Listening deeply to refugee background women to understand experiences of domestic and family violence in their communities to foster engagement with global support systems

ABSTRACT

As trauma survivors, women and girls from refugee backgrounds face significant challenges when settling in host countries; the risk of domestic and family violence (DFV) accentuates these difficulties. Reflecting on findings from a seven-year university and industry research partnership, this article explores the etiology of DFV in women from refugee backgrounds living in non-metropolitan Australia. Drawing on action research principles and intersectional and social ecological theoretical frameworks, this study captured diverse women’s views about experiences and strategies for addressing DFV in refugee communities. Having developed trusting relationships with participants over the different study phases, the first author conducted in-depth interviews with women of refugee backgrounds, listening deeply and confirming findings with participants as they emerged. Interviews were also conducted with staff from settlement, health and specialist domestic violence services to offer a broad perspective on how best to support refugee women experiencing DFV. Key findings revealed stressors and support that impact violence, such as employment status and acculturation, and identification of who the women would trust if experiencing violence. By understanding the interweaving factors influencing women’s risk of DFV and strategies to address it, global healthcare providers will be better positioned to collaborate with refugee communities and specialist services.

KEYWORDS:

• Refugee
• women
• domestic and family violence
• healthcare

Introduction

Having survived violence and trauma in their home countries and during their journeys seeking refuge, newly arrived refugee women and children are at risk of domestic and family violence (DFV)¹ in their settlement locations (Njie-Carr et al., 2021; Timshel et al., 2017; Vaughan et al., 2015; Wachter et al., 2016). Navigating everyday needs is compounded by negotiating the norms and expectations of a new place and a new culture (Sabri et al., 2018; Simbandumwe et al., 2008), including foreign healthcare systems marked by ethnocentrism and inadequate identification and management of DFV in marginalised populations (Damra & Abujilban, 2022). DFV experiences further complicate settlement processes and can severely impact refugee women and children’s physical and mental health and their sense of safety and belonging in the new home. Listening deeply to refugee women’s knowledge of DFV in their communities acknowledges structural disadvantages and recategorises perceived vulnerability as ‘risk’ (Maher & Segrave, 2018). Prioritising refugee women’s agency allows health service providers to engage with and support this cohort safely and effectively.

This article shares insights from a university and industry research partnership conceived to examine a program supporting the social inclusion of women from refugee backgrounds in regional Australia. The lessons learned from this, and additional research phases, provide insights for a diverse range of global healthcare practitioners to serve these communities better. Findings from some of these subprojects have been reported elsewhere (Hughes et al., 2021; Hughes et al., 2023; Whitaker et al., 2018; Whitaker et al., 2021). This article discusses research addressing the questions: What are women’s understandings of the multiple layers of family violence in their communities? What barriers do women face? How can women be empowered to seek support? The article shares findings to inform how global healthcare providers understand, prevent and respond to DFV in refugee communities.

Supporting refugee background and migrant women: the program

The 3Es to Freedom: Education, Employment and Empowerment program was established in 2016 by Anglicare North Coast, a not-for-profit organisation in non-metropolitan Australia. Rural and regional Australia has become home to a growing number of humanitarian migrants over the past few decades (Piper, 2017). In response to this newly diverse population, health and settlement services have been established or refocused to cater for the new arrivals. Through a tailored education program coordinated by community welfare staff and delivered by a range of guest speakers from health and social services and visiting community resources, the 3Es to Freedom program supported women to build their knowledge, skills, and confidence to feel empowered in their new communities and, in the longer term, be less likely to be victims of domestic and family violence (Whitaker et al., 2018). The Australian Government funded the 3Es to Freedom program in support of the National Action Plan to End Violence against Women and their Children 2012 and subsequent Plans (Australian Government, 2016) as part of their efforts to reduce and prevent domestic and family violence.

