Fediša Modikologo: breaking the intergenerational cycle of violence against women and children. Theoretical framework and protocol for a prospective cohort study.

In South Africa, after two decades of national femicide surveillance, we know comparatively little about what places women who experience intimate partner violence (IPV) at risk of intimate partner femicide. Further we have not mapped the multi-generational health, social and economic impact of severe IPV on women subjected to it, and their children, nor the consequences of help-seeking, nor described what helps, STET recovery trajectories. This study aims to deepen understanding of risk factors for femicide and the health, social and economic impacts of severe IPV on women and their families, including understanding risk and resilience to intergenerational cycling of violence. It further aims to describe how statutory and community measures operate to enable recovery and safety. Following pilot research, we developed a prospective questionnaire-based cohort study with three components, and plan for nested qualitative research. The primary cohort will enrol 12,000 women experiencing severe IPV, recruited using non-probabilistic methods (mostly referral from services and community members, and chain-recruitment). Following a baseline interview, participants will complete annual on-line surveys to track key outcomes for five years. The main questionnaire will measure exposure to range of different forms of IPV in the past year, lifetime trauma exposure history, childhood background, health, social and economic circumstances and help-seeking practices. A sub-cohort of the women (a 20% sub-sample), will be followed more intensively over 3 years. Among these, the children aged 6 years and over, of consenting mothers, will also be followed for three years. Deaths in the cohorts will be tracked through the National Population Register through participants' national identity numbers. Mixed-methods verbal autopsies will be conducted with friends or family members of deceased participants. Results will guide femicide prevention nationally, and will build understanding of what is needed to prevent intergenerational cycling of violence and enable recovery of exposed women and children.