“I Couldn’t Leave the Farm”: Rural Women's Experiences of Intimate Partner Violence and Coercive Control

Intimate partner violence (IPV) is a pattern of behavior that can include physical, psychological, emotional, verbal, economic, sexual, and spiritual abuse; excessive jealousy and control; and harassment after separation (Provincial Association of Transition Houses and Services of Saskatchewan [PATHS], 2018). Coercive control is a dangerous form of IPV that involves the strategic use of “tactics to intimidate, degrade, isolate, and control victims” (Stark, 2013, p. 18), often in conjunction with physical and sexual violence or coercion. Other hallmarks of coercive control include “acute jealousy, degradation, microregulation of daily life, social isolation, disallowing independent thinking or decision-making, deprivation, surveillance, forced sex, sexual exploitation, shaming, forced adherence to a belief system that condones IPV, intimidation, [and] threats” (Saskatchewan Police Commission, 2018). It has also been described as patriarchal terrorism and intimate terrorism (Johnson, 2008).

IPV and coercive control are prevalent across Saskatchewan and Canada; however, the complexity of experiences of IPV and coercive control is exacerbated by regionality, with women who live in rural areas disproportionately affected. This study is part of a larger mixed methods, multisite exploratory study conducted in the Canadian Prairie provinces of Alberta, Saskatchewan, and Manitoba titled: Responding to Women who Experience IPV in Rural Municipalities Across the Prairies (Kardashevskaya et al., 2022). ¹ The purpose of the larger study was to (a) explore rural women's experiences of IPV and help-seeking by considering specific barriers related to living in a rural area and (b) determine the availability of interventions, services, and supports to inform recommendations for improving service response for rural women who are victims/survivors of IPV. The present study draws on qualitative interviews with rural women in Saskatchewan who experienced IPV (n = 13) and focus groups with service providers (n = 13) whose clients include rural survivors of IPV in Saskatchewan, Canada.

The aim of this study was to explore rural women's experiences of IPV and coercive control and how conditions of rurality exacerbate these experiences and influence a woman's capacity to exert control over her life choices, that is, her space for action (Sharp-Jeffs et al., 2018).

Context

This study was situated in Saskatchewan, a province in the Canadian Prairies. Saskatchewan is unique in that the proportion of the population that lives outside of a census metropolitan area (35.6%) is double the national average (16.8%) (Statistics Canada, 2017). The rural contexts in which people live in this province include small towns and villages, farms outside small towns, First Nations, and northern communities.

Rates of IPV reported to police in Saskatchewan are over double the national rate (724 vs. 344 victims per 100,000, respectively). Rates of IPV reported in rural areas of Canada are nearly double that reported in urban areas (548 vs. 300 per 100,000 population, respectively), and rates of IPV experienced by women in rural areas are dramatically higher than that reported for men (860 vs. 246 victims per 100,000, respectively) (Conroy, 2021). Women, particularly Indigenous women, are the most frequent victims of IPV and experience the most severe and dangerous forms of violence (Native Women's Association of Canada, 2020; Statistics Canada, 2016). Rates of domestic homicide are also higher in rural areas of Canada. Over 10 years (2010–2019) there were 718 cases of domestic homicide in Canada that involved 815 victims and 760 accused; nearly a third (31%) took place in rural, remote, or northern areas (Dawson et al., 2021). Approximately one-quarter (23%) of all victims of domestic homicide were Indigenous, and many Indigenous victims (66%) also lived in rural, remote, or northern areas (Dawson et al., 2021). Saskatchewan had the highest rate of domestic homicide among all Canadian provinces (Dawson et al., 2021). An analysis of intimate partner homicides in Saskatchewan indicates coercive control usually precedes the homicide (Latimer, 2021).

Coercive Control

While coercive control can be experienced, and perpetrated, by people of all genders, it is most often perpetrated by men against women (Johnson, 2008; Stark, 2007). Patriarchal norms and attitudes create the conditions in which coercive control can occur and increase women's vulnerability (Stark, 2013). Coercive control impacts victims’ lives in multiple ways, including creating social isolation and limiting relationships with friends and family, impacting and controlling parenting, and limiting participation in employment (Conroy & Crowley, 2021; Stark, 2013; Walklate & Fitz-Gibbon, 2019). The effects of coercive control are felt on individual, emotive, cognitive, and social levels, with wide-ranging impacts affecting women's self-esteem, confidence, and sense of self-respect (Walklate & Fitz-Gibbon, 2019).

