HHS Celebrates One-Year Anniversary of the U.S. National Plan to End Gender-Based Violence with Fact Sheet of Recent Accomplishments

On May 25, 2023, the White House published the first-ever U.S. National Plan to End Gender-Based Violence, a seven-pillar plan that takes a whole-of-government approach to preventing and addressing sexual violence, intimate partner violence, stalking, and other forms of gender- based violence (GBV). GBV is an urgent public health problem. In the United States, more than half of women and almost a third of men experience unwanted sexual contact in their lifetime. Children are also often impacted by exposure to intimate partner violence, and many perpetrators also abuse children in their homes.

The causes of GBV are complex and include gender inequality, economic factors, cultural norms that legitimize violence, and exposure to displacement caused by migration and climate change. GBV disproportionately impacts communities that have been marginalized, with perpetrators often targeting people with vulnerabilities such as age, gender and sexual identity, race and ethnicity, poverty, disability, and incarceration, all of which may make receiving help more challenging.

As a public health issue, exposure to sexual violence has significant implications for survivors. Individuals impacted by GBV are more likely than their peers to experience mental health conditions such as post-traumatic stress disorder, substance use disorder, and suicidal ideation and behaviors; adverse sexual health outcomes such as dysfunction, unwanted pregnancy, and sexually transmitted infection; and chronic medical conditions such as fibromyalgia, gastrointestinal disease, and cardiovascular disease.

As a Department, HHS recognizes that gender-based violence is a complex public health problem that requires research-driven, survivor-centered solutions. For the past year, HHS has worked to implement the National Plan to End Gender-Based Violence throughout our nation’s public health and human service programs. Some recent accomplishments have included making improvements to existing programs and developing innovative projects, including many programs that are the first of their kind. These implementation efforts mark a critical validation of GBV as a preventable public health issue that can and should be prioritized.

The National Plan framework separates goals under seven Pillars; 1) Prevention; 2) Support, Healing, Safety, and Well-Being; 3) Economic Security and Housing Stability; 4) Online Safety; 5) Legal and Justice Systems; 6) Emergency Preparedness and Crisis Response; and 7) Research and Data.  HHS equities and related efforts largely focus on Pillars 1, 2, 6 and 7, and include a wide range of funding opportunities, collaborative efforts, and policies.

The implementation of these goals has had significant, real-world implications for survivors and providers. For example, the Administration for Children and Families (ACF)’s Culturally Specific Domestic Violence and Sexual Assault Discretionary Grants and Supplemental Funding Subgrants have connected 35 culturally specific organizations with the funding they need to provide services to underserved communities, and places additional funding in the hands of 145 subgrant recipients so that they may provide accessible, culturally responsive, and linguistically appropriate services for survivors and their children.

In celebration of the one-year anniversary of the National Plan’s release, HHS is publishing the fact sheet below to share highlights of our progress.

Pillar 1: Prevention

Patient Consent for Sensitive Exams: On April 1, Secretary Becerra announced new guidance from Centers for Medicare & Medicaid Services (CMS) to clarify the informed consent requirements for sensitive examinations conducted at teaching hospitals particularly when patients are under anesthesia. This is also a racial equity issue. In one study, black women were 4 times more likely to have experienced a pelvic exam without consent while under anesthesia. The guidance affirms the importance of clear hospital guidelines to ensure providers and trainees first obtain and document informed consent from patients before performing sensitive examinations in all circumstances. This action will help ensure that patients are treated with dignity and respect in health care settings and advances the National Plan to End Gender-based Violence’s goals of enhancing and promoting prevention.

The Centers for Disease Control and Prevention (CDC) Collaboration with Department of Defense (DOD): The CDC entered an interagency agreement with the DoD to provide technical assistance that supports the implementation of a comprehensive prevention planning system grounded in a public health approach. This work is focused on preventing harmful behaviors, including sexual violence and intimate partner violence, in the Military and Armed Services. Following the publishing of the National Plan, accomplishments include the development of a new resource, “Community and Organizational Level Prevention of Harmful Behaviors in the Military” which has been disseminated to military audiences and is designed to assist the Integrated Primary Prevention Workforce (IPPW) in identifying evidence-informed programs, practices, and policies. Additionally, CDC is developing and evaluating online bystander intervention tools for Servicemembers to mitigate risk for harmful behaviors in the cyber environment. The first phase of this project is identifying relevant research, intervention, and approaches to inform a future bystander intervention project or intervention resources for bystander intervention approaches for the prevention of technology-facilitated abuse. Tools developed through IPWW are expected to be completed in FY2025 and will be implemented throughout DoD’s respective instillations.

