Artigos

Conteúdo (article):

Violência de gênero no Brasil: revisão de escopo sobre fatores de risco e agravos à saúde
Gender-Based Violence in Brazil: Scoping Review of Risk Factors and Associated Health Consequences
Violencia de género en Brasil: revisión de alcance sobre factores de riesgo y consecuencias para la salud

Odette del Risco Sánchez
Instituição: Departamento de Tocoginecologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, Brasil.
e-mail: oderisco89@gmail.com
ORCID: https://orcid.org/0000-0002-7094-0378
Larissa Rodrigues
Instituição: Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, Brasil.
e-mail: rlarissa@unicamp.br
ORCID: https://orcid.org/0000-0001-8714-7010
Erika Zambrano
Instituição: Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, Brasil.
e-mail: ezambrano@fenf.unicamp.br
ORCID: https://orcid.org/0000-0001-9913-2975
Natividad Guerrero Borrego
Instituição: Centro de Estudios Sobre la Juventud, La Habana, Cuba.
e-mail: nguerrero5361@gmail.com
ORCID: https://orcid.org/0000-0001-5359-1420
Fernanda Garanhani Surita
Instituição: Departamento de Tocoginecologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, Brasil.
e-mail: surita@unicamp.br
ORCID: https://orcid.org/0000-0003-4335-0337

Resumo
O presente estudo busca mapear formas de violência abordadas na literatura, fatores de risco à exposição a violência de gênero e agravos à saúde associados, assim como regiões e níveis de atenção nas quais são produzidas as evidências no contexto brasileiro. A revisão foi conduzida segundo o método do Joanna Briggs Institute para revisões de escopo, com estratégia de busca aplicada nas bases de dados: PubMed, Biblioteca Virtual em Saúde, Scopus, Web of Science, Embase e Cinahl. Foram incluídos 55 estudos produzidos em contextos de saúde no Brasil nos últimos cinco anos. As evidências mostram que a violência tem caráter cíclico e transgeracional. A violência psicológica é a forma mais prevalente nos estudos primários, no entanto esta é menos reportada nos sistemas de notificação nacionais. Características sociodemográficas como idade, usos de substâncias psicoativas, situação conjugal, religião, renda e escolaridade, acrescentam as vulnerabilidades a exposição a violência, porém existe alta variabilidade e divergências entre os achados dos estudos. Destaca-se a necessidade de que as evidências sobre boas práticas na abordagem da violência nos serviços de saúde sejam sistematizadas para efetiva prevenção e assistência nos diferentes níveis de atenção.

Abstract
This study aims to map the forms of violence discussed in the literature, the risk factors of exposure to gender-based violence, and the associated health complications, as well as the regions and levels of care where evidence is produced within the Brazilian context. The review was conducted following the Joanna Briggs Institute\'s method for scoping reviews, with a search strategy applied across the following databases: PubMed, Biblioteca Virtual em Saúde, Scopus, Web of Science, Embase, and Cinahl. A total of 55 studies conducted in health contexts in Brazil over the past five years were included. The evidence indicates that violence is cyclical and transgenerational. Psychological violence is the most prevalent in primary studies, although it is underreported in national reporting systems. Sociodemographic factors such as age, use of psychoactive substances, marital status, religion, and education contribute to increased vulnerability to violence. However, there is considerable variability and divergence across the studies. The findings underscore the need for systematized evidence on best practices for addressing violence in health services to ensure effective prevention and care at various levels.

Resumen
El presente estudio busca mapear formas de violencia abordadas en la literatura, factores de riesgo para la exposición a la violencia de género y problemas de salud asociados, así como regiones y niveles de atención en los que ha sido producida la evidencia en el contexto brasileño. La revisión se realizó según el método de Joanna Briggs Institute para revisiones de alcance, con una estrategia de búsqueda aplicada en las siguientes bases de datos: PubMed, Biblioteca Virtual en Salud, Scopus, Web of Science, Embase y Cinahl. Se incluyeron 55 estudios producidos en contextos de salud en Brasil en los últimos cinco años. La evidencia muestra que la violencia tiene un carácter cíclico y transgeneracional. La violencia psicológica es la forma más prevalente en los estudios primarios, sin embargo, se reporta menos en los sistemas nacionales de notificación. Las características sociodemográficas como la edad, el uso de sustancias psicoactivas, el estado civil, la religión, los ingresos y la educación añaden vulnerabilidades a la exposición a la violencia; sin embargo, existe una alta variabilidad y divergencias entre los hallazgos de los estudios. Se destaca la necesidad de sistematizar evidencia sobre buenas prácticas en el abordaje de la violencia en los servicios de salud para una prevención y asistencia efectiva en los diferentes niveles de atención.
Palavras-chave: Violência de Gênero; Violência contra a Mulher; Fatores de risco; Resultados de Saúde; Revisão de Escopo.
Keywords: Gender-Based Violence; Violence Against Women; Risk Factors; Health Outcomes; Scoping Review.
Palabras clave: Violencia de Género; Violencia contra la Mujer; Factores de riesgo; Resultados de salud; Revisión de alcance.

INTRODUCTION
Gender-based violence (GBV) occurs in various forms due to differences socially attributed to the gender in which “violent actions are produced in relational contexts and spaces and, therefore, interpersonal with non-uniform societal and historical scenarios”1. GBV is a public health problem and a serious human rights violation.
Historically vulnerable groups, such as cisgender women and girls or people with divergent heteronormativity identities, may suffer, throughout their lives, physical, sexual, psychological, moral, economic or other kinds of violence, such as sexual exploitation, forced pregnancy, homophobic or transphobic rape and hate crime, negatively impacting their health and well-being2,3.
