# Domestic and urban violence faced by community health workers: a multidimensional analysis in vulnerable territories in northeastern Brazil during and after the COVID-19 pandemic

## TL;DR

This study examines how gender influences the experience and perception of domestic and urban violence among health workers in Brazil during and after the pandemic.

## Contribution

The study provides new insights into gender-specific patterns of violence perception among community health workers in vulnerable regions.

## Key findings

- Male health workers reported higher awareness of urban violence, while females showed greater awareness of domestic and sexual violence.
- Males experienced higher rates of physical aggression and stabbing, whereas females were more likely to report rape awareness.
- The findings highlight the need for gender-responsive policies to address violence in vulnerable communities.

## Abstract

Community Health Workers (CHWs) play a critical role in frontline public health, especially in vulnerable regions. However, their exposure to violence remains an understudied issue. This study explores how CHWs gender shape the perception and experience of different types of violence in Northeastern Brazil during and after the COVID-19 pandemic.

We conducted a cross-sectional analysis using data collected from 3800 CHWs in 2021 and 2023, across eight municipalities in Northeastern Brazil. Data were analyzed by gender, comparing perceptions and reported experiences of domestic (DV) and urban violence (UV). Inference used Cochran-Mantel-Haenszel (CMH) pooled odds ratios with Breslow–Day tests for homogeneity.

Male CHWs consistently reported higher perception to urban violence (CMH OR 0.67 [95% CI 0.53–0.83]; p < 0.001), while female CHWs reported greater awareness of domestic violence (CMH OR 1.18 [1.00–1.40]; p = 0.058). Direct victimization was higher among males, particularly for physical aggression (CMH OR 0.80 [0.67–0.97]; p = 0.023), stabbing (CMH OR 0.75 [0.59–0.95]; p = 0.022), and non-lethal gunshot incidents (CMH OR 0.71 [0.58–0.87]; p < 0.001). In contrast, females consistently reported higher awareness of rape across both years (CMH OR 1.40 [1.15–1.70]; p < 0.001).

Violence is not experienced or perceived uniformly, rather, it is shaped by gender roles and context. Female CHWs demonstrated greater sensitivity to domestic and sexual violence, while male CHWs were more attuned to urban violence and criminal dynamics. These are self-reported signals and should be interpreted with appropriate caution, yet they provide actionable intelligence for local prevention. Recognizing CHWs as strategic observers of community suffering, this study underscores the urgent need for intersectional, gender-responsive, and territorially differentiated public policies.

This project was funded by 10.13039/501100005283FUNCAP, Fiocruz-PMA, and the Lemann Research Fund from 10.13039/100007229Harvard University.