Intimate Partner Violence and Barriers to Help-Seeking Among Black,Asian,Minority Ethnic and Immigrant Women: A Qualitative Metasynthesis of Global Research

Abstract

It is well known that victims of intimate partner violence experience numerous barriers to leaving abusive relationships. For ethnic minority and immigrant women these barriers are significantly exacerbated. This metasynthesis explored barriers to help-seeking as experienced by Black, Asian, minority ethnic and immigrant women with experience of intimate partner violence. A review of worldwide literature published in English in peer-reviewed journals on this topic from 2000 to July 2020 produced 2597 relevant articles. After removing duplicates and applying the exclusion criteria, a total of 47 articles were selected for inclusion in the review. The synthesis found that these women faced additional barriers as a result of institutional racism, immigration laws, culture and religion, and issues of cultural competence, and lack of diversity within frontline services. Such barriers, from a range of formal and informal resources, services and other mechanisms of support, served to exacerbate feelings of fear, threat, isolation and powerlessness. The barriers were also further weaponised by perpetrators in order to extend their reign of terror and control. As a result, women were caught in a double-bind – stay in an abusive relationship or face further threats and consequences if they attempted to leave. Whilst our search criteria focused on barriers to help-seeking, many of the papers included in our synthesis also explored facilitators to help-seeking, which are included in our findings and overwhelmingly relate to informal support from females.

Introduction

Intimate partner violence (IPV) is defined by the World Health Organization (2012, p. 497) as:

…one of the most common forms of violence against women and includes physical, sexual, and emotional abuse and controlling behaviours by an intimate partner… [it] occurs in all settings and among all socioeconomic, religious and cultural groups. The overwhelming global burden of IPV is borne by women.

It is well known that victims of IPV experience numerous barriers to leaving abusive relationships (Women’s Aid, 2019). It is not unusual for the perpetrator to attempt to manipulate and devalue his victim, isolating her from friends and family and ensuring that she becomes dependent on him, and under his control (Refuge, 2017a; Women’s Aid, 2019). This may then be followed by an increasingly threatening campaign of abuse, during which the perpetrator may use threats to instil a sense of fear in his victim to prevent her from leaving. Perpetrators often attempt to humiliate and shame their victims, and may threaten both victims and her loved ones with physical harm (Refuge, 2017b; World Health Organization, 2012). Perpetrators may also threaten to separate victims from their children in order to keep the women in dangerous relationships. As a result, victims are left feeling powerless and trapped.

This systematic review highlights that barriers to leaving are often exacerbated for Black, Asian, minority ethnic and immigrant women through immigration laws, cultural norms and values, religion, racism, and issues of diversity and representation within frontline services, which all serve to hinder women’s attempts to leave abusive relationships. Critical race theory (Donovan & West, 2015) and Black feminisms in social work (Bent-Goodley, 2004, 2005) have provided a powerful vocabulary with which to understand and counter the inequalities and barriers experienced by Black women in leaving abusive relationships – for example, the response of child welfare services and the criminal justice system to Black women in US and European contexts. The barriers also provide enhanced power and control to the abuser who uses these as threats to ensure that victims remain fearful, powerless and isolated. As a result, victims are caught in a double-bind – experiencing abuse if they remain in the relationship and yet potentially facing consequences if they attempt to access services, resources and other mechanisms of assistance and support.

Whilst we use the acronym ‘BAME’ to refer to ‘Black, Asian, and Minority Ethnic’ women, as did many of the papers included in our systematic review, we acknowledge that the term is not without its limitations, chief of which is the way that the term subsumes and subsequently serves to erase a diverse range of racial identities and ethnicities. As such, where possible, reference is made here to the women’s own declarations of identity – such as ‘Black British’ – or the researcher’s categorical description, based on cultural location/heritage (e.g. ‘South Asian women’). Although the focus of this paper is on the barriers experienced by women on account of culture, religion and ethnicity, it is important to view marginalisation through an intersectional lens in order to best describe the myriad of ways in which women experience multiple and intersecting oppressions on the basis of identity (Crenshaw, 1989), and we draw attention to subsequent analyses of sexuality alongside the praxis of race and ethnicity by some of the papers from the synthesis.

In relation to existing syntheses, we found two systematic reviews to date that have explored BAME women’s experiences of help-seeking in the realm of IPV – Satyen et al. (2019) and (Femi-Ajao et al., 2020). Whilst both reviews explore a similar terrain to the current metasynthesis, there are important and distinct differences. In contrast to this review, Satyen et al. (2019) only include studies based in the US. In addition to this, the source material for the Satyen et al. (2019) review mainly comprised secondary data analysis, not primary data, and the study relied heavily on statistical comparison across datasets rather than qualitative analysis. Lastly, a key difference which differentiates this review from that by Satyen et al. (2019) is the fact that the latter only includes papers which undertook a cross-cultural comparison of help-seeking behaviour; papers which did not distinguish between rates of help-seeking between different minority ethnic groups were excluded. As such, we answer the call of Satyen et al. (2019) for further investigation into the barriers affecting minority ethnic women from across all cultures.

The second review to address a similar field of inquiry is the qualitative systematic review by Femi-Ajao et al. (2020). Here, the focus is solely on the UK context, and includes eight papers from four studies. The review also focuses on the facilitators of help-seeking and, as such, there is less in-depth analysis of the barriers to IPV help-seeking. Our review therefore represents a key addition to this field with its international remit. Furthermore, given that the papers included in our synthesis all include a qualitative element, we are able to provide a more in-depth analysis of the key barriers to IPV help-seeking as experienced by BAME women from across different countries and cultures.

Methodology

Search

A systematic search was undertaken across SCOPUS, PsycInfo, Medline, CINAHL and Criminal Justice Abstracts. Terms for IPV were combined with terms for ethnic minority groups and help-seeking. A full search strategy is available in Supplemental Appendix 1.