Globally, violence committed by an intimate partner (IPV) is one of the most prevalent forms4. Data from the World Health Organization (WHO) show that the rate of violence against women between 15 and 49 is 25% in Latin America5. In Brazil, in 2023, there was growth in all the indicators of domestic violence, reaching 1,467 registered femicides6.
As eradication of any form of violence and fostering of gender equality are among the U.N. Sustainable Development Objectives, in the coming decades, several countries, including Brazil, will need to strive to achieve them7.
Quite apart from the extreme case of mortality, recurrent exposure to violence affects victims\' morbidity, causing diverse physical lesions (fractures, bruises, burns), chronic diseases and multiple grave mental health issues (depression, anxiety, post-traumatic stress, sleeplessness, dietary disorders and stress, suicidal ideation and behavior), and sexual and reproductive health issues (miscarriage, STIs) 8-10.
GBV remains a persistent problem in the lives of women and other people with a uterus. Studies show that the intersection of individual, relational, community and societal factors are associated with greater risks of victimization4,11, and it is emphasized that, for example, young black women are more vulnerable to this form of violence6.
The relationship between violence and socioeconomic and/or educational level, age, skin color/race, taking of psychoactive substances, gender identity, sexual orientation, involve attitudes that legitimize prevalence of violence, thus illustrating the complexity of this phenomenon12,13.
Considering the impacts of GBV on health, it is necessary to address the grievances arising from violence in order to discuss integral healthcare services based on intersectoral and multidisciplinary action14.
Given the context, this review aims to map the forms of violence addressed in the literature, the risk factors for exposure to GBV and associated aggravated health issues, as well as regions and levels of care in which evidence regarding GBV is produced in the Brazilian context.
METHODS
This review was conducted according to the JBI (Joanna Briggs Institute) method for scoping reviews15. In the health area this type of review allows mapping the literature in relation to the phenomenon of interest and tracking of evidence produced from analysis of various types of data sources. Registration was made in the Open Science Framework (DOI 10.17605/OSF.IO/P6H2S), and its structure comprised the following steps:

Formulation of the research question
The research question was devised through the strategy P (population: female gender, age range 10 – 49), C (concept: gender violence), and C (context: regions and levels of healthcare in Brazil).
For the scope review, the following research questions were prepared:
● In which regions and levels of healthcare have evidence been produced in relation to GBV?
● What forms of violence are addressed in studies?
● What are the risk factors for GBV exposure?
● What health consequences have been associated with violence in the studies?
Search and selection strategy in the evidence sources
The search in the databases was realized on June 5, 2024. The temporal delimitation to be observed for production was January 2019 to June 2024. After prior consultation with a Health Science librarian, this phase was conducted by researchers experienced in the development of this type of study. A manual search was developed to identify national evidence and secondary data from government health organs.
The search was confined to English, Spanish and Portuguese. Search terms were defined according to DeCS/MeSH - Descriptors in Health Sciences/Medical Subject Headings and free terms.
For presentation of the search process and the selection of evidence, Prisma Extension for Scoping Reviews (PRISMA-ScR)16 was employed. The publications identified were imported to the Rayyan Qatar Computing Research Institute software (Rayyan QRI. https://www.rayyan.ai/), through which duplicate detection and removal was performed, as well as independent, blind assessment by two researchers. Initially, for the pre-selection of the materials, the titles, keywords and abstracts were read.
The selection criteria were tested with a sample of 25 titles/abstracts, that is, those assessed by the team according to the criteria described in the protocol. The selected texts were also read in full by two researchers (LR and ORS), assessing their correspondence according to the importance of the publications and the inclusion criteria. Divergences in the selection process were solved by consensus. Whenever necessary, in disagreements, the third reviewer (FGS) was consulted.
The databases included PubMed, BVS, Scopus, Web of Science, Embase and Cinahl. Research terms for this review included combinations and variations of the following words and phrases: “Domestic Violence”, “Violence Against Women”, “Gender Violence”, “Intimate Partner Violence”, “Sexual Offenses”, “Mistreated Women”,“ Conjugal Maltreatment”,“ Exposure to Violence”,“ Risk Factors”,“ Women\'s Health”,“ Mental Health”. AND/OR Boolean operators were used to construct the equation.
Eligibility criteria
The selected articles responded to the following criteria: 1) Female participants including the age group of 10 – 49; 2) Secondary and primary studies including ones with quantitative, qualitative and mixed methods; 3) Evidence produced in the health context and levels of healthcare (primary, secondary and tertiary) in Brazil.
Data extraction
To assist in the extraction of the data, the characteristics of the studies and their main findings were identified, the following information being systematized: title, author(s)/year, place of study, collection date, study design, objective(s), participants/target population, healthcare levels, main results, limitations and recommendations.
The articles were exported to a database in Microsoft Excel - Windows (https://products.office.com/). With a view to ensuring the consistency and reliability of the data extracted, one of the reviewers (ORS) performed the data extraction, and a second reviewer the verification of the process (LR). The data extraction form was revised, discussed and validated by the team.
Analysis and presentation of the results
The NVIVO 14 (QSR International, MA, USA) software was used for the organization and thematic analysis of the material17. The data collected were organized through synthesis and diagram matrixes to identify, characterize and summarize evidence by developing considerations around factors and risk groups for violence and symptoms and clinical signs associated with violence. The implications of the studies and their recommendations were discussed by the team.
RESULTS
In total, 3,798 articles were retrieved, and 1,757 duplicates were eliminated. Another 40 studies were identified by reading references, including 55 articles produced in Brazil for full text analysis (Figure 1).
Figure 1. Document selection process (PRISMA). Source: Devised by the author(s).
For the organization of results, 4 thematic categories were constructed: 1) Evidence production contexts: regions and healthcare levels; 2) Forms of violence; 3) Risk factors for exposure to gender violence; and 4) Impacts of gender violence on health. These are presented below through significant points found during the analysis.