HHS Innovation Challenge to Prevent Human Trafficking Among Women and Girls: The Office on Women’s Health (OWH) has developed a national prize competition to identify existing innovative programs that address human trafficking prevention among women and girls. This program will help to identify and amplify innovative and evidence-based approaches that successfully prevent human trafficking and/or improve health outcomes related to human trafficking. In Phase 1, HHS may select up to 20 submissions to each receive a prize of up to $50,000 from existing programs that have demonstrated successful outcomes in preventing human trafficking and/or improving health outcomes related to human trafficking among women and girls. The participants selected to receive a prize in Phase 1 may compete for consideration to receive a prize in Phase 2.  In Phase 2, HHS may select up to 8 Phase 2 submissions to each receive a prize of up to $100,000 from programs that have successfully expanded and/or replicated to increase the impact of their program in preventing human trafficking and/or improving health outcomes related to human trafficking on women and girls.

HHS Task Force to Prevent Human Trafficking: In August 2023, the Task Force hosted the first National Human Trafficking Prevention Summit and released of the National Human Trafficking Prevention Framework, which will help HHS agencies, divisions, programs, and regions increase abilities to prevent and respond to human trafficking.

Rape Prevention Education (RPE) Funding Opportunities: The CDC published three new Notice of Funding Opportunities (NOFOs) for their Rape Prevention Education (RPE) Program, which provides nation-wide funding to states, territories, and tribal nations so that they can address sexual violence prevention and response needs. One RPE NOFO is currently funding 53 State and Territorial Health Departments and puts emphasis on four key strategies for preventing sexual violence, which are: building infrastructure for sexual violence prevention, developing comprehensive state/territory action plans, implementing prevention strategies at community and societal levels that promote health equity, and using data-driven approaches to maximize impact. The CDC published two additional 4-year NOFOs for state and Tribal sexual assault coalitions. These NOFOs are first-time, new NOFOs with funding authorized under the 2022 reauthorization of the Violence Against Women Act (VAWA). Funding authorized under the 2022 reauthorization continues to be rolled out, and these NOFOs reflect funding appropriated in the FY2024 budget. The key strategies that will be implemented include building infrastructure, developing comprehensive action plans, implementing prevention approaches, and utilizing data to inform action.

CDC is also funding four RPE research projects which were awarded in September 2023. These projects are collaborations between academic researchers and RPE-funded organizations to expand the evidence base and advance the field of sexual violence prevention. The projects are in the rigorous evaluation phase of their selected SV prevention approach, which is a primary prevention program, policy, or practice that has been implemented by CDC’s RPE program. These projects also fit under pillar 7, Research and Data.

Violence Against Women and Substance Use Prevention Initiative: The OWH is addressing the intersections of intimate partner violence (IPV) and substance use disorders (SUD) through statewide pilot projects that include partnerships with domestic and sexual violence organizations at the state and local level that will: incentivize SUD providers treating pregnant and postpartum women to be trained on identifying and addressing IPV; train SUD treatment providers to address IPV with patients and train IPV staff on SUD; identify, utilize, and disseminate best practices; integrate IPV and SUD protocols into medical practice; and integrate perinatal and postpartum programs into existing substance use programs.

State, Local, Territorial, and Tribal (SLTT) Partnership Programs to Reduce Maternal Deaths Due to Violence: The OWH is expanding surveillance and evidence-based implementation for programs dealing with maternal death due to violence to improve outcomes related to violence and reduce deaths due to violence among pregnant and postpartum women through a five-year funding opportunity.

Pillar 2: Support Healing, Safety, and Well-Being

Interagency Collaboration on Sexual Violence Against People with Disabilities: The Administration for Community Living (ACL), the Office of the Assistant Secretary for Health (OASH), and the Administration for Children and Families (ACF), Office of Family Violence Prevention and Services (OFVPS) developed an Interagency Collaboration on Sexual Violence Against People with Disabilities to encourage collaboration and coordination across HHS and improve capacity to serve this population in federally supported programs. In April 2024, the interagency collaborative released a Dear Colleague with guidance to rape crisis centers, domestic violence programs, and programs serving people with disabilities grantees on how to better serve victims with intellectual and developmental disabilities.