Study Inclusion

Figure 1 This metasynthesis focused on the experiences of barriers to help-seeking among BAME female victims of IPV. To achieve our objectives, studies were required to be primary qualitative studies involving data collection with victims/survivors of IPV. Mixed method studies were included only if there was sufficient qualitative data presented to contribute to the synthesis, and qualitative studies not involving data collection with IPV survivors (e.g., discourse analysis studies of secondary data) were excluded. Study records from the searches were uploaded to Endnote® and were classified into the following groups: exclude title/abstract; exclude full-text (with reasons); include full-text; query.

Figure 1.

Study selection flow chart.

For the purposes of our work, we had a broad definition of BAME women – defined as anyone belonging to a non-majority ethnic group in their current country of residence. Additionally, we identified a number of studies including both ethnic majority and minority women, and these were included if it was clear which quotes were attributable to the minority ethnic women. Inclusion and exclusion criteria are summarised in Supplemental Appendix 2.

Whilst our search criteria focused on barriers to help-seeking, many of the papers included in our synthesis also discussed facilitators to help-seeking, which we have included in our findings. Whilst inclusion of the search term ‘help-seeking’ should have captured papers exploring facilitators, we cannot claim to have included an exhaustive list of facilitators to help-seeking in our findings.

Quality Appraisal

Figure 2 All studies were appraised for methodological quality using the Critical Appraisal Skills Programme (CASP) tool for qualitative studies. The objective of the quality appraisal exercise was to identify possible common methodological limitations of the body of literature, so as to also understand possible limitations of our metasynthesis. Each study was rated on the CASP by one reviewer and independently checked by a second. In cases of disagreement, a third reviewer was consulted to adjudicate and arrive at a final decision (see Supplemental Appendix 4). There were generally few clear methodological limitations within the synthesised literature. The most common potential issue with the methodological quality of the literature was a lack of reflexivity (not addressed in 24 articles and partly addressed in five articles). Other possible common limitations in the literature were ethical considerations (not addressed in four articles, partly addressed in 16 articles), and analytical rigour (not addressed in seven articles and partly addressed in two articles).

Figure 2.

Quality appraisal: Authors’ judgements about methodological quality across the data set.

Data Synthesis

A thematic synthesis (Thomas & Harden, 2008) was undertaken to analyse the overall patterns in the corpus of studies. PDFs of included studies were imported into NVivo® software and read iteratively. The findings sections of our included articles were treated as our raw data, and were initially coded line-by-line, staying close to the language of the study participants and researchers. The themes created in this stage identified 25 different types of barriers experienced by the victims and a range of 14 different facilitators they used or were supported by. The most commonly mentioned barriers were cultural issues, discrimination/racism, documentation issues and dealing with the legal system, whilst the most common facilitators were family, religion and spirituality, accommodation and advocacy agencies. In the next stage of analysis, a process of constant comparison was undertaken to identify commonalities and discrepancies within the dataset. Comparisons were undertaken in a number of ways: by members of the team manually examining codes for patterns, through discussions among the whole research team, and finally by using some of the analysis tools in NVivo®, especially the cluster analysis function. This process resulted in a shorter list of more general overarching codes that described substantive amounts of the included data.

Findings

Supplemental Table 1 (in Supplemental Appendix 3) describes the background detail of the studies. The number of women included in the samples across all 47 papers totalled approximately 921 BAME women, of whom approximately 630 were immigrants. The majority of the studies that met our selection criteria were undertaken in the USA (34 papers). The others were undertaken in UK (4); Hong Kong (3); Australia (2); and Norway, Canada, Taiwan and Sweden (1 each). Respondents in the studies came from a wide range of regions, ethnic groups, countries and religions. The most common identified were Latina (Hispanic) (12 papers), African American (9 papers), South Asian (7 papers) and Asian (5 papers). Other identified groups included Vietnamese, African immigrant and Muslim (3 papers each), Mexican, West African and multiracial (2 papers each) and Cambodian, Chinese, Pacific Islander, African-Caribbean, Irish, Jewish, Nigerian and Ethiopian (1 paper each). A wide age range was represented, from early to late adulthood.

Study methodology and key findings are summarised in Supplemental Table 2 (in Supplemental Appendix 3). Many papers did not report a specific analytical approach to their investigations (17 articles), but common approaches were participatory action research (5 articles), grounded theory (4 articles), feminist inquiry, phenomenology and thematic analysis (3 articles each). Data overwhelmingly were collected in interviews (28 articles), with six articles using focus groups and seven using a mix of both approaches. Four articles used some other mix of methods (e.g. ethnographic observation, surveys and document analysis).

As our synthesis reveals, women experience a number of barriers which prevent disclosure. These barriers are heightened for BAME and immigrant women and include fears that children will be removed, fear of deportation, police brutality, racial discrimination and lack of trust in formal services and systems. These barriers, alongside socio-economic issues (such as employment and housing instability), mean that minority ethnic and immigrant women are more likely to access informal sources of support over more formalised routes of help-seeking.

Figure 3 attempts to capture the unique challenges faced by BAME women leaving abusive relationships, as developed through the synthesis of the 47 papers included. We see barriers to escaping GBV among ethnic minority and immigrant women operating at three, interwoven levels: the ‘individual experiences of abuse’ category captures key features of control that are used by perpetrators of gender-based violence (GBV) in intimate relationships (see Goodman et al., 2009; Refuge, 2017b; World Health Organization, 2012), irrespective of women’s minority ethnic or immigration status. However, the impact of these forms of abuse is exacerbated by specific factors affecting BAME and immigrant women. At the broad socio-cultural and political level, women’s experiences of GBV are underpinned by a context of racism and patriarchal gender norms. These, in turn, feed into barriers operating within ‘meso-level’ systems which women experiencing GBV need to navigate, and which we focus on in the analysis that follows. In summary, our synthesis identified three key areas that reveal the unique challenges experienced by ethnic minority and immigrant women: service issues (including difficulties accessing domestic violence support, housing and state support services, and experiences of structural racism in policing), immigration issues (including threats of deportation and ineligibility for services) and cultural issues (including language barriers, family systems, cultural expectations and religion).

Figure 3.

