Gender-Based Violence Survivors: Comparison
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Please note this is a comparison between Version 2 by Jessie Wu and Version 1 by Olutoyin Opeyemi Ikuteyijo.

Survivors of sexual and gender-based violence (SGBV) are often hindered in their quest to access quality healthcare. This has a significant effect towards the achievement of Sustainable Development Goal SDG Target 3.7. to ensure universal access to sexual and reproductive healthcare services. 

  • health providers
  • female adolescents
  • sexual and gender-based violence
  • barriers

1. Introduction

Around the world, female adolescents and young women are at risk of sexual and gender-based violence perpetuated by their intimate male partners. Globally, statistics have shown that nearly one in three adolescent girls (aged 15–19 years), or about 84 million, have been victims of physical, emotional, and sexual violence perpetrated by their husbands or intimate partners. Additionally, about 15 million have experienced forced sex, and one in five women aged 20–24 were married before 18 [1].
The well-being of young people, particularly young women is a critical developmental agenda and featured prominently in the Sustainable Development Goals (SDG) [2]. According to the Secretary General of the United Nations, “Adolescents are central to everything wresearchers want to achieve, and to the overall success of the 2030 Agenda” [3]. Within the African continent, The Maputo Plan of Action (2016–2030), and The African Agenda 2063 all converged on the need to prioritize investment in ensuring a healthy and productive young generation, as the future of adolescents is essential in the development of societies.
The age of adolescence relates to diverse experiences that are, however, different from experiences of other age groups, which explains the need for specific programs and interventions targeting the diverse group of adolescents [4]. Initiatives such as the Global Strategy for Women’s Children’s and Adolescents’ Health 2016–2030 and the WHO Global Accelerated Action for the Health of Adolescents (AA-HA!) [4] have called for research on adolescents’ sexual and reproductive health as well as their experiences of gender-based violence. Research has shown that in Sub-Saharan Africa, 33% of women aged 15–49 years have experienced sexual SGBVand gender-based violence (SGBV) in their lifetime, and 20% experienced SGBV in the previous year [5]. Additionally, 1 in 4 adolescent girls who have been in a relationship had experienced all forms of SGBV [5].
Nigeria is a signatory and has made commitment to several international developmental agendas and initiatives, including the SDG [2], the International Conference on Population and Development (ICPD) and ICPD Beyond 2014 Follow-Up Action [6], and the Convention on Elimination of All Forms of Discrimination against Women (CEDAW) [7]. Despite Nigeria’s commitment, nearly 3 in 10 women have experienced physical violence by the age of 15 years [8], and 9% had experienced sexual violence in the previous year [9]. At sub-national level, a study from Calabar, in southeastern Nigeria among teenage girls, found that beatings by sexual partners and guardians were prevalent in the study area [10] while a study from the eastern part of Nigeria also found a high prevalence of violence among adolescents, with parents and relatives being the major perpetrators [11]; in Lagos a study among adolescents found that 36% initiated sex by coercion and 64% believed sexual violence was common in the community [12].
Nigeria is a multi-cultural and multi-ethnic society with over 500 languages and about 250 ethnic groups. However, across the country, a patriarchal system dominates Nigerian societies providing an environment for SGBV. Within this context of gender inequity and cultural norms, the magnitude of some of these gender-based vices continue to increase. Although the government has enacted the Violence Against Peoples Prohibition Act [13], this has not translated into the desired outcome [14]. Despite the high incidence and magnitude of SGBV, there is also a lot of concern for care and support for survivors, particularly for their health and general well-being.
AYW face countless barriers in utilizing services for their health and well-being, particularly the survivors of GBV. The demand side of services by AYW, ranging from psycho-social support, counseling, justice, and other therapies, are influenced by many factors. The first step is the ability to report to the appropriate service. However, this is overshadowed by some values and restraints which are described as “culture of silence” [15] a social norm that is often referred to as common among women experiencing SGBV in an intimate relationship “The culture of silence is described as the behavior of a group of people that by unuttered agreement do not mention, discuss, or acknowledge a particular subject. In this context, it is the act of keeping an unspoken agreement not to speak about what happened to them”survivor [15]. Not only in Nigeria, but also in other contexts, adolescents and young women find it difficult to speak out due to shame, stigma, and some socio-culturally shaped ideation [16] about retaliation effects on the survivors [17,18][17][18]. In addition, depending on the relation to the state, there is also a perceived notion of a lack of confidence in the state agencies, including the healthcare systems [19,20][19][20]. While there has been an increase in youth-friendly sexual and reproductive health services (YF-SRHS) that target contraceptive uptake of young people in Nigeria, there is still a gap in integrating SGBV services into this youth friendly initiative.
An extension of youth-friendly services to issues of violence among young people will enhance disclosure of SGBV in intimate relationships. There is evidence that family planning clinics that provided education about gender-based violence improved health providers’ knowledge of handling SGBV cases and support to survivors of SGBV [21]. However, in the past, the support services available to adolescents and young women in Nigeria have been mostly informal, i.e., families, friends, and religious bodies [22]. This support has not necessarily translated into the desired improvement for mitigating SGBV experiences among young women. Hence, there is a need to focus on improving the health system’s preparedness to address and support the survivors of SGBV, particularly vulnerable adolescent girls.

