Understanding and Preventing Gender-based Intimate Partner Violence among West African Immigrants of Washington State, USA Community-based Participatory Research

1.1. Background

Sexual and gender-based violence (GBV) is defined as any act that is perpetrated against a person’s will and is based on gender norms and unequal power relationships. Most victims of sexual and gender-based violence are women and girls; most perpetrators are or have been intimate partners of victims and survivors [1]. Intimate partner violence (IPV) refers to behavior by an intimate partner or ex-partner that causes or is intended to cause physical, sexual, or mental or psychological harm, including physical aggression, sexual coercion, psychological abuse, and control [1, 2].

Globally, nearly 1 in 3 women have been subjected to physical and or sexual violence, and 26% of ever-married/partnered women aged 15 years and older have been subjected to physical and/or sexual violence from a current or former husband or male intimate partner at least once in their lives [1-3]. Other documented forms of violence against women worldwide include cyberviolence, acid throwing, deliberate marking, deprivation (food, resources, social), forced marriage (dowry deaths, honor killings), sexual trafficking, slavery, and rape [3-6].

From 2011-2015, data from the Washington Department of Health indicated that reported DV offenses in King County were common at 450 cases per 100,000 persons [7]. In 2016, Washington State also reported that 19.7% of DV homicide victims were born outside the United States [8].

From 1997 through 2009, there were 61 confirmed fatalities from DV in Washington State for which the victims were identified to be immigrants or refugees [9, 10]. There is no data available on the geographical demographic or ethnic origins of the homicide victims.

The African immigrant community in Washington state, started growing in the 1990s following socio-political crises on the continent of Africa [11]. In 2024, of the about 8 million residents of WA state, only about 4% or ~346,000 identified as black/ African American, whether domestic or foreign-born African immigrants [12]. Of this number, the foreign-born Africans make up just over 78,000 people. Because the East African immigrant population who migrated following the wars in Somalia and the Horn of Africa in the early 1990s constitutes a much longer and larger presence in Washington state, it is estimated that the West African diaspora is much smaller in number. The community organization Washington West African Center WAWAC reports serving more than 20,000 people of West African descent in Snohomish, Pierce, and King counties, identifying many barriers to achieving optimum health for this community, many amplified during the COVID-19 pandemic [13, 14].

Historically, most of the early West African immigrants came from The Gambia, seeking political asylum following decades of the brutal, repressive military regime of then President Yahya Jammeh [15, 16].

The Washington West African Center (WAWAC) was initially conceived to address the need gap for the Gambian community who survived that trauma. With time, WAWAC was expanded to include other West African immigrant people from other West African countries - Senegal, Mali, Ivory Coast, Nigeria, Ghana, Gabon, Togo, and Cameroon [14]. WAWAC reports that the community it cares for is predominantly family-oriented, majority Muslim, and conservative. The members of the WAWAC community largely hold conservative views on traditional gender roles, with men as providers/decision-makers and women as homemakers and mothers [14].

In addition to these cultural norms, members of the West African community also embody other intersecting identities that marginalize them and make them more vulnerable to systemic and structural harm. Those intersecting identities include being black/ black race, immigrant or undocumented status, non-native English speaking, unemployed or underemployed, being poor, culture of patriarchy, traditional gender roles, and other factors that make them more likely to suffer DV and ill health [17-21]. Other US and regional studies have revealed how the immigrant status confounds with other negative socioeconomic factors like poverty, overworking, or low employment to exert negative pressures on marital and other intimate relationships that can lead to DV that harm children and families [21-29]. According to WAWAC, the community they serve exists in mostly close-knit, culturally conservative heterosexual families, with DV being gender based, and perpetrated by men on women [30]. Therefore, throughout this study, we will refer to IPV as DV against women or DV.

1.2. Rationale/ Justification for Study

A prior community health assessment conducted by WAWAC in partnership with the University of Washington’s School of Public Health in 2022 identified DV against women (DV) as a key concern of the community, undermining the health of families [21].

WAWAC had provided anecdotal evidence gathered through interactions with community members supporting families through their programs, such as the Grandma Association's traditional marriage counseling that has been utilized by many couples to resolve conflict, including those that qualify by definition as DV against women or DV. Those anecdotes have documented DV against women and girls, which is prevalent in the West African immigrant community of the greater Seattle area. WAWAC therefore reached out to the study team to collaborate in gathering scientific evidence of the public health problem, its impact on families, how best to support survivors, and prevent its recurrence. In doing so, the researchers used a Constructivist stance to co-create a truly collaborative study that seeks to build understanding and knowledge from the perspective of the survivors of DV in this community. In the same paradigm, the study findings are also expected to improve WAWAC’s programs and services to families experiencing DV. WAWAC collaborated with the study team from conceptualization to the end of the study with the collective goal of ending the root causes of DV and IPV that are harming the families and communities they serve and identify with in a culturally acceptable way.