A model of the drivers of ethnic minority women’s difficulties in exiting violent relationships.

Exacerbating Factor: Cultural/Religious Norms and Values

The 47 papers included in the synthesis focused on samples of women from several different cultures including African, Hispanic/Latina and Asian. Although heterogeneous in nature, all cultures nonetheless contained their own patriarchal norms, the common contours of which were identified in this synthesis. These related to ideas that women were responsible for ‘keeping the family together’ and that women’s roles were primarily domestic and ‘private’ in contrast to the ‘public’ breadwinner roles of men. In addition, some acceptance of gendered violence was also apparent, together with the importance placed upon maintaining an intact marriage, both in cultural and religious terms.

Patriarchy

Women’s sense of isolation was deeply bound with patriarchal norms and cultural pressure to remain in abusive relationships. Within Latin American culture, ‘machismo’ sets the expectation for men to be dominant, the decision-maker and the provider. In contrast, ‘marianismo’ refers to women’s responsibility for maintaining relationships and peace. The following survivor quote highlights the ways in which these concepts work towards keeping women in abusive relationships:

If your husband says something that you do not like, your obligation is to shut up and put up with it, because he is your husband, I mean you already got married, you are there and you put up with it. (Silva-Martínez, 2016, p. 531).

Similarly, male dominance and female submission were significant themes among Chinese respondents’ experiences of IPV, one of whom recalled her husband’s announcement that ‘The woman whom I marry should be as docile as a sheep, and should never talk back’ (Chiu, 2017, p. 1301). According to Jordan and Bhandari (2016) South Asian cultural values also prize masculinity, believed to derive through virility and the ability to control women.

Both Anitha (2008) and Parson et al. (2016) claim that South Asian and Hispanic cultures value virginity, with the expectation that women are virgins at marriage. This meant that women remained trapped in abusive relationships, afraid they would be unlikely to find another husband:

Sometimes I felt that I wasn’t worth anything, because of what people in Mexico said to me. That if you aren’t a virgin anymore, you are worthless… if I didn’t have him [her abuser in the U.S.], nobody else was going to love me. (Parson et al., 2016, p. 24).

Single African women are viewed unfavourably, labelled as ‘prostitutes’, with negative stereotypes ascribed to single parents (Ogunsiji et al., 2012). Ting and Panchanadeswaran (2009) found that African women, even after being divorced by an abusive first husband, often remarried quickly due to fear of negative stereotypes and community ostracisation as single women.

Women lacked the opportunity to obtain an independent income which could assist them with the financial support necessary to leave. As such, poverty served to compound issues related to financial abuse that are experienced by many non-minority women in abusive relationships, with the perpetrator controlling the household finances completely. ‘He wouldn’t let me go back to school. He wouldn’t let me go to work. He wouldn’t let me do anything. Just stay at home being a mom’ (Tam et al., 2016, p. 533).

Women were obliged to care for their husband, children and in-laws, obtaining respect by fulfilling the role of the ideal wife and mother. Socio-economic dependence on their husbands meant that women felt powerless and isolated, unable to leave the house (Parson et al., 2016). A Chinese victim articulated her feelings of isolation by describing herself as ‘a bird in a cage’ (Chiu, 2017, p. 1302). Ting and Panchanadeswaran (2009) describe how African women are traditionally regarded as their husband’s property after paying a bride price, meaning that they are financially obligated to remain with their husband. In the same study, a respondent described being unable to leave her husband who had paid her family five cows to marry her, which meant that she was now his ‘property’, rejected by her family of origin.

Cultural Acceptance of Abuse

Cultural norms included acceptance of male violence towards women, which often prevented women from recognising abuse. South Asian respondents noted that culturally, partner abuse is a private family issue and as such is largely overlooked or considered normal (Sabri et al., 2018). Similarly, traditional gender roles within Mexican culture, including the man’s entitlement to physically harm their wives, were noted by women in the study by Vidales (2010). Six of the ten women in the study by Reina et al. (2014) identified that Latina cultural views of marriage influenced their perceptions of abusive relationships, which impeded help-seeking:

In Mexico it is normal to have fights . . . is like there is still machismo in Mexico . . . like everything is part of marriage . . . I thought it (domestic violence) was part of marriage (Reina et al., 2014, p. 602).

The narratives of African women highlighted their feelings of isolation and powerlessness experienced due to cultural acceptance of IPV (Ogunsiji et al., 2012; Ting & Panchanadeswaran, 2009).

In my country, it is okay for men to discipline their wives. I told myself this was not abuse, this was ‘normal discipline’. Other wives I know said the same thing? “oh yes, my husband hits me too; that’s normal”, so that is how we believed, and how we all survived (Ting, 2010, p. 353).

Sex is considered the marital right of the husband and sexual abuse is therefore not recognised in South Asian culture (Sabri et al., 2018). This is highlighted by Jordan and Bhandari (2016, p. 238), discussing the experiences of Pakistani and Indian women: ‘The role of culture in examining the women’s conception of the abuse they experienced cannot be understated. Women were more likely to be able to identify physical and psychological abuse as violence than they were sexual violence as such’.

Family Honour and Shame

Termed ‘familismo’ in Latin American culture, remaining loyal to family – family honour – served as a powerful barrier to exiting an abusive relationship (Kasturirangan & Williams, 2003; Reina et al., 2014). The studies evidenced that women within strong cultural and religious communities were often fearful of the consequences of leaving their abusive relationship, concerned about the shame and humiliation this would bring to themselves and their family. A respondent from Sabri et al. (2018, p. 247) noted:

As the cultural Indian girl, I’m not allowed to leave him, because I can change the man by changing my tactics. It will be a disgrace to the family. The children will have a black spot on their name, and no one will marry them when they grow older.