Evidence production contexts: regions and healthcare levels
As for the regions of Brazil, 30 articles present primary data collected in health services in the Northeast (n = 9), North (n = 1), South (n = 7) and Southeast (n = 11). There were two multicenter articles, each of which presented data collected in health services in a pair of regions, the Northeast and Southeast, and the Southeast and South (Figure 2).
Figure 2. Evidence production by regions, delineation of the studies and healthcare levels.
Source: Devised by the author(s).
The health services included belong to the primary care network (n = 12), general hospitals and maternity hospitals, as well as other specialized services (n = 17), mostly run by the Unified Health System (SUS). One of the articles includes private antenatal care clinics and public services, and another a female penitentiary as part of a project focused on healthcare for this population in the Southeast. Among the health services, those intended for antenatal care and postnatal care were places where data collection was concentrated.
Evidence was observed produced from analysis of GBV behavior found through health enquiries with nationally representative samples, such as the National Health Research (n = 4) and the Levantamento Nacional sobre o Uso de Drogas pela População Brasileira [National Survey on Illicit Drug-Taking] by the Brazilian Population (n = 1 ) (Chart 1).
Chart 1. Characteristics of the studies.
Most studies were produced by authors affiliated with Brazilian institutions, mostly public universities. However, collaboration was identified between national researchers and foreign institutions from Australia (n = 1), Chile (n = 1), the UK (n = 5) and the United States (n = 3). Two articles were produced by authors from the United States, and one was a joint publication prepared by researchers from Brazil, Canada and the United States (Chart 1).
As for the characteristics of the studies, most of them employ observational methodological designs, among those that prevail the cross-sectional studies (n = 25). Some of the articles analyzed employ secondary data analysis of national researches (n = 5), hospital records (n = 3) and especially the notification system established in the country (n = 19). Three qualitative studies were included with data collected through individual interviews (Figure 2).
Forms of violence
The majority of the articles include violence perpetrated, especially by men, in intimate partnerships and other relationships (n = 50). Among the types of violence reported in studies, physical (n = 44), psychological/moral (n = 38) and sexual (n = 42) are the ones most addressed; but these do not occur in isolation (Chart 2).
Table 2. Synthesis matrix.
Those works that include transgender, lesbian and bisexual women, in addition to the previously described forms of violence, also consider other manifestations in the analyses, such as self-inflicted lesions, sexual exploitation, homophobia and transphobia, xenophobia and adverse family conditions13,18.
It is observed that some of them included property/economic violence (n = 8), in addition to other forms such as digital violence19, negligence20, verbal violence/threats19,21,22 and community violence23.
Exposure to domestic and family violence over a lifetime, both direct and indirect, and of abuse in childhood and adolescence, is also explored23-26. Other forms are little explored, such as situations of torture and human trafficking, especially in vulnerable populations such as indigenous, cisgender and transgender women13,27-29, expulsion from home and other forms, albeit not specified21,30, are addressed. Usually these types are encompassed in the “other” categories, including child labor, torture or neglect20,28-30.
Lethal violence, and especially cases of femicide, are studied by analyzing secondary data from the national systems for reporting of disease complications and mortality information31-37.
Sexual violence includes abuses perpetrated during childhood and adolescence, sexual coercion and rape, whether marital or by a stranger, and other forms committed by family members, known or unknown, whether recent or in the past.
Risk factors for exposure to gender violence
Most studies mention that adolescents, women of reproductive age13,19,20,27-32,35,36,38-50, and black/brown people are more exposed to various forms of violence28,31,35,40, 42.44 45.47-49.51-53.
Some of the studies allow observation of the intersection of skin color, age, gender identity and sexual orientation, whose indicators show additional vulnerabilities for black cisgender and transgender women, as well as people with non-heteronormative sexual orientation13,18,26. However, three studies, presenting data from states and cities in the South and Southeast regions, reported that, among the victims of femicide and sexual violence, there was a prevalence of white women32,34,54. Other articles identified the vulnerabilities of indigenous women20,35,37,53.
A low level of education was related to various forms and intensities of violence20,21,28,33,34,38-40,42,43,48,555-58, but some of the articles showed divergent results19.32, 44.53.59.
The consumption of alcohol and/or other psychotropic substances, as much by the partner as the victim, was one of the other aspects within the context of violence, both in the perpetration of violence and in the victimization, mentioned in 13 of the articles20,23,30,33,43,44, 52.55.56.58.60.61.
Other conditions associated with women\'s socioeconomic status, such as having a low income19,21,38-40,44,45,56, being the head of the household21,32, unemployed50, beneficiaries of the Brazilian Cash Transfer Program (Bolsa Família), and experiencing situations of food insecurity21 have shown association with violence. However, one of the studies conducted in two municipalities of the Southeast and Northeast states showed that pregnant women were more likely to suffer psychological and physical/sexual violence when they had the highest family incomes59. In other studies, violence committed by a partner and femicide were prevalent among women with employment or in informal work33,62.
to several categories. Marital situations, official or partnerships20,30,36,57,58, separated or divorced19,28,34,44,48,50,52,54,56, cohabiting or not19,19 57 were associated with violence, but one study conducted in a municipality in the South showed divergent results in relation to coexistence62. Women with children are more exposed to violence, including its lethal form32,34,62.
Religion was explored in a few studies. In three of them, there was violence perpetrated by an intimate partner43.56.58. However, reports of sexual violence were more prevalent among those who declared no religion63.
Among other characteristics that make women vulnerable to lethal31 and sexual violence 30 is some kind of disability. However, in Espírito Santo State, the notifications of sexual violence were more frequent among people without health disabilities and/or disorders46.
Experiences of previous violence, either throughout life with a partner23,30,31,33,51,56, or adverse events during childhood, such as suffering abuse or witnessing family violence23,24,44, 51,52,56,60,63,64 are factors that increase the chances of experiencing violent situations again later. In cases of femicide, reports of previous violence were mentioned by the partner and ex-partner.
