Gender based violence(GBV)

MODULE 2
 Gender based violence
• Learning Objectives
• At the end of this module, you will be able to:
• Define sexual and gender-based violence
• Describe the prevalence of gender-based
violence and its impact on reproductive health
• Discuss factors associated with GBV
• Recognize the types of GBV
• Care and support GBV survivors
 What is gender-based violence, and how prevalent is it?

• Thus, at the end of this chapter, you will be

able to:
• Define GBV and describe factors associated
with GBV
• Explain the prevalence of GBV in Ethiopia
• Distinguish between myths and realities of
GBV
 Gender-based violence (GBV)

• GBV refers to any act that is perpetrated against a

person’s will and is based on gender norms and
unequal power relationships.
• GBV encompasses threats of violence and coercion.
• It can be physical, emotional, psychological, or sexual
in nature, and can take the form of a denial of
resources or access to services.
• It inflicts harm on women, girls, men and boys.
• GBV is a violation of human rights.
• It denies the human dignity of the individual and hurts
human development.
 GBV terminologies:
• Gender- based violence:
• Includes all forms of violence involving women and
men in which the female is usually the victim.
• The term ‘gender-based’ is used to highlight the
need to understand violence within the context of
women’s and girl’s subordinate status in society.
Such violence cannot be understood, therefore, in
isolation from the norms, social structure, and
gender roles within the community, which greatly
influence women’s vulnerability to violence.
 Domestic violence:

• Is a term used with many meanings:

• The most common usage is with reference to
violence by the spouse or intimate partner.
• However, the term is also used sometimes to
describe violence within the family, where the
perpetrators are usually male members, as for
example violence by the father against the
daughter, son against mother and so on
 Cont..
• Any act of gender-based violence that results
in or is likely to result in physical, sexual, or
psychological harm or suffering to women,
including threats of such acts, coercion or
arbitrary deprivation of liberty, whether
occurring in public or private life (United
Nations General Assembly, Declaration on the
Elimination of Violence Against Women,
1993).
 Cont..
• Violence against women or girls:
• is a term often used synonymous with gender-
based violence.
• However, the term does not make it clear
whether or not the violence is derived from
unequal power relationships between women
and men in society.
Types of GBV
 Violence can be Direct or Indirect
Direct Violence Indirect violence
 Human trafficking Prejudice
 Stalking Stereotypes
 Sexual violence Norms
 Economic violence
 Psychological violence
 Forced marriage
 Child marriage
 Bulling
 Female genital mutilation
 Slavery
 Beliefs and Norms
• The beliefs that we have about gender, gender
norms and roles affect the way in which we
treat other people.
• Unfortunately, they can lead to discrimination
and violence, and the freedom to discriminate
and act violently (impunity).
• The same norms that ‘allow’ discrimination
and violence, also discourage prosecution of
the perpetrators.
 Prevalence of Gender-Based Violence
• GBV is a serious public health concern worldwide
and in Ethiopia.
• It is fueled by persistent gender-biased attitudes
and practices.
• Intimate partner violence (IPV) and other forms of
GBV in Ethiopia have adverse health impacts.
• World health organization(WHO) indicates
globally approximately 35% of women experience
a form of gender based violence in their lifetime
 Cont..
• One in five women have been sexually abused
as a child.
• Nearly 1 in 4 of all Ethiopia women have been
victims of physical violence.
• 1 out 10 Ethiopian women have been victims of
Rape.
• Ethiopian women who experience intimate
partner violence(IPV) almost twice as likely to
have HIV.
 Cont..
• Men may also be victims of sexual violence, particularly in
conflict settings, and can experience violence from an intimate
partner, although the rates are much lower and the impacts
are different
• Sexual violence against men in emergencies tends to be
committed by other men as a means of disempowering them,
their families and communities.
• Boys may be at risk of child sexual abuse, which is usually
perpetrated by family members or other men who are known
to the child.
• Sexual and gender minorities, people with disabilities, children
and adolescents are also often at increased risk of violence.
 Factors Associated with Gender-Based
Violence
• One of the root causes of GBV is gender
inequality.
 GBV is caused on multiple levels:
Individual level
Relational level
Community level
 Cont..
• Gender norms are the socially assigned roles and
responsibilities of women and men.
• Cultural and social norms often socialize men to be
aggressive, powerful, unemotional, and controlling.
• This contributes to a social expectation (by both men
and women) that accepts men as dominant. Similarly,
expectations of women are that they be passive,
nurturing, submissive, and emotional.
• This reinforces women’s roles as weak, powerless,
and dependent on men.
 Cont..
 According to the WHO, factors that make a man
more likely to perpetrate violence against women
include:
Limited educational opportunities;
History of being abused as a child;
Exposure to domestic violence against their mothers;
Misuse of alcohol;
Attitudes that accept the use of violence; and
Sense of entitlement over women.
 Cont..
 Women are more likely to experience violence
if they have had:
Limited educational opportunities;
Whose mothers have been abused by a
partner;
Whose have experienced abuse during
childhood; and
Whose accept violence, male privilege, and
women’s subordinate status.
 Cont..
• Children and young people who experience violence in
their family surroundings are more likely to become
perpetrators or victims of violence later in life.
• Specifically, children who experience sexual violence more
often become problematic smokers, drinkers, or
substance misusers and are more likely to engage in risky
sexual behaviors than children who do not experience this
type of behavior.
• So, if you work with children or young people who engage
in such behaviors, be aware that there may be more to
the situation than meets the eye.
 Causes of GBV
Root causes of GBV
 Abuse of power
 Gender inequality
 Poverty
Contributing factor on GBV
 Alcohol or drug abuse
 Disrespect
 Lack of police protection
 Conflict
 Lack of education
 Health consequences of GBV
• GBV often has significant health consequences
that includes both fatal and non-fatal outcomes.
• Fatal outcomes may be the immediate result of
being killed by the perpetrator, or they may be
longer-term adverse health outcomes such as
material mortality or HIV/AIDS.
• Non-fatal outcomes include physical, chronic,
mental, behavioral, and reproductive
consequences.
Some examples of Non-fatal outcomes
Physical: . Injury
. Functional impairment
. Permanent disability
. Poor subjective health
 Chronic : . Chronic pain syndrome
. Irritable bowel syndrome
. Fibromyalgia
 Cont..
 Mental : . Post-traumatic disorders
. Anxiety
. Depression
. Panic disorders
 Behavioral : . Smoking, alcohol and drug abuse
. Sexual risk taking
. Physical inactivity
. Eating disorders
 Cont..
Reproductive: . Unwanted pregnancy
. STI
. HIV
. Unsafe Abortion
. PID
 Myths and Realities of Gender-Based
Violence
• Myths: are traditional stories, especially one
concerning the early history of a people or
explaining a natural or social phenomenon,
and typically involving supernatural beings or
events.
• Myth: Violence against women is an inherent
part of maleness or a natural expression of
male sexual urges.
 Cont..
• Reality: Male violence is not genetically
based; it is perpetuated by a model of
masculinity that permits and even encourages
men to be aggressive.