Crossman and Hardesty (2018) examined women survivors’ experiences of control/constraint. They found that, while in those relationships, some women experienced “constraint through force,” whereby the men in their lives used social norms and expectations to constrain them (Crossman & Hardesty, 2018). Other women experienced “constraint through commitment,” whereby they had made compromises and sacrifices, often related to their commitment to their relationships and family and influenced by social norms. Other researchers (Wendt & Hornosty, 2010) found rural women victims/survivors often privilege the needs of their children, partners, and farm before their own. This research highlights the need to recognize coercive control as a pattern that involves men's use of control and force, with the frequency of the use of controlling behaviors leading to the entrapment of women victims and exacerbated by women's commitments to children, extended family, community, and the farm.

Coercive control is characterized by a pattern of behavior used by the perpetrator to control behavior by instilling fear, maintaining dominance, and entrapping their partner (Conroy & Crowley, 2021; Stark, 2013). Behaviors can include frequent intimidation, degradation, threats of violence, surveillance, isolation from family and friends, humiliation, and intimidation as well as sexual and physical violence and coercion (Saskatchewan Police Commission, 2018; Stark, 2007, 2013; Walklate & Fitz-Gibbon, 2019). Although patterns of control may be established by using violence, physical violence does not always accompany coercive control (Myhill & Hohl, 2019). Dutton and Goodman (2005), for example, detail four ways that perpetrators of violence control victims, including: “(a) creating the expectation of negative consequences, (b) creating or exploiting the victim's vulnerabilities, (c) wearing down the victim's resistance” (p. 748), and (d) “facilitating—and then exploiting—emotional dependency” (p. 749).

Individuals experiencing coercive control can be entrapped in the relationship through microregulations aimed at instilling shame (Kelly & Johnson, 2008; Stark, 2007, 2013) and taking away independent movement and choice. Victims of coercive control are also frequently subjected to threats and fear not only for themselves but also for their family members, support network, and animals (Giesbrecht et al., 2023; Kelly & Johnson, 2008; Stark, 2007), both while they are in the relationship and if they form plans to escape. Coercive control is gendered in a way that situational violence is not (Johnson, 2008). Gill and Aspinall (2020) link coercive control to the continued prevalence of the domination and relatively superior position of men over women, with women's higher risk of victimization via coercive control and the tactics used reflecting patriarchal gender norms throughout history. Economic or financial abuse (Postmus et al., 2020) is an example of a tactic of violence linked to men's continued dominance as well as structural inequality within rural societies.

Rurality and IPV and Coercive Control

While IPV and coercive control are prevalent in urban, suburban, and rural areas, authors have drawn attention to the differences between these contexts (see Edwards, 2015; Farhall et al., 2020; Stokes, 2012). Living in a rural area physically limits access to safety as formal supports (such as shelters or health care services) are further away, police response times are longer, and natural supports, such as neighbors, are at a greater distance and therefore less accessible in an emergency (DeKeseredy, 2021, 2022; Ruddell & O’Connor, 2022). Economic, educational, and employment opportunities, housing, childcare, and legal services are also less available in rural areas, which may restrict a survivor's ability to plan to leave the relationship (DeKeseredy, 2021). These limitations are exploited by perpetrators (DeKeseredy, 2021).

In addition to limited opportunities and services, many rural communities are often conservative in nature, especially in the promotion of men having a more dominant position. DeKeseredy, for example, notes that “many, if not most, rural communities, especially in the United States, Canada, and Australia, are conservative to begin with and promote the principles of hegemonic masculinity” (2021, p. 63). For many people who live in rural areas, rurality is not simply an address, but an identity that may include a connection to personal and family histories, relationships with farming, rural families, animals, communities, and the land (Barton et al., 2015; Crawford & Bohac Clarke, 2012; Doherty & Hornosty, 2008; Giesbrecht, 2022; Jeffrey et al., 2019; Letourneau et al., 2023; Wendt & Hornosty, 2010).

