VAWA 30th Anniversary Brief: HHS Key Actions to End Gender-based Violence

Over the past four decades, federal legislation has brought relief to survivors of gender-based violence and made tremendous strides towards prevention. With the Family Violence Prevention and Services Act (FVPSA) authorized by Congress in 1984 and then-Senator Joe Biden leading the passage of the Violence Against Women Act (VAWA) in 1994, a new era in the nation’s response to gender-based violence began to emerge.  Over time, VAWA evolved to meet new and ongoing needs of survivors, their families, and communities. In commemoration of the 30th anniversary of VAWA and the 40th anniversary of FVPSA, HHS is celebrating President Biden’s leadership and the role of HHS in the Biden-Harris Administration’s efforts to end gender-based violence.

The Biden-Harris Administration’s National Plan to End Gender-Based Violence, released in May 2023, builds on VAWA and FVPSA to foster a public health approach to gender-based violence. Taken together, HHS initiatives focus on preventing sexual violence, leading with equity in our response to gender-based violence and supporting and improving health and behavioral health outcomes in survivors. Below are highlights of the extensive work underway across the Department to implement VAWA, FVPSA and related initiatives.

Preventing Sexual Violence

Prevention is an integral part of the National Plan to End Gender-based Violence and a focal point for HHS agencies and their respective programs. The Center for Disease Control and Prevention (CDC) Rape Prevention Education Program (RPE) was authorized in VAWA in 1994 and plays a crucial role in sexual violence prevention across the United States. Primary prevention- stopping sexual violence before it begins- is the focus of the RPE program. To find out more watch the RPE Program latest informational video read on below.

• CDC awards RPE Program funding to state health departments in all 50 states, D.C., Puerto Rico and the U.S. Virgin Islands, as well as state, territorial, and Tribal sexual assault coalitions.  Currently, CDC is supporting 111 RPE grant recipients.
• CDC’s RPE program encourages comprehensive prevention strategies by using the public health approach and social-ecological model as a guiding framework. Grant recipients implement a range of activities based on the best available evidence to effectively address the ways individual, relationship, community, and societal factors impact sexual violence
• These evidence-based approaches are more likely to prevent sexual violence across a lifetime than any single intervention and also more likely to benefit the largest number of people and reduce sexual violence.
• RPE implementation efforts, such as bystander intervention programs, have demonstrated evidence of empowering young people to speak up against sexist language and behaviors that promote violence. These programs cultivate positive social norms and help respond to and prevent violence. RPE program implementation research studies are contributing to the evidence base for sexual violence prevention, helping to shape more effective strategies and interventions.
• From January 2019 through January 2024, RPE programs:
  • Implemented evidence-informed programs, policies and practices from CDC’s Sexual Violence Prevention Resource for Action. Programs embraced a public health model of violence prevention, with over 55% of implementation efforts focused on making positive changes at the community and societal levels.
  • RPE programs reported that their prevention efforts had the potential to reach over 7.5 million people.

Supporting Survivors

At HHS, embracing a public health approach to gender-based violence means prioritizing efforts that support the health and healing of survivors. The Office of Family Violence Services (OFVPS) at the Administration for Children and Families (ACF) leads HHS’ comprehensive response to domestic violence, focusing on survivor-centered and trauma-informed services. OFVPS administers the Family Violence Prevention and Services Act (FVPSA) funding annually for the nation’s network of domestic violence shelters and supportive services. OFVPS also administers FVPSA grants for the National Domestic Violence Hotline which was initially authorized by VAWA in 1994.