• It is up to us as individuals, communities, and
society to change these gender norms so that
violence against women is not accepted or
tolerated.
 Cont..
• Myth: Poverty lead to attacks on, and abuse of, women.
• Reality: Poverty may exacerbate levels of violence. Some
studies have found these phenomena to be risk factors
for gender-based violence. However, they are not the
cause of violent behavior.
• GBV cuts across socio-economic levels.
• There are many individuals living in poverty who are not
violent toward women, and there are many individuals
in higher economic quintiles that are violent toward
women.
 Cont..
• Myth: Style dressing of girls is a way of
seducing males to perpetuate sexual and
gender based violence
• Reality: It’s the right of individual to dress
what she wants according to her culture.
• However, it's mentioned as a common reason
for SGBV.
 Cont..
• Myth: Gender-based violence is an inevitable
part of intimate partner relations.
• Reality: Disagreements and disputes may be
inevitable parts of intimate partner relations.
However, violence as a way to resolve those
disputes is not.
• Violence is a learned behavior and can be
unlearned.
TYPES OF GBV
 Consent & Coercion
• Before we continue, it's important to have a clear
understanding of the terms 'consent' and 'coercion'.
• Consent refers to the act of giving permission for
something to happen or agreement to do
something.
• Coercion, on the other hand, is the practice of
persuading someone to do something by using
force or threats.
• When someone is coerced, they are not giving their
consent.
 Physical violence
• Physical violence is defined as the intentional use
of physical force with the potential to cause death,
disability, injury, or harm.
• Physical violence includes, but is not limited to:
scratching, pushing, shoving, throwing, grabbing,
biting, choking, shaking, poking, hair pulling,
slapping, punching, hitting, burning, use of a
weapon (gun, knife or other object), and use of
restraints or one’s body, size, or strength against
another person.
 Cont..
• Physical violence also includes coercing other
people to commit any of the above-
mentioned acts.
• It also includes, often in children, the acts or
omissions or deprivation/neglect.
 Sexual Violence / Abuse
• Sexual violence/abuse is the act of sexual
activity without consent and/or any sexual act
on a person who could not give consent, such
as children and persons with disabilities.
• This act includes:
 Cont..
• This act includes:
• Use of physical force to compel a person to engage
in a sexual act against his or her will, whether or
not the act is completed.
• Harassment, rape, marital rape,
abuse/exploitation, sexual child abuse/incest,
sexual abuse (non-penetrating), forced prostitution
(often an act of coercion), child prostitution, sexual
trafficking and forced abortion, etc.
 Cont..
• An attempted or completed sex act involving a person
who is unable to understand the nature or condition of
the act, to decline participation, or to communicate
unwillingness to engage in the sexual act (e.g. because
of illness, disability, or the influence of alcohol or other
drugs, or due to intimidation or pressure).
• The act of an adult or someone older than a child
involving the child in any form of sexual activity, ranging
from fondling the child’s sexual parts to actual or
attempted sexual acts.
 Rape / Attempted Rape
• Rape/Attempted rape is an act of non-
consensual sexual intercourse.
• This can include the invasion of any part of the
body with a sexual organ and/or the invasion
of the genital or anal opening with any object
or body part.
 Cont..
• Rape and attempted rape involve the use of
force, threat of force, and/or coercion.
• Any penetration is considered rape.
• Efforts to rape someone which do not result in
penetration are considered attempted rape.
 Cont..
• Rape of women and of men is often used as a
weapon of war, as a form of attack on the enemy,
typifying the conquest and degradation of its
women or captured male fighters.
• It may also be used to punish women for
transgressing social or moral codes, as for instance
those prohibiting adultery or drunkenness in
public.
• Women and men may also be raped when in police
custody or in prison.
 Cont..
• Rape/Attempted Rape may include:
Rape of an adult female
Rape of a minor (male or female), including
incest
Gang rape, if there is more than one assailant
Marital rape, between husband and wife
Male rape, sometimes known as sodomy
 Psychological and Emotional Violence -
Abuse and Neglect
• Psychological/emotional violence/abuse and neglect:
are acts of coercion or use of abusive language (e.g.
verbal assaults) and arbitrary deprivation of liberty,
whether occurring in public or in private life.
• Psychological/emotional abuse can include but is not
limited to: humiliating a person; controlling what the
person can and cannot do; withholding information
from the person; getting annoyed if the person
disagrees; deliberately doing something to make the
person feel diminished (e.g. less smart, less attractive);
 Cont..
• Deliberately doing something to make the person feel
embarrassed; isolating the person from friends and
family; prohibiting access to transportation or
telephone; denying access to money and other
resources; threatening loss of custody of children;
and, smashing the person’s objects or destroying his
or her property.
• Moreover, it includes threats of acts, coercive tactics
when there has also been prior physical or sexual
violence, or prior threat of physical or sexual violence.
 Cont..
• In general, most relationships do not start off as
abusive, because most people would never start
a relationship with someone if they were abusive
from the start.
• It is only after a period of time, after the people
in the relationship have become attached to each
other, that the abuse begins or starts to show.
• In some cases, there is a clear abuser and a clear
victim, but, in many situations, there is not.
 Cont..
• As a healthcare worker or educator, it is
important to be aware of this.
• For example, while physical abuse is more
visible (bruises, broken bones), emotional
abuse can be silent and hidden but equally
dangerous to the person’s wellbeing.
 There are multiple reasons why people abuse others:

