A Systematic Review of Public Stigmatization Toward Women Victims of Intimate Partner Violence in Low- and Middle-Income Countries

A Systematic Review of Public Stigmatization Toward Women Victims of Intimate Partner Violence in Lowand Middle-Income Countries (ACCEPTED VERSION FOR PUBLICATION IN TRAUMA, VIOLENCE, & ABUSE) Full Citation: Murvartian, L., Matías-García, J. A., Saavedra-Macías, F. J., & Crowe, A. (2023). A Systematic Review of Public Stigmatization Toward Women Victims of Intimate Partner Violence in Lowand Middle-Income Countries. Trauma, Violence, & Abuse, 0(0). https://doi.org/10.1177/15248380231178756 Non-Commercial and Non-Derivative Uses Only Abstract Public stigmatization of women victims of intimate partner violence (IPV) has begun to be studied because of its negative impact on recovery from violence. This systematic review aimed to analyze such stigmatization in low and middle-income countries (LAMIC) by identifying social norms and perceptions linked to public stigmatizing responses, such responses, negative consequences of those responses on victims, and other factors associated with public stigma. Following PRISMA guidelines, five databases were searched using “stigma” and multiple synonyms of IPV as keywords. Selected articles were empirical, written in English, published in peer-reviewed journals, and reported findings on public stigma toward women victims of IPV that had occurred in LAMIC. Nineteen articles met the inclusion criteria. Patriarchal gender roles, normalization of IPV and the consideration of violence as a private matter were the most prevalent social norms among the studies. These led to blaming, isolating and discriminating against the victim, making her feel ashamed, considering her less valuable than before suffering IPV, and dismissing or denying the abuse. Many negative consequences were identified. Anticipated public stigma, associated with not disclosing the abuse and not seeking help, was the most popular. Public stigmatization was stronger when other public stigmas intersected and in the case of disadvantaged social circumstances. Consequences were diminished by protective factors such as informal support and gender-based violence support services. This review provides a global vision for future research in each specific sociocultural context and is a first step in the design of anti-stigma programs in LAMIC. Keywords: public stigma; intimate partner violence; domestic violence; low and middle-income countries Based on World Health Organization’s definition [WHO] (2022), intimate partner violence (IPV) against women perpetrated by a man is the most common type of violence against women and continues to be a serious global problem. As a result, the United Nations 2030 Agenda for Sustainable Development Goals (SDGs) included the elimination of IPV against women (United Nations, 2022). This violence includes physical aggressions, controlling behaviors, sexual coercion, and/or psychological abuse by men who are their (ex)partners. It has serious short and long-term repercussions for the physical, psychological, and reproductive health of women, which for some is fatal (WHO, 2022). Because of this, in the present study we focus on IPV towards women by men who are their (ex)partners when we discuss IPV. According to WHO (2022) global prevalence estimates in 2018, 27% of women aged 15 to 49 years who have been in an intimate relationship claimed to have experienced physical and/or sexual IPV at least once in their lifetime. Regarding recent experiences of IPV, 13% of women age 15-49 who have been in an intimate relationship suffered physical and/or sexual IPV in the past year. Currently, there is a scarcity of data on violence experienced by women 50 years or older. Since in this study we focus on IPV occurring in low and middle-income countries (LAMIC), it is worth noting that in these countries the lifetime prevalence of IPV is higher than in high-income countries and that these differences are even greater when we compare IPV in the last 12 months. WHO (2022) believes that this could be because in LAMIC there is less access to economic resources, social services, and divorce and family laws that make it easier to leave abusive relationships. It has been shown that the process of recovery and liberation from violence is determined by interconnected individual (e.g., age of children), interpersonal (e.g., severity of IPV), and sociocultural factors (e.g., legislative and economic context of the country; Barrios et al., 2020; Flasch et al., 2017; WHO, 2022). Among these factors, recent literature in the field of IPV (e.g., Kennedy & Prock, 2018; Murray et al., 2018) highlights the importance of public stigma towards IPV victims, since it is a barrier to recovery from violence. Public stigma towards IPV victims was the focus of this study and will be further described below. Public Stigma toward Victims of Intimate Partner Violence Stigma has been defined in sociology as a process that emerges in social interactions in which a series of negative stereotypes are associated with a label, leading to prejudice and discrimination toward the people to whom that label is assigned (Goffman, 1963; Link & Phelan, 2001). Public stigma refers to stereotypes, prejudices, and discriminatory actions commonly endorsed by the general public (e.g., friends, family, employers; Pescosólido & Martin, 2015). Regarding existing theories that explain the public stigma associated with suffering IPV, Overstreet and Quinn (2013) were the first to point out in their studies in the USA that the label of "victim" carried a social image of passivity, weakness, and guilt for the abuse that leads to reactions such as discrimination and isolation of victims by third parties. This social image is anticipated (anticipated stigma; Goffman, 1963) and internalized (internalized/selfstigma) by the victims, which leads to inadequate coping strategies and psychological problems (Overstreet & Quinn, 2013). Further, seven possible manifestations of public stigma associated with IPV victim status have been proposed (Link & Phelan, 2011; Murray et al., 2018): blame, discrimination, loss of status, isolation, shame, dismissed/denied, and blatant unprofessionalism. These reactions are related, according to Murray et al. (2016) to certain social beliefs and perceptions about women, IPV, and victims. Consistent with stigma theories (Pescosolido & Martin, 2015), Barnett et al. (2016) concluded from an investigation they conducted in Kenya that victim labeling, stereotyping, and devaluation emerged first, followed by victim discrimination. Public stigma acted as a social control mechanism to maintain social norms and the resolution of marital conflicts. Some authors have researched the association of public stigma towards IPV women victims with several variables. For example, this stigma is sometimes exerted by people close to the victim (e.g., family, friends) and professionals who are assumed to be a fundamental source of support (Kennedy & Prock, 2018; Murray et al., 2016), posing a clear obstacle for the disclosure of abuse and help seeking (Murray et al., 2016). Regarding geographic factors, difficulties may be