The program was multidimensional and staff listened deeply to respond to the women’s unique needs and interests (Whitaker et al., 2021). Staff used existing professional and personal networks to source appropriate partners, guests and opportunities for the women (Whitaker et al., 2021). As well-connected individuals are more likely to be ‘hired, housed, healthy and happy’ (Woolcock, 1998, p. 154) than those with fewer social connections, relationships were fostered across cultures with activities connecting the women to place and resources (Whitaker et al., 2018). The program’s success was observed in how the destination communities welcomed the women, offering something of the refuge and safe haven they may have sought. The women gained driver’s licences, formal qualifications, and work experience, secured preferred jobs and strengthened their links to their community. These factors contributed to building their agency to seek support to keep themselves and their families healthy and safe.

Summary of the literature – refugee women and their children

Understanding the context of DFV for refugee women and their children can assist in offering effective preventative and responsive healthcare services. This knowledge includes an awareness of the incidence and experience of violence in these communities, as well as cultural expectations and nuances, and how difficulties faced when negotiating life in a new culture can impact risk, reporting violence and seeking support.

Risk of abuse

Domestic and family abuse rates in migrant and refugee populations are estimated to be equivalent to the broader population or higher (Vaughan et al., 2019). While difficult to ascertain due to underreporting (Menjívar & Salcido, 2002), some studies suggest refugee women and children, in particular, are at high risk of family violence (El-Moslemany et al., 2022; Pittaway, 1991; WHO, 2020), with international research suggesting abuse occurs in an estimated 30-50% of refugee families (Timshel et al., 2017). Although there has been international support for impactful responses to DFV in refugee and migrant communities (OCASI, n.d.; United Kingdom Government, 2020), research and practice gaps remain (Gonçalves & Matos, 2016; Vaughan et al., 2015) and this cohort remains largely understudied (Pogarell et al., 2019). Furthermore, the lack of engagement between multicultural communities and DFV services makes it challenging to evaluate programs to design more effective interventions to prevent violence (El-Murr, 2018).

Domestic abuse in refugee background families is multilayered and characterised by socioeconomic challenges, isolation, limited English language proficiency, limited knowledge about legal rights, dependency, and gender norms that legitimise male authority (El-Murr, 2018; Henriksen et al., 2023; Murray et al., 2019; Vaughan et al., 2015). Refugees have been exposed to trauma, with most refugee background women being survivors of sexual assault and/or torture (Kaplan, 2018). Pre-migration trauma cannot be underestimated and continues to impact lives post-settlement, with research highlighting the correlation between family members’ experience of Post Traumatic Stress Disorder (PTSD) and an increased likelihood of DFV (Timshel et al., 2017).

Navigating acculturation

Timshel et al. (2017) observed how the breakdown of traditionally held values, including prescribed gender roles, has heightened domestic abuse. Ajlan (2022), in a recent study of Syrian refugees in Germany, noted the culturally specific nature of domestic violence and how new ‘freedoms’, such as divorce, can trigger intimate partner violence. Although DFV is observed in all cultures, traditional beliefs about gendered power relations can cause conflict (Vaughan et al., 2015). Whilst these beliefs are not bound to specific cultures (El-Murr, 2018), men from refugee and migrant backgrounds may have firmly held opinions about traditional gender roles, and less gender equality can equate with higher rates of domestic abuse (Brotherhood of St Lawrence, 2015).

Barriers to seeking support

Understanding what prevents refugee women from seeking help is essential when designing responsive and preventative violence interventions. Women experiencing violence may not wish to access formal support, legal or health services and may prefer assistance from trustworthy, known individuals (UN Women, 2019). When speaking out about violence, women can be outcast in their communities and blamed for the men’s abuse (Maher & Segrave, 2018; Vaughan et al., 2015). Women may hold legitimate fears about being deported if they have temporary or partnered visa status and leave a dependent relationship (Vasil, 2023). They may also hold concerns about losing custody of their children and may not have sufficient knowledge of their legal rights. DFV might also be accepted in some communities (Vaughan et al., 2015). Additionally, suspicion of those in authority may discourage them from seeking support in their home or settlement countries (El-Murr, 2018; Maher & Segrave, 2018; Nasser-Eddin, 2017; Porter & Haslam, 2005).