The results from the study are expected to contribute to generalizable knowledge of preventing IPV and DV in similar culturally conservative immigrant communities and possibly inform future culturally acceptable policy on public health that centers on and protects women, children, and families surviving DV in this demographic.

1.3. Objectives

This study aims to answer the research questions of how immigrant West African women experience DV in their community and how the community can work together to end it. The study will assess the experience and forms of DV in this community, assess the strategies for survival or resilience, and include the community’s knowledge of resources available in the community to support survivors of DV.

The specific study objectives were to assess/ determine:

(1) Risk factors for DV among the WA immigrant community

(2) Strategies for survival/resilience by DV survivors

(3) Explore policy recommendations to help prevent DV in West African immigrant communities

(4) Knowledge of resources available in the community to support survivors of DV

1.4. Definition of Terms

2.1. Study Design

This descriptive cross-sectional study was designed as a qualitative community-based Participatory Research (CBPR) study where academic researchers collaborated with a community partner (WAWAC) and its program participants to conceptualize and conduct the study. University of Washington Institutional Review Board approved the study on July 11, 2023; recruitment of participants and data collection were completed on September 18^th, 2023.

2.2. Study Setting

The study was designed and conducted as a collaborative effort between academic researchers and a local community organization (WAWAC) that served primarily West African immigrant residents of Snohomish and King counties. An earlier community health assessment conducted by University of Washington students identified addressing DV against women as a major health concern for WAWAC’s community. WAWAC already had programs in place to tackle the issue of DV, but needed to scientifically understand what was driving the problem, how the community was responding to their program, how to better serve survivors of DV, and any ideas to help prevent future violence and improve outcomes for survivors and their families.

WAWAC’s programs included: (1) emergency food and housing for survivors to escape DV, (2) food for families and afterschool programs for children to prevent future DV by reducing known financial stressors and aggravators of DV, and (3) Grandma association marriage counselling service to help resolve couples’ conflict and DV issues in a culturally acceptable way.

Interviews were conducted in three settings based on participant preference: (1) a private room at the WAWAC office, (2) participants’ homes when deemed safe, and (3) Zoom for individuals who preferred remote participation or faced childcare/transportation barriers. Privacy was prioritized by ensuring that no partners or family members were present; participants were reminded to choose a safe, uninterrupted space for Zoom interviews. When safety concerns arose, interviews were paused or rescheduled. Participants were recruited from all of Washington State as long as they satisfied our inclusion criteria.

Interview questionnaires were designed in English and French in anticipation of the anglophone and francophone languages of West African people. Interviews were conducted in English, with interpreters (on standby) as needed. All study settings were intended to strengthen the contextual transferability of study results to this unique community.

2.3. Study Population

2.3.1. Eligibility and Recruitment

We employed a purposive sampling technique to recruit immigrant African women survivors of DV who have received services through WAWAC. Women were recruited via WAWAC’s WhatsApp messaging using e-fliers advertised at all WAWAC program websites and physical locations (Appendix A). It was not possible to track how many individuals actually viewed the materials, but we estimate that up to 500 people were potentially reached through all the channels. Survivors who felt ready and able to share their experiences self-identified and contacted WAWAC, who in turn contacted the study team using the information provided, who then proceeded with screening for eligibility, informed consent, and applying other study procedures. The recruitment process is outlined in Fig. (1) below.

We determined eligibility for the study according to our inclusion criteria and excluded those who did not meet them.

2.3.1.1. Inclusion Criteria

We included people who self-identified as adult African immigrant women 18 years or older, married, in long-term intimate or cohabiting relationships of any duration, living in Snohomish, King, or Pierce County. Must be receiving or have received services from WAWAC.

2.3.1.2. Exclusion Criteria

We excluded those who did not meet our inclusion criteria, i.e., those who did not identify as African immigrant women who had never been in a cohabiting DV relationship, such as marriage or ever living together, and those who never lived in areas served by WAWAC (i.e. lived outside of Snohomish, King, or Pierce counties of WA states). People who were unable to provide verbal consent in the languages included (English, French, Wolof, Hausa, Fulfulde, Mandinka) were also excluded.

Following the advertisement, we were contacted by about 60 women, and we determined that 34 of them were potentially eligible for in-depth interviews (IDI). During the IDIs, researchers interviewed 34 women, of whom 31 experienced violence from long-term heterosexual relationships with male partners, while 2 women experienced violence from other women in same-sex relationships, and one was a key informant.