1. They may have a difficulty tolerating feelings of

hurt and may think or feel that they have the right
not to be hurt and embarrassed. Consequently,
when they feel hurt by others, they ‘punish’
them.
2. They may lack empathy: they think that the other
person wants to harm them.
3. Many people who abuse have histories of
childhood abuse or trauma; they witnessed
abusive behavior or were abused themselves.
 Cont..
4. Abuse also happens in situations in which the
abusive behavior is not rejected by other
people; in away, abusers abuse because they can.
• This happens if people feel peer pressure to act
in a dominant or violent way; may have learned
abusive behavior at home and/or are
influenced by violence in the media and society.
• In a way, they are not held accountable
(enough) for their violent behavior.
There are many reasons why people stay in an abusive relationship:

They feel responsible for the other person;

Think that jealousy and possessiveness are a
sign of love;
They may not realize they are in an abusive
relationship;
Have no one to go to;
Are inexperienced with relationships;
 Cont..
Feel pressured to be in a relationship;
Have low self-esteem;
Do not want to think the person they love is
hurting them;
May believe the abuse is their fault;
Hope that the other person will stop being
abusive;
Believe they are in love; and/or are not ready to
stop the relationship.
 Female Genital Mutilation
• The World Health Organization (WHO) defines
female circumcision, also called FGM, as the
ritual cutting or removal of some or all of the
external female genitalia.
• A very specific form of violence against
women is female genital mutilation (FGM).
 Cont..
• Because there is no medical reason for female
circumcision and due to the severe health
risks involved, the World Health Organization
(WHO) classifies it as female genital
mutilation.
• They have fought for the international
recognition of this practice as a violation of
the human rights of children and women.
 Cont..
• Here are more than 200 million circumcised
girls and women worldwide.
• FGM occurs in 30 countries in Africa, the
Middle East and Asia.
• Removal of the genitals in girls is a complex
tradition that touches on many major topics:
human rights, gender, religion and culture.
 Types of FGM
• There are four types of female circumcision:
1. Type I – Clitoridectomy. Removal of the clitoris (partially
or completely).
2. Type II – Excision. Removal of the clitoris and the labia
minora (lips of the vagina).
3. Type III - Full infibulations. The vaginal opening is
narrowed by cutting and stitching of the labia minora and
majora and the clitoris may also be removed.
4. Type IV - All other harmful procedures to the female
genitalia for non-medical purposes, for example:
pricking, piercing, incising, scraping and cauterization.
Types of FGM
 Cont..
• The age at which FGM is performed depends on
local traditions and circumstances.
• FGM is usually performed on young girls (4-12 years
old) but can also take place just before marriage, for
example.
• Traditionally, female circumcision is done by local
women/midwives who are not medically trained.
• FGM often takes place in a non-clinical setting
under unhygienic circumstances and without
anesthesia.
 FGM in Ethiopia
• FGM is a violation of human rights and has
been prohibited in Ethiopia’s criminal code
since 2004.
• Nevertheless, 65 percent of girls and women
(nearly 25 million women and girls) aged 15 to
49 have undergone FGM in Ethiopia.
Some key facts:
FGM mostly occurs in the Afar and Somali region,
where more than 90% of women and girls have
undergone FGM.
 Cont..
• Removing flesh is the most common form of
FGM in Ethiopia (type I and II).
• The most severe form of FGM, in which the
vaginal opening is sewn closed (type III), is
common in the Somali and Afar regions, but
rare elsewhere.
 Why is FGM still performed when it is
forbidden in Ethiopia?
• Female circumcision is an old cultural tradition that is
associated with views on purity, beauty, femininity and
sexual morals.
• The reasons why parents opt for circumcision are very varied.
• The marriageability of the girl can be an important factor,
and the choice may be influenced by the prevailing social
norm.
• In a community where circumcision is traditional, the
(psycho)social consequences for a girl who has not
undergone circumcision can be considerable (because it
makes her ‘different’).
 In general the reasons given for practicing FGM fall into five categories:

Psychosexual reasons: FGM is carried out as a

way to control women’s sexuality, which is
sometimes said to be insatiable if parts of the
genitalia, especially the clitoris, are not
removed.
• It is thought to ensure virginity before
marriage and fidelity afterward, and to
increase male sexual pleasure.
 Cont..
Sociological and Cultural reasons: FGM is
seen as part of a girl’s initiation into
womanhood and as an intrinsic part of a
community’s cultural heritage.
• Sometimes myths about female genitalia
(e.g., that an uncut clitoris will grow to the size
of a penis, or that FGM will enhance fertility or
promote child survival) perpetuate the
practice.
 Cont..
 Hygiene and Aesthetic reasons: In some communities,
the external female genitalia are considered dirty and
ugly and are removed, ostensibly to promote hygiene and
aesthetic appeal.
 Socio-economic reasons: In many communities, FGM is a
prerequisite for marriage.
• Where women are largely dependent on men, economic
necessity can be a major driver of the procedure.
• FGM sometimes is a prerequisite for the right to inherit.
• It may also be a major income source for practitioners.
 Cont..
Religious reasons: Although FGM is not
endorsed by either Islam or by Christianity,
supposed religious doctrine is often used to
justify the practice.
• Many famous imams and priests advocate to
eradicate FGM preaching that FGM has absolute
no relation or justification in religion, on the
contrary, it’s a harmful practice and therefore a
religious and moral duty to abandon it.
 Complications arising from FGM
• FGM is associated with various complications,
both long term and short term, physically,
psychologically and psychosocially.
• A few examples of common complications of
FGM are ;menstruation problems; difficulties
during child birth; sexual problems, such as
pain during sex or making it impossible for a
woman to have sex; anxiety and depression.
 Cont..
• Circumcised girls and women are often
unaware that (sexual) symptoms and/or
problems can be the result of FGM.
• This is why they often do not mention these
issues.
• It is therefore important for you, as a person
interacting with young people about such
topics, to be aware that (sexual) problems can
occur due to FGM.
 Health risks of FGM
• Female circumcision is usually performed in a
non-sterile environment without anesthesia
and can be fatal if the child goes into shock,
hemorrhages or becomes septic with
infection.
• Depending on the degree and severity of the
procedure chosen for the girl, she may
experience a lifetime of chronic pain and
dysfunction.
 Short-term health risks of FGM:
 Severe pain:
 Excessive bleeding (hemorrhage):
 Shock:
 Genital tissue swelling:
 Infections:
 Human immunodeficiency virus (HIV):
 Urination problems:
 Impaired wound healing:
 Death:
 Psychological consequences:
 Long-term Health risks from Types I, II and III
(occurring at any time during life) :
 Pain
 Infections
 Painful urination
 Menstrual problems:
 Keloids
 Human immunodeficiency virus (HIV)
 Female sexual health
 Obstetric complications
 Obstetric fistula
 Perinatal risks
 Psychological consequences:
Since FGM is part of a cultural tradition, can
it still be condemned?
• Yes. Culture and tradition provide a
framework for human well-being, and cultural
arguments cannot be used to condone
violence against people, male or female.
• Moreover, culture is not static, but constantly
changing and adapting.
 Child Marriage
• Child marriage is defined as marriage before the age of 18
years.
• Child marriage is more common in girls than boys.
• It is a violation of human rights, however, unfortunately, it
is still very common.
• One in five girls in the world is married before the age of 18
years.
• Approximately 82% of all children married before 18 years
are girls; 18% are boys.
• The highest numbers of child marriage occur in countries in
South Asia and sub-Saharan Africa.
The reasons why child marriage happens vary and are complex;

 Examples include:
gender inequality,
culture/tradition and
(food/financial) insecurity.
 Negative consequences of child marriage
include:
 Married children usually end their education
prematurely
 Child marriage blocks opportunities to gain
vocational and life skills
 Marriage exposes girls to the risks of too-early
pregnancy, child bearing, and motherhood before
they are physically and psychologically ready
 Child marriage increases the risk of intimate partner
violence, sexual violence and HIV infection.
 Child marriage in Ethiopia
• Four in ten young women in Ethiopia are
married in childhood.
• Levels vary across Ethiopia.
• Fewer than 10 per cent of young women were
married in childhood in Addis Ababa
compared to 50 percent or more in Afar,
Benishangul Gumuz and Somali regions.
 How to prevent child marriage?