DFV responses in multicultural communities require in-depth evaluation to understand the limitations of service engagement (Vaughan et al., 2015). Murray et al. (2019) suggest that interventions have historically been applied through an Anglocentric lens that fails to recognise refugee and migrant women’s specific context of DFV. Program designers must, therefore, listen meaningfully to refugee and migrant women’s voices to understand risk and protective factors to better support their needs (Timshel et al., 2017). Researchers have noted that once settled in their new country, refugee women may report abuse to trusted settlement services rather than contact unknown specialised DFV services (Vaughan et al., 2019). They may also prefer sharing their DFV experiences with health professionals they know and connect with (El-Murr, 2018). Language challenges can also impact refugee women’s confidence in seeking support. Al-Shdayfat and Hatamleh (2017, p. 96), in their study of Syrian refugee women, noted that ‘refugee women who prefer to keep silent about domestic violence were overwhelmed by cultural constraints and disadvantaged living circumstances’, and their vulnerability compounded their feelings of powerlessness to report abuse. Awareness of these intersections can assist in understanding how violence is perpetrated and experienced in diverse communities and inform responses to treat those abused and prevent abusive behaviours (Nasser-Eddin, 2017).

Engaging global healthcare practitioners to support refugee women in the context of violence

The World Health Assembly acknowledged the vital role of the global health system in promoting multisectoral responses to violence against women and girls (WHO, 2016). Health practitioners are at the frontline in supporting refugee women exposed to violence. Al-Shdayfat and Hatamleh (2017) note that although only small numbers of women report abuse to health practitioners, they are more likely to reveal their experience of violence in a health setting than report to police. Reasons for reporting abuse to health workers include already having a reason for the visit due to a health concern and already having built a relationship with a healthcare professional. However, reasons for not reporting violence to healthcare workers might include a lack of privacy in public health facilities (Damra et al., 2015) or perceived disinterest of the workers (Abu-Ras, 2003; Al-Shdayfat & Hatamleh, 2017). Ultimately, healthcare responses may have limited risk tolerance and may be perceived as making decisions for women and disregarding agency.

Study context and design

This study emerged from a seven-year university and industry research partnership investigating the social inclusion of women from refugee and migrant backgrounds in non-metropolitan Australian communities (Hughes et al., 2021; Whitaker et al., 2018; Whitaker et al., 2021). In this later phase of the study, the authors were commissioned to capture the views of women program participants and community service providers about domestic and family violence in their communities. Initial findings were disseminated in a report for stakeholders and community presentations were shared to reflect on participant and key informant observations to better inform cross-sector support services.

The regional city in which this study was located has a population of approximately 78,000 (ABS, 2021), including more than 2000 refugees who came to Australia as part of the federal government’s Humanitarian Regional Settlement Program (Department of Home Affairs, 2020). The new arrivals come from various countries, including Afghanistan, Burundi, Congo, Eritrea, Ethiopia, Iraq, Iran, Myanmar, Syria and South Sudan (Department of Home Affairs, 2020). A large settlement service provides immediate assistance on arrival, and an additional service provider meets medium to longer-term needs for this cohort. There is a much-needed and now well-established refugee health clinic and a trauma-informed counselling service. Despite the provision of these specialised services, program staff advised services are limited due to the regional location. There are many gaps in support services, and much work is needed to better inform mainstream providers, especially those in the health sector, to better serve this cohort, especially in the context of DFV.