2. The Role of Health Providers

Healthcare services are essential in mitigating the consequences of violence among women, especially the most vulnerable group of female adolescents and young women living in low-income neighborhoods or slums. Globally, healthcare facilities remain one of the key entry points for survivors of violence among AYW to provide diverse support services [23] as to seek treatment for sexual, physical, psychological, and other reproductive morbidity due to a violent experience. The World Health Organization (WHO) manual [24] identified healthcare providers as critical in addressing SGBV. According to the manual, they are an important agency in “identifying a survivor, facilitating access to support services, contributing to preventing the recurrence of violence, integrating into health education and health promotion with clients, involvement in community awareness about human rights and documenting the magnitude of the problem for advocacy”. A Lancet publication on violence against women identified the healthcare facility as a safe environment for survivors of violence that will aid in open disclosure and appropriate support systems for survivors [25].
There is a dearth of studies that addressed specific sectors of the health system (psychology, psychiatry, counseling, and rehabilitation centers) on their roles in combating violence in Nigeria. Healthcare providers are critical stakeholders in improving the health outcomes of SGBV survivors [26]. Studies on SGBV from Nigeria have largely focused on issues of justice and the involvement of legal authorities, such as the police [27,28,29][27][28][29]. Other studies available are mostly from high-income countries [20,21,30][20][21][30].

3. Intersectionality in Healthcare Service for Gender-BVased Violence Survivors

Intersectionality theory is a systemic perspective [31] to understand how systems of power and privilege constitute people’s experiences of oppression and marginalization. It addresses various ways in which individuals belong to multiple social positions simultaneously such as age, gender, ethnicity, cultural background, socioeconomic class, sexual orientation, religious belief, dis/ability status, and citizenship status, and how this shapes people to continuously inform positions of social power relations [32,33][32][33].
From a health system perspective, intersectionality brings attention to diversity within population groups that were considered homogenous, giving explanations to nuances surrounding vulnerabilities and the intricate nature of health inequities [34]. Intersectionality is regarded as an approach to fostering a multifaceted analysis of power structures and relations that interact to produce and sustain inequalities in various health outcomes [31,34,35][31][34][35] by addressing the power dynamics, which invariably exist at the center of violence experienced by AYW. Intersectional violence occurs in terms of place and time “The term “survivor” in this text refers to adolescents and young women who have experienced sexual and gender-based violence at some point in their intimate relationship and who have suffered pain and injury but not death. The term “survivors” also refers to those women who are currently still in an abusive relationship” as systemic domination and exclusion to form a unique oppression that is typically not detected by traditional methods and modes of interpretation [33]. This focus on power dynamics first encompasses how different experiences of violence create diversity in terms of support (social and health), what is available, and social locations of privilege and disadvantage. City dwellers in marginalized areas are exposed to poor healthcare services due to low socioeconomic status and environmental conditions. AYW are disadvantaged due to the location where they reside and linked the lack of available services. The majority of health professional services (psychologists, psychiatrists, counselors, and rehabilitation centers) that would give support in the process of recovery from violence are not available in most or any of the PHC facilities in the low-income urban communities in Nigeria. However, these services are essential to mitigate experiences of SGBV among AYW and also to prevent re-victimization and morbidity among this group. Increased risk of SGBV among female AYW creates differential burdens with less access to formal support services. Each of these services is important although they were less emphasized in the past, especially in the Nigerian context where these services were not sufficient or ever existed and were most needed.