 To prevent child marriage, communication is an

important tool.
 Children and young people can be empowered
by giving them information about their rights
and ensuring that they have the skills to
exercise their rights.
 Inform your students, peers and the
community about the importance of education
and the consequences of child marriage.
GBV SURVIVOR
 Guiding Principles to Care for a GBV
Survivor
 Survivor-centered care promotes the following
survivors’ rights:
o Dignity and respect – the right to be treated with
dignity and respect, and not be blamed for the
violence perpetrated against her.
o Life – the right to a life free from fear and violence.
o Self-determination – the right to make one’s own
decisions, including sexual and reproductive
decisions; to refuse medical procedures and/or take
legal action; and to choose the course of action.
 Cont..
o The highest attainable standard of health – the
right to health-care services of good quality,
that are available, accessible and acceptable
o Non-discrimination – the right to be offered
health-care services without discrimination, i.e.
treatment is not refused based on race,
ethnicity, caste, sexual orientation, gender
identity, religion, disability, marital status,
occupation, political beliefs or any other factor.
 Cont..
o Privacy and confidentiality – the right to be
provided with care, treatment and counseling that
is private and confidential, and to decide which
information is included in one’s records and for
information not to be disclosed without consent.
o Information – the right to know what information
has been collected about one’s health and to have
access to this information, including medical
records.
 Protocol for Quality Care
• Sexual violence and GBV damages women’s
health in many ways – immediate and long
term, obvious and hidden.
• Women who have experienced violence can
suffer injuries (including genital injuries),
unintended pregnancy and pregnancy
complications, sexually transmitted infections
(STIs) including HIV, pelvic pain, urinary tract
infections, fistula and chronic conditions.
 Psychological consequences of GBV can
be:
 Behavioral (e.g., self-harm)
 Cognitive (e.g., attention and memory
problems)
 Mental health problems (e.g., anxiety,
depression, post-traumatic stress disorder)
 Emotional (e.g., self-blame, anger, feelings of
humiliation)
 Cont..
• The mental health impact of sexual violence
may include acute stress reactions, post-
traumatic stress disorder (PTSD), depression,
anxiety, sleep disturbances, substance misuse,
self-harm and suicidal behavior.
• In addition, survivors may face stigma and
rejection from their families and communities.
The protocol to provide quality care to survivors
of sexual and GBV is divided into six parts:

1. Preparations, including consent for a medical

consultation
2. Providing first-line support
3. Clinical management of rape (step by step)
4. Identification and care for survivors of intimate
partner violence
5. Additional care for mental health and
psychosocial support
6. Caring for child survivors
 Providing First-line Support
• First-line support involves five simple elements: “LIVES”
 Listening: Listen to the woman closely, with empathy, and
without judging.
 Inquiring about needs and concerns: Assess and respond to her
various needs and concerns – emotional, physical, social and
practical (e.g. childcare).
 Validating: Show her that you understand and believe her. Assure
her that she is not to blame.
 Enhancing safety: Discuss a plan to protect herself from further
harm if violence occurs again.
 Supporting: Support her by helping her to access information,
services and social support.
 Question for GBV Survivor
 Phrase your questions as invitations to speak
 Example: “What would you like to talk about?”
 Ask open-ended questions to encourage her to talk, instead of asking questions that
can be answered with just “yes” or “no”
 Example: ''How do you feel about that?”
 Reflect her feelings back to her in your words so she knows that you have
listened/observed and understood
 Example: “It sounds as if you are feeling angry about that” OR "You seem upset''