greater in rural areas where isolation and certain social perceptions (e.g., gender roles, women's functions in the family) are even more present (Wright et al., 2021). In addition, Kennedy and Prock (2018) conducted a systematic review that included information on IPV public stigma and focused on samples of IPV women victims. They found a relationship between this stigma and clinical variables (PTSD, psychological distress, and reduced quality of life). Furthermore, we conducted a systematic review on public stigma toward women victims of IPV in high-income countries (Murvartian et al., under review) where we identified a series of social norms (e.g., gender roles) that were linked to the stigmatizing responses from the general public toward victims of Murray et al.'s (2018) model. These responses in turn were associated with negative consequences for victims (e.g., not disclosing the abuse, the need to constantly prove they were doing things right, etc.), in part because public stigma was internalized and anticipated by them, something that has already been mentioned in the literature (Kennedy & Prock, 2018; Murray et al., 2018; Overstreet & Quinn, 2013). We also identified other factors associated with public stigma, of which the intersection of the public stigma of being a victim of IPV with the public stigma associated with other socially disadvantaged identities (e.g., being diagnosed with HIV) is noteworthy. As such, Murray et al. (2016) emphasize that each experience of public stigma is unique and other added stigmas need to be taken into account, since they amplify the obstacles that IPV public stigma entails, such as the difficulties for help-seeking. The Current Systematic Review In this review we aimed to study the public stigma that takes place in LAMIC for several reasons. First, most research generally assumes as the normative center of humanity the populations of Western, educated, industrialized, rich, and democratic countries, especially the United States (Heinrich, 2020), and these countries receive more scientific attention than others (Kahalon et al., 2022; Medin et al., 2017). This represents a clear bias, since it limits the generalizability of results and the understanding of experiences and behaviors of individuals in relation to their sociocultural contexts (Kahalon et al., 2022). Second, public stigma is dependent on the context in which it emerges (Goffman, 1963), which is supported by data. For example, Tran et al. (2016) analyzed the prevalence of physical IPV acceptance attitudes among 39 LAMIC and found significant variations between countries, and a higher prevalence in people with disadvantaged circumstances (e.g., rural areas, poverty, low level of formal education). They explained that patriarchal hegemony was present in many LAMIC and that this influenced education, legislation, and the criminal justice system in a way that facilitated those attitudes. The incidence of IPV in the past 12 months is also higher in LAMIC (WHO, 2022) and previous research indicates trends in predictors and risk factors of IPV for women living in these countries (Coll et al., 2021). Furthermore, the victim’s autonomy and financial status influence public stigma and help-seeking (McDougal et al., 2019), which may differ between high-income countries and LAMIC. Third, this follows the conventional classifications of other global IPV studies where the results are divided into high-income or LAMIC (WHO, 2022) and ensures manageable sample sizes. To the best of our knowledge, there are currently no reviews on public stigma toward women victims of intimate partner violence in LAMIC. However, a systematic review on the experiences of racial and ethnic minority IPV survivors in the US highlighted the weight of certain social norms in their countries of origin: gender roles, the normalization of violence and the consideration of IPV as a private matter (Ragavan et al., 2020). These and other social norms were identified in Murvartian et al.’s review (under review) in high-income countries. We consider that the social norms associated with public stigmatizing responses toward IPV victims, such responses, associated consequences of these responses for victims, and other factors related to IPV public stigma from Murvartian et al.’s (under review) study might vary in LAMIC, and that understanding how this stigma works in these contexts is the first step in designing sensitive interventions to prevent and combat stigma. Nevertheless, we also must consider that there will be multiple differences between LAMIC due to cultural diversity and varying laws related to IPV, as well as different socioeconomic levels of the population within and between countries. All these aspects, on their own, could produce substantial variation related to public stigma. Therefore, we will make these differences visible throughout this review to the extent possible. Taking all of this into consideration, we aimed to analyze public stigma toward women victims of IPV in LAMIC. This main objective, based on the previous findings of Murvartian et al. (under review)’s study, was specified in the following research questions: RQ1. What are the social norms and perceptions associated with public stigmatizing responses toward IPV victims? RQ2. What are the public stigmatizing responses (by family, neighbors, etc.) toward IPV victims? RQ3. What are the consequences of those responses for IPV victims? RQ4. What other factors are associated with public stigma towards IPV victims? Methods Search Strategy This review was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Moher et al., 2015). Five electronic databases (Web of Science, Scopus, PsychINFO, PUBMED, and the Cochrane Database of Systematic Reviews) were searched for peer-reviewed journal articles published between January 2010 and October 2022. Titles, abstracts and keywords were searched for the following terms: (stigma* AND ("partner abus*" OR "partner aggress*" OR "intimate partner violen*" OR "intimate violen*" OR "intimate terrorism*" OR "domestic violen*" OR "domestic abus*" OR "domestic violen* offen*" OR "violen* relation" OR "violen* between parent*" OR "violen* between partner*" OR "partner violen*" OR "spous* abus*" OR "battere*" OR "violen*against wom*n" OR "marital violen*" OR "marital abus*" OR "husband* abus*" OR "dating violen*" OR "family violen*" OR "situational violen*" OR "abus* relation*" OR rape OR "sexual violen*" OR "sexual agress*" OR "sexual abus*" OR gender NEAR/3 violen*). Because sexual violence is referred to in the context of an intimate relationship, terms related to sexual violence were included. Inclusion and Exclusion Criteria Empirical studies written in English and published in peer-reviewed journals were included. They were eligible if reporting components of public stigma mentioned in the research questions toward women victims of IPV perpetrated by a man who was her (ex)partner, and only when the violence and public stigma had occurred in LAMIC. Therefore, participants could be living in low, middle or high-income countries as long as the stigma and violence had taken place in LAMIC. It is worth clarifying that the samples of the studies included