Research approach and framework

This action research project (Wadsworth, 2010) was initiated by a not for profit organisation to develop a partnership with local university researchers to gain insights and respond to the specific needs of their clients and better support program implementation in the region and contribute to national and international knowledge about regional settlement. In line with action research principles, the researchers aimed to create ‘reciprocal research’ to ‘move beyond harm minimization … to bring about reciprocal benefits for refugee participants and/or communities’ (Mackenzie et al., 2007, p. 299). The collaborative approach sought to address issues of equity and inclusivity by engaging deeply with research participants to validate findings and realise tangible benefits (Tajima, 2021, p. 4953). This approach addresses power imbalances in research, which is especially important when collaborating with potentially vulnerable groups (Doná, 2007). Adhering to cultural safety was essential in the study to support participant wellbeing. The university ethics committee approved the study (approval no. 2020/132).

The conceptualisation of DFV for refugee populations in this study drew on the theory of intersectionality (Carbado et al., 2013; Crenshaw, 1991), to explore the complexity of the participants’ social identities by recognising the interplay between gender, ethnicity, class and other social categories. Applying an intersectional framework is helpful in understanding complex DFV situations, such as those experienced by women from refugee and migrant communities (Vaughan et al., 2019). Additionally, measures to address DFV were understood through a social ecological lens that recognises the interaction of individuals, relationships, communities and societies in determining health outcomes (Hawkins et al., 2021), and is consistent with a multidimensional response.

Participants and methods

After determining that refugee women clients wanted to talk about their communities’ experiences of DFV, staff from the non-for-profit organisation running the women’s program and a local domestic and family violence specialist service sought to capture these insights to enable a better-informed response to support these women. Building on the existing research partnership, the agencies identified potential participants, and, with their consent, introduced the lead researcher to five participants from refugee backgrounds (referred to herein as participants). The insights from participants were complemented with interviews with five key service staff from health, settlement/migration and domestic violence support services (referred to herein as key informants) to offer a broad perspective on how best to support refugee women experiencing DFV. Women currently seeking support from the DFV specialist service or women known to be currently experiencing DFV were excluded from the study to minimise potential re-traumatisation. The researcher used an interview guide to conduct in-depth, semi-structured interviews of up to one-hour duration with all participants. Written informed consent formed the basis of the women’s participation in the study.

The study was undertaken in New South Wales in 2019 during the COVID-19 pandemic lockdown and interviews took place via Zoom or phone, depending on participant preference. The researcher planned to use interpreters to align with best practices for working with people from refugee backgrounds. However, participants chose to be interviewed in English. A research safety plan was designed to refer participants to a specialised trauma counselling service if needed.

Thematic analysis

The authors applied an inductive thematic analysis approach to interpret and organise data to enhance understanding of lived experiences (Berg, 2009; Perakyla, 2005). Interviews were transcribed verbatim and checked by the first author. The first author manually colour-coded the data and created thematic labels summarising commonly occurring points made by study participants. The author applied van Manen’s (1990, pp. 92–93) approach to thematic analysis by examining the text wholistically, undertaking multiple readings to identify specific statements or phrases that carry meaning about particular experiences, and, finally, closely examining specific sentences to provide insight.

Results

The themes emerging from interviews with refugee women and key informants about DFV included the challenges faced in adapting to a new country, such as finding sustainable employment, the incidence of alcohol abuse due to dealing with trauma, and the experience of acculturation (especially concerning gender roles). Study participants also discussed the importance of trust and barriers to seeking support for DFV. The refugee participants were all over 18 years old, originally from Myanmar, Ghana and Syria, and had lived in Australia for less than ten years. The participants had been previous clients in the lead agency’s program to support refugee background women. Like most of the refugee background community members in this regional area, the women in the study had permanent residency as they arrived through the Australian Government’s Regional Refugee Settlement Program. The women had varied employment status (full-time, part-time and casual) and worked in social services, education, childcare, hospitality and agriculture. Most women were in partnered relationships and had children; however, several were single.