Care for companion animals is a significant barrier for many survivors of IPV. Animals are an important source of love and companionship for many people; when survivors have been abused and isolated by their partners, their bonds with animal companions are even more central to their well-being (Crawford & Bohac Clarke, 2012; Giesbrecht et al., 2023; Hardesty et al., 2013). Animal abuse is often concurrent with IPV, with animals potentially subject to harm by perpetrators of IPV (Barrett et al., 2018; Fitzgerald et al., 2021; Giesbrecht, 2022; Giesbrecht et al., 2023). Survivors who care for companion animals report delaying or choosing not to leave relationships in which they are experiencing IPV because they could not find anywhere to go with the animal (whether short-term shelter or longer-term housing) and did not want to leave the animal behind with the perpetrator (Barrett et al., 2018; Barton et al., 2015; Doherty & Hornosty, 2008; Giesbrecht, 2022; Giesbrecht et al., 2023; Hardesty et al., 2013). The situation is even more complex for rural women who care for horses and livestock as well as companion animals (Crawford & Bohac Clarke, 2012; Doherty & Hornosty, 2008, 2016; Giesbrecht, 2022; Giesbrecht et al., 2023). Finding permanent housing or temporary boarding solutions is challenging for larger animals and especially larger herds of animals. Jointly owning animals that are an income source with the perpetrator creates another barrier to ending the relationship.

Perpetrators’ ability to use coercive controlling tactics, the ways in which these tactics are employed, and the impacts on victims of coercive control in rural communities are amplified by geographic isolation, gender, reduced access to resources, and the attachment that bonds women to the land, farm, or community. Rurality, therefore, may reduce a woman's space for action, and increase the likelihood that they remain vulnerable to continued control and stay in relationships in which violence and abuse are occurring. In understanding the dynamics of IPV and coercive control and the impact on victims/survivors, it is important that we seek to understand the importance of the capacity, or space, for women to act.

Space for Action

Space for action refers to the capacity for women to exert control over their life choices across multiple domains, including individual, social, economic, and community (Sharp-Jeffs et al., 2018). In her discussion that explores tensions relating to gender and abuse, Lundgren (1998) suggests that, through gendered violence, a continued rebalancing of gendered power relations occurs, and that, “the woman's space for femininity is reduced and the man's space for masculinity increased” (p. 171).

The notion of space for action allows for contradictions of agency and constraint across the symbolic, bodily, and social domains. In a 2003 publication on trafficking that explores the complexity of victimization and agency, Liz Kelly (2003) drew from Lundgren's notion of space for action to consider how women adapted their behaviors through “everyday, routine power and control relationships” (p. 140) to escape the violence and/or cope day to day, and Farhall et al. (2020) further suggest “women's space for action decreases as they adapt their behavior in attempts to avoid abuse, and this space is restricted and controlled by the perpetrators regimes to limit her freedom” (p. 183). A woman's space for action in which the rebalancing of gendered power relations can occur may include employment/work, financial management, social activities, and caring for children. Space for action also includes the capacity for women to seek assistance when their safety is threatened.

In their meta-synthesis of studies on the impact of rurality on the space for action for women experiencing domestic violence, Farhall et al. (2020) found that “geographical and social isolation [in rural areas] were used to hold women in literal captivity” (p. 181). They state the impact of rurality on coercive control and space for action is linked to such factors as geography, isolation, class, race, as well as social norms and gender roles. Specifically, rurality can exacerbate women's lack of freedom and space for action due to physical constraints (e.g., lack of transportation, limited employment and financial resources, limited emergency services and supports [e.g., medical, shelter, legal, police]), and social normative constraints (e.g., gendered norms, faith-based expectations and norms, lack of confidentiality). Furthermore, gender roles impact women's space for action in a social as well as physical sense. Women often remain in such relationships because their identity is connected with the land, farm, and community (Wendt & Hornosty, 2010).

Women have the capacity for agency in these contexts. The rural experience, particularly related to farming, impacts many women's choices to remain in, resist, and/or leave relationships in which they are experiencing IPV to protect their livelihood, their children's future livelihood, or the family's reputation.

The tactics of coercive control by aggressors, and the impacts on victims, are amplified in rural environments. While attention has been paid to rurality and coercive control in relation to space for action, there is a gap in the literature that renders visible and links the lived experiences of rural women who experience IPV with their capacity to take action. This study aims to build on the existing literature and address this gap.