in our review were composed of professionals, community samples (i.e., general population), victims, among other sources, as long as societal stigma toward victims was examined in some way (e.g., professionals giving their opinion on the stigma they had observed from others, victims narrating the stigma they suffered from others, etc.). Studies were excluded when they were not empirical, not written in English, and not published in peer-reviewed journals. They were also excluded if they did not report findings on the components of public stigma mentioned in the research questions toward women victims of IPV perpetrated by a man who was her (ex)partner. For example, if it was an intervention against stigma, if stigma was only mentioned in the introduction section, if stigma was associated to other types of violence (e.g., sexual violence that was not perpetrated by an intimate partner or ex-partner), or if the results did not refer to public stigma, but to other types, such as internalized stigma by the victims (e.g.,, victims' feelings of guilt). Studies were also excluded when violence and public stigma occurred in highincome countries. After eliminating duplicates, the titles and abstracts were independently screened according to the above criteria by ML (principal investigator), who reviewed 100% of the results, and the third author, SJ, who reviewed a randomly assigned subset comprising 30% of the total, exceeding the recommended minimum of 20% (Ojeda and Del-Rey, 2021). Disagreements were discussed with a third reviewer (MJ), and consensus was reached. Then, ML and MJ independently analyzed the full texts of the remaining articles, and disagreements were discussed with SJ until a consensus was reached. Data Extraction and Methodological Quality Assessment Both researchers, ML and MJ, were simultaneously engaged in extracting data in an Excel document. Data collected included author(s) and year of publication, aim(s) of the study, sample(s) characteristics, methodology used in the study of public stigma, role of IPV public stigma in the study (“central role” when stigma was part of the aim(s) of the study, or “secondary role”, when it did not), methodological quality rating, and findings on social assigned gender role, such as being obedient wife and faithful to the husband (Alvarado et al., 2018, Ghana; Furr, 2014, India; Muuo et al., 2020, Kenya; Thurston et al., 2016, China), for choosing the wrong husband (Alvarado et al., 2018, Ghana; Thurston et al., 2016, China), or because something was wrong with their character (Alvarado et al., 2019, Pakistan; SnellRood, 2015, India). In keeping with the psychological characteristics of women, if they appeared too strong or too weak, they could be blamed (Thurston et al., 2016, China). Isolation. Another frequent response (n=11) from friends, family, and the community that victims experienced was isolation (Byrskog et al., 2014, Somalia; Shuman et al., 2016, Coast of Ivory; Snell-Rood, 2015, India; Thurston et al., 2016, China; among others). Women in these studies were not invited to social events because people feared that their daughters would follow their steps (Alvarado et al., 2019, Pakistan). As for family relationships, they were also isolated by their families. For example, they were rejected (Morse et al., 2012, Jordan), no longer helped (Childress et al., 2022, Kyrgyzstan), and excluded from family events (Furr, 2014, India). Shame. It was also very common to make the victim feel ashamed if she disclosed the abuse (n=11) (Alvarado et al., 2018, Ghana; Mannell et al., 2018, Afghanistan; Snell-Rood, 2015, India; Thurston et al., 2016, China; among others). This occurred with the general public as well as family members to victims (Childress et al., 2022). In this sense, it was frequently reported that disclosures could bring shame, not only to the victim, but also to the family (McClearly-Sills et al., 2016, Tanzania; Strang et al., 2020, Iraq; Superable, 2017, Philippines), so by making the victim feel ashamed, families tried to avoid stigma by association. Dismissed/denied. Looking the other way, helping the abuser, and downplaying or denying the abuse were also frequent responses from others after disclosure (n=11). On the one hand, they community minimized the problem (Apatinga & Tenkorang, 2022, Ghana; Childress et al., 2022, Kyrgyzstan; Thurston et al., 2016, China). Sometimes, people told women that IPV was normal and pressured them to sort things out at home, not leave the abuser, and/or not to press charges (Apatinga & Tenkorang, 2022, Ghana; Childress et al., 2022, Kyrgyzstan; McClearly Sills et al., 2016, Tanzania). Sometimes, the person to whom the woman disclosed the abuse refused to help (Snell-Rood, 2015, India) or returned her to the abuser (Strang et al., 2020, Iraq). Professionals in health, law enforcement, legal, and other sectors also did not provide support to victims (Thurston et al., 2016, China). Several studies indicated that the police were not helpful (Alvarado et al., 2019, Pakistan; Morse et al., 2012, Jordan; Shuman et al., 2016, Coast of Ivory); or that law enforcement and legal professionals did not believe disclosures (Barnett et al., 2016, Kenya). Some studies even reported that professionals supported the abuser or let the abuser go free after being bribed by him (Apatinga & Tenkorang, 2022, Ghana; Childress et al., 2022, Kyrgyzstan; Shuman et al., 2016, Coast of Ivory; Thurston et al., 2016, China). One article highlighted the abandonment of the case by the victims' families in exchange for money (Childress et al., 2022, Kyrgyzstan). In another article, elders did not listen because they refused to talk about problems of marriage (Apatinga & Tenkorang, 2022, Ghana). In line with the above, there were people who suggested to victims not to disclose the abuse because they were aware of the public stigma surrounding IPV (Ogunwale & Oshiname, 2017, Nigeria). Loss of status. Another commonly mentioned stigmatizing response (n=9) was that women were considered less valuable than they were before IPV disclosure, losing the respect of others (Morse et al., 2012, Jordan; Shuman et al., 2016, Coast of Ivory; Strang et al., 2020, Iraq). They were considered unwise for having chosen that husband or for their behavior being contrary to what was expected according to gender roles (Alvarado et al., 2018, Ghana), bad wives (Barnett et al., 2016, Kenya; Superable, 2017, Philippines), untrustworthy, with less remarriage prospects (Alvarado et al., 2019, Pakistan), of no integrity (Thurston et al., 2016, China), and sinners (Barnett et al., 2016, Kenya). Also, after disclosure, women leaders in the community were perceived as incapable and forced to leave their leadership positions (Alvarado et al., 2018, Ghana; Mannell et al., 2018, Afghanistan). Discrimination. Among the studies (n=6) women were treated differently, in a negative way, after the abuse was disclosed. Victims were humiliated and insulted (Shuman et al., 2016, Coast of Ivory), lost custody of children and their house because they were considered the husband's property (Alvarado et al., 2019, Pakistan; Barnett et al., 2016, Kenya; Morse et al., 2012, Jordan) or could