with an adjusted odds ratio of 0.84. Decision-making empowerment, by contrast, was essentially at the null, with high versus low empowerment yielding an adjusted odds ratio of 1.05.

The bivariate patterns reinforced the same hierarchy. Among women with high empowerment in attitudes towards violence, 22.7 percent reported past-year physical violence compared with 38.3 percent of those with low empowerment, and 8.2 percent reported sexual violence compared with 15.2 percent. Emotional violence followed the same gradient, affecting 25.5 percent of highly empowered women versus 36.0 percent of those with low empowerment. For decision-making, the pattern was inconsistent and non-monotonic, with physical violence actually slightly more common among women with high decision-making empowerment than among those with low empowerment.

The study’s covariate findings add nuance to the empowerment story. Education showed a mixed pattern: primary education was associated with slightly higher odds of IPV, an adjusted odds ratio of 1.08, while higher education was associated with lower odds, an adjusted odds ratio of 0.75. The authors suggest several possible explanations for the primary-education signal, including greater willingness among women with some schooling to recognize and report abusive behavior, and a transitional position in which modest gains in autonomy outpace changes in partners’ attitudes or household power dynamics. Older age, cohabitation, parity of two or more children, several occupational groups, and partner’s secondary education were all associated with higher odds of IPV, while Islamic affiliation and wealth in the richer or richest quintiles were associated with lower odds.

The authors are careful to frame these as associations rather than causal effects, and they flag the possibility of reverse causation. Women experiencing violence may withdraw from household decisions, reduce social participation, or shift their views about the acceptability of abuse as a coping mechanism, meaning that lower measured empowerment could partly be a consequence of violence rather than a precursor. Similarly, the relationship between education and IPV is difficult to disentangle, since schooling can be interrupted by early marriage, pregnancy, or controlling partners. A country-adjusted sensitivity analysis broadly confirmed the main SWPER findings, suggesting the results were not driven solely by which countries were included.

Methodologically, the analysis was rigorous for a pooled cross-sectional design. The Hosmer-Lemeshow goodness-of-fit test indicated adequate model calibration, the area under the receiver operating characteristic curve was 0.624, and variance inflation factors showed no problematic multicollinearity among the SWPER domains or covariates. A preliminary multilevel model found that clustering by country accounted for a negligible share of variance in IPV, supporting the use of standard survey-weighted logistic regression with country as a fixed covariate in sensitivity analyses. Roughly 98 percent of the descriptive sample had complete data for the primary regression model.

The policy implications are pointed. The authors argue that education and rights-based information should be integrated with, rather than substituted for, interventions addressing unequal power within relationships, community norms that tolerate violence, and barriers to confidential, survivor-centered support. Because decision-making empowerment showed no independent association with IPV, participation in selected household decisions alone may not adequately represent women’s actual power or safety. Sustainable reductions in intimate partner violence, they conclude, will require coordinated action that supports women’s agency while simultaneously challenging harmful social norms, enforcing laws against gender-based violence, and improving access to health, legal, and psychosocial services for survivors.

The study also carries important caveats. IPV may be underreported due to fear, stigma, or social desirability bias, and cultural differences in how violence is understood and disclosed may complicate cross-country comparisons. The SWPER index, while validated, may not capture context-specific forms of empowerment such as legal literacy, property ownership, or collective mobilization. The authors did not test whether the associations varied across individual countries, so the pooled estimates should be read as average associations rather than uniform effects. Still, the core message stands out clearly: empowerment is multidimensional, and the domains that matter most for reducing violence risk are those that reshape internalized norms about whether abuse is ever acceptable, and that expand women’s broader social position beyond the household.

Subject of Research: Association between multidimensional women's empowerment and intimate partner violence in sub-Saharan Africa

Article Title: Women's empowerment and its association with intimate partner violence in sub-Saharan Africa: a study using recent demographic and health surveys

Article References: Mugisha, J., Dushimirimana, T., & Koray, M. H. (2026). Women's empowerment and its association with intimate partner violence in sub-Saharan Africa: a study using recent demographic and health surveys. Frontiers in Global Women's Health, 7, Article 1929589. https://doi.org/10.3389/fgwh.2026.1929589

Image Credits: AI Generated

DOI: 10.3389/fgwh.2026.1929589

Keywords: intimate partner violence, women's empowerment, sub-Saharan Africa, SWPER Global Index, Demographic and Health Surveys, gender norms, attitudes towards violence, social independence, decision-making, public health, gender-based violence, Women's