The stigma associated with divorce and the blame attached to women for marriage break-ups commonly served as barriers to help-seeking. Shame is described as a powerful agent of social control in South Asian culture and a key deterrent to disclosure: ‘My father said, “if you divorce, you are dead to me, do not come back home”’ (Tonsing & Barn, 2017, p. 633). As this quote illustrates, family often reinforced the necessity of preserving family honour through the use of threats. It was not uncommon for women from various cultural backgrounds to experience interference from their in-laws, as noted by an African respondent: ‘My mother-in-law, she tell me she will tell the police I am the troublemaker, that I am the crazy one’ (Ting & Panchanadeswaran, 2009, p. 825). Jordan and Bhandari (2016) note that South Asian women may also experience abuse from their husband’s family, highlighting the significant impact of culture and the resulting powerlessness experienced by women.

Marriage to cousins is common in South Asian culture (Tonsing & Barn, 2017), and thus, divorce resonates through the wider family, impacting other relationships and tarnishing family honour: ‘I am married to my first cousin so tolerated it because women get divorce then many families get affected … it will disrupt family...’ (Tonsing, 2016, p. 22). In addition, fears of jeopardising the marriage prospects of their sisters may prevent South Asian women from disclosing abuse (Gill, 2004; Izzidien, 2008). It was clear from the papers that issues around family honour often led to victim blaming which, in turn, made it difficult for women to seek help.

Religion/Spirituality

The findings from this synthesis highlight the significant power that cultural and religious identity forces upon women. Two of the papers included in the synthesis focused on samples of Muslim women (Ghafournia, 2017; Hassouneh-Phillips, 2003) and the evident similarities between these religious and cultural norms were deemed difficult to separate (Ghafournia, 2017).

Religion was often useful in assisting women to cope with the abuse (n = 9). Visiting a place of worship also provided some women with feelings of peace and reduced isolation (Hassouneh-Phillips, 2003). However, religion and spirituality often provided sources of empowerment and strength to remain in the relationship rather than the strength to leave (Ghafournia, 2017). Thirteen papers highlighted that religion impeded help-seeking. A few women believed that God assisted in the termination of their relationship. Despite leaving due to familial help, a shelter or legal protection, women often believed it was God who had saved them. ‘Looking back…when [the batterer] left, my prayers were answered. [God] did get me out of it…he rescued me out of it, no matter how it happened’ (Potter, 2007, p. 272).

Family members used religion to pressurise women to remain loyal to their marriage vows: ‘My mother said to me that divorce is not Christian; God will not accept it. She asks why I insist on doing this. I explained to her how he treats me, but she does not believe it…’ (Ting & Panchanadeswaran, 2009, p. 824).

Abusers also used religion as a tool to assist them in their abuse, for example, an Indian respondent described how religion meant that women were unable to refuse their husband sex and that husbands had the right to leave women should they refuse (Sabri et al., 2018).

Women’s feelings of powerlessness were often exacerbated after seeking help from religious leaders, who tended to support abusers, blame women for being controlling and/or advise women to remain in their abusive marriages (n = 9). Religious leaders most often prioritised the church or community above women’s safety. Across the literature, Latina women’s religious beliefs most often hindered help-seeking, as their predominantly Catholic faith advocates tended to side with the abusers. In the words of one survivor, her situation was ‘…interpreted as an unchangeable circumstance designed by god as a challenge to be met with dignity in order to enter heaven after death’ (Vidales, 2010, p. 537).

Potter (2007) found that although both Muslim and Christian women described patriarchal religious experiences, mosques were more likely to respond proactively when approached about domestic abuse. However, this was not the experience of a Muslim respondent in Ghafournia (2017, p. 154) whose fear and powerlessness was apparent as she described her Imam’s response to her pleas for help:

He told me that the woman who is patient with her husband’s bad deeds will go to paradise. They said to me million times until I said to them, I don’t want to go to paradise this much quick. If I stay with him, I will die soon; someone should help me. They just kept telling me I have to be patient.

The relationship between culture and religion is often difficult to separate, a factor acknowledged by women who ‘believed that it was mainly cultural values and expectations that delayed their responses to the abuse’ (Ghafournia, 2017, p. 157).

Racial Stereotypes

The issue of isolation interacted with women’s minority status in an array of ways. Most often, BAME women’s experiences of isolation in violent relationships were exacerbated by issues of migration or patriarchal practices within their cultures. However, an interesting anomalous case that stood out was the comparison of Black and White women in the US by Few (2005). This case highlights some of the complex pathways by which race and racism interact with GBV. Few (2005) found that Black women in the shelter had greater levels of social support outside of the shelter context among other Black women. It seemed that this discrepancy was rooted in the higher chances for Black women to live in predominantly Black neighbourhoods, where the way to survive in a country and economy deeply undergirded by racism was by forming close kinship ties and networks of support. On the other hand, the Black women were more isolated from formal support in the form of state services. African American women commonly noted keeping family/personal issues to themselves, due to cultural influence, the impact of racism and internalisation of stereotypes. ‘They are also aware of the impact that racism has on their friends and family members and do not wish to subject them to further oppression by other actors, such as police’ (Monterrosa, 2019, p. 16).

Black women experienced barriers to help-seeking which were based on both structural racism and pervasive stereotypes of Black women as ‘strong’. The ‘Strong Black Woman’ (SBW) stereotype of tough, domineering and insensitive women who are hard to handle and who necessitate the use of physical control by men (Taylor, 2005) impeded Black women’s help-seeking, through fear of being disbelieved, being perceived as vulnerable/weak and unworthy of care and concern (Few, 2005; Monterrosa, 2019). This seemingly ‘positive’ stereotype which denotes strength, resilience and independence, self-sacrifice and the ability to survive, arose in contrast to ‘negative’ stereotypes of enslaved Black women by an oppressive society and as such, has racist underpinnings which serve as an additional impediment to Black women’s help-seeking. African American women’s accounts within the synthesised studies highlighted awareness of such stereotypes, noting an unwillingness to confide in family and the belief that they should have the ability to handle their abusive situation alone (Monterrosa, 2019). Previous research identified the negative impact that the SBW stereotype had on women’s mental health (Carter & Rossi, 2019; Donovan & West, 2015), with Black women who subscribed to the notion of the SBW less likely to seek formal help for abuse (Asbury, 1987; Few, 1999).