• In Fiscal Year (FY) 2023, OFVPS awarded a total of $234.875 million in FVPSA grants to 56 states and territories; 56 domestic violence coalitions; and 252 Tribes who provide shelter and support services to more than 1.3 million people a year experiencing domestic violence, dating violence, and family violence. Advocacy interventions like those provided by FVPSA-funded services promote healing and wellbeing, increase self-efficacy, and reduce self-blame and hopelessness.
• The National Domestic Violence Hotline, is a 24-hour, confidential resource for survivors of domestic violence that provides text, chat, and call services and referrals throughout the United States.  Individuals can text "START" to 88788 or call 1.800.799.SAFE (7233) for help.
  • Since its inception, the Hotline has responded to more than 7 million individuals reaching out for help.
  • One survey of Hotline contacts found that nearly universally, survivors felt emotionally supported by their interaction with the Hotline. A large majority also reported increased knowledge of domestic violence, safety planning, and awareness of resources.
  • The Hotline also manages the Love is Respect Dating Abuse Hotline, an initiative promoting healthy relationships for teens and young adults, and partners with the National Indigenous Women’s Resource Center to support the StrongHearts Native Helpline which can be found online or is available on the phone at 1-844-7NATIVE (762-8483) and over text at 1-844-762-8483.
  • In 2023, OFVPS awarded $19,987,500 in FVPSA funding to support the National Domestic Violence Hotline.
• With American Rescue Plan funds, OFVPS reached 841 sexual assault programs that received subawards from the $198 million in sexual assault supplemental funding by state and territory agencies.

Leading with Equity

HHS is committed to addressing inequities and advancing equity through assessing and changing policies, programs, and processes across the Department. Additionally, HHS is working to shift the culture, resources, and approaches to institutionalize and sustain a focus on equity over time. This work acknowledges the historical disparities in the response to gender-based violence and the need for culturally responsive, linguistically accessible, and trauma-informed services, including for people with disabilities. Below a few HHS programs that exemplify leading with equity are highlighted:

• The Office of Family Violence Prevention and Services (OFVPS) awarded $7.5 million in Culturally Specific Domestic Violence and Specific Domestic Violence and Sexual Assault Discretionary Grants to 35 culturally specific organizations. The grants were awarded in 2023 and the project period for these grants ends on September 30, 2027. Culturally specific programs increase gender-based violence knowledge, self-esteem, coping skills, and participant’s sense of support from providers.
• FVPSA American Rescue Plan Culturally Specific Domestic Violence and Sexual Assault Resource Centers, including 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 culturally specific community-based organizations.
• The Indian Health Services (IHS) Domestic Violence Program is a nationally coordinated program that provides culturally appropriate domestic violence and sexual assault prevention and intervention resources to American Indians and Alaska Natives (AI/ANs). Culturally specific programs in Tribal communities have shown success in improving health and GBV prevention in Tribal communities.  communities.
• The Interagency Collaboration on Sexual Violence Against People with Disabilities released a Dear Colleague Letter in April 2024. Individuals with intellectual/developmental disabilities experience higher rates of sexual violence. In April 2024, the interagency collaborative released guidance to HHS grantees, including rape crisis centers, domestic violence programs, and programs serving people with disabilities on how to better serve victims with intellectual and developmental disabilities.

Improving the Health Care Response to GBV

VAWA and the National Plan to End Gender-based Violence recognize that health care providers are integral to the response to gender-based violence. In 2005, VAWA provided the initial funding to begin training for health care providers and to improve the health system response to intimate partner violence. Today, HHS continues to build the capacity of health care providers to provide trauma-informed care to survivors. Health care responses and linkages to services for intimate partner violence have been shown to reduce violence and harm. Below are a few programs striving to improve health care response to gender-based violence.

