Economic crisis, immigrant women and changing availability of intimate partner violence services: a qualitative study of professionals´ perceptions in Spain

Violence against women (VAW) is an extreme manifestation of gender inequality in society and a serious violation of fundamental human rights. The United Nations declaration on the Elimination of VAW defines it as any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of acts such as coercion or arbitrary deprivation of liberty, whether occurring in public or private life [1]. Intimate Partner Violence (IPV) against women is the most common type of male VAW. It takes place within couples, and the perpetrators are almost exclusively men who are or who have been in an intimate relationship with the woman [2].

IPV against women occurs without exception in all countries, all cultures and at every level of society [3]. In the EU-27, it affects between 20% and 25% of adult women who have ever had an intimate partner [4]. However, within countries, some populations of women may be at greater vulnerable situation such is the case of migrant women due to different factors related to social exclusion: expatriation, lack of legal immigrant status, economic hardship and economic dependence on their partners [5]-[11].

At the end of 2012, a total of 314,358 persons from abroad set up residence in Spain. Although males traditionally maintained a slightly higher prevalence, women accounted at least for 48% of the total of foreigners that arrived to Spain [12]. The majority of immigrant women living in Spain come from Morocco, East Europe, Ecuador and Colombia. A cross-sectional study of 10,202 women attending primary health care centres showed an IPV of 27.9% in migrants compared to 14.3% in Spanish women [13]. According to the Annual Report of The National Observatory on Violence against women, in 2012, 47% of intimate partner violence-related murders in Spain were produced among migrant women [14].

Several advances in IPV and immigration policies have been achieved in recent years in Spain which have facilitated immigrant women´s access to resources, including the Organic Law/2004 [15]. According to this one, the public sector in Spain (state, regional and local government) is required to provide support to female victims of IPV in the form of information, comprehensive welfare services and free legal aid. This is delivered through 24-hour specialist emergency services, IPV-based courts and specialist units in the state security bodies, and involves professionals from different disciplines (physicians, psychologists, psychiatrists, lawyers, sociologists, educators, social workers, employment specialists). Provided support encompasses health care, emergency services, assistance, accommodation and comprehensive recovery. Support also includes social welfare benefits (unemployment benefit, income support), protection measures, job placement programmes, general and specialised social services (information, counselling, social support, follow up on women´s rights claims, educational support for the family, preventive education and support for vocational training and job seeking), a mobile telecare service, women´s shelters, and priority access to public housing and public residential homes for senior citizens. According to the 2004 law all these resources should be available to all women once an official complaint has been lodged. However, the lack of reports informing on the nationality of women accessing such resources does not allow to point out differences/inequalities on access to such services between immigrant and non-immigrant women exposed to IPV in Spain.

The Organic Law 10/2011 of July 27, 2011 extends the rights of battered immigrant women in an irregular situation, establishing the possibility of requesting permission to reside (including their children) and work due to exceptional circumstances once a restraining order has been granted. Such permission is not definitively approved until criminal proceedings have concluded. They can also apply for provisional authorization to reside and work due to exceptional circumstances at the time of filing the official complaint [16]. NGOs also play a key role in providing care for immigrant women, particularly immigrant associations, since translation and cultural mediation services are not required by law, and are even less likely to be provided now that funding for these resources has been removed. In addition to these State policies, it is important to note that Spain is divided into Autonomous Communities at regional level. Each of the Autonomous Communities has its own government and adopts its own policies, although following some common national policy guidelines. For example, the afore mentioned Organic Law 1/2004 on Comprehensive Protection Measures against Gender-Based Violence is applicable throughout the country, but each region can also have its own law on gender-based violence. Meanwhile, there are 17 Social Services Acts, one for each of the Autonomous Communities. These Acts differ in terms of social rights, social services, and social expenditure. In terms of the health-sector response to IPV whilst all the regions have developed protocols and guidelines, great variation exist between regions in terms of training programs, intersectorial coordination and monitoring systems [17].