The region is one of the necessary aspects to analyze so as to understand the dynamics of violence. In this sense, the findings of studies developed in the border regions20,37.44 have been important, as they assess disparities between regions of the country, some of them including comparisons between rural and urban areas22,28,29,31,35,36,46,49, and in contexts of extreme socioeconomic inequality58,65. On the other hand, one of the studies that analyzed cases of femicide in the municipality of Campinas, São Paulo State, showed that women who migrated from other states were at greater risk of femicide33.
Other aspects, such as attitudes that legitimize and justify gender-based violence, and social disparities and lack of an integrated response to violence, were also identified23,66. In three of the studies, the Covid-19 pandemic was presented as another of the elements analyzed21,50,51.
Impacts of gender violence on health
Exposure to violence impacts physical integrity causing various lesions, such as bruising, cuts, fractures, burns, maxillofacial trauma, among others19,23,47,65. It has also been associated with mental health diseases, such as symptoms of depressive disorder, post-traumatic stress disorder19,38,43,45,60,63,67, anxiety symptoms43 and postpartum depression25. The intense psychological suffering that provokes violence is accompanied by fear of retaliation19,23,38,66,68. Several articles provide evidence of other impacts such as food problems, anhedonia, feelings of failure and despair19, feelings of loneliness23, as well as suicidal thoughts and self-inflicted violence18,19,50,63.
Violence impacts lifestyles and healthy habits in periods such as pregnancy and after delivery. One of the studies showed that among survivors there was a lower quality nutritional pattern during pregnancy68. Other impacts were associated with the greater risk of a baby not being breastfed during the first 12 months of life69, as well as practices and behavior where violence is reproduced in educational methods and care practices70.
Regarding aspects linked to sexual and reproductive health, we observe an association with the start of sexual relations up to age 1439, pregnancy arising from sexual violence and desire to terminate pregnancy39,48, as well as maternal morbidity 39, 57. Victims of sexual violence under 19 are less likely to be protected by contraception54. Women who experienced sexual violence committed by partners had a greater chance of being infected by sexually transmitted infections and having an unwanted pregnancy19.
People in violent situations may seek healthcare more frequently, especially the primary or secondary care provided by the national health service (SUS)19. Studies show adverse consequences in healthcare, above all, for people living with HIV26, as well as worsening health self-perception19,22.
DISCUSSION
This scoping review covered studies with data gathered in the primary, secondary and tertiary care networks, as well as secondary data analysis of national information systems and research produced from health indicators of the Brazilian population.
In methodological terms, cross-sectional observational studies prevail, but with limited possibilities for conducting cause-effect inferences. Sample sizes and sample power are some of the limitations that interfere with the possibility of generalization of findings13,26,57,68. Furthermore, there is underreporting of violence and difficulties in ensuring the completeness of the records 13,22,27-30,33,35,45,45,46,49,53,63.
However, considering the dimensions of Brazil, marked by contexts of socioeconomic disparities, we highlight the value of these studies in observing patterns in violent behavior in specific regions and locations, with a view to contributing to the devising of local strategies for preventing and addressing the violence in the health services.
In the primary studies, we observed broad variability in the prevalence of violence, the most prevalent being psychological, followed by physical and sexual21,39,41,43,44,51,52,55,56,59-62,67. Some report that all the participants have suffered some kind of violence38.55. This variation could be caused by methodological issues, as well as particularities of the sociocultural contexts where data5 is collected.
In general, studies have addressed specific groups, such as indigenous women and those who live in rural contexts and border regions20,27,37,44, pregnant women, puerperas and mothers of children in early childhood21,25,27,30,39, 41,51,57-59,67-69.71, transgenders, lesbian and bisexual women18,26, in imprisonment52, as well as populations that live with stigmatizing health conditions, such as mastectomized women66, with impairment of mental health60,67, and people living with HIV24,26.
The experience of violence in these groups needs to be understood from the intersections of determinants such as socioeconomic situation, gender identity, sexual orientation, as well as elements of community and social contexts, such as public policies and access to services aimed at the care and needs of these populations.
Regarding sociodemographic characteristics as factors associated with violence, inconsistencies are found between studies. These divergences have been identified in studies where variables, such as education, income, age, skin color, have not shown significant associations59,62.
The data regarding the profile of women in situations of violence and victims of femicide should be analyzed according to the context in which the evidence is produced. A look at the territory becomes necessary when addressing GBV behavior in the country. An analysis of the deaths of women by aggression in the 122 municipalities that are part of the Brazilian border line has shown vulnerabilities among indigenous women, as well as a larger number of deaths in locations where there are the highest concentrations of migrants37.
Other factors also impinge on the dynamics of violence, such as living in rural contexts31 and socioeconomic vulnerability23,36,58,65. Likewise, a study that analyzed cases of femicide in a city in the Southeast region, pointed out vulnerabilities of internal migrant women33. These elements stimulate discussion about the disparities in access to formal and informal women\'s support networks for those who live in these contexts, and the implementation of local action and strategies that realize these groups are necessary.
In this sense, we highlight the heterogeneity of the findings in relation to sociodemographic characteristics and their relationship with exposure to violence. Likewise, some of the studies included in the analyses showed significant associations in the bivariate analyses, but were not subsequently maintained in the multivariate analyses, which has been commonly observed in the analysis of factors associated with violence57,72.
Another issue observed in the articles was the overlapping of violence. People at risk may be exposed to various forms of violence, reflecting the cyclical character of violence and its dynamics in which episodes tend to intensify and become worse6. In this sense, victims of femicide tend to be exposed to situations of recurring violence. This observation results in an important element in discussing the need for efficient integrated interventions by various sectors of society, such as health, security, education, civil society, among others. Early identification of risk situations contributes to prevention of more severe violence in these cases.