The 2023-2025 Health Resources & Services Administration (HRSA) Strategy to Address Intimate Partner Violence (IPV): The agency-wide plan outlines aims, objectives, and activities for HRSA Bureaus and Offices to encourage preventing and responding to IPV across HRSA activities. These are grouped under three aims: (1) Enhance HRSA coordination of IPV efforts; (2) Strengthen infrastructure and workforce capacity to support IPV prevention and response services; and (3) Promote prevention of IPV through evidence-based programs. The Strategy to Address IPV is also accompanied by the Preventing and Responding to IPV resource, which is an Implementation Framework for HRSA-Supported Settings of Care. The Implementation Framework provides HRSA-supported settings of care with five key building blocks and associated actionable steps they can take to prevent and respond to IPV in the communities they serve.

National Training and Technical Assistance Partners Cooperative Agreement - Health Partners on IPV + Exploitation: The Health Partners on IPV + Exploitation is administered by Futures Without Violence and trains health center staff to identify, treat, and refer patients experiencing or survivors of IPV or human trafficking to recovery services. Training and technical assistance offerings include policy and procedure change and partnership development for the 1,400 health centers and over 15,000 service sites funded by HRSA’s Bureau of Primary Health Care (BPHC) Health Center Program. From 2023-2024, the Health Partners on IPV + Exploitation have conducted trainings regarding Health Center Emergency Preparedness for Survivors of IPV + Exploitation, Understanding Harm Reduction Approaches to Address IPV, Human Trafficking, and Exploitation and Homelessness in Health Centers, and shared tools to develop partnerships between health centers and domestic and sexual violence advocacy programs.

National Child Traumatic Stress Network (NCTSN) Updates: The Substance Abuse and Mental Health Services Administration (SAMHSA)’s National Child Traumatic Stress Network (NCTSN) announced several activities supporting victims of childhood sexual violence; including a call series and a webinar series focused on improving best practices for supporting gender-diverse trauma victims and the creation of the Violence Prevention and Restoration Consortium, which connects professionals, providers, and people with lived experience to share innovations. The anticipated impacts of these activities include increased connectedness within the field, improved efficacy for prevention and response strategies, and higher quality care for victims. By connecting survivors, practitioners, and other professionals, these collaborative efforts will help increase the visibility of advocacy for victims of child sexual abuse.

Supporting Families Impacted by Domestic Violence: The Children’s Bureau within the Administration on Children and Families (ACF) and the ACF Office on Family Violence Prevention and Services (OFVPS) are committed to improving outcomes for children, youth, and families impacted by domestic violence. On April 26, 2024, the Children’s Bureau issued Information Memorandum (IM) ACYF-CB-IM-24-03 on Supporting Families Impacted by Domestic Violence: Opportunities to Partner with Families to Promote Family Violence Prevention Programs and Services. The purpose of this IM is to increase awareness of the prevalence and impact of domestic violence on children, youth, and families; highlight effective strategies to support families impacted by domestic violence and to encourage child welfare agencies to enhance partnerships with domestic violence programs, State Domestic Violence Coalitions, tribal programs, culturally specific domestic violence programs, community-based organizations focused on supporting families impacted by domestic violence.

Sexual Assault Capacity Building Centers: The OFVPS at ACF issued three grant awards to Sexual Assault Capacity Building Centers to help provide specialized sexual assault intervention and prevention technical assistance for Family Violence Prevention and Services Act (FVPSA) grant recipients. The grant awarded funds to two Sexual Assault Capacity Building Centers, the National Alliance to End Sexual Violence and Pennsylvania Coalition Against Rape and supported one Culturally Specific Sexual Assault Capacity Building Center for the African American Community, the National Organization of Sisters of Color Ending Sexual Assault, to provide training and technical assistance to states, territories, tribes, coalitions, culturally specific organizations, and LGBTQI+ organizations to help meet the needs of sexual assault survivors nationwide. The funding allocated to these organizations will help FVPSA grant recipients respond to the intersectional needs of sexual assault survivors and will help expand technical assistance services at the organizational level.

Culturally Specific Domestic Violence and Sexual Assault Discretionary Grants: The OFVPS at ACF awarded $7.5 million in grant funding to 35 culturally specific organizations to facilitate the provision of trauma-informed, developmentally sensitive, and culturally relevant services for individuals affected by sexual assault and domestic violence from racial/ ethnic specific populations, underserved communities, and historically marginalized communities across the nation. The grants were awarded in 2023 and the project period for these grants ends on September 30, 2027.