even be imprisoned (Mannell et al., 2018, Afghanistan), threatened and battered by their own family, the husband's family, or the person to whom they disclosed the violence (Morse et al., 2012, Jordan; Thurston et al., 2016, China) or killed (Mannell et al., 2018, Afghanistan), sometimes constituting honor killings (Alvaradao et al., 2019, Pakistan; Morse et al., 2012, Jordan). Discrimination also occurred by police officers, who sexually harassed, threatened (Alvarado et al., 2019, Pakistan; Shuman et al., 2016, Coast of Ivory), and raped victims, as well as charged them a fee (Shuman et al., 2016, Coast of Ivory). Consequences of public stigmatizing responses for the victims. Several consequences of public stigmatizing responses for the victims were identified. First, anticipating public stigmatizing responses by victims was present in all WHO regions. This anticipation prevented women from seeking help -this consequence was present in all WHO regions-, and from not disclosing the abuse -which was present in all but the European regions-, and it made women choose not to work -which was present in the Eastern Mediterranean region-. Other consequences were not breaking up the abusive relationship - which was found in the African, the Eastern Mediterranean, and the Western Pacific Region articles-, and having difficulties in employment -which appeared in all but the European Region article-. The rest of the consequences were avoidance coping strategies and depression, the need to relocate or abandon their school, the development of internalized stigma, the escalation of violence and dropping the case once it reached the court, which were each explicitly mentioned in just one or two regions. One of the consequences was that women anticipated stigmatizing responses from others (n=15), therefore, in order to avoid the cultural stigma exerted by the community, women commonly chose not to disclose the abuse (n=15; Apatinga & Tenkorang, 2022, Ghana; Childress et al., 2022, Kyrgyzstan; Strang et al. 2020, Iraq; Snell-Rood, 2015, India; Thurston et al, 2016, China; among others), and not to seek help (n=15; Alvarado et al., 2018, Ghana; Mannell et al., 2018, Afghanistan; Snell-Rood, 2015, India; Superable, 2017, Philippines; among others). They often avoided telling friends, neighbors (Snell-Rod, 2015, India; Superable, 2017, Philippines) or even their family (Alvarado et al., 2019, Pakistan). Women also avoided public and institutional services. This prevented them access to health, legal or gender-based violence support services (Muuo et al., 2020, Kenya; Ogunwale & Oshiname, 2017, Nigeria; Thurston et al., 2016, China), which led to even greater vulnerability. Another consequence of anticipated stigma was what victims would decide not to work to avoid societal judgement and blame (Alvarado et al., 2019, Pakistan). Public stigma also kept women in the abusive relationships, preventing breakup (n = 6); Alvarado et al., 2019, Pakistan; Thurston et al., 2016, China), even when violence was extreme (Apatinga & Tenkorang, 2022, Ghana). In addition to the loss of economic and material resources that resulted from divorce in these situations, public stigma would leave them without any other kind of resource. This put victims and their children in a difficult situation (Superable, 2017, Philippines; Morse et al., 2012, Jordan). In some of the articles reviewed, difficulties in employment (n=3) were also mentioned. Women were denied employment (Furr et al., 2014, India), and potentially lost employment (Maticka-Tyndale et al., 2020, Kenya; Thurston et al., 2016, China). Public stigma was also mentioned as it related to depression, as well as avoidance coping strategies (n=3; Alvarado et al., 2018, Ghana; Superable, 2017, Phillipines; Thurston et al., 2016, China). Women had to relocate (n=2; Alvarado et al., 2019, Pakistan; Maticka-Tyndale et al., 2020, Kenya) or abandon school (n=1; Alvarado et al., 2019, Pakistan) due to the stigma exerted by neighbors and peers. Some articles also explicitly linked public stigma to the development of internalized stigma (n=2), in the form of internalized blame, shame, and isolation (Apatinga & Tenkorang, 2022, Ghana; Childress et al., 2022, Kyrgyztan). In addition, one article mentioned the escalation of violence as a consequence. Violence increased after police officers notified the batterer that a complaint had been filed, to assist him in getting it dismissed (Shuman et al., 2016, Coast of Ivory). Lastly, an article explained that, if a case reached the court, women were usually forced to “accept payment for agreeing to drop the case” to avoid public stigma (Childress et al., 2022, p.187, Kyrgyztan). Other factors associated with public stigma toward IPV victims. Different factors related to social norms and perceptions, public stigmatizing responses, and consequences were discussed. The existence of other intersecting stigmas that made the effects of IPV public stigma worse were mentioned in articles from all WHO regions but the article from the European Region. Furthermore, certain disadvantaged social circumstances were identified that made stigmatizing responses and their consequences worse for victims, which were described in some articles from the African, and Eastern Mediterranean Regions. Finally, several protective factors were explicitly explored in different articles from all WHO regions but the European, which helped victims cope with their situation. Intersecting stigmas. Some studies described how the public stigma associated with IPV intersected with other socially stigmatized characteristics -divorce, and facial disfigurementwhich reinforced social norms, public stigmatizing responses, and consequences described before. The public stigma of divorce was prominently brought up in several articles (n=7) because it made it more difficult for victims to abandon their abusive relationship (SnellRood, 2015, India). According to Superable (2017, Philippines), divorced women were perceived as incapable of fulfilling their roles in maintaining the family. They faced reduced remarriage prospects (Alvarado et al., 2019, Pakistan; McClearly-Sills et al., 2016, Tanzania, Thurston et al., 2016, China), or even exclusion from future marriages (Strang et al., 2020, Iraq). They could also be watched (Morse et al., 2012, Jordan), treated differently, or they could be a victim of further violence by others (Morse et al., 2012, Jordan; Thurston et al., 2016, China). After divorcing, their family would also reject them (Morse et al., 2012, Jordan). In certain cases, IPV left visible marks on women that were associated with further stigmatization. Furr (2014, India) described the public stigma that Indian women faced after suffering facial disfigurement from a fire attack by their husbands. According to this research, these women were rejected, isolated, and marginalized by their families and others due to facial disfigurement public stigma. They received continuous hostile and humiliating verbal abuse from others, and were publicly avoided on buses, streets, and shops. They were also blamed for the problems in their neighborhood, and considered unfit mothers, and of low value. Disadvantages