The types of violence most studied are psychological, physical and sexual, usually perpetrated by a partner, former partner, family member(s) or a known person(s). These last two tend to occur more in notification systems, but, in primary studies, psychological/moral violence in its various manifestations is the most prevalent form.
Other forms, such as economic and digital violence, are rarely addressed19. Likewise, it is important to discuss the impacts of community violence, the naturalization of violence, gender norms and expectations, as well as the impact of health emergency situations as aspects that may exacerbate exposure to this phenomenon.
In this sense, it is important for notification systems and health service professionals to be prepared to identify, welcome and offer the necessary support for survivors of violence, which tend to be more “subtle” and naturalized, but nevertheless very present in women\'s lives.
The costs of violence are diverse. In this review, the impacts on health according to the studies produced in the Brazilian context have been addressed. Violence has impacts on physical and mental health, sexual and reproductive health, care practices and lifestyles3. Its intergenerational character points out the need for caregivers to conduct integral intervention aimed at reducing the exposure of children and adolescents to various adverse experiences in their family environments64,70.
Over the years, in the Brazilian context, GBV has been addressed through policies and legislation aimed at improved prevention via significant amendments, production of data on the incidence of violence, creation of specialized services, and the adoption of national plans confront this phenomenon73.
Despite the efforts, this problem needs systematic, integrated action. Among the main recommendations of the studies are those related to evidence production, and above all, those focused on improvements in the practice of health service professionals. Equally, it is necessary to build effective formal and informal support networks, as well as programs aimed at a culture of peace, based on dialogue and the establishment of equitable relationships, as well as initiatives that foster the empowerment and financial autonomy of vulnerable groups (Figure 3).
Figure 3. Main recommendations of the studies to deal with gender violence.
Source: Devised by the author(s).
Understanding social problems such as violence and its impacts on health, the need for intersectoral coordination to address this theme, and educational activities based on the gender focus, are some of the proposals.
In this review, the inclusion of evidence in health service contexts can limit the reach of populations that may be further away from these services. Most of the primary studies were collected in public health services, which may focus on the participants\' sociodemographic characteristics. However, evidence from National Survey of Health, a national household-based health investigation, was included, conducted by the Ministry of Health with the Brazilian Institute of Geography and Statistics (IBGE) in 2013 and 2019.
Likewise, characteristics of studies on violence, such as underreporting, as well as gaps in terms of evidence production of other forms of violence (e.g. property-based violence, reproductive coercion, dating violence) can focus on the analyses presented.
CONCLUSIONS
GBV is a recurring, systematic problem in Brazilian society that affects historically marginalized groups, affecting their physical and mental health, as well as impacting them in various phases of their lives, entailing individual and collective costs.
Evidence shows that violence remains present at various moments in the course of people\'s lives, and therefore health services need to strengthen their capacity as appropriate, safe spaces to address this problem. Violence against women has been a priority theme in the Brazilian context, but still requires evidence about good health practices for prevention at healthcare levels.
Funding: This study was financed in part by the National Council for Scientific and Technological Development – CNPq and the Department of Science and Technology of Secretariat of Science, Technology, Innovation and Health Complex of Ministry of Health of Brazil – MoH. Project number 444414/2023-1 CNPq. Proposal Call No. 21/2023 – Transdisciplinary Studies in Public Health.
Authors\' Contribution: Study conception and planning: ORS, LR, EZ and FGS. Analysis, interpretation, writing the paper and critical review of its content: ORS, LR, EZ, NGB and FGS. All the authors approved the final version.
Conflicts of interest: The authors declare that they have no competing interests to do this work.
REFERENCES
1. Bandeira LM. Violência de gênero: a construção de um campo teórico e de investigação. Soc estado 2014;29(2):449-69.
2. Pinto CL, Christino JMM. Violência contra mulheres: 44 anos de pesquisa mapeados a partir dos softwares citespace e VOSviewer. Pensando fam 2021;25(2):159-75.
3. García-Moreno C, Hegarty K, d\'Oliveira AF, Koziol-McLain J, Colombini M, Feder G. The health-systems response to violence against women. Lancet 2015 Apr 18;385(9977):1567-79.
4. World Health Organization. WHO multi-country study on women\'s health and domestic violence against women: initial results on prevalence, health outcomes and women\'s responses. Geneva: World Health Organization; 2005.
5. World Health Organization. Violence against women prevalence estimates, 2018. Global, regional and national prevalence estimates for intimate partner violence against women and global and regional prevalence estimates for non-partner sexual violence against women. Geneva: World Health Organization; 2021.
6. Fórum Brasileiro de Segurança Pública. 18º Anuário Brasileiro de Segurança Pública 2024. São Paulo: Fórum Brasileiro de Segurança Pública; 2024.
7. Fields L, Perkiss S, Dean BA, Moroney T. Nursing and the Sustainable Development Goals: a scoping review. J Nurs Scholarsh 2021 Sep;53(5):568-577.
8. Campbell JC. Health consequences of intimate partner violence. Lancet 2002 Apr 13;359(9314):1331-6.
9. Black MC. Intimate Partner Violence and Adverse Health Consequences: Implications for Clinicians. American Journal of Lifestyle Medicine 2011;5(5):428-439.
10. Pallitto CC, García-Moreno C, Jansen HA, Heise L, Ellsberg M, Watts C. Intimate partner violence, abortion, and unintended pregnancy: results from the WHO Multi-country Study on Women\'s Health and Domestic Violence. Int J Gynaecol Obstet 2013 Jan;120(1):3-9.