Exacerbating Factor: Immigration

The barriers to help-seeking for BAME women discussed above were compounded for immigrant women, whose immigration status and unfamiliarity of the legal system (legal rights and services) rendered them vulnerable and allowed abusers to exercise threats of deportation and arrest in order to further control victims.

Immigration Control

Women who have travelled to the UK on a temporary visa can apply to the government for ‘leave to remain’ if their relationship has ended due to domestic violence. However, the literature highlighted the problematic nature of this legislation in practice, in terms of the barriers and further risks it presents to vulnerable and newly-immigrated women. The legislation requires women to submit evidence of the abuse before they leave the relationship and, thus, when they are most at risk. Anitha (2008) found that only a third of the women in her study had managed to contact service providers – often at great risk to themselves – while still in an abusive relationship. According to Anitha (2008), the UK Domestic Violence Rule served to put women’s lives in danger because of the onus on victims to gather evidence while they were still in an abusive relationship. Even when victims did make contact with services, it was not guaranteed that evidence would be adequately documented (Anitha, 2008).

The No Recourse to Public Funds requirement in the UK which applies to immigrants with insecure status to the UK means that basic domestic violence services such as safe accommodation and financial support were not available to victims when needed. According to Voolma (2018, p. 1840), in relation to the UK context: ‘…the aim of immigration control precedes that of ending violence against women. This can be seen as state complicity in domestic abuse, as the exclusion from services prevents survivors from being able to leave violent partners’. A similar system also applies to undocumented women in Sweden. These rules meant that women had limited options for leaving abusive relationships (Voolma, 2018).

Discrimination was also experienced by immigrants to the US, as South Asian women claimed that by being an immigrant, not having a job and being a single mother, they struggled to rent an apartment due to discriminatory landlords (Kiamanesh & Hauge, 2019). This meant that whilst their cases were being reviewed, they had no choice but to reside in shelters for lengthy periods.

Women often worked as undocumented workers for low wages and believed that without money they could not seek help (Ting & Panchanadeswaran, 2009). Even women with qualifications and professions in their native countries encountered barriers to obtaining an independent income because their qualifications were no longer recognised. Feelings of powerlessness were exacerbated through immigrant women’s socio-economic dependence upon their husbands: ‘Just being an immigrant makes me ashamed, because I had a job and I am educated. I was supposed to be independent, but here (in Norway) I am helpless’ (Kiamanesh & Hauge, 2019, p. 304). Kasturirangan and Williams (2003) described how the majority of Latina women worked in low-paid jobs. The few opportunities they may have had for job advancement were often compounded through discrimination or poor English language skills.

Threat of Deportation

It is well known that perpetrators use a range of threats to deter their victims from leaving violent relationships (Refuge, 2017b; World Health Organization, 2012). However, the literature revealed a number of threats that were unique to immigrant women of BAME backgrounds. Many of the women in the papers synthesised were undocumented immigrants, most of whom had relocated to their husband’s host country. The threat of deportation was sometimes explicitly used against women without settled status by perpetrators and their families, illustrating how women’s immigration status and ‘tough’ immigration policy served to deepen the ways in which violent partners and families could control their victims: ‘My visa expired but (they) were not ready to apply for indefinite leave for me. His mother always used to say, “Deport her!”’ (Anitha, 2008, p. 194). An undocumented immigrant victim whose son was a citizen, noted:

Every time I wanted to leave, he would tell me “If you say something I will go to immigration and accuse you. If you talk with the police, I will tell them that you are illegal and you won’t ever see the boy again” (Silva-Martínez, 2016, p. 537).

Numerous intersecting vulnerabilities combined to ensure that BAME women, and particularly immigrants, were continually exploited, leaving few opportunities for leaving abusive relationships, articulated by a Latina immigrant living in the US: ‘[immigrants] not only experience domestic abuse but also abuse from their employers because they don’t pay them, and they do nothing because they are afraid of getting deported’ (Reina et al., 2013, p. 1482).

The real fear of deportation and an acute awareness of the powerlessness imposed by their immigration status commonly prevented women from seeking help from formal agencies. Many women with legal rights as immigrants were unaware of these rights and stayed in abusive relationships due to their husbands’ threats to stop the immigration paperwork if they attempted to leave (Vidales, 2010, p. 539). Perpetrators who were also recent immigrants used their own immigration status as a threat to restrict women’s communications outside of the relationship, creating fear that ‘they or their abusive partners might be forcibly repatriated’ (Kanuha, 2013, p. 1185).

As the papers by Anitha (2008), Reina et al. (2013) and Kanuha (2013) reveal, perpetrators can weaponise any asymmetries between the couple, using his language proficiency, residency and knowledge of local laws and customs in order to further threaten, abuse and control his victim. In addition, as highlighted in research by Kanuha (2013), even when both members of a migrant couple face similar cultural barriers and challenges, a perpetrator may draw on his own vulnerability (in this case, lack of residency and permanent citizenship) in order to further subdue and isolate his partner.

Isolation from Support Networks

A particularly common theme in all accounts of domestic abuse is the isolation experienced by the victim, noted as a key method of control among survivors of IPV. The process is often accelerated for immigrant women who moved away from established support networks and found themselves living in separate ethnic, linguistic or religious communities. These women had little opportunity for contact outside of the home, and outside of the reign of the abuser.

Some women were prevented from contacting their family back home ‘which left them afraid and lonely, and shifted the balance of control considerably in the abuser’s favour’ (Jordan & Bhandari, 2016, p. 236). Difficulties acclimatising to the new culture combined with lack of support networks to keep women locked in abusive relationships. Shiu-Thornton et al. (2005) highlight the ways in which these dual processes work to further isolate immigrant women:

…in contrasting their life in Vietnam with life in the United States, women recalled that their role in Vietnam was to suffer silently, assume all the blame for problems, and endure. However, women when describing life in the United States in contrast to life in Vietnam expressed general feelings of isolation and spoke of their difficulties in adjusting to a new cultural setting (Shiu-Thornton et al., 2005, p. 967).