social circumstances. Some articles explained how being poor or living in rural areas impacted public stigmatizing responses and their consequences on victims. Alvarado et al. (2019, Pakistan) mentioned that threats and harassment from police were more likely to occur after reporting their case if the victim belonged to a poor family. Similarly, displaced women faced more difficulties in disclosing IPV than settled women, as divorce and public stigma were an ‘impossible price to pay’ due to their precarious life conditions (Strang et al., 2020, Iraq). Finally, the scarcity of services in rural communities (i.e., only one market or school) could result in the victim losing access to services due to public stigma, leading to worse isolation (Alvarado et al., 2018, Ghana). Protective factors. Several factors that reduced the consequences of public stigma for victims were described, which we refer to as protective factors (n=10). Some articles describe instances of informal support from their family (Snell-Rod, 2015, India; Strang et al., 2020, Iraq; Thurston et al., 2016, China), neighbors (Snell-Rod, 2015, India), or other women (Strang et al., 2020, Iraq). They could provide emotional or instrumental support and were preferable to formal help. When matters could not be resolved in the family, religious and/or community leaders were considered a mediation resource in certain countries (Morse et al., 2012, Jordan; Strang et al., 2020; Iraq). Although formal resources were usually scarce, mistrusted, and stigmatized, some articles explored their usage by victims. These articles described the benefits to victims of GBV support services, which could provide material resources, emotional support, key information, or housing (Mannell et al. 2018, Afghanistan; Maticka-Tyndale et al., 2020, Kenya; Muuo et al., 2020, Kenya). Additionally, Barnett et al. (2016, Kenya)’s participants claimed that hospitals and the health care systems worked against stigmatization, providing them advice and effective support. However, due to fear of public disclosure, that help was rarely accepted. Other protective factors identified in the articles were victims’ awareness of support services, and self-perceived severity of IPV, as they promoted help seeking (Muuo et al., 2020, Kenya). Women’s participation in household responsibilities and financial decision making, as well as involvement in business was also seen as protective (Byskog et al., 2014, Somalia), and was associated with disclosure (Mactika-Tyndale et al., 2020, Kenya). Having a future orientation (Byskog et al., 2014, Somalia), developing a sense of empowerment, and learning how to deal with public stigma (Furr et al., 2014, India) were also considered beneficial. Lastly, in some articles, religion and spiritual beliefs were considered a source of strength (Byrskog et al. 2014, Somalia; Morse et al., 2012, Jordan). In these articles, IPV was portrayed by women as abnormal and forbidden in Islam, developing a certain resistance discourse through religion. Discussion Public Stigmatization in Lowand Middle-Income Countries The aim of this review was to identify and analyze four components involved in the process of public stigmatization of women victims of IPV in LAMIC. These components were: Social norms and perceptions associated with public stigmatizing responses toward IPV victims, such public stigmatizing responses, consequences of those responses for victims, and other factors that could reinforce or weaken the former components. The most significant findings are summarized in Table 1. [Table 1 here] First, we observed that the literature on public stigma in LAMIC is still scarce, and this stigma was usually not the focus of the study. Next, we discuss the aspects that we have considered most relevant regarding the public stigma components mentioned before. Considering social norms and perceptions that were associated with public stigmatizing responses toward victims, the weight of patriarchal gender roles, the consideration of IPV as a private matter, and the normalization of violence were noteworthy, which has already been noted by recent literature (Ragavan et al., 2020; Tran et al. 2016). The deeply rooted gender patriarchal roles could be considered at the core of public stigmatization and worked to maintain social order (Barnett et al., 2016). For instance, although we found that financial involvement and autonomy in women was associated with higher disclosure (Mactika-Tyndale et al., 2020), women's financial autonomy was also considered a threat to masculinity in certain countries and was associated with a higher risk of IPV and public stigmatization (Horn et al., 2014; McDouglas et al., 2019). The perception of violence as a private matter of the partner or family was predominant. In this regard, it is interesting how public stigma toward victims was largely extended toward their families (Strang et al., 2020, Iraq) referred to as stigma by association. The family lost social status (Snell-Rood, 2015, India; Strang et al., 2020, Iraq; Superable, 2017, Philippines), was blamed (Alvarado et al., 2019; Pakistan), and shamed (McClearlySills et al., 2016, Tanzania; Superable, 2017, Philippines), which could increase social and financial problems (Strang et al., 2020). The severity of this stems from the fact that women could be expected to anticipate, not only the consequences of disclosing the abuse for themselves (Overstreet & Quinn, 2013), but also for their families, contributing to their silence. Likewise, those who decided to disclose abuse sometimes lost the support of their family, leaving them helpless (e.g., Snell-Rood, 2015). IPV was normalized and justified in most countries. However, the types of violence and the degree to which it was legitimized varied from country to country, which is consistent with Tran et al.’s (2016) findings. In Tanzania, for example, sexual IPV was accepted as a mechanism for men to discipline their wives, and only certain very extreme forms of violence were considered reportable (McCleary-Sills et al., 2016). This was the case, for example, with gun violence, or anal rape, in this case because sexual practice per se was considered taboo in their context. However, most of the selected articles focused on physical, sexual, or instrumental violence, and barely mentioned emotional or psychological violence, except in a few studies (Shuman et al., 2016; Thurston et al., 2016). There is a possibility that public stigma toward psychological IPV is even higher due to its "invisible" nature and normalization, so disclosure is not warranted. Therefore, studying the public stigma associated with psychological IPV could be a challenge for researchers, especially in LAMIC, as participants may not even recognize it as such. In addition, and consistent with authors such as Tran et al. (2016), legislation in several countries could form a breeding ground for the normalization and legitimization of IPV from a structural level (structural stigma). In this regard, IPV laws varied from country to country. In some countries, legislation did not criminalize IPV except in cases of very extreme violence (McClearly Sills et al., 2018, Tanzania; Thurston