11. Dahlberg LL, Krug EG. Violência: um problema global de saúde pública. Cien Saude Colet 2006;11(suppl):1163-78.
12. Abramsky T, Watts CH, Garcia-Moreno C, Devries K, Kiss L, Ellsberg M, Jansen HA, Heise L. What factors are associated with recent intimate partner violence? findings from the WHO multi-country study on women\'s health and domestic violence. BMC Public Health 2011 Feb 16;11:109.
13. Marinho Neto KRE, Girianelli VR. Interpersonal violence against transgender and cisgender women in Brazilian municipalities: trends and characteristics. Cien Saude Colet 2024;29(7):e02702024.
14. d\'Oliveira A, Pereira S, Bacchus LJ, Feder G, Schraiber LB, Aguiar JM, Bonin RG, Vieira Graglia CG, Colombini M. Are We Asking Too Much of the Health Sector? Exploring the Readiness of Brazilian Primary Healthcare to Respond to Domestic Violence Against Women. Int J Health Policy Manag 2022 Jul 1;11(7):961-972.
15. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Scoping reviews. In: Aromataris E, Munn Z, organizadores. Joanna Briggs Institute reviewer’s manual. Disponível em: https://wiki.jbi.global/display/MANUAL/Chapter+11%3A+Scoping+reviews
16. Tricco AC, Lillie E, Zarin W, O\'Brien KK, Colquhoun H, Levac D, Moher D, Peters MDJ, Horsley T, Weeks L, Hempel S, Akl EA, Chang C, McGowan J, Stewart L, Hartling L, Aldcroft A, Wilson MG, Garritty C, Lewin S, Godfrey CM, Macdonald MT, Langlois EV, Soares-Weiser K, Moriarty J, Clifford T, Tunçalp Ö, Straus SE. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med 2018 Oct 2;169(7):467-473.
17. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology 2006;3(2):77-101.
18. Pinto IV, Andrade SSA, Rodrigues LL, Santos MAS, Marinho MMA, Benício LA, Correia RSB, Polidoro M, Canavese D. Profile of notification of violence against Lesbian, Gay, Bisexual, Transvestite and Transsexual people recorded in the National Information System on Notifiable Diseases, Brazil, 2015-2017. Rev Bras Epidemiol 2020;23 Suppl 1:e200006.SUPL.1.
19. Signorelli MC, de Souza FG, Pinheiro Junior RVB, Valente J, Andreoni S, Rezende LFM, Sanchez ZVM. Panorama of Intimate Partner Violence Against Women in Brazil and its Association With Self-Perception of Health: Findings From a National Representative Survey. J Interpers Violence 2023 Jul;38(13-14):8453-8475.
20. Santos JD, Carmo CND. Characteristics of intimate partner violence in Mato Grosso do Sul state, Brazil, 2009-2018. Epidemiol Serv Saude 2023;32(1):e2022307.
21. Correia LL, Machado MMT, Vieira-Meyer A, Araújo D, Gomes E, Saldanha AB, Rodrigues RCR, Gomes YVC, Castro MC. Domestic violence patterns in postpartum women who delivered during the COVID-19 pandemic. Rev Bras Epidemiol 2024 Apr 19;27:e240022.
22. Cruz MS, Irffi G. [What is the effect of violence against Brazilian women on their self-perception of health?]. Cien Saude Colet 2019 Jul 22;24(7):2531-2542.
23. Xavier Hall CD, Evans DP. Social comorbidities? A qualitative study mapping syndemic theory onto gender-based violence and co-occurring social phenomena among Brazilian women. BMC Public Health 2020 Aug 18;20(1):1260.
24. Tsuyuki K, Stockman JK, Knauth D, J Catabay C, He F, Al-Alusi NA, Pilecco FB, Jain S, Barbosa RM. Typologies of violence against women in Brazil: A latent class analysis of how violence and HIV intersect. Glob Public Health 2020 Nov;15(11):1639-1654.
25. Santos DF, Silva RP, Tavares FL, Primo CC, Maciel PMA, Souza RS, Leite FMC. Prevalence of postpartum depression symptoms and their association with violence: a cross-sectional study, Cariacica, Espírito Santo, Brazil, 2017. Epidemiol Serv Saude 2021;30(4):e20201064.
26. de Sousa Mascena Veras MA, Menezes NP, Mocello AR, Leddy AM, Saggese GSR, Bassichetto KC, Gilmore HJ, de Carvalho PGC, Maschião LF, Neilands TB, Sevelius J, Lippman SA. Correlation between gender-based violence and poor treatment outcomes among transgender women living with HIV in Brazil. BMC Public Health. 2024 Mar 13;24(1):791.
27. Freitas GA, Marcon GEB, Welch JR, Silva C. Analysis of the completeness and consistency of records of violence against indigenous women in the health macro-region of Dourados, Mato Grosso do Sul state, Brazil, 2009-2020. Epidemiol Serv Saude 2024 May 27;33:e20231075.
28. Oliveira CABd, Alencar LNd, Cardena RR, Moreira KFA, Pereira PPdS, Fernandes DER. Profile of the victim and characteristics of violence against women in the state of Rondônia-Brazil. Revista Cuidarte 2019;10(1):e573.
29. Sousa BS, Maciel NTVG, de Oliveira MPA, Batista JFC, de Oliveira Musse J, Lima GCdBB. Violência contra mulher no nordeste brasileiro: tendência temporal de 2009 a 2018. Interfaces Científicas-Saúde e Ambiente 2022;9(1):53-67.
30. Mascarenhas MDM, Tomaz GR, Meneses GMSd, Rodrigues MTP, Pereira VOdM, Corassa RB. Análise das notificações de violência por parceiro íntimo contra mulheres, Brasil, 2011-2017. Revista Brasileira de epidemiologia 2020;23:e200007. SUPL. 1.
31. Pinto IV, Bernal RTI, Souza MFM, Malta DC. Factors associated with death in women with intimate partner violence notification in Brazil. Cien Saude Colet 2021 Mar;26(3):975-985.