Kanuha (2013, p. 1187) identified that isolation was compounded among immigrant South East Asian LGBTQ women through the intersection of their identities with available forms of social support. For one study respondent who had immigrated from the Philippines, the combination of her immigration status and moving to the United States with her controlling and dangerous lesbian partner who was also Filipina only reinforced that she had no recourse but to stay with her partner until she could find an alternative social-support system, either within or outside the Filipino and/or LGBTQ community.

Language Barriers

Language issues were another common barrier to help-seeking (coded in 22 articles). Women were often prevented by perpetrators from learning the local language. Conversely, perpetrators’ local language skills and knowledge of the system were more developed, providing them with additional power and control. Bi-lingual assistance was often absent in formal services, leading perpetrators to exploit this gap in order to thwart women’s attempts at help-seeking, highlighted by the following respondent – a Mexican immigrant to the US:

When the police came, they could tell I couldn’t speak English, so they started to talk to my husband. I could understand enough of their conversation in English to make out some of what they were saying. My husband told them it was his home and that he wasn’t sure if he’d let me stay here. Soon the police were asking him to please let me stay. I was crying and really frustrated because the police didn’t take the time to understand what I wanted to say…After a while the police and my husband began talking about football and laughing. It was like they were part of a male club or something (Vidales, 2010, p. 536).

Separation from children became a reality for some respondents unable to speak the dominant language, illustrated by a Spanish-speaking immigrant to the US who was left with a criminal record:

Her husband returned from work one night and attacked her. Fearing for her life, Ada reached for an object and scraped him with it in self-defence. When the police arrived, her abuser explained to them in English what had happened, and the police had no communication with Ada because of language barriers. The police arrested Ada and gave her abusive husband their girls (Parson et al., 2016, p. 30).

Unfamiliarity with Legal Rights and Services

Linking closely with the theme of language barriers, a significant barrier to disclosure cited by women in 26 of the papers synthesised was unfamiliarity with the legal rights and services available to them in their new countries. There were many cases across the papers where perpetrators knew the local law better than the victims and would intentionally mislead women about the consequences of seeking legal intervention. As one survivor noted: ‘He told me several times that he had told everyone I was mad … no one would listen to me. If I contacted the police, they could consider me mad and arrest me’ (Anitha, 2008, p. 195).

Women’s prevention of learning the language meant they were also unable to research information on their new country. An Iranian immigrant to Sweden articulated this powerfully: ‘I didn’t know what are my rights…Migrants don’t have any information…It is a new form of slavery… You have not language, you have not contacts’ (Voolma, 2018, p. 1843). The unequal access to information could be said to perpetuate racial inequality through omission, a factor found across several papers in relation to various services. A South Asian immigrant to the UK noted: ‘I think there should be some leaflets to advise (us) about (our) rights in the UK if the marriage breaks down... You are completely at the mercy of your husband and in-laws. I have not seen anything anywhere’ (Anitha, 2008, p. 197).

The power dynamics involved in marriage migration are significant, articulated by a participant who believed that this was part of the abuser’s tactics: ‘husbands won’t bring them here if they know their rights’ (Voolma, 2018, p. 1844).

Exacerbating Factor: Service Issues

BAME and immigrant women encountered significant barriers within the realm of formal help-seeking – most notably immigration control, policing, legal services, shelters and social services. According to Brittain et al. (2005 as cited in Anitha (2008 p. 197)) minority ethnic women make, on average, 17 contacts with formal services prior to receiving help, contrasting with 11 contacts for non-minority ethnic women. The quote below from an immigrant Latina woman in the U.S. illustrates how multiple intersecting vulnerabilities rendered her powerless:

When you don’t know where they are [services], when you don’t know where to turn, when you don’t know the language, when you don’t know the people, you realize that you are blind and you need to stay where you are (Silva-Martínez, 2016, p. 532).

Analysis of the articles synthesised revealed common themes relating to a lack of culturally and ethnically sympathetic services, signposting and a lack of outreach by services. For example, Few (2005) found that only a fifth of Black women in their study had been informed about their local shelter by police, compared to three-fifths of White respondents.

Distrust of Police

A key theme to emerge from the literature was Black women’s fear and distrust of the police which stems from ‘the traditionally hostile relationship law enforcement has had with Black communities’ (Richie, as cited in Few (2005, p. 497). As a result of a long history of police brutality and discrimination against the Black community, Black women viewed police officers with fear and suspicion. None of the Black women interviewed by Few (2005, p. 493) felt that the police ‘could be used as a vehicle for temporary safety...’. Elsewhere, one respondent noted: ‘I never called the police…We were taught that the police were not our friends…The police are not there to help Black people. For Black people, we don’t tell our business. Calling the police was out of the question’ (Monterrosa, 2019, p. 12). The extent of Black women’s mistrust in the police often stemmed from previous negative experiences:

Natalie also described how being Black, poor, and gay had resulted in her being mistreated by the police...Once, she called the police when she was being abused and she said that the officers hadn’t liked her attitude and so they had “pulled me, you know, slammed me against the floor, handcuffed me and took me to jail”’ (Simpson & Helfrich, 2014, p. 455).

As a result of the historically adverse relationship between the police and the Black community, Monterrosa (2019, p. 160) found that many women were deterred from seeking police assistance and, as such, endured ‘longer periods of more severe abuse’. Women only called the police when they were in life-threatening situations (Jordan & Bhandari, 2016; Parson et al., 2016). Respondents from other ethnic groups also noted police discrimination. In Tang and Wang’s (2014, p. 280) study, a social worker reported that the police ‘were not neutral and deliberately provided incorrect information…’ to immigrant Vietnamese victims in Taiwan.

Racist stereotypes of Black men as violent also hindered women’s help-seeking (Monterrosa, 2019; Ting & Panchanadeswaran, 2009). Black women were fearful that their partner’s race and ethnicity would be further weaponised by the police and wanted to shield their partners from police brutality by not reporting the abuse or downplaying the impact of IPV. According to Ogunsiji et al. (2012, p. 1663), women ‘were preoccupied with the fear that the punishment from law enforcement agents may be too grievous for their husbands to bear’. Victims also wished to avoid their partners being added to the disproportionately high number of Black men incarcerated in the US prison system.