As our study is on DV in this predominantly culturally conservative community, we excluded the data collected from the 2 participants who were in same-sex relationships to prevent an outlier effect on the results. Cases involving same-sex relationships were outside the scope of this project due to the study’s focus on heterosexual IPV dynamics within the majority conservative West African immigrant community. Only 2 out of the 33 participants were in same sex female only sexual relationships, and that largely did not reflect this community. Study finding is expected to be transferable to other similarly conservative demographic African immigrant communities, but may likelynot be transferable to the LGBTQ+ survivor communities, where risk factors may be different.

2.4. Data Collection

We used in-depth interviews to gather all our data from the study participants. We used purposive sampling techniques to recruit only participants who fit our inclusion criteria and who had accessed any of WAWAC’s services or programs. WAWAC acted as collaborative study partners to aid us in recruiting participants and achieving our study objectives.

3.1. Language Barrier

WAWAC serves diverse African and colonial language speakers (English, French, Mandinka, Wolof, Hausa, Fulfulde, Pidgin). We mitigated these by providing options to communicate research materials in the language of choice of the participants, both verbally and in print.

3.2. Recall Bias

People might not recall in full detail experiences of violence, especially very traumatic events, for which forgetting was a coping mechanism. Researchers mitigated this bias by allowing interviewees sufficient time to think about their answers before answering.

3.3. Social Desirability Bias & Underreporting

DV is a very stigmatized subject in the West African immigrant community, associated with a lot of shame about being a victim of DV. It is possible that the actual severity of violence experienced was underreported, watered down, or hidden. Participants were given the option to opt-out of audio-recording, to ensure confidentiality and maintain anonymity.

3.4. Economic Ethical Threat

Participants of the study each received $20 grocery gift cards from WAWAC to compensate for their time after being interviewed by the research team. To mitigate, participants were not aware that they would be receiving the gift card until a week after all data collection was completed. It is worth noting that, $20 is regarded a fair compensation for an hour according to the Seattle area standard minimum wage of $20.76 per hour.

3.5. Rigor and Trustworthiness of Data

All the women included in the study came directly from a pool that was reached out to through the advertisement by WAWAC DV program personnel. Phone numbers and other contact information included in the Ad only listed WAWAC official phone numbers (see Appendix A), making the participant pool strictly from WAWAC program recipients. Only one key informant was included in the study, and data from the key informant largely confirmed participants’ results and sentiments on DV risk, causality, and experience in this unique mostly religiously conservative community. As mentioned earlier in the paper, study results were presented to community members in December 2024 with many of the participants in attendance, appreciating how their stories, strengths, and resiliency were respectfully portrayed.

5.1. Demographic Characteristics of Study Participants

The study participants were 31 women in total (N=31); 30 were survivors of DV, while one was a key informant. The mean and modal age of the male abusers were identified as 29 and 30 years, respectively. The mean age was 25 years, and the modal age of the participants was 26 years. The duration of an abusive relationship reported ranged from 3 to 36 months. The overall mean duration of abuse was 32 months. See Table 2 below for a tabular representation of the overall key socio-demographic characteristics of the participants included in the study.

5.2. Findings

6.1. Risk Factors for DV Among Immigrant Communities

It has been established that migrants and refugees are at an increased risk of experiencing DV because they are isolated from supportive families, face unstable employment, have economic dependence on their partner, have an uncertain immigration status, struggle with a language barrier, and are more likely to report a lack of access to support services [25, 27]. We found that all our study participants had reported one or more of these well-known risk factors to accompany their experience of DV.

In a 2009 analysis of the relationship between immigration and experience of DV, interviews with 137 immigrant women in the United States revealed how the stress of relocation to the US introduced their partners to new interests, such as alcohol, drugs, gambling, and infidelity, which were soon followed by new abusive behaviors by their partners [31, 32]. We unfortunately heard similar narratives from the women in this study who reported that relocation to the U.S. was associated with a rise in the level of violence in about 50% (n=16) of cases, with another 22% (n=7) stating that violence from their partner began after relocation to the US.

Several studies over time and space have consistently reported the role of patriarchy and gender roles in risking by several studies of predictors of IPV and DV over time and place. Several studies have postulated how the increased economic opportunities in the U.S. for immigrant women threatened widely accepted patriarchal traditional gender hierarchy and norms in their community, with some men responding with violence when those long-held beliefs are challenged [31-34]. It is important to note that traditional gender roles that inform behavior remain dominant in this culturally conservative West African community, with many of our study participants reporting that their personal economic success in the USA, which challenged traditional gender roles were not welcomed by their envious male spouses, who in turn sometimes responded with violence and/or abuse.

Another important intersection we found that worsened DV was an unfavorable or vulnerable immigrant status, such as the DV victim being undocumented or dependent on a male spouse to obtain a permanent residence permit (green card). About 42% of the women we spoke to (n=13) reported spouses using threats of deportation as a tool of financial, sexual, and emotional abuse, similar to some studies that reported threats of calling Immigration and Customs Office (ICE) officials and reporting their spouse’s irregular immigration status [31]. A meta-analysis of 30 IPV studies in Canada also identified the use of immigration as a threat to women by their spouses [24]. However, we uncovered a unique situation in this study, not supported by the literature review, whereby the male perpetrator of violence is protected from immigration enforcement by the DV survivors because the women feared community stigma of marital separation (n= 5), or did not want their children to be without a father (n= 8).