et al., 2016, China) or the laws themselves provided for spousal obligations that legitimized the husband's use of IPV as a control mechanism (Barnett et al., 2016, Kenya). Furthermore, the law sometimes favored the husband in cases of divorce, for example, by granting him custody of the children (Morse et al., 2012, Jordan). Although the existence of laws against IPV and family measures in divorce would imply less structural normalization of violence and, with it, IPV prevalence (WHO, 2022), for these to be effective, efforts to decrease public stigma are necessary. In this sense, Kodikara (2018) found that victims preferred to ask for food assistance instead of relying on existing legislation related to IPV, to avoid public stigma. Interestingly, none of the study participants mentioned this relationship between structural stigma and public stigma. succeeded or not, how many times they tried to leave), and public stigma associated with psychological IPV. In addition, culturally-sensitive evidence-based interventions to combat stigmatization should be developed. A summary of all these implications for practice, policy, and research can be seen in Table 2. [Table 2 here] Conclusions From the results in this review, it can be concluded that living in a context of public stigmatization leaves victims completely isolated. This is because, in addition to the isolation caused by stigma, there is a lack of resources to leave the violence and rebuild their lives autonomously, laws and social norms do not favor divorce and access to support resources, or, when resources exist, they are not properly applied by professionals. Despite the multiple cultural, economic, and other differences between and within LAMIC, we could identify many similarities in public stigma that warrant an in-depth systematic review such as this. We believe this review provides a comprehensive overview that can serve as a compass for further research on the nature of stigma for each specific sociocultural context. Likewise, the findings constitute a first step in the design of prevention and anti-stigma programs and highlight their necessity. To the best of our knowledge, there is only one intervention aimed at combating stigma in LAMIC (Le Roux et al., 2020, Democratic Republic of Congo), which focused on faith community members. As revealed by our systematic review, addressing social norms regarding IPV in the community, local and/or religious leaders, service providers, and authorities, as well as providing IPV support services free of stigma, creating IPV laws, and awareness of services in the population are essential. References References from our study sample are indicated with *. *Alvarado, G., Fenny, A. P., Dakey, S., Mueller, J. L., O'Brien-Milne, L., Crentsil, A. O., … Schwenke, C. (2018). The health-related impacts and costs of violence against women and girls on survivors, households and communities in Ghana. Journal of Public Health in Africa, 9(2), 110-114. https://doi.org/10.4081/jphia.2018.860 *Alvarado, G., Mueller, J., O’Brien-Milne, L., Ghaus, K., Duvvury, N., & Scriver, S. (2019). The social costs of violence against women and girls on survivors, their families and communities in Pakistan. Pakistan Journal of Women’s Studies: Alam-E-Niswan, 26(1), 1–20. https://doi.org/10.46521/pjws.026.01.0013 *Apatinga, G. A., & Tenkorang, E. Y. (2022). Barriers to help-seeking for sexual violence among married or cohabiting women in Ghana. Violence Against Women, 28(15–16), 3844–3864. https://doi.org/10.1177/10778012211060861 *Barnett, J. P., Maticka-Tyndale, E. & Trócaire, K. (2016). Stigma as social control: Genderbased violence stigma, life chances, and moral order in Kenya. Social Problems, 63(3), 447–462. https://doi.org/10.1093/socpro/spw012 Brooks, J., McCluskey, S., Turley, E., & King, N. (2015). The utility of Template Analysis in qualitative psychology research. Qualitative Research in Psychology, 12(2), 202–222. https://doi.org/10.1080/14780887.2014.955224 *Byrskog, U., Olsson, P., Essén, B., & Allvin, M. K. (2014). Violence and reproductive health preceding flight from war: accounts from Somali born women in Sweden. BMC Public Health, 14, 892. https://doi.org/10.1186/1471-2458-14-892 *Childress, S., Shrestha, N., Anekwe, K. Small, E., & McKay, M. (2022). Barriers to HelpSeeking for Domestic Violence in Kyrgyzstan: Perspectives of Criminal Justice, Social, Health, and Educational Professionals. Global Social Welfare, 9, 179–192. https://doi.org/10.1007/s40609-022-00226-x Coll, C., Santos, T., Devries, K., Knaul, F., Bustreo, F., Gatuguta, A., … Barros, A. (2021). Identifying the women most vulnerable to intimate partner violence: A decision tree analysis from 48 low and middle-income countries. EClinicalMedicine, 42. https://doi.org/10.1016/j.eclinm.2021.101214 Flasch, P., Murray, C. E., & Crowe, A. (2017). Overcoming abuse: A phenomenological investigation of the journey to recovery from past intimate partner violence. Journal of Interpersonal Violence, 32(22), 3373–3401. https://doi.org/10.1177/0886260515599161 *Furr L. A. (2014). Facial disfigurement stigma: A study of victims of domestic assaults with fire in India. Violence Against Women, 20(7), 783–798. https://doi.org/10.1177/1077801214543384 Goffman, E. (1963). Stigma: Notes on the management of a spoiled identity. Simon & Schuster. Heinrich, J. (2020). The weirdest people in the world. How the west became psychologically peculiar and particularly prosperous. Farrar, Strauss and Giroux Publisher. Horn, R., Puffer, E.S., Roesch, E., & Lehmann, H. (2014). Women’s perceptions of effects of war on intimate partner violence and gender roles in two post-conflict West African Countries: consequences and unexpected opportunities. Conflict & Health, 8(12), 113. https://doi.org/10.1186/1752-1505-8-12 Kahalon, R., Klein, V., Ksenofontov, I., Ullrich, J., & Wright, S. C. (2022). Mentioning the sample’s country in the article’s title leads to bias in research evaluation. Social Psychological and Personality Science, 13(2), 352-361. https://doi.org/10.1177/19485506211024036 Kennedy, A. C., & Prock, K. A. (2018). "I still feel like I am not normal": A review of the role of stigma and stigmatization among female survivors of child sexual abuse, sexual assault, and intimate partner violence. Trauma, Violence & Abuse, 19(5), 512527. https://doi.org/10.1177/1524838016673601 Kodikara, C. (2018). Battered wives or dependent mothers? Negotiating familial ideology in law. Violence Against Women, 24(8), 901–921. https://doi.org/10.1177/1077801217724452 Le Roux, E., Corboz, J., Scott, N., Sandilands, M., Lele, U.B., Bezzolato, E. & Jewkes, R. (2020). Engaging with faith groups to prevent VAWG in conflict-affected communities: results from two community surveys in the DRC. BMC International Health and Human Rights, 20(1), 1–21. https://doi.org/10.1186/s12914-020-00246-8 Liang, B., Goodman, L., Tummala-Narra, P., & Weintraub, S. (2005). A theoretical framework for understanding help-seeking processes among survivors of intimate partner violence. American Journal of Community Psychology, 36(1-2), 71–84. https://doi.org/10.1007/s10464-005-6233-6 Link, B. G., & Phelan, J. C. (2001), Conceptualizing