The current global recession has prompted a wide range of economic, political and social reforms in Europe and Spain which involve cutbacks in social investment [18]-[20]. These policies reflect the priority given by governments to reduce their fiscal deficits by cutting back on social expenditure [21]. The concomitant dismantling of the welfare state means that social and health care services are the first to be affected by government austerity measures [22],[23]. For example, between 2006 and 2011 the percentage of the total Spanish State Budget allocated to health care fell from 35.2% to 33.7% (almost 2 points), representing a reduction of more than 8 million Euros [19]. Other institutional reports have indicated that per capita social expenditure in the period 2009-2011 fell significantly by a state-wide average of 4.4% [24]. In 2011, the at-risk-of-poverty rate stood at 21.8% for the population of Spain, and one in four people under the age of 16 were living below the poverty line [25].

Austerity measures are harming the social well-being of the populations affected [26],[27]. Previous research has shown that due to their effects on the labour market and resource access, economic downturns have negative consequences for public health [23],[28],[29]. Similarly, social inequalities between population groups widen during recessions; rising unemployment and poverty hit the most disadvantaged hardest and increase their vulnerability [30],[31]. In the particular case of the immigrant population in Spain, it has already been observed that those who still do not return to their country of origin are among the many unemployed who struggle to meet very basic needs for food, housing, health, education, and social protection [32].

Implementation of public IPV policies depends heavily on the service providers [33], and they can also be an important source of information about the impact of the economic crisis on social strategies targeting immigrant women. Therefore, an analysis which takes into account the perspectives of those involved might identify the factors which could prevent the crisis from affecting public health [23],[34]. The effects of the reforms prompted by the current economic crisis on IPV resources have not been explored in Spain [35]. An exploration of service providers´ opinions and concerns about areas under threat could serve as a first step in formulating policy and research actions [36]-[38]. Meanwhile, at an organisational level, it is necessary to study how professionals tackle changing conditions [39].

This study formed part of a wider research project examining the determinants of access to the health and social services available in Spain for tackling IPV in general, and among immigrant women in particular [40]. Concern about anticipated spending cuts prompted by the crisis and their impact on resources was a theme that emerged from the interviews, since the fieldwork was conducted in a context of an economic recession (March-December, 2011). Therefore, the aim of the present study was to explore IPV service providers´ perceptions concerning the impact of the economic crisis on both the changing availability of IPV-related services and their own capacity to respond to immigrant women experiencing IPV in Spain.

The analysis of the interviews with service providers revealed four categories related to the negative impact of the reforms prompted by the economic crisis, as perceived by professionals: a) "Immigrant women have it harder now", b) "IPV and immigration resources are the first in line for cuts", c) "Fewer staff means a less effective service" and d) "Equality and IPV policies are no longer a government priority". These categories described the perceived and anticipated effects of changes in the allocation of resources for IPV support (Additional file 3: Figure S1).

A cross-cutting theme emerged from the categories, which expressed the latent content of the interviews: Immigrant women are triply affected; by IPV, by the economic crisis and by structural violence. Service providers perceived immigrant women to be particularly vulnerable to IPV, on the one hand, and to the effects of the recession on the other. In the opinion of the professionals interviewed, the economic crisis could lead to structural violence against immigrant women who experience IPV; they anticipated a reduction in support resources for these women as a result of budget cuts, and consequently, fewer opportunities for the empowerment which would enable them escape from situations of IPV (Additional file 3: Figure S1).

This study points out two important aspects regarding how professionals perceived the effect of austerity measures on the resources available for immigrant women exposed to IPV. First, they considered that the economic crisis was hitting harder immigrant women compared to non immigrant women. They also considered that the crisis had led to cutbacks of funding that were affecting the quality of the services they were offering to women exposed to IPV in general, and to immigrant women in particular. Secondly, they were pessimistic in terms of the future. Policy changes and economic cuts in health and social services were identified as the main threats to IPV services. These changes were expected to set drawbacks in policies and programs related to migrants´ rights and gender equality.