 Ask for clarification if you do not understand

 Example: “Can you explain that again, please?” OR “Could you tell me more about
that?”
 Help her to identify and express her needs and concerns
 Example: “Is there anything that you need or are concerned about?” OR “It sounds like
you may need a place to stay” OR “It sounds like you are worried about your children”
 Validating
• Validating lets a woman know that her feelings
are normal, that it is safe to express them,
that she has a right to live without violence
and fear, and that you believe what she says
without judgment or conditions
 Important things that you can say:
• “It’s not your fault. You are not to blame.”
• “Help is available.” (Say this only if it is true.)
 Cont..
• “What happened has no justification or excuse.”
• “No one deserves to be hit by their partner or
anyone.”
• “You are not alone. Unfortunately, many other
women face this problem too.”
• “You are valuable. Your life and your health are
important.”
• “I am worried that this may be affecting your
health.”
CLINICAL MANAGEMENT
Clinical Management of Rape OF
RAPE
 Clinical Management of Rape
• Survivors should seek care as soon as possible,
preferably within 24-72 hours of the assault.
• However, if one is unable to seek care within
this time, they should still be able to receive
medical care.
• By seeking medical treatment, survivors are
acknowledging that physical and/or emotional
damage has occurred.
• They most likely have health concerns.
 Cont..
• The health care provider can address these
concerns and help survivors begin the
recovery process by providing compassionate,
thorough and high-quality medical care, by
centering this care around the survivor and
her needs, and by being aware of the setting-
specific circumstances that may affect the care
provided
 Cont..
• First, it is crucial to take a brief history
regarding:
Time and place of the assault
What was done to them: nature of sex (oral,
penetrative, touching, kissing etc.)
If contraception or condoms were used
The essential components of medical care
after a rape are:
Documentation of injuries; perform a thorough
general and genital examination to look for any injuries
and to collect evidence for forensic evaluation.
Collection; of forensic evidence
Treatment; of injuries
Test for STIs and preventive care; some of these tests
include tests for HIV, hepatitis B, syphilis, chlamydia,
gonorrhea and trichomonas. In case of negative
results, prophylactic treatment for STIs must be
provided.
 Cont..
 Test for STIs and preventive care; some of these tests
include tests for HIV, hepatitis B, syphilis, chlamydia,
gonorrhea and trichomonas.
• In case of negative results, prophylactic treatment for STIs
must be provided.

 Evaluation for risk of pregnancy and prevention; conduct a

pregnancy test to rule out any pre-existing pregnancy in all
women of childbearing age.
• Emergency contraception can be offered up to three and
possibly five days after unprotected vaginal rape.
 Cont..
 Psychosocial support, counseling and follow-up; Rape is
a traumatic experience.
• Counseling will help facilitate recovery in assault victims,
and help them regain control of their lives.
• Ask them to come back to the health facility at a later date
to discuss the test results, review how the patient is
coping, assess the healing, and to perform further testing.
• If counseling has not already been arranged, assess and
discuss the need for it.
 Report
HISTORY OF RAPE SURVIVOR
 Preventi on of Gender-
Prevention of Gender-Based Violence
Based Violence
 How to Prevent GBV?
• Human rights approach
• GBV is a society wide issue across the world,
hence different actors (governments, donors
and civil society) are working towards creating
appropriated prevention and response
mechanisms to address the complex
intersecting dynamics that perpetuate such
violence.
 Cont..
• Human rights do not only entail rights but they also
entail obligations, of which the State is the main bearer.
• Accordingly, the State assumes obligations and duties
under international law to respect, to protect and to
fulfill human rights of all persons and actions which
violate or fail to support the realization of human rights
contravene human rights obligations.
• A rights-based approach thus presumes the creation of
an environment which enables the enjoyment of human
rights
 Primary prevention