Participants understood DFV to be far-reaching and included physical and emotional abuse, as well as coercive control such as ‘not giving women the right to make decisions’. Although the incidence of domestic abuse in refugee families remains uncertain, participants commented on its frequent occurrence in their communities:

Yes, I have many friends, most of my friends are not very happy families. Most of the time they have some problems, they are arguing … there are many, many families … who have some problems with violence. Domestic violence.

Challenges in a new homeland

Employment status

Securing preferred employment in non-metropolitan areas can be financially challenging for any newcomer but presents further precarity for refugee communities. Study participants acknowledged the role of employment and unemployment in determining household wellbeing beyond meeting financial needs. A participant said:

His English is not good. He can’t improve his English … So, he loses his job. He just starts sitting at home, nothing he can do, just sitting home. That is something not happen in my community, and never ever the men can sit at home. So, he starts to get angry.

Cultural expectations mean that being unemployed is profoundly disempowering for men, and this change to the gendered division of labour contributes to increased household tensions. A participant said: ‘when only one of them is working, the problem starts from there. When men don’t have an income there’s violence’.

Gambling and alcohol abuse

Tied in with feelings of disempowerment, study participants commented on the frequency of alcohol abuse for refugee background men, especially those from one specific country. The following observations describe the occurrence of alcohol abuse and its link with DFV:

The one issue that we have been worried about lately is actually the drinking, the alcoholism that’s become an issue, particularly with the [name of cultural group] we’ve noticed, not so much with the other cultures or ethnicities … it’s been a big issue … we’ve had a couple of deaths as well. (key informant)

I think most violence happens because of alcohol, most men drink alcohol, some are very abusive when they get drunk. (participant)

It is uncertain why the presentation of alcohol abuse is so high in one specific cultural group, and key informants commented that further investigation is required to better support these men to reduce the risk of alcohol-fueled violence.

Key informants and participants frequently observed gambling addiction in conjunction with alcohol abuse, and this presentation added further complexity to DFV experiences. As noted by one participant: ‘the biggest issue is that men are drinking alcohol and gambling. Sometimes women are saving money for the children and the men lose it all on a game’. Another participant stated: ‘especially the men, they’re gambling or they’re drunk, that’s the biggest problem’ and a different woman added ‘the men are working, they earn money but if they drink lots of alcohol there’s not enough money for the bills and renting. Very big problem for the families’.

Acculturation and gender roles

Learning about new cultural ways can be stressful and changes to gender roles and freedoms can heighten the incidence of gendered violence in refugee communities. A key informant said:

There’s a lot of reasons why I think things turn ugly … I think it is about disempowerment. They might not have been a violent or even controlling kind of person, but here they lose all – they probably feel even worse here, that they lose all control.

Additionally, others commented on how refugee men from communities with patriarchal gender norms were reluctant to embrace new gender expectations in Australia.

They don’t know how to be a man in Australia. They don’t know the rules … they’ve come from very patriarchal society. They’ve only watched their dads and their uncles and their grandfathers treat their wives this way and that’s the norm for them.

The experience of disempowerment, as well as a lived experience of torture and trauma, can intersect for refugee background men and can lead to increased incidence of violence and other abuse.

Valuing trusted relationships

Study participants identified the importance of trusted relationships when disclosing violence and seeking support. Trusted individuals could include family, close friends, settlement workers, health professionals, interpreters, community and religious leaders. A participant shared her experience of a friend’s disclosure of her violent relationship:

I have a close friend, and she will talk to me about her relationship between her and her husband. Her husband will drink alcohol, and physically abuse her, sometimes yelling and yelling at the children and her, so she is very, very unhappy.

However, not all trusted relationships offer support for women fleeing violence. Participants discussed how well-intentioned family and friends may encourage the women to remain in their household regardless of abuse. A participant explained how she advised her friend to: ‘think about your children, your husband might change one day, no more alcohol and no more abuse’.