The results are consistent with those reported in other studies, in that they indicate that the economic crisis may contribute to increasing the risk of social exclusion among certain populations, which in the specific case of this study would imply increased vulnerability among immigrant women to remaining in a situation of IPV [44]. It is well known that the context of migration poses additional difficulties associated with situations of greater social vulnerability, such as the lack of a residence permit, existence of language barriers and the lack of support networks in the event of difficulties or problems [45],[46],[10]. The crisis adds to this burden by increasing unemployment rates among immigrant women, with the consequent deterioration in their standard of living, increased economic dependence on violent partners and decreased chances of finding employment.

The results indicate that service providers experience an overwhelming amount of work followed by burnout, which in turn affects the care given to women. On the one hand, the professionals interviewed were already beginning to experience funding cuts, in line with the general tendency among governments in times of recession to reduce public spending by implementing changes in funding, prioritisation and governmental regulation, and by decentralising health services [38]. That could be explained because they are considered as "unproductive" components of government spending [20]. In consequence, and as the results show, such services are subject to staff cuts, leading to an overload of work and the risk of burnout among the staff who are still employed. Other studies have indicated that one of the main barriers to the provision of effective care in cases of IPV is understaffing, given that in times of economic recession it is more difficult to ensure the quality of care by hiring interpreters or staff with specialised training in matters related to immigration and intercultural skills [47],[48]. This reduction in staffing levels is worrying because when other resources are being cut at national level (macro level) or regional level (meso level), the professional role of human resources (micro level) becomes decisive [47],[49].

As regards future expectations, the service providers interviewed in this study anticipated that IPV services and services aimed at vulnerable populations were particularly at risk in the current economic climate. Participants thought that the new government would cut public services, and that the lack of economic resources would lead to a reduction in infrastructures and staff and the closure of some services. This would have a negative impact on their ability to respond to IPV, especially in the case of immigrant women because these are exposed to multiple factors of social exclusion. These predictions have subsequently been confirmed: several services frequently utilised by immigrants, such as NGOs, are closing due to budget cuts, and immigrants" free access to health services has been curtailed [27],[50]. Current health reforms will hinder the protection of immigrant women living in Spain "those without official immigrant status and experiencing IPV- as they will be excluded from the health system. Consequently, they will not be able to provide crucial evidence when they need to apply for a restraining order against their aggressor. Both their perceptions and the confirmed facts indicate that the effect of macroeconomic and neo-liberal political reforms is to impose structural violence on vulnerable populations because, on the one hand, such reforms increase individual and community vulnerability to specific problems, and on the other hand, they lead to a dismantling of already debilitated public services [51].

As well, they were right about the change of government and the impact on IPV support policies and strategies. In Spain, from 2004 to 2011, the previous socialist government was heavily committed to the implementation of IPV services, especially following enactment of Organic Law 1/2004 on gender-based violence. These facts confirm that, what the professionals considered to be consequences of the crisis, however, were in fact the effects of government priorities prompted by the recession, priorities which have meant that today, the health and social services are facing financial constraints [36]. Proof of this is that spending on equality policies has been changed and some of these policies are being reformulated to the detriment of women´s fundamental rights, such as the right to abortion. In this sense, there is a need for further research about how policies towards mitigating IPV in immigrant women operate in other European countries and whether EU countries have introduced similar cuts.

These findings lead us to conclude that the policy changes prompted by the crisis hinder effective coverage of services for women victims of IPV in general, and more specifically, for immigrant women in this situation. The present study revealed that service providers tended to think that IPV services and programmes, and especially those for immigrant women, were under threat, since politicians might considered them the most dispensable aspect of the health and social services. Although the maintenance of services and programmes for immigrant battered women is a question of equality, the interviewees felt that this principle was being flouted as a result of government responses to the economic crisis.