Threat of Removing Children

The racist politics embedded in state-provided services acted as an ongoing implicit and sometimes explicit threat against leaving violent relationships, highlighted by South Asian immigrants to the UK, who found that upon contacting their Local Authority, social workers offered to take their children into care rather than supporting the family (Anitha, 2008). Women are then unlikely to pursue that Local Authority again for fear of having children taken into care and thus will have no ‘evidence’ of reporting their abuse despite having contacted a service (for the purpose of the Domestic Violence Rule). Immigrant victims in the UK may also refuse to divulge personal details to the relevant agencies and will thus not have the evidence needed for the Domestic Violence Rule (Anitha, 2008), resulting in further punitive consequences.

Women sought help in order to protect themselves and their children from violence but, in doing so, risked having children taken away because they were deemed neglectful in not being able to shield their children from the violence of their partners. The fear of removal served as a major barrier for women seeking help. Some participants reported having previously had their children taken away when they had sought help. Rather than receiving help, however, women were blamed, deemed neglectful in not seeking help sooner even though they did their best to protect themselves and their children from their partner’s violence.

Help-Seeking Facilitators

The systematic review of the 47 articles identified many barriers that made leaving violent and abusive relationships more complex for BAME and immigrant women. Recognition of the multi-layered barriers is important to promote the need for more culturally sensitive services and to challenge individual, organisational and structural racism. Within some of the studies synthesised, women were able to identify what or who had enabled them to leave. These facilitators enabled some women to overcome the main themes of threat, fear, isolation and powerlessness identified through our analysis, whilst others offered empowerment and comfort to cope whilst remaining with the perpetrator. The facilitators were more intrinsically linked not to the impact of the abuse but to the ethnicity, cultural and religious practices applicable to the women, and the willingness of predominantly family and friends, to offer support. The facilitators are analysed below.

Informal Support Networks

Family was indisputably the largest theme which facilitated women’s ability to leave, with mothers and sisters playing significant roles both emotionally and practically (Kyriakakis, 2014; Monterrosa, 2019). Children also played a noteworthy role, more often as a catalyst to women leaving. Women often reached a point where the need to protect their children became absolute, and this was the most common reason for women to leave abusive relationships. Across the studies synthesised, it was evident that over time the risk and violence experienced by the women escalated to such an extent that children became at risk of being hurt and traumatised by the abuse. Women witnessing traumatisation of their children were spurred into leaving: ‘I decided I needed to make myself strong for my daughter’ (Jordan & Bhandari, 2016, p. 239). This was despite the prevalence of cultural and religious norms which heavily influenced women into remaining in the relationship – believing that the child needed a father and that she would be shamed as a single mother.

There was a distinct lack of visible, helpful men throughout the literature. Instead, emotional and practical support often fell to female family members and friends who helped women leave via the provision of shelter and childcare (Kyriakakis, 2014).Women with the same cultural and ethnic identity enabled victims of IPV to feel that their experience was understood: ‘Black women’s ability to share their experiences with other Black women who have a thorough understanding of the symbolic function of the strong Black woman stereotype allows Black women to be vulnerable among one another, without judgement’ (Monterrosa, 2019, p. 12). Female friends with lived experience were also invaluable in providing support (Kyriakakis, 2014; Shiu-Thornton et al., 2005), and knowledge regarding legal rights, and access to education/employment opportunities (Few, 2005; Kyriakakis, 2014), which enabled women to act to protect themselves and their children through legislative frameworks.

Leaving was often positively influenced by the help of just one person. An offer of emotional help and support by someone recognising the impact of the abuse was an important trigger to enable women to leave. However, it can be argued that this is due to a distinct lack of relevant and bespoke services offering interventions and support for minority ethnic women, leaving them further isolated, at risk and fearful, beholden to individuals to make a difference to their lives.

Formal Support

There were several women’s accounts which highlighted that although services may not have been influential in helping them leave, once certain services were accessed, they assisted with safety and moving forward. Shelters were considered safe havens (Anitha, 2008; DeVoe & Smith, 2003; Few, 2005), where the common experience of victimisation bonded women of different ethnicities.

Informal advocacy, mental health and counselling services were crucial in enabling women to become more independent and confident about their rights (Anitha, 2008; DeVoe & Smith, 2003; Tam et al., 2016). Significantly, the most positive comments related to individuals within services who respondents felt had gone over and above their job role, in demonstrating kindness, staying late or phoning regularly (DeVoe & Smith, 2003; Tam et al., 2016).

Discussion

Black, Asian, minority ethnic and immigrant women experience several barriers in the realm of IPV help-seeking, most notably as a result of systemic racism and a politics of exclusion across policing, immigration and frontline services. Structural racism entwined with, and intensified, the stranglehold of patriarchy to ensure that BAME and immigrant women had little option but to remain trapped in abusive relationships. Where women were eventually able to leave, the considerable barriers and roadblocks in their way did not make this process smooth or easy. As our synthesis revealed, the very mechanisms designed to assist women in leaving abusive situations in many cases served to make it harder for women from marginalised communities to escape violent relationships.

There were numerous instances of BAME and immigrant women being blamed for their plight – both by their communities and sometimes from formal services. Concerning the latter, this translated into being deemed neglectful if they were not able to seek help earlier, despite the consequences (which were potentially life-threatening) and barriers faced. In both cases, IPV was viewed as the victim’s responsibility. Often, women were put in an impossible position, blamed and subsequently punished for their partner’s violence – the message being that, as mothers, it is their duty to protect their children from violence, regardless of their own victimisation, while the men in their lives were not held to account. The fear that the authorities would remove their children served as a major barrier for women seeking help and resulted in women downplaying the seriousness of their situation, delaying or avoiding help-seeking altogether. Immigrant women face additional barriers related to language and unfamiliarity with laws, rights and services, all of which were further weaponised by perpetrators through threats (deportation, removal of children) and manipulation (the perpetrator acting as a translator and mistranslating the victim’s needs within formal services).