Instead of disclosing to community members, some women felt more comfortable disclosing abuse to professionals they have relationships with, such as health practitioners or settlement services. Disclosing to health or support workers could be more appealing if the workers had a shared cultural understanding. A key informant commented on a client disclosing their experience of violence to a bicultural worker:

She speaks her language … So this particular worker built a very trusting relationship with that client, and she started to share some of her stories, what she had gone through when she was newly arrived. Because she was a migrant herself and that way the women open up to her.

However, participants reported that they would not necessarily seek support from someone within their own cultural group due to fears about community gossip and individual notions of trust extended well beyond assumptions around cultural homogeneity.

For women from refugee backgrounds, navigating health and social support systems can be daunting, therefore, trust also plays an important role in making ‘warm’ referrals when acting on behalf of clients. A key informant emphasised the importance of listening to the women’s stories to identify trustworthy supporters and assist them in ‘knowing where to go and having a response that is warm and inviting and encouraging, and being prepared to go at a slow pace with the woman’. Participants described how their friends would only seek support for abusive relationships if referrals came from someone they knew well and trusted: ‘they want to know who is the person that will talk to them. They not trust anyone to talk to … They ask many, many questions before they say, okay, we are happy to go’. A key informant stated:

So often it comes through a friend of a friend, or an agency has made this warm referral. There’s lots of fear – if I start talking, what are you going to do with my information now? Giving women numbers doesn’t cut it, because they’ve got no idea what the service is … where’s the respect of walking alongside her, saying these people are good people.

The role of interpreters

In some instances, trusted interpreters are privy to violence disclosures. A key informant said: ‘our interpreter … the women are calling her 24/7 when they have problems’. With confident English language skills, interpreters can offer a trustworthy, culturally appropriate connection to mainstream support services. Nonetheless, using interpreters comes with other complexities, including suspicions about sharing private information and difficulties in maintaining professional boundaries. Key informants spoke of how some women would opt to use phone interpreters outside their local community. These interpreters were considered trustworthy as they shared a common language but geographic distance provided assurance that the women would not be the subject of local gossip.

Identifying and confiding in community leaders

The role of community leaders in supporting those fleeing violence remains contentious. These attitudes varied depending on differences in ethnicity, time in Australia, the newly settled community’s size, and individual experiences with community leaders. Participants and key informants agreed that community leaders were potentially supportive and certainly powerful and therefore should be well informed about appropriate ways to respond to DFV.

Community leaders do play a vital role in some of these DV situations. Because the men and the women are leaders, especially because back in their country. (key informant)

In our community and in our culture people we respect, like pastors, or leaders help if they think we have a problem. They will talk to both men and women and just consult and give some advice, encourage the married life, we have something like that. (participant)

Identifying community leaders is not always straightforward in refugee background communities. A key informant commented on the uncertain status of, and necessity for, community leaders:

One of our interpreters said they were trying to get him to be a leader because he had good English. He turned around and said to them, well you know what? You’re in Australia now. We’re an egalitarian society. You all are equal. You can all speak for yourself. You don’t need a community leader.

Key informants suggested that those supporting settler populations, such as health professionals, are aware of these subtleties and do not assume who community leaders are, that they are necessarily trustworthy or that they represent an entire cultural group.

Participants observed the possible negative influence of community leaders, especially when a community leader was a potential violence perpetrator. A participant commented:

Because what if the community leader was a perpetrator of violence and abuse? How is it seen or how is it presented, in keeping the secret, and then he’s sitting with other men, perhaps in a different position in their little community, how does that fit?

Educating community leaders about appropriate responses to domestic abuse is essential in supporting refugee communities to be safe. Some participants held fears that engaging with community leaders could worsen the experience of violence because ‘things might just get solved the old ways’. Working with community leaders positively however can have the potential to promote safety, as a key informant noted, ‘they can be a link between those communities and the wider society and human rights, it’s fundamental, and I think it has to be’.