• Primary prevention of GBV means undertaking any targeted

activities with the aim of eliminating the systemic conditions for GBV
to occur.
• This includes addressing the underlying causes of GBV related
to discrimination and existing inequalities between men and women,
as GBV disproportionally affects women and girls.
• Furthermore, addressing social norms and environmental factors that
contribute to violence (e.g. attitudes and beliefs that
condone/disregard GBV).
• Moreover, and very importantly, prevention strategies should aim to
reduce risk factors and promote protective factors for GBV.
• This can be done by developing prevention activities that avert initial
perpetration or victimization.
 Cont..
• For comprehensive prevention strategies, a multi-
targeted approach including factors that influence
GBV/SV at all levels - individual, relationship,
community, and society – should be adequately
addressed.
• The ecological framework model offers a
comprehensive basis for understanding the risk
factors of GBV and their interaction among many
factors at the different levels – individual,
relationship, community and societal.
• It is based on the fact that no single factor can
explain why some people or groups are more
vulnerable to violence than others.
Cont..
 Cont..
Secondary prevention
• Measures to avoid repetition of the
incident (this includes identification of
persons who were survivors of GBV).
Tertiary prevention
• Care for the survivor following the
incident and early intervention in order
to improve rehabilitation and avoid
permanent ill health.
Requirements for Sustainable
Prevention Interventions
 In order to sustainably
prevent GBV, prevention
interventions should:
• Increase awareness of the scope of the
problem of GBV and its impact;
• Challenge the existing gender values, norms,
and the relative power dynamics governing
relations between women and men;
• Identify and try to eliminate risk factors that
increase vulnerability of persons to become
victims of GBV;
 Cont..
 Include risk reduction techniques (focused on
perpetrator), i.e. strategies which attempt to alter
risk and protective factors in order to decrease the
likelihood of an individual to commit such violence.
- Increase knowledge of the elements of sexual
consent;
- Increase knowledge and awareness of sexual
abuse and harassment;
- Start early in life, by educating and working with
young boys and girls to foster respectful
relationships, and gender equality;
- Involve actions to improve women’s
empowerment, economic autonomy and security
 Strategies to Prevent GBV and
the Role of Healthcare Providers
• The two main strategies for prevention
intervention are visibility at community -
and health facility level:
• 1. Community level interventions
• 2. Facility level interventions
• Community Mobilization and Process of
Social Change
• Primary prevention of GBV in the community
through health extension workers is a
critical and essential intervention.
 Cont..
• Prevention and sensitization programs in
communities are essential to promote
positive behavioral change and to eventually
eliminate GBV. Changing community norms
is a process, not a single event.
• Interventions which are based on an
understanding of how individuals naturally
go through a process of change can be more
effective than haphazard messages pushed
into the community
Stages of the Theory of change of how individuals can change
their behavior can be used to design strategies for community
mobilization.
 Cont..
 In order to address each of the Stages of
Change, health extension workers and
health care providers should:
Adopt a human rights-based approach
Organize and promote awareness-raising
activities
Increase male engagement
Make GBV a standing agenda
Strengthen secondary and tertiary
prevention measures
 2. Facility Level Interventions

• The way cases of GBV are managed by health

workers in health facilities, also with regard to
the multi-sectoral approach including social
and legal support for survivors, is important in
the aim of eliminated such form of violence.
• Indeed, compassionate and appropriate car
e can go a long way.
• It can help to identify and better understand
causes and consequences of GBV, and can
contribute to eliminating risk factors as well as
promoting protective factors.
 Identifying a Survivor who may
be exposed to GBV
• It is important for health care providers to be
aware that health problems may be caused or
made worse by violence.
• Survivors, especially women and children
subjected to violence in intimate relationships,
often seek health care for
resulting emotional or physical conditions,
including injuries.
• However, they do not always disclose about
the violence due to feelings of shame and guilt
or fear of being judged.
 Cont..
• Moreover, confidentiality and fear of
reprisal can be reasons why survivors
prefer to keep silent.
• Nevertheless, early identification of
survivors of GBV is important in providing
adequate care and follow-up.
• Therefore, health care providers
should consider the possibility of
GBV to have occurred when clinically
assessing and managing patients.
 You should feel alerted if a woman
comes with any of the following:
 Ongoing emotional health issues, such as stress,
anxiety or depression;
 Harmful behaviors such as misuse of alcohol or drugs;
 Thoughts, plans or acts of self-harm or (attempted)
suicide;
 Repeated injuries or injuries of which the origin cannot
be well explained;
 Repeated sexually transmitted infections;
 Unwanted pregnancy; Unexplained chronic pain or
conditions (pelvic pain or sexual problems,
gastrointestinal problems, kidney or bladder infections,
headaches);
 Repeated health consultations with no clear diagnosis;
 Promotion of Health Education within
Health Facilities

 Health education within health facilities

can be promoted through the following
interventions:-
• Making the prevention of GBV a standing
agenda during health education sessions
at health facilities.
• Raising the following topics to prompt
discussion among attendees of health
facilities and to critically challenge their
understanding.
END