References

  1. United Nations. UN Special Representative of the Secretary-General on Violence against Children. 2021. Available online: https://violenceagainstchildren.un.org/content/girls (accessed on 4 October 2022).
  2. United Nations. Transforming Our World: The 2030 Agenda for Sustainable Development. Department of Economic and Social Affairs Sustainable Development. 2015. Available online: https://sdgs.un.org/2030agenda (accessed on 15 October 2022).
  3. World Health Organization. Global Accelerated Action for the Health of Adolescents (AA-HA!): Guidance to Support Country Implementation. 2017. Available online: https://www.who.int/publications/i/item/9789241512343 (accessed on 6 January 2023).
  4. World Health Organization. Global Strategy for Women’s, Children’s and Adolescent’s Health 2016–2030. 2018. Available online: https://www.who.int/publications/i/item/A71-19 (accessed on 15 October 2022).
  5. World Bank. Violence against Women and Girls—What the Data Tell Us. 2022. Available online: https://genderdata.worldbank.org/data-stories/overview-of-gender-based-violence/ (accessed on 15 October 2022).
  6. UNFPA. ICPD Beyond 2014, High-Level Global Commitments: Implementing the Population and Development Agenda. 2016. Available online: https://www.unfpa.org/sites/default/files/pub-pdf/ICPD_UNGASS_REPORT_for_website.pdf (accessed on 15 October 2022).
  7. United Nations. Convention on the Elimination of All Forms of Discrimination against Women New York, 18 December 1979. United Nations Human Rights Office of the High Commissioner. 1979. Available online: https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-elimination-all-forms-discrimination-against-women (accessed on 19 October 2022).
  8. NPC and ICF. Nigeria Demographic and Health Survey 2018; NPC and ICF: Abuja, Nigeria; Rockville, MD, USA, 2019.
  9. NPC and ICF. Nigeria Demographic and Health Survey 2013; NPC and ICF: Abuja, Nigeria; Rockville, MD, USA, 2014.
  10. Egbe, I.B.; Augustina, O.O.; Itita, E.V.; Patrick, A.E.; Bassey, O.U. Sexual behaviour and domestic violence among teenage girls in Yakurr local government area, cross river state, Nigeria. Acad. J. Interdiscip. Stud. 2020, 9, 101–110.
  11. Okey-Orji, S.; Asogwa, E.U. Prevalence and perpetrators of domestic violence against adolescents in Rivers State. Arch. Bus. Res. 2020, 8, 1–14.
  12. Odeyemi, K.; Olufunlayo, T.; Ogunnowo, B.; Onajole, A. Sexual violence among out-of-school female adolescents in Lagos, Nigeria. SAGE Open 2016, 6, 2158244016669972.
  13. International Labour Organization. Violence against Persons (Prohibition) Act 2015. 2015. Available online: https://www.ilo.org/dyn/natlex/docs/ELECTRONIC/104156/126946/F-1224509384/NGA104156.pdf (accessed on 17 August 2022).
  14. Mshelia, I.I.H. Gender based violence and violence against women in Nigeria: A sociological analysis. Int. J. Res. Innov. Soc. Sci. (IJRISS) 2021, 5, 647–683.
  15. Akoja, M.I.; Anjorin, A.G. Social media and women’s culture of silence on sexual violence: Perception of babcock university’s female undergraduates. Commun. Cult. Afr. 2020, 2, 50–76.
  16. Aborisade, R.A. Sexual violence at music festivals and the ‘theory of silence’: Unravelling the ‘hideous’ sexual assault problem in Nigerian open-air musical events. J. Vict. Vict. Justice 2021, 4, 68–87.
  17. Adegbite, O.; Ajuwon, A. Intimate partner violence among women of child bearing age in Alimosho LGA of Lagos State, Nigeria. Afr. J. Biomed. Res. 2015, 18, 135–146.
  18. Herrero-Arias, R.; Truong, A.N.; Ortiz-Barreda, G.; Briones-Vozmediano, E. Keeping silent or running away. The voices of Vietnamese women survivors of Intimate Partner Violence. Glob. Health Action 2021, 14, 1863128.