Fear of speaking out

In refugee communities, DFV is often considered a private matter and admitting to needing assistance can disgrace families. Women can be ostracised if they speak out about their experiences of violence, as noted by a participant: ‘they feel pressure by the community, to hide the incident and be resolved within the family’. There is a persistent fear that speaking out could mean losing access to children or, for those on partner temporary visas, could mean deportation. There is reluctance for women to seek assistance, and many choose to remain in DFV situations.

Involving support services external to refugee communities can be considered problematic, as a key informant explained:

There’s just been so much fear associated with stepping outside of the community, even though women have not had lots of support in the community, because they’ve been silenced and they just feel fear.

Another participant confirmed these concerns:

The majority of my friends in my community, because of our culture, when they have problems in the family they are ashamed to talk to others, they’re shy … In our culture if we talk about our family’s problems that means we don’t respect our husbands.

Refugee background women also experience distress once they are labelled as being in a violent relationship:

There’s just a high level of shame and when you have the realisation that you are in a DV relationship … that can be really shocking for people to understand that they’re living in a DV relationship.

Not having sufficient knowledge about laws protecting individuals from DFV also prevents refugee backgrounds women from acting on violence. A participant shared an example of an undesired legal process:

When she called the police, they came and arrested her husband and said you can’t go back to your wife and to your children for one year. So based on that situation, my friend didn’t want to call the police because she doesn’t want to separate from her husband.

A key informant also mentioned unfavourable responses to unwanted legal interventions:

When she got home the police car had actually arrived at the house to take the husband away … a community member lived in the same complex. So as soon the husband was taken away in the police car the community member walked up to the lady and said, what have you done, why have you reported to the police? You know you have brought shame to the community.

Participants and key informants said when refugee women become more confident in their new communities, they become empowered to call out their experiences of violence. Different factors impact the women’s feelings of empowerment, which can vary depending on time in Australia and cultural differences. But there was general agreement that once the women had knowledge about their rights and pathways to support, and utilised trusted relationships, they were more likely to act on violence. A participant said:

I think they are now starting to get to that step. They start to go to someone to ask for help, especially the women, they try to say, okay, I have a problem … do you know someone who can help me, please?.

Discussion and conclusion

The aim of the study was to document refugee background women’s experiences of DFV in their communities and to use this knowledge to better support the women in a range of contexts. The following insights from a refugee health worker interviewed in this study illustrate the importance of these findings for global healthcare practitioners and systems. ‘We just had to deal with the medical side because she wasn’t going to say anything to us. She kept insisting she had a fall’. The health worker told of how husbands watched and listened closely and discontinued visits to that clinic if they felt they were under suspicion of DFV. The informant shared a story of a new arrival who disclosed intimate partner violence to a colleague, she: ‘had got off the plane practically, and she was scared of him and didn’t want anything to do with the relationship’. In this case, DFV specialist services were engaged, and police intervened. But open disclosures such as this were rare in the health setting for various reasons, including lack of privacy and fears around surveillance. The same key informant commented: ‘It just worries me because it’s noisy … Sometimes you wonder if people might disclose if it was in a different situation’. Placing this account at the forefront of our discussion illustrates the fear of speaking out and reminds us of the complexity in supporting refugee women to feel safe to enable them to reach out to healthcare professionals.

Interviews with study participants and key informants explored a range of issues about experiences of domestic and family violence in refugee communities. Research findings indicate that domestic abuse is a concerning issue and there is a lack of specialised support to combat violence in refugee background communities, especially in non-metropolitan areas. Investment is needed in culturally safe DFV prevention programs, but as an immediate response, frontline healthcare workers should focus on developing trusting relationships that encourage disclosure and offer trauma-informed responses. As Al-Shdayfat and Hatamleh (2017, p. 99) stated: ‘these women are in critical need of help from healthcare providers who are well-equipped and skilful in screening for domestic violence in a culturally sensitive manner’.