Methods

This study was part of a larger mixed-methods, multisite exploratory study of rural women's experiences of IPV and the process and experience of help-seeking in rural areas that was conducted in the three Canadian Prairie provinces of Alberta, Saskatchewan, and Manitoba (Kardashevskaya et al., 2022). The study was approved by research ethics boards in the three provinces: the University of Manitoba Psychology/Sociology Research Ethics Board, the University of Calgary's Conjoint Health Research Ethics Board, and the University of Saskatchewan Research Ethics Board. As well as qualitative interviews and focus groups conducted in all three provinces, the tri-provincial study included an environmental scan of services available to women who experience IPV in the three provinces (RESOLVE, 2022) and used Geographic Information System (GIS) mapping to assess the availability and accessibility of services to rural women across the three provinces.

To explore rural women's experiences of IPV and coercive control and how conditions of rurality exacerbate these experiences and influence a woman's capacity to exert control over her life choices (her space for action), the present study considers the qualitative interviews with rural women in Saskatchewan who experienced IPV (n = 13) and focus groups with service providers who served rural survivors of IPV in Saskatchewan (n = 13). The decision to focus on one province, Saskatchewan, was made because of the magnitude of data from the interviews, and that the researchers who did the data collection for Saskatchewan, were based in Saskatchewan and therefore familiar with the unique regional characteristics of the province. Further analysis of these findings will be considered with the other two provinces that participated in the broader study in future publications.

Findings

The nature of rural Saskatchewan women's experiences of IPV and coercive control included physical abuse; sexual violence and coercion; emotional and verbal abuse; economic abuse and control; and threats to their own safety as well as the safety of their children, livestock, and companion animals, including threats involving firearms. Survivors talked about the prevalence of verbal and emotional abuse within their daily lives; several women experienced daily verbal and emotional abuse and persistent threats made against themselves, their children, and their companion animals. The women shared how their partners would manipulate them to ensure control, and how difficult it was to recognize this as a form of violence or abuse. For example, one participant described years of emotional and verbal abuse and her difficulty in defining it as abuse:

I didn’t know it was abuse for many years, you know. I was young when I got together with him, and I didn’t know what he was doing was abusive … it was more mental, verbal, emotional abuse. And it was, I don’t know, it was very subtle the way he did it. It was tough to pinpoint if I was going crazy or what. (Survivor Interview 1)

Verbal abuse uses language as a form of harm against another person; emotional abuse engages other tactics of emotional harm, including for example, criticisms, control over behaviors, and other forms of humiliation (Bennett, 2021). Verbal and emotional abuse may be used by perpetrators as part of a pattern of controlling victims’ behaviors. Three participants specifically said they experienced ongoing verbal abuse while in their relationship, including their partner screaming or yelling at them or calling them names. For example, one participant recalled that her partner used verbal abuse in the form of name-calling, in what she explains was an attempt to regulate her workplace behavior and to control others’ perceptions of her. She explained how, being new to a small town, she got a job in a restaurant and followed the lead of her co-worker in an attempt to fit into the culture of the community and how this was used against her:

The [other] waitress did, she always called people honey, dear and sweetie, and so I did too  … that's how you get to know people, being in a small town … and so then he would call me a whore …  (Survivor Interview 6)

The presence of firearms and the threat that they would be used was another tactic used by perpetrators to enact control. Both survivors and service providers commented that firearms are present in many rural homes, often for hunting, sport shooting, or control of pests or predators on farms and ranches. In situations of IPV, firearms are often used to threaten and instill fear; they create a very real barrier to safety for victims who know they could be killed. Five participants discussed their fear of their partners’ lethal violence based on the presence of firearms and weapons in their homes and the threats their partners had issued. For example, one woman recalled that her partner told her about his

guns being kept away from him due to a certain ex-girlfriend. My best guess as to what this meant was that maybe a friend or family member was keeping his guns away from him to prevent him from doing something to me. (Survivor Interview 4)

Economic and psychological violence often go together (Kutin et al., 2017). The verbal and emotional abuse the women experienced served to restrict their individual power and was compounded by financial and economic abuse, which in the context of IPV refers to control over financial assets, money, and work (Anitha, 2019). Survivors described their partners’ efforts to ensure their financial dependence, indicating it happened gradually and in ways that would not be easily noticed by others. Experiences with economic abuse varied, including workplace interference, control of farm assets, restricting victims’ access to financial information, and limiting victims’ access to their own earned income as well as family assets. One participant described the subtle ways her husband would interfere with her ability to do her job, resulting in her using up sick days and putting her job at risk. She explained:

…At the time, I didn't realize it. But when I was working with [name], he would sometimes send me like, just pepper me with text messages at work. And I know that interfered with my job and my position and my ability to do my job. And probably took a bunch of sick days as a result  …  (Survivor Interview 5)

She went on to describe how the control she experienced became worse when she became unemployed. She reported that when she asked for $20 to spend while they were on vacation together, he said, “You don't work right now. You don't even have a job.” In this example, the partner used access to money to maintain control of the relationship. This survivor did not have access to funds for transportation or other needs if she chose to leave the relationship. Other participants experienced their partner controlling the finances and limiting their access to money, even though the women worked and earned an income:

…there [was] some financial abuse where it was like, I was the manager of a bar down there, but all the money I was making was going to him, and then I would get an allowance from that and I would buy groceries with the tip money that I would make  … I was in charge of the groceries and stuff, but I was only using [the] allowance to buy that, and then everything else had to go through him, to ask for. So he made me very financially dependent on him. (Survivor Interview 10)

Perpetrators employing tactics of financial control such as these reinforce barriers to victims’ independence and limit their ability to end the relationship. Rural women survivors also faced economic challenges related to a lack of available or well-paid employment where they lived, as well as a lack of available childcare and/or transportation and consequent difficulties getting work outside of the home. Financial control intersects with other coercive controlling tactics to limit victims’ choices and regulate their everyday activities and behaviors.

We focus on understanding these experiences, and specifically coercive control, in relation to rurality and the women's capacity to exert control over their life choices or space for action. Themes that emerged in this regard fall under two broad categories: (1) physical elements of rurality that impact IPV and coercive control and (2) elements of normative rurality that affect women's experiences of IPV and coercive control.

Discussion

IPV against women “is recognized as being reflective of the society, ways people interact, norms, and values” (DeKeseredy, 2022, p. 22). Our findings suggest rurality magnifies conditions of coercive control through, for example, physical conditions such as isolation and normalization that restrict women's space for action. Our participants’ experiences of coercive control were exacerbated by the geographic reality of living in a rural/remote location.

While we recognize the diversity of women's experiences, reflections here demonstrate the prevalence of coercive control in rural communities. Microregulation of everyday life (Stark, 2007) was evident in these data. Participants recalled their experiences of ongoing verbal abuse and threats, both explicit and implicit, while in their relationship. Survivors recalled ways in which they experienced coercion from their partners and described instances in which they regulated their own behavior in private or in social situations to appease their partner and avoid violence or verbal abuse. Other research echoes these findings and shows perpetrators of coercive control regularly use multiple nonviolent ways of maintaining dominance (Crossman & Hardesty, 2018), including threats, instilling fear, and using belittlement tactics that result in women feeling little or no self-worth. Crossman and Hardesty (2018) demonstrate, for example, that women's experiences of constraint and coercion are enacted both through force, where men have used social expectations and norms to constrain them, as well as coercing the women based on their commitment to their families and social norms.

Participants also found heightened control in rural areas related to threats of gun violence, which is also reflected in other current research on coercive control. Lynch et al. (2021), for example, discuss how firearms are used as a tool for intimidation, which includes the threat of homicide. They further suggest the perceived risks of the use of guns are lower in rural areas, noting this relates to “rural and urban gun culture differences in that guns may be more common in a variety of households in the rural area” (p. 8010). As guns are more commonly present in rural homes, many rural women are at risk of firearm-related threats and intimate partner homicide; this issue requires further explanation to understand the differential risk experienced by rural victims and to inform recommendations for mitigating this risk.

Rurality clearly contributes to experiences of coercive control. Geography, in particular rural settings, has been explored as a particular space for partners to exert coercive control by limiting their partners’ freedom through a variety of means. Findings in the present study demonstrate that women's experiences are often shaped by factors related to isolation, including but not limited to being new to a community, lack of informal and formal supports, and problems with confidentiality. For example, some rural survivors in our study sought services from formal IPV-specific services (e.g., shelters), though these were often a significant distance away. Others sought services from other formal service providers (e.g., police, hospitals) or help from informal or natural supports (e.g., church, neighbors) but found problems with a lack of services, distance from supports, and long response times. Many mid-sized rural communities do not have domestic violence shelters or IPV counseling services within the region, and specialized services are usually not available for specific groups (e.g., newcomers, Indigenous, LGBTQ2S+). For this reason and others, survivors often sought support for IPV from natural supports (e.g., churches) or from more “generalized” services (e.g., hospitals or health clinics) that must attempt to serve a diverse client base. Survivors also feared that services and informal supports are not confidential and noted challenges related to maintaining anonymity in small communities where acquaintances may see them entering a service provider's office or see their vehicle parked outside.