  19. Rohn, E.; Tenkorang, E.Y. Motivations and barriers to help-seeking among female victims of intimate partner violence in Ghana. Violence Against Women 2022.
  20. Rodella Sapia, M.D.; Wangmo, T.; Dagron, S.; Elger, B.S. Understanding access to professional healthcare among asylum seekers facing gender-based violence: A qualitative study from a stakeholder perspective. BMC Int. Health Hum. Rights 2020, 20, 25.
  21. Miller, E.; McCauley, H.L.; Decker, M.R.; Levenson, R.; Zelazny, S.; Jones, K.A.; Anderson, H.; Silverman, J.G. Implementation of a family planning clinic–based partner violence and reproductive coercion intervention: Provider and patient perspectives. Perspect. Sex. Reprod. Health 2017, 49, 85–93.
  22. Le Roux, E.; Kramm, N.; Scott, N.; Sandilands, M.; Loots, L.; Olivier, J.; Arango, D.; O’Sullivan, V. Getting dirty: Working with faith leaders to prevent and respond to gender-based violence. Rev. Faith Int. Aff. 2016, 14, 22–35.
  23. UN Women. Handbook for National Action Plans on Violence against Women; UN Women: New York, NY, USA, 2012; Available online: https://www.unwomen.org/sites/default/files/Headquarters/Attachments/Sections/Library/Publications/2012/7/HandbookNationalActionPlansOnVAW-en%20pdf.pdf (accessed on 7 January 2023).
  24. World Health Organization. Strengthening Health Systems to Respond to Women Subjected to Intimate Partner Violence or Sexual Violence: A Manual for Health Managers. 2017. Available online: https://apps.who.int/iris/handle/10665/259489 (accessed on 17 August 2022).
  25. García-Moreno, C.; Zimmerman, C.; Morris-Gehring, A.; Heise, L.; Amin, A.; Abrahams, N.; Montoya, O.; Bhate-Deosthali, P.; Kilonzo, N.; Watts, C. Addressing violence against women: A call to action. Lancet 2015, 385, 1685–1695.
  26. Ogbe, E.; Jbour, A.; Rahbari, L.; Unnithan, M.; Degomme, O. The potential role of network-oriented interventions for survivors of sexual and gender-based violence among asylum seekers in Belgium. BMC Public Health 2021, 21, 25.
  27. Fawole, O.I.; Ajuwon, A.J.; Osungbade, K.O. Evaluation of interventions to prevent gender-based violence among young female apprentices in Ibadan, Nigeria. Health Educ. 2005, 105, 186–203.
  28. Wada, O.Z.; Olawade, D.B.; Amusa, A.O.; Moses, J.O.; Eteng, G.J. Gender-based violence during COVID-19 lockdown: Case study of a community in Lagos, Nigeria. Afr. Health Sci. 2022, 22, 79–87.
  29. Azuh, D.E.; Egharevba, M.E.; Azuh, A.E.; Olaoye, O.P.; Alabi, E.O. Knowledge and Predicaments of Gender-Based Violence in Southwest Nigeria. Proceedings of ADVED—7th International Conference on Advances in Education, Online, 18–19 October 2021.
  30. Briones-Vozmediano, E.; Goicolea, I.; Ortiz-Barreda, G.M.; Gil-González, D.; Vives-Cases, C. Professionals’ perceptions of support resources for battered immigrant women: Chronicle of an anticipated failure. J. Interpers. Violence 2014, 29, 1006–1027.
  31. Crenshaw, K.W. Mapping the margins: Intersectionality, identity politics, and violence against women of color. In The Public Nature of Private Violence; Routledge: London, UK, 2013; pp. 93–118.
  32. Sokoloff, N.J.; Dupont, I. Domestic violence at the intersections of race, class, and gender: Challenges and contributions to understanding violence against marginalized women in diverse communities. Violence Against Women 2005, 11, 38–64.
  33. Grzanka, P.R. From buzzword to critical psychology: An invitation to take intersectionality seriously. Women Ther. 2020, 43, 244–261.
  34. Kapilashrami, A.; Hankivsky, O. Intersectionality and why it matters to global health. Lancet 2018, 391, 2589–2591.
  35. Kapilashrami, A. What is intersectionality and what promise does it hold for advancing a rights-based sexual and reproductive health agenda? BMJ Sex. Reprod. Health 2020, 46, 4–7.
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