stigma. Annual Review of Sociology, 27, 363-385, https://doi.org/10.1146/annurev.soc.27.1.363 *Mannell, J., Ahmad, L., & Ahmad, A. (2018). Narrative storytelling as mental health support for women experiencing gender-based violence in Afghanistan. Social Science & Medicine, 214, 91–98. https://doi.org/10.1016/j.socscimed.2018.08.011 *Maticka-Tyndale, E.,Barnett, J. P., & Trócaire, K. (2020). Exploring the relationship between stigma, stigma challenges, and disclosure among slum-dwelling survivors of intimate partner violence in Kenya. Violence Against Women, 26(10), 1188–1208. https://doi.org/10.1177/1077801219856101 *McCleary-Sills, J., Namy, S., Nyoni, J., Rweyemamu, D., Salvatory, A., & Steven, E. (2016). Stigma, shame and women's limited agency in help-seeking for intimate partner violence. Global Public Health, 11(1-2), 224–235. https://doi.org/10.1080/17441692.2015.1047391 McDougal, L., Klugman, J., Dehingia, N., Trivedi, A., & Raj, A. (2019) Financial inclusion and intimate partner violence: What does the evidence suggest? PLoS ONE, 14(10), e0223721. https://doi.org/10.1371/journal.pone.0223721. Medin, D., Ojalehto, B., Marin, A., & Bang, M. (2017). Systems of (non-)diversity. Nature Human Behaviour, 1, 1–5. https://doi.org/ 10.1038/s41562-017-0088 *Morse, D. S., Paldi, Y., Egbarya, S. S., & Clark, C. J. (2012). "An effect that is deeper than beating": Family violence in Jordanian women. Families, Systems & Health: The Journal of Collaborative Family Healthcare, 30(1), 19–31. https://doi.org/10.1037/a0027137 Murray, C., Crowe, A. & Akers, W. (2016) How can we end the stigma surrounding domestic and sexual violence? A modified Delphi study with national advocacy leaders. Journal of Family Violence, 31, 271–287. https://doi.org/10.1007/s10896-015-9768-9 Murray, C. E., Crowe, A., & Overstreet, N. M. (2018). Sources and components of stigma experienced by survivors of intimate partner violence. Journal of Interpersonal Violence, 33(3), 515-536. https://doi.org/10.1177/0886260515609565 *Muuo, S., Muthuri, S. K., Mutua, M. K., McAlpine, A., Bacchus, L. J., Ogego, H., … Izugbara, C. (2020). Barriers and facilitators to care-seeking among survivors of gender-based violence in the Dadaab refugee complex. Sexual and Reproductive Health Matters, 28(1), 245-260 https://doi.org/10.1080/26410397.2020.1722404 *Njuki, R., Okal, J., Warren, C.E., Obare, F., Abuya, T., Kanya, L., … Askew, I. (2012). Exploring the effectiveness of the output-based aid voucher program to increase uptake of gender-based violence recovery services in Kenya: A qualitative evaluation. BMC Public Health, 12(426), 1-7. https://doi.org/10.1186/1471-2458-12-426 *Ogunwale, A. O., & Oshiname, F. O. (2017). A qualitative exploration of date rape survivors' physical and psycho-social experiences in a Nigerian university. Journal of Interpersonal Violence, 32(2), 227–248. https://doi.org/10.1177/0886260515585541 Overstreet, N. M., & Quinn, D.M. (2013). The intimate partner violence stigmatization model and barriers to help-seeking. Basic and Applied Social Psychology, 35(1), 109-122. https://doi.org/10.1080/01973533.2012.746599 Pescosolido, B. A., & Martin, J. K. (2015). The stigma complex. Annual Review of Sociology, 41, 87–116. https://doi.org/10.1146/annurev-soc-071312-145702 Ragavan, M. I., Thomas, K. A., Fulambarker, A., Zaricor, J., Goodman, L. A., & BairMerritt, M. H. (2020). Exploring the needs and lived experiences of racial and ethnic minority domestic violence survivors through Community-Based Participatory Research: A systematic review. Trauma, Violence & Abuse, 21(5), 946–963. https://doi.org/10.1177/1524838018813204 Ragusa, A. T. (2013). Rural Australian women’s legal help seeking for intimate partner violence: women intimate partner violence victim survivors’ perceptions of criminal justice support services. Journal of Interpersonal Violence, 28(4), 685–717. https://doi.org/10.1177/0886260512455864 Rai, A., Perkins, N. H., Grossman, S. F., & Malazarte, N. (2022). Development of B.R.A.K.E. the cycle: A culturally responsive bystander intervention for South Asian immigrants in the United States. Families in Society, Online First, 1–8. https://doi.org/10.1177/10443894221132339 *Shuman, S. J., Falb, K. L., Cardoso, L. F., Cole, H., Kpebo, D., & Gupta, J. (2016). Perceptions and experiences of intimate partner violence in Abidjan, Côte d'Ivoire. PloS One, 11(6), e0157348. https://doi.org/10.1371/journal.pone.0157348 *Snell-Rood, C. (2015). Informal support for women and intimate partner violence: the crucial yet ambivalent role of neighbors in urban India. Culture, Health & Sexuality, 17(1), 63–77. https://doi.org/10.1080/13691058.2014.950333 *Strang, A., O'Brien, O., Sandilands, M., & Horn, R. (2020). Help-seeking, trust and intimate partner violence: Social connections amongst displaced and non-displaced Yezidi women and men in the Kurdistan region of northern Iraq. Conflict and Health, 14(61), 1–12. https://doi.org/10.1186/s13031-020-00305-w *Superable, C. S. (2017). Lived experiences of battered women in Ozamiz City, Philippines. The Qualitative Report, 22(13), 3447-3460. https://doi.org/10.46743/21603715/2017.3437 *Thurston, W. E., Tam, D. M., Dawson, M., Jackson, M., & Kwok, S. M. (2016). The intersection of gender and other social institutions in constructing gender-based violence in Guangzhou China. Journal of Interpersonal Violence, 31(4), 694–714. https://doi.org/10.1177/0886260514556109 Tran, T.D., Nguyen, H., & Fisher, J. (2016) Attitudes toward intimate partner violence against women among women and men in 39 lowand middle-income countries. PLoS ONE 11(11): e0167438. https://doi.org/10.1371/journal.pone.0167438 United Nations. (2022, December 6). Goal 5: Achieve gender equality and empower all women and girls. Sdgs.un.org/. https://sdgs.un.org/goals/goal5 Weisz, B. M., Quinn, D. M., & Williams, M. K. (2016). Out and healthy: Being more "out" about a concealable stigmatized identity may boost the health benefits of social support. Journal of Health Psychology, 21(12), 2934–2943. https://doi.org/10.1177/1359105315589392 World Health Organization. (2022, December 6). Violence against women prevalence estimates, 2018. Who.int. https://www.who.int/publications/i/item/9789240022256 Wright, E. N., Anderson, J., Phillips, K., & Miyamoto, S. (2021). Help-seeking and barriers to care in intimate partner sexual violence: A systematic review. Trauma, Violence, and Abuse. https://doi.org/10.1177/1524838021998305 Murvartian, L., Saavedra-Macías, F. J., & Infanti, J. J. (under review) Public stigma toward women victims of intimate partner violence: a systematic review. Aggression & Violent Behavior. Yin, R. K. (2018). Case Study Research and Applications: Designs and Methods. Sage. Figure 1 Initial coding template, developed in Murvartian et al. (under review) Social Norms and Perceptions Public Stigmatizing Reactions Consequences on Victims Other Factors - IPV as a Private Matter - Normalization of IPV - Gender Roles - Victim Profile - Leaving the Abuser is Easy - Stereotype of Right Victims - IPV as Cyclical - Blame - Discrimination - Loss of Status - Isolation - Shame - Dismissed/Denied - No Help-Seeking - No Disclosure - No Breakup - Difficulties in Employment-Seeking - Avoidance-Coping Strategies and Depression - Proving They are Doing Things Right - Belonging to Ethnic Groups - Having Experienced Abuse Before - Gender - Years of College - Type of Abuse - Intersectionality with Other Stigmas Figure 2 PRISMA flowchart for the inclusion process Studies included in review (n = 19) Included Records identified from databases (n = 3510) Web of Science (n = 1105) Scopus (n = 580) PsycINFO (n = 1343) PubMed (n = 474) The Cochrane Database of Systematic Reviews (n = 3) Duplicates removed (n = 2110) Records screened (n = 1400) Records excluded (n = 1201) Reports assessed for eligibility (n = 199) Reports excluded, with reasons (n = 180): (1) Not written in English (n = 5) (2) Not empirical study (n = 4) (3) Data from country could not be extracted (n = 1) (4) No findings on cultural stigma in low or middle income countries toward women victims of IPV (n = 168) (5) Full-text not found (n = 2) Identification Screening Eligibility Morse et al. (2012) - Jordan (Eastern Mediterranean Region) - Focus groups of women who had ever been married (N=12, 6 participants each, 70 women in total). Four groups were formed with women that had reported family violence exposure - Convenience sampling - Mean age: 37.8. Group average age range 29.8-45.9. - Married, 47.1%; Widowed, 28.6%; Divorced, 24.3%. - No ethnicity information. - No job information (unspecified diverse socioeconomic backgrounds). - Average group years of education range 3.5-18. To inform about Jordanian women's experiences and beliefs regarding family violence - Qualitative - Focus groups - Thematic analysis SR 5/5 Snell-Rood (2015) - India (South-East Asia Region) - Women and their households living in one Delhi slum community (N=10) - Convenience sampling through snowballing. - Mean age: 35: Range 23-60. - No marital status information. - Diverse ethnic groups (unspecified). - No job information (Mean household income 5900 rupees/month; range 3000 Rs-10,000 Rs). - No formal education information. To explore from whom and how lowincome women experiencing domestic violence in urban India seek informal support. - Qualitative - Participant observation and semi-structured interviews - Longitudinal cross-case comparison SR 5/5 Furr (2014) - India (South-East Asia Region) - Focus groups of women with visible facial disfigurement due to fire assault by their husbands (N=2, 10-11 participants each, 21 women in total) - Purposive sampling - Age range 19-51. - All married (90,5% living with or near husband). - No ethnicity information. - Some employed (servants or street-side vendors, unspecified %) (all lower caste origins, low to modest income families). - No formal education information. To study the life of women survivors of domestic assaults with fire in India - Qualitative - Focus groups - Analysis not specified SR 4/5 Superable (2017) - Philippines (Western Pacific Region) - Women living with their legal of common-law husbands that had experienced at least three times of physical battering by them and had at least one child (N=6) - Purposive sampling through snowballing - Age range 24-35. - All married. - No ethnicity information. - Unemployed depending on husbands’ income, 66.6%; Connected to government service, 16.6%; Teacher, 16.6%. - No information (lower than college), 83.4%; College, 16.6%. To explore how battered women viewed their experiences as victims - Qualitative - Interviews - Heidegger's hermeneutic phenomenology SR 5/5 Thurston et al. (2016) - China (Western Pacific Region) - Women who had been abused and had either left the abusive relationship or had no experience of an acute episode of abuse for at least 12 months (N=13) - Convenience sampling, through snowballing - Age range: early twenties-mid forties. - Divorced, 53.8%; Cohabiting, 46,2%. - No ethnicity information. - Full-time working, 61.5%; Part-time working, 23.1%; Unemployed, 7.7%; Housewife, 7.7%. - Junior high, 15.4%; High school, 15.4%; College diploma, 15.4%; Post-secondary, 46.2%; Missing; 7.7%. To understand the intersections of gender and other social institutions in constructing GBV from the perspectives of GBV victims in Guangzhou, China - Qualitative - Semi-structured in-depth interviews - Thematic analysis SR 5/5 Childress et al. (2022) - Kyrgyz Republic (European Region) - Focus groups (n=63) and in-depth interviews (n=20) with women (n=65) and men (n=18) who had worked with IPV victims in their current positions (domestic violence or legal advocates, psychologists, healthcare providers, educators, and law enforcement officials) (N=83) - Theoretical sampling - Over 18 years old - No marital status information - Russian, 6%; Kyrgyz, 94% - All employed (at least 1 year in their current job) - No formal education information To understand the structural and legal barriers that prevent survivors of DV from seeking help in Kyrgyzstan from the perspectives of professionals working directly with survivors (law enforcement, judicial system, social, health, and educational professionals) - Qualitative - Semi-structured in-depth interviews and focus groups - Grounded theory approach SR 5/5 Appendix B Presence of social norms and perceptions associated with public stigmatizing responses and public stigmatizing responses Social norms and perceptions Public stigmatizing responses Author (year) IPV as a private matter IPV normalization Gender roles Thinking all victims will reconcile after reporting Isolation Blame Discrimination Shame Loss of Status Dismissed/ Denied Apatinga & Tenkorang (2022) X X X X Muuo et al. (2020) X X X X Maticka-Tyndale et al. (2020) X X Alvarado et al. (2018) X X X X X Ogunwale & Oshiname (2017) X X X Barnett et al. (2016) X X X X X X X Shuman et al. (2016) X X X X X X X McCleary-Sills et al. (2016) X X X X X X Njuki et al. (2012) X Strang et al. (2020) X X X X X Alvarado et al. (2019) X X X X X X X Mannell et al. (2018) X X X X Byrskog et al. (2014) X X X X X Morse et al. (2012) X X X X X X X X X Snell-Rood (2015) X X X X X Furr (2014) X X X Superable (2017) X X X X X Thurston et al. (2016) X X X X X X X X X Childress et al. (2022) X X X X X X X Appendix C Presence of consequences of public stigmatizing responses and other factors associated with public stigma Author (year) Consequences of public stigmatizing responses for victims Other factors Anticipated stigma No breakup Dropping the case Relocation School abandonment Difficulties in employment Avoidance coping strategies and depression Internalized stigma Escalation of violence Intersecting stigmas Disadvantaged social circumstances Protective factors No helpseeking No disclosure Deciding not to work Apatinga & Tenkorang (2022) Muuo et al. (2020) X X X MatickaTyndale et al. (2020) X X X Alvarado et al. (2018) X X X X X X Ogunwale & Oshiname (2017) X X Barnett et al. (2016) X X X X Shuman et al. (2016) X X McClearySills et al. (2016) X X X Njuki et al. (2012) X X Strang et al. (2020) X X X X X Alvarado et al. (2019) X X X X X X X X X Mannell et al. (2018) X X Byrskog et al. (2014) X X Morse et al. (2012) X X X X Snell-Rood (2015) X X X X Furr (2014) X X X Superable (2017) X X X X X Thurston et al. (2016) X X X X X X X Childress et al. (2022) X X X