Where immigration laws and policies were mentioned in the synthesis, this was primarily in relation to the UK and Sweden. In both countries, victims of IPV who were recent migrants faced a number of additional barriers as a result of particularly punitive legislation which prioritised restriction of movement over supporting women who have been subject to abuse and violence. A clear change of priorities is needed, and, in a UK context, this could involve a suspension of the current ‘no recourse to public funds’ condition which prohibits migrants from accessing a range of welfare benefits. As our synthesis reveals, socio-economic independence – via education, housing and employment opportunities – is crucial for women escaping from violence. In the absence of this – and with additional barriers in the form of threats of deportation, and employment and housing discrimination (highlighted by the U.S. data) – immigrant women are at risk of exposure to long-term and escalating violence.

Women found informal support networks to be more helpful than formalised help-seeking, highlighting both the need for improvement within mainstream services and the need to strengthen other areas, such as peer-support. This is especially crucial for women who could not rely on family or friends as they were left reaching out to services that did not specifically cater for their needs as BAME women. As such, the synthesis revealed the pressing need for change at a systemic level across culture, policy and services in order to tackle the sheer array of intersecting barriers that women from BAME and immigrant backgrounds face in the realm of IPV help-seeking. It is interesting to note that there was also a highly gendered element to informal help-seeking. It primarily fell to other women to become the facilitators to leaving, with mothers, sisters, friends and those with lived experience predominantly providing the lifeline that victims needed. This observation seems to suggest that intimate partner violence is still unfortunately seen as a private matter and, within the sphere of patriarchy, a women’s issue – one that does not concern men.

The lack of racial diversity among shelter staff meant that shelters were sometimes considered to be the last resort for Black women. According to Few (2005), four out of ten Black women reported feeling ‘somewhat isolated’ because of the distinct lack of BAME staff at the shelters. As a result, this affected what they might share with other residents: For example, in mandatory support group meetings, Black women revealed that they did not discuss with White women how it felt to be abused by Black men or challenges they may have faced with different social services (Few, 2005: 495). These women perhaps anticipated prejudicial treatment by staff or felt that staff would not be culturally or racially sensitive to their needs. In addition to this, the stereotype of the ‘Strong Black Woman’ (Taylor, 2005; Few, 2005; Monterrosa, 2019) emerged as a crucial barrier to help-seeking both across formal and informal contexts both as a result of a victim’s self-perceptions and beliefs, and in terms of unhelpful practitioner attitudes and response.

Summary

Black, Asian, minority ethnic and immigrant women experience significant additional barriers to leaving abusive relationships primarily because of punitive immigration laws, systemic and structural racism, cultural exclusion and police brutality. Such barriers, from a range of formal and informal resources, services and other mechanisms of support, served to exacerbate feelings of fear, threat, isolation and powerlessness amongst victims. The barriers also provided enhanced power to perpetrators who manipulated state sanctions and deficits of service in order to extend their reign of terror and control. As a result, women were caught in a double-bind – stay in an abusive relationship or face further threats and consequences if they attempted to leave.

Limitations

Overall, there is a dearth of research on both ethnic minority and immigrant women’s experiences of barriers and facilitators to leaving abusive relationships and it would be beneficial for future research to explore this further. Whilst we included the term ‘help-seeking’ in our search terms – therefore producing papers which focus on facilitators of leaving – a consequence of our exclusion of papers with insufficient primary data on barriers to help-seeking means that there may be some which do provide further information on facilitators of help-seeking.

In relation to the above, although this systematic review set out to explore the experiences of as diverse a range of IPV survivors as possible, the experiences of indigenous women are not included in the final synthesis. Whilst initial searches did find several papers describing the experiences of indigenous women, they were ultimately excluded because they did not meet the strict inclusion criteria needed – for example, the papers did not focus on barriers around IPV help-seeking, did not contain sufficient qualitative data to contribute to the synthesis, or did not involve data collection with IPV survivors directly (or sufficient survivor quotes). This deficiency highlights the need for more research to be undertaken around barriers to help-seeking for indigenous women experiencing IPV.

Implications for Practice, Policy and Research

Our synthesis highlighted the following key needs:

1. Bi-lingual, anti-racist and culturally sensitive services that support women in the long-term. Ideally, services should be run by women from a diverse range of identities and cultural backgrounds (Few, 2005; Gonzalez-Guarda et al., 2016; Jordan & Bhandari, 2016).

2. A more diverse culture inside domestic violence shelters via the recruitment of more minority ethnic staff (including representation at senior levels) as well as staff with multi-language proficiencies; more interpreters in agencies; information and leaflets in victim’s own language; shelters ensuring to cater for all cultural and religious needs (e.g. halal food).

3. Better community outreach – particularly across the realm of the police, social work and health services – to ensure that minority ethnic women are signposted to appropriate sources of help and support. Few (2005) found that social workers were viewed with less suspicion and as being more helpful when they were based in other settings such as community mental health services or maternity, which is an important observation for practitioners.

4. Revision to immigration laws and policies are needed.

5. In addition to services, our synthesis revealed the importance of immediate financial assistance post-separation, and the need for accessible training and employment opportunities for women, regardless of background and immigration status, to enable independence and well-being in the longer term

Supplemental Material

sj-pdf-1-tva-10.1177_15248380211050590 – Supplemental Material for Intimate Partner Violence and Barriers to Help-Seeking Among Black, Asian, Minority Ethnic and Immigrant Women: A Qualitative Metasynthesis of Global Research

Supplemental Material, sj-pdf-1-tva-10.1177_15248380211050590 for Intimate Partner Violence and Barriers to Help-Seeking Among Black, Asian, Minority Ethnic and Immigrant Women: A Qualitative Metasynthesis of Global Research by Joanne Hulley, Louis Bailey, Gill Kirkman, Graham R. Gibbs, Tim Gomersall, Amrana Latif and Adele Jones in Trauma, Violence, & Abuse