Another study of Korean immigrant women experiencing IPV in the US attributes childhood victimization and patriarchy as a risk factor for experiencing, staying, and or accepting IPV [17]. A 2023 study found strong links between the occurrence of IPV and patriarchy in the homes and lives of DV survivors on asylum applications in the United States [20]. Both patriarchy and weaponizing precarious immigration situations of women have been blamed to increase risk of DV by the women in our study. Other risk factors like toxic masculinity, antisocial personality disorders, low level of education, substance use, and traditional gender roles/ patriarchy that give men perceived control or rights, including sexual liberties over their female spouses and partners, have been well studied as factors increasing the risk of perpetrating DV/IPV against women and girls [29, 35-37]

6.2. Impacts of Violence Against Women, DV, IPV, and GBV

Globally, women exposed to IPV have a 42% increased risk of death and serious physical and sexual injury from the encounter, while about 38% of all murdered women died at the hands of their intimate partner [1, 3]. Victims of IPV/GBV are 2 times more likely to experience depression, anxiety, sleep and eating difficulties, psychiatric and other substance use disorders; 1.5 times more likely to acquire a sexually transmitted infection, and 16% more likely to have poor birthing outcomes, including preterm deliveries and low birth weight babies [26, 28]

Women suffering IPV are more likely to suffer isolation, lost wages, and poverty than their non-abused counterparts, while children living in violent homes are more likely to suffer behavioral and emotional problems, are at increased risk of experiencing and perpetrating violence later in life, and more likely to die or suffer childhood illnesses as their mothers have limited access or ability to care for themselves [3, 17, 23]

6.3. Strategies for Survival / Resilience

In a 2017 qualitative study of survival strategies used by low-income black women who experience intimate partner violence, religion was uncovered as an internal strategy to surviving DV [38]. Some of our study participants (n=5, 16%) shared that their faith, belief in God, their religion, or reaching out in church helped them endure or overcome the violence experienced at the hands of their abusers.

Another internal strategy was independence and self-reliance. Many of the women (n= 8, ~26%) identified strategies to gain financial independence, such as getting a job or working a degree. Women attributed obtaining independence to empowering them to leave the abusive relationship, while others reported physically fighting back using defensive violence to either save their lives or to reduce the violence inflicted on them by their abusers.

A common external strategy used by most women (n=21, ~68%) was leaning into social support networks, such as relying on close family or friends or community elders to plead with their husband or man about ending the abuse. However, they also reported that this strategy was usually unsuccessful. This finding is similar to other regional DV studies in North America on immigrant groups [29, 36, 37].

Another documented external strategy was utilizing community resources, including hospitals, shelters, DV organizations, or other non-punitive/legal organizations in the community. In our study, few women (n=4, ~13%) reported the use of DV services shelters to exit the abusive relationship, even though they expressed favor of emergency shelter and housing as a culturally appropriate long-term solution to ending DV. This finding was similar to a 2017 US study on low-income black women experiencing DV [38].

Well-known barriers to access and utilization of social services by abused immigrant women include language/ communication barriers, involvement of legal systems, and complex immigration issues [23]. As some of our study participants (n= 6,~19%) have explicitly alluded to aversion to legal channels like involving the police to resolve DV, the successes of such strategies that involve criminalization will likely continue to be perceived as not culturally suited or appropriate in tackling DV; like an earlier Canadian study among immigrant communities [24]. In fact, in our studies, most women (n=22, 71%) preferred to do nothing rather than reach out to community resources for DV intervention for fear of stigma or the possibility of negative outcomes because of involvement of police or immigration officials when resolving DV matters.

A scoping review of 15 articles addressing the topic of DV among Asian and Latinx immigrant communities suggests building unique interventions unique to the immigrant groups, which would better prioritize survivors and enable survivors to engage in social services, rather than going the path that criminalizes perpetrators, which induces fear of social isolation [38]. Such an example of a culturally responsive program to ending DV, known as SASA! was developed and implemented in Uganda. SASA! uses aspects of the UN/WHO RESPECT framework for preventing violence against women and tenets to address power imbalances of traditional gender roles. SASA! also utilizes community mobilization, interactive and reflective activities (rather than the path of criminalization) to unpack different dimensions of power and other key themes (gender, violence, activism, and collective responsibility) to help create community-level collective change in violent behaviors. SASA! The program has been shown to make communities safer for women by decreasing women’s risk of experiencing physical violence from their male partners by 52% [39-41].