FVPSA American Rescue Plan Culturally Specific Domestic Violence and Sexual Assault Supplemental Funding Subgrants: In 2023, FVPSA Culturally Specific Special Issue Resource Centers,  Ujima, Esperanza United, the Asian Pacific Institute on Gender-Based Violence, the National Women’s Resource Center, and the Alaska Native Indigenous Women’s Resource Center issued 145 American Rescue Plan Culturally Specific Domestic Violence and Sexual Assault subgrant awards to 145 culturally specific community-based organizations to support  accessible, culturally responsive, and linguistically appropriate services for survivors and their children.  These subgrants support services for survivors from the American Indian; Alaska Native; African American; Asian/Pacific Islander, and Latino/Latina communities.

Cooperative Agreement for the Refugee and Migrant Behavioral Health Technical Assistance Center: SAMHSA created a Refugee and Migrant Behavioral Health Technical Assistance (TA) center to grow the capacity of healthcare providers and organizations to serve migrant and refugee populations in the United States. This TA center will be responsible for supporting clinical case consultation services for behavioral health providers and developing website content that addresses gender-based violence in refugee and migrant populations. The TA center will also create online learning modules, establish learning communities, and provide targeted technical assistance on gender-based violence.  On November 30, 2023, the Cooperative Agreement was granted to Southwest Key, who subsequently started a needs assessment for providers and professionals in March 2024 to ensure resources best meet population needs.

Pillar 6: Emergency Preparedness and Crisis Response

Sustaining Essential Health Care Services Related to IPV During Public Health Emergencies: An ad hoc committee of the National Academies of Sciences, Engineering, and Medicine developed a conceptual framework for delivering essential preventive and primary health care services related to IPV during Public Health Emergencies using an all-hazards approach and published a subsequent 2024 Consensus Study Report that defines and describes essential health care services related to IPV during Public Health Emergencies and suggests activities to help HRSA-supported facilities meet those needs.

Pillar 7: Research and Data

National Intimate Partner and Sexual Violence Survey Updates: The CDC announced revisions to their data collection methods on the National Intimate Partner and Sexual Violence Survey (NISVS), which collects the most current and comprehensive national- and state-level data on sexual violence, intimate partner violence, and stalking victimization in the United States.  Improvements include revamped sections on perpetrator behaviors that reduced burden on participants; improved specificity of technology-facilitated stalking; additional questions about technology-facilitated sexual violence; additional questions about the mental and emotional harm of sexual violence; updated questions about reproductive coercion; updated questions about sex at birth and gender identity; and improved sensitivity for transgender and non-binary respondents. Revisions were announced in January 2023, with data collection wrapping up in December 2023. Initial data results are expected to be released in late 2024. Revisions and updates to the survey and methodology are expected to improve data quality and specificity to help inform future research priorities. The improvements to NISVS measurement related to technology-facilitated stalking and sexual violence also fit under Pillar 4, Technology-Facilitated GBV.

National Institutes of Health (NIH) Future Directions in Violence Against Women: Request for Information (RFI) Report: The NIH National Institute on Nursing Research conducted an analysis of public input gathered in response to an RFI intended to identify scientific directions in violence against women (VAW) research, including violence perpetrated against cisgender, transgender, and gender-diverse persons. The report synthesized responses from researchers, healthcare providers, advocates, and people with lived experiences, and compiled nine emergent themes for future research directions. These themes included advancing social determinants of health research to understand and mitigate risks; informing policy efforts to create a broader impact on prevention; strengthening measures and methodologies in VAW research to address magnitude, victimization, and perpetration; increasing the focus on intersectionality; expanding research to focus on health effects of VAW beyond the acute phase; incorporating research on violence perpetration; assessing intergenerational violence; leveraging diverse settings to promote and prevent VAW; and expanding the focus on populations disproportionately impacted by VAW.

National Institutes of Health Understanding and Addressing the Health Impacts of Online Abuse and Harassment

NIH hosted a two-day workshop in December 2023 on the health impacts of online abuse and harassment, with specific consideration for victims of in-person gender-based violence and harassment to help identify gaps and challenges in the research. Presentations and discussions focused on five key areas: (1) understanding the health impacts of online abuse and harassment; (2) meeting the needs of vulnerable and under-resourced populations; (3) lessons learned from related research areas; (4) potential collaborations to tackle online abuse and harassment; and (5) research approaches for prevention and intervention.