A Distorted Process of Care Framework: Why Do South African Women Stay in Abusive Relationships?

Abusive relationships are too often explained solely in terms of individual behaviour, as if a woman’s decision to stay were simply a matter of psychology or poor judgement. In South African communities, however, the reality is considerably more complex. The reasons women remain are situated within what can be described as a distorted process of care: a network of relational, material, and structural forces that alter the very meaning of care itself. This study aimed to explore these interconnections. Guided by an ethics of care framework, we employed multimodal qualitative methods to engage participants from four South African communities between August 2024 and July 2025. Participants (n = 262) were recruited through snowball, purposive, and convenience sampling. Data were coded using ATLAS.ti V8 and analysed thematically. Five interconnected themes shaped the framework. Distorted care described how caregiving could become coercive, shaped by fear, rigid gender roles, intergenerational abuse, and substance misuse. Care under constraint highlighted the material limitations, financial dependency, daily survival challenges, and self-sacrificing caregiving, that left women depleted. The silence of care captured emotional withdrawal, isolation, and the disabling effect of shame on help-seeking. Reclaiming care traced the tentative routes towards healing through ethical self-care, faith, forgiveness, and a conscious effort to disrupt harmful patterns. Woven throughout was structural failure, including absent family networks, the moral decline of communities, and institutional systems that consistently failed women. Remaining in an abusive relationship is not a sign of weakness. It is a negotiation, profoundly constrained, within systems of care that have been fundamentally distorted. Effective intervention should move beyond framing gender-based violence as an individual problem and address it as a collective one, restoring care as a shared social and political responsibility.