This cohort’s unique health and safety needs must be considered in the context of their specific social circumstances, including challenges with securing housing, precarious employment and developing English language confidence (Pogarell et al., 2019). Observing cultural integrity is important when working with diverse communities; however, culture is one factor in understanding social identities and behaviours (Debbonaire, 2015), and assumptions around cultural homogeneity must be avoided. Applying an intersectional approach (Crenshaw, 1991) that responds to the interaction between gender, ethnicity, class and language is essential in understanding emerging communities’ complex challenges. Successful supports for refugee communities need to be responsive, not make assumptions about cultural homogeneity and acknowledge differences in individual as well as community concerns and priorities (Lee et al., 2022).

Listening deeply to refugee background women provides valuable insights for frontline health workers, as well as program designers and facilitators. These women are experts in their own communities and can identify challenges in seeking support for domestic abuse. In this instance, observing the interplay between employment status, alcohol abuse and gambling reveals the complexity for refugee men as they negotiate life in a new country and can offer some explanations about the causes of violence and controlling behaviour. The time of residence in a settlement country must also be considered to understand and support incidences of DFV. For example, those who have had longer to acculturate may be less likely to be perpetrators of abuse (Timshel et al., 2017). Additionally, although navigating acculturation can increase conflict, maintaining some positive traditional beliefs can also provide protective factors to enhance wellbeing.

A potential limitation of the study was that it included a small number of participants and took place in a non-metropolitan community in Australia. Nonetheless, the research provides rich narratives on DFV in refugee communities and these insights can be drawn on to create place-based health responses in different global contexts. For example, a key learning from this study is that cross-cultural and cross-sector collaboration is essential in designing and implementing effective empowerment-based responses to DFV (Rees & Pease, 2007). Additionally, collaborating with well-equipped, knowledgeable community leaders, interpreters, health and other support workers who do not accept violence and readily foster violence prevention can assist in creating safer communities. Better equipping these first responders to support families is essential to preventing domestic abuse in emerging communities (Vlais et al., 2017). Acknowledging the structures that govern refugees and entrench disadvantage must also be considered (Maher & Segrave, 2018; Vasil, 2023). In this sense, a social ecological model of health (Hawkins et al., 2021) can draw on cross-disciplinary understanding and expertise to support the complex needs of refugee women (Pogarell et al., 2019).

The refugee women in this study shared broad experiences of DFV that included physical and emotional abuse, as well as coercive control. They have attended education sessions about DFV but more importantly have their own knowledge and experiences to draw on. They are experts on their own lives and they require well informed health and social care to support their communities. Micro studies such as this can be used to better inform global healthcare workers and systems to recognise refugee women’s agency to deliver ‘service and legislative responses that can support rather than inhibit women’s efforts to secure their own safety are critical’ (Maher & Segrave, 2018, p. 503). Sharing these participants’ stories can provide rich data to inform policy responses such as the National Plan to Reduce Violence Against Women and their Children (Australian Government, 2021) and the Global plan of action to strengthen the role of the health system within a national multisectoral response to address interpersonal violence (WHO, 2016). Working with refugee background women in this context revolves around developing trusted relationships so that women can feel safe and empowered to discuss their experiences openly. These learnings can be used across global healthcare systems to encourage domestic and family violence victims who have experienced DFV to seek support that will lead to empowerment and violence prevention.

Acknowledgements

The authors received funding to undertake this study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was funded by Anglicare North Coast.

Notes

1 According to the United Nations, violence against women is defined as ‘any act of gender-based violence that results in, or is likely to result in, physical, sexual, or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life’ (1993). Various terms are used to locate this abuse within the ‘domestic’ setting and there is some contention over the most suitable term (Women Against Abuse, 2023). For the purpose of this research, domestic and family violence (DFV) will be used to include intimate partner violence and coercion that occurs within a domestic setting.