Consistent with the findings in the current study, other researchers have drawn links between rurality and coercive control. DeKeseredy (2021) draws attention to the problems for rural women, specifically based on geography and living further away from informal supports, criminal justice agencies, and different types of service providers. Rural areas with greater distance between homes can lead to less visibility of IPV (DeKeseredy, 2021). IPV services, including shelters, are limited in rural areas (Maki, 2019), and response times for police and other emergency services can be lengthy, resulting in barriers to survivors calling for assistance when needed—or to help arriving in time (Kohtala, 2021; McKay, 2019; Ruddell & O’Connor, 2022; Wuerch et al., 2019).

Awareness of IPV in general and the idea that IPV is not just physical (including coercive control and other nonphysical forms of abuse) was lacking among natural/community supports who could have assisted survivors (e.g., family members, churches). This meant that survivors in the present study often did not receive a supportive response when reaching out. Survivors themselves were also unfamiliar with warning signs/definitions, which therefore delayed their decision to seek help.

The normalization of violence noted in our findings is reflected in the literature on IPV in rural areas. In communities where everyone knows everyone, survivors face substantial barriers to help-seeking (Doherty & Hornosty, 2016; Kohtala, 2021). They may be concerned that information will be relayed back to their partner by service providers or by natural supports, such as friends or coworkers. They may also be concerned that they will be gossiped about when they share their experiences with supports, whether formal or informal (Banyard et al., 2019; Doherty & Hornosty, 2016; Kohtala, 2021). Other research on IPV and coercive control in rural communities identifies patriarchal values that lead to the normalization of subordination and violence against women (e.g., Eastman et al., 2007; Kohtala, 2021). These values often place women in positions of economic dependence, which impacts their ability to plan for the future, successfully end relationships, and live independently (Kohtala, 2021; Musielak et al., 2020). A qualitative study by Kohtala (2021) identified barriers to safety planning for survivors in rural, remote, and northern regions of Canada, including: “victim-blaming and patriarchal attitudes, geographical barriers, confidentiality concerns, access to firearms, and a distrust in systems” (p. 38). These all align with the experiences described by survivors and service providers in our study.

Our study's focus on space for action enables us to highlight ways in which coercive control impacts women survivors living in rural areas in a manner that allows for the contradictions inherent with women's victimization in relation to restricted or loss of control and agency. We found evidence of both, that is, times where space for action was decreased and, in a few examples, how space for action was expanded and how these examples linked to rurality. The prevalence of verbal and emotional abuse within the women's daily lives, how abusive partners would manipulate them to ensure control, threats against children and animals, financial and economic abuse, and how difficult it was for the women to recognize these as forms of violence or abuse, all served to decrease the women's capacity to act against the control they were experiencing and their power to leave. The reduction in the women's space for action was exacerbated by physical and/or normative rurality or, in a few cases, increased, as was noted by the service provider who explained that informal or “natural” supports such as extended family, neighbors, friends, coworkers, and members or leaders of a church, are most often the first form of support for rural women experiencing IPV.

Conclusion

Both the physical elements of rurality and the normalization of violence within rural communities affected the woman's capacity to act, their space for action, and opportunities for ending a relationship where they are subjected to abuse. Rural communities were shown to increase social isolation, shape norms linked to gender roles, normalize coercive control, and decrease the women's capacity for control over their life choices in multiple domains, including the ability to find work, seek informal support or formal assistance, and therefore their ability to leave a controlling IPV relationship. The words of the survivors and service providers in the present study remind us of the importance of Farhall and colleagues' (2020, p. 2) words that rural women may be held in “literal captivity” through geographic and social factors. While service providers and survivors identify the need for increased communication, transportation, education, employment, care, and services, they also identify the need for women to have a voice and the freedom and space to act.