32. Moroskoski M, Neto FC, Machado de Brito FA, Ferracioli GV, de Oliveira NN, Dutra AC, Baldissera VDA, de Oliveira RR. Lethal violence against women in southern Brazil: Spatial analysis and associated factors. Spat Spatiotemporal Epidemiol. 2022 Nov;43:100542.
33. Caicedo-Roa M, Cordeiro RC, Bandeira LM. Femicide in Campinas, São Paulo, Brazil: Matched case-control study. J Forensic Leg Med 2023 Nov;100:102606.
34. Caicedo-Roa M, Cordeiro RC, Martins ACA, Faria PH. [Femicides in the city of Campinas, São Paulo, Brazil]. Cad Saude Publica 2019 Jul 4;35(6):e00110718.
35. Moroskoski M, Brito FAM, Oliveira RR. Time trend and spatial distribution of the cases of lethal violence against women in Brazil. Rev Lat Am Enfermagem 2022 Jul 15;30:e3609.
36. Sandoval G, Marinho F, Delaney R, Pinto I, Lima C, Costa R, Bello-Corassa R, Pereira VOM. Mortality risk among women exposed to violence in Brazil: a population-based exploratory analysis. Public Health 2020 Feb;179:45-50.
37. Meneghel S, Danielvicz I, Polidoro M, Plentz L, Meneghetti B. Femicide in frontier municipalities in Brazil. Cienc Saúde Colet [Internet]. 2020. [citado 5 agosto 2024] Disponível em: http://www.cienciaesaudecoletiva.com.br/en/articles/femicide-in-frontier-municipalities-in-brazil/17868?id=17868
38. Both LM, Favaretto TC, Freitas LHM, Benetti S, Crempien C. Intimate partner violence against women: Operationalized Psychodynamic Diagnosis (OPD-2). PLoS One 2020 Oct 1;15(10):e0239708.
39. Silva RP, Leite FMC. Intimate partner violence during pregnancy: prevalence and associated factors. Rev Saude Publica 2020 Nov 2;54:97.
40. Vasconcelos NM, Andrade FMD, Gomes CS, Pinto IV, Malta DC. Prevalence and factors associated with intimate partner violence against adult women in Brazil: National Survey of Health, 2019. Rev Bras Epidemiol 2021 Dec 13;24(suppl 2):e210020.
41. Conceição HND, Coelho SF, Madeiro AP. Prevalence and factors associated with intimate partner violence during pregnancy in Caxias, state of Maranhão, Brazil, 2019-2020. Epidemiol Serv Saude. 2021;30(2):e2020848.
42. Reynolds SA. Do health sector measures of violence against women at different levels of severity correlate? Evidence from Brazil. BMC Womens Health. 2022 Jun 13;22(1):226.
43. de Araújo Lima LA, de Souza Monteiro CF, Nunes B, da Silva Júnior FJG, Fernandes MA, Zafar S, Dos Santos MA, Wagstaff C, Diehl A, Pillon SC. Factors associated with violence against women by an intimate partner in Northeast Brazil. Arch Psychiatr Nurs. 2021 Dec;35(6):669-677.
44. Silva GK, Rocha-Brischiliari SC, Miura AS, Becker M, Santos MF, Martins W. Intimate partner violence in a region of the triple border. Reme Revista Mineira de Enfermagem 2021;25: e-1361.
45. Mrejen M, Rosa L, Rosa D, Hone T. Gender inequalities in violence victimization and depression in Brazil: results from the 2019 national health survey. Int J Equity Health 2023 May 24;22(1):100.
46. Leite FMC, Pedroso MRdO, Fiorotti KF, Ferrari B, Paulucio MD, Entringer AM, Pampolim G. Sexual violence against women: an analysis of notifications in Espírito Santo, Brazil. Escola Anna Nery 2023;27:e20220288-e.
47. Mayrink G, Araújo S, Kindely L, Marano R, Filho ABdM, de Assis TV, Jadijisky M Jr, de Oliveira NK. Factors associated with violence against women and facial trauma of a representative sample of the Brazilian population: results of a retrospective study. Craniomaxillofacial Trauma & Reconstruction 2021 Jun;14(2):119-125.
48. Teixeira EC, Leite APL, Santos WHMd, Chaves JHB, Duarte IdAC, Cavalcante JC. Characteristics of cases of sexual violence that occurred in Alagoas between 2007-2016. Mundo Saude 2019;43(4):834-53.
49. Viana VAO, Madeiro AP, Mascarenhas MDM, Rodrigues MTP. Tendência temporal da violência sexual contra mulheres adolescentes no Brasil, 2011-2018. Cien Saude Colet. 2022 Jun;27(6):2363-2371.
50. Padilha L, Menetrier JV, Dalla Costa L, Perondi AR, Zonta FdSN, Teixeira GT. Caracterização dos casos de violência contra a mulher em tempos de pandemia por Covid-19 em um município do sudoeste do Paraná. Arq. ciências saúde UNIPAR 2022;26(3): 410-427.
51. Sánchez ODR, Tanaka Zambrano E, Dantas-Silva A, Bonás MK, Grieger I, Machado HC, Surita FG. Domestic violence: A cross-sectional study among pregnant and postpartum women. J Adv Nurs. 2023 Apr;79(4):1525-1539.
52. Fanger VC, Santiago SM, Audi CAF. Factors associated with violence against women in the previous life of imprisoned women. Reme Revista Mineira de Enfermagem. 2019;23:e-1249.
53. Moroskoski M, Brito FAMd, Queiroz RO, Higarashi IH, Oliveira RRd. Aumento da violência física contra a mulher perpetrada pelo parceiro íntimo: uma análise de tendência. Cien Saude Colet 2021 Nov 15;26(suppl 3):4993-5002.