• The 2023-2025 Health Resources & Services Administration (HRSA) Strategy to Address Intimate Partner Violence (IPV) is an agency-wide plan that outlines aims, objectives, and activities for HRSA Bureaus and Offices to encourage preventing and responding to IPV across HRSA activities.
• HRSA’s National Training and Technical Assistance Partners Cooperative Agreement – Health Partners on IPV + Exploitation reaches 1,400 health centers and over 15,000 service sites funded by HRSA’s Bureau of Primary Health Care Health Center Program. Training programs increase knowledge and competence of providers to provide care for GBV survivors.
• HRSA’s Advanced Nursing Education – Sexual Assault Nurse Examiners (ANE-SANE) Program aims to increase access to quality health care by building the sexual assault nurse examiner (SANE) workforce. In 2022-2023, the ANE-SANE program trained 3,220 participants with 632 graduates. Forty percent of ANE-SANE graduates are employed in medically underserved areas.
• IHS’ Forensic Nursing Consultation Program Contract – Supporting Training and Education was awarded in 2023 and serves as the forensic health care program within the IHS Division of Nursing Services. The Forensic Nursing Consultation Program was established to provide training opportunities for all IHS, Tribal, and Urban Indian Organization providers interested in becoming Sexual Assault Nurse Examiners/Sexual Assault Examiners (SANE/SAE).
• IHS’ Forensic Healthcare Funding Opportunity – Providing Access to Care was established in March 2023, and was designed to support building community capacity by forensic health care program development and expansion through training opportunities for health care providers. A total of $10 million, over a five-year period, will be dispersed to 16 sites.
• IHS’ Medical Forensic Examination Guidebooks and Interactive Map was developed to support providers in the fieldcaring for AI/AN patients,and to focus efforts on culturally centered and trauma-informed care, program development, and prevention efforts, including medical forensic examination considerations. The interactive map displays the active IHS, Tribal, and Urban Indian (I/T/U) facilities equipped to offer medical forensic healthcare. Prompt access to this information reduces delays in care and evidence collection.

Behavioral Health Outcomes

Gender-based violence significantly impacts behavioral health. People who experience gender-based violence have higher rates of anxiety, depression, post-traumatic stress disorders, eating disorders, and substance use disorders (SUD). Gender-based violence increases risks for maternal mortality, including a higher risk for pre-term labor and other fatal complications. Through ongoing programming at the Office of Women’s Health (OWH) and new initiatives from the Substance Abuse and Mental Health Services Administration (SAMHSA), HHS is addressing these intersections, including for pregnant and postpartum women.

• Since 2020, OWH has increased funding for violence-related projects from $2.1 million to $10.1 million. OWH’s violence-related focus resulted in bolstered review of maternal  deaths due to violence, and improved screening and referral of violence and intersectional issues such as suicide and substance use disorders among pregnant and postpartum women.
• OWH’s Violence Against Women and Substance Use Prevention Initiative launched an intersectional curriculum to bolster the screening and referral of IPV and SUD across both fields and established cross-referral systems between healthcare providers, IPV providers, and SUD providers to link the usually siloed fields and ensure those who screen positive for either IPV or SUD receive the care they require. This practice led to 5,921 patients screened for IPV/SUD, with 2,598 screening positive and being referred to the care they need when they would not have before.
• OWH’s State, Local, Territorial and Tribal Partnerships to Reduce Maternal Deaths Due to Violence has made strides to prevent maternal deaths due to violence by expanding the review of maternal deaths due to violence in specific states; establishing referral systems between health systems and domestic violence providers; and engaging culturally-trained doulas to screen for violence. These efforts increased DV/IPV screening and referral of pregnant and post-partum patients from 0% to 49% after one year of implementation.
• SAMHSA’s Women’s Behavioral Health Technical Assistance Center will enhance the capacity of providers to address the diverse needs of women with- or at risk for- mental health and substance use conditions, including individuals greatly impacted by COVID. Gender-based violence is a core topic that will be addressed by the Center’s activities.
• SAMHSA’s Community-Based Maternal Behavioral Health Services Program will ensure improved access to evidence-based, timely, and culturally relevant maternal behavioral health intervention and treatment. The goal is to strengthen community referral pathways and provide seamless transitions in care for pregnant people who are at risk for, or currently have a behavioral health condition in the perinatal and postpartum periods.
• In May 2024, HHS announced the release of a national strategy, with recommendations developed by the Task Force on Maternal Mental Health, a subcommittee of SAMSHA’s Advisory Committee for Women’s Services, to address the urgent public health crisis of maternal mental health and substance use issues.
• The Report to Congress and the accompanying National Strategy to Improve Maternal Mental Health Care are part of broader federal efforts to address women’s overall health, and maternal health in particular. The report and the national strategy also highlighted the intersection of GBV and maternal mental health.

HHS is committed to furthering the public health approach to gender-based violence prevention and to supporting survivors. This vision builds on key VAWA initiatives and the long history of FVPSA-funded services. To learn more about the Biden-Harris Administration’s ongoing efforts to end gender-based violence you can find the latest briefing here.