54. Santarem MD, Marmontel M, Pereira NL, Vieira LB, Savaris RF. Epidemiological Profile of the Victims of Sexual Violence Treated at a Referral Center in Southern Brazil. Rev Bras Ginecol Obstet 2020 Sep;42(9):547-554.
55. Formiga K, Zaia V, Vertamatti M, Barbosa CP. Intimate partner violence: a cross-sectional study in women treated in the Brazilian Public Health System. Einstein (Sao Paulo). 2021 Nov 22;19:eAO6584.
56. Santos IBD, Leite FMC, Amorim MHC, Maciel PMA, Gigante DP. Violence against women in life: study among Primary Care users. Cien Saude Colet 2020 May;25(5):1935-1946.
57. Caprara GL, Bernardi JR, Bosa VL, da Silva CH, Goldani MZ. Does domestic violence during pregnancy influence the beginning of complementary feeding? BMC Pregnancy Childbirth 2020 Aug 5;20(1):447.
58. Steiner ML, Vieira de Lima Veloso AB, Castrucci Ingold C, Martinelli Sonnenfeld M, Sousa LVA, Aparecida Giovanelli S, Strufaldi R, Carneiro M, Henrique da Silva M. Characterisation of pregnant women in a maternity hospital in Brazil who ever suffered domestic violence. Eur J Contracept Reprod Health Care. 2022 Apr;27(2):136-141.
59. Ribeiro MRC, Silva A, Schraiber LB, Murray J, Alves M, Batista RFL, Rodrigues LDS, Bettiol H, Cavalli RC, Barbieri MA. Inversion of traditional gender roles and intimate partner violence against pregnant women. Cad Saude Publica. 2020;36(5):e00113919.
60. Frazão MCLO, de Carvalho Viana LR, Pimenta CJL, da Silva CRR, Bezerra TA, Ferreira GRS, Costa TF, Costa KNFM. Violência praticada por parceiros íntimos a mulheres com depressão. REME-Revista Mineira de Enfermagem 2020;24(1). [citado 5 agosto 2024] Disponível em: https://periodicos.ufmg.br/index.php/reme/article/view/49936
61. Veloso C, Monteiro CFdS. Consumption of alcohol and tobacco by women and the occurrence of violence by intimate partner. Texto & Contexto - Enfermagem 2019;28:e20170581-e.
62. Kwaramba T, Ye JJ, Elahi C, Lunyera J, Oliveira AC, Sanches Calvo PR, de Andrade L, Vissoci JRN, Staton CA. Lifetime prevalence of intimate partner violence against women in an urban Brazilian city: A cross-sectional survey. PLoS One 2019 Nov 14;14(11):e0224204.
63. Diehl A, Molina de Souza R, Madruga CS, Laranjeira R, Wagstaff C, Pillon SC. Rape, Child Sexual Abuse, and Mental Health in a Brazilian National Sample. J Interpers Violence. 2022 Jan;37(1-2):NP944-NP967.
64. Buffarini R, Hammerton G, Coll CVN, Cruz S, da Silveira MF, Murray J. Maternal adverse childhood experiences (ACEs) and their associations with intimate partner violence and child maltreatment: Results from a Brazilian birth cohort. Prev Med. 2022 Feb;155:106928.
65. Bernardino ÍM, da Nóbrega LM, de Souza LT, Ribeiro Monteiro de Figueiredo T, Massoni A, d\'Ávila S. Spatial-temporal distribution of maxillofacial injuries resulting from intimate partner violence against women. Dent Traumatol. 2024 Mar;40 Suppl 2:82-90.
66. Leite FMC, Oliveira AG, Barbosa B, Ambrosim MZ, Vasconcellos NAV, Maciel PMA, Amorim MHC, Furieri LB, Lopes-Júnior LC. Intimate Partner Violence against Mastectomized Women: Victims\' Experiences. Curr Oncol. 2022 Nov 10;29(11):8556-8564.
67. Lima LS, Carmo TOAd, Brito Neto CdS, Pena JLdC. Síntomas depresivos en gestantes y violencia de pareja: un estudio transversal. Enferm glob 2020;19(60).
68. Vaz JDS, Souza M, Valério ID, Silva MTD, Freitas-Vilela AA, Bierhals IO, Hasselmann MH, Kac G. Physical intimate partner violence and dietary patterns in pregnancy: a Brazilian cohort. Cien Saude Colet 2022 Apr;27(4):1317-1326.
69. Ribeiro MRC, Batista RFL, Schraiber LB, Pinheiro FS, Santos AMD, Simões VMF, Confortin SC, Aristizabal LYG, Yokokura AVCP, Silva AAMD. Recurrent Violence, Violence with Complications, and Intimate Partner Violence Against Pregnant Women and Breastfeeding Duration. J Womens Health (Larchmt). 2021 Jul;30(7):979-989.
70. Coll CVN, Barros AJD, Stein A, Devries K, Buffarini R, Murray L, Arteche A, Munhoz TN, Silveira MF, Murray J. Intimate partner violence victimisation and its association with maternal parenting (the 2015 Pelotas [Brazil] Birth Cohort): a prospective cohort study. Lancet Glob Health 2023 Sep;11(9):e1393-e1401.
71. Sussmann L, Faisal-Cury A, Pearson R. Depression as a mediator between intimate partner violence and postpartum sexual issues: a structural analysis. Rev Bras Epidemiol 2020;23:e200048.
72. Taillieu TL, Brownridge DA. Violence against pregnant women: Prevalence, patterns, risk factors, theories, and directions for future research. Aggression and Violent Behavior 2010;15(1):14-35.
73. Coelho EBS, Bolsoni CC, Conceição TB, Verdi MIM, Delpino PP. Políticas públicas no enfrentamento da violência. [recurso eletrônico] Florianópolis: Universidade Federal de Santa Catarina; 2014.