GENDER BASED

VIOLENCE
Dr Olive Sentumbwe-Mugisa,
Family Health and Population Advisor
WHO,Uganda

Purpose of this
presentation

To understand how and why Gender Based

Violence remains a major public health
concern in Uganda and how it can be
addressed.

Factors which have an impact on health

Biological differences:
Anatomical
Physiological (hormones)
Genetic susceptibilities
Immune system

Social-cultural differences:
Gender roles & responsibilities
Gender norms
Expectations

Access & control over resources:

Resources:
Economic: money, credit, food, transport
Social : community resources, social networks
Political: position of leadership, access to decision-makers, participation
Information & education: formal & informal education, opportunities to exchange information and opinions
Time: time available to participate in community and other activities, as well as access health services
Internal resources: self-esteem. Self confidence and ability to express own interests

Control & decision-making: knowledge, skills & authority

Health outcomes & response:

Human Rights

ADVOCACY

All human beings are born free and equal in dignity

and rights (Universal Declaration of Human Rights)
Human rights are universal, inalienable, indivisible,
interconnected and interdependent.
Everyone is entitled to all the rights and freedoms,
without distinction of any kind, such as race, gender,
religion, political opinion, etc.
Prevention of and response to gender-based violence is
directly linked to the protection of human rights.

GBV and Human Rights

ADVOCACY

GBV violates a number of human rights principles:

- life, liberty and security of the person
- freedom from torture or cruel, inhuman, or degrading
treatment or punishment
- freedom of movement, opinion, expression, and association
- entering into marriage with free and full consent and the
entitlement to equal rights to marriage, during
marriage and
at its dissolution
- equality, including to equal protection under the law, even
during war
- human dignity and physical integrity
- be free from all forms of discrimination
- equality in the family
- the highest attainable standard of physical and mental health

What is Gender based sexual

violence?
Any sexual act, attempt to obtain a sexual act,
unwanted sexual comments or advances or acts to traffic,
or otherwise directed against a persons sexuality
using coercion, by any person regardless of their
relationship to the victim or survivor
In any setting including but not limited to home and
work

Magnitude of sexual violence

The True magnitude is not known because of fear
of
shame, blame, threat
powerlessness,
lack of support, breakdown or unreliability of
public services, the dispersion of families and
communities, etc

Highlights on the MDGs

Eradicate extreme poverty and hunger

Achieve Universal Primary Education
Promote Gender equality and empower women
Reduce Child Mortality
Improve Maternal Health
Combat HIV/AIDS, malaria and other diseases Ensure
environmental sustainability
Develop a global partnership for development

Gender and the MDGs

The MDGs cannot be reached without
attention to GENDER !

Of the 8 MDGs #3 is specifically about Gender equality and

Empowerment of women
All the others have significant implications for gender
mainstreaming, especially 1, 2,4, 5, 6, 7 in relation to SGBV

Addressing gender norms and inequalities is of critical

importance to every MDG.

Context in WHO
Health for All
All are not the same
All DO NOT enjoy the same rights and
opportunities

SEX AND GENDER

Whats the difference?

SEX
Biological concept
Biological & physiological
difference
Set by nature
Universal norm
Relatively fixed (except by
surgery)

GENDER
Sociological concept
Social difference
Norms set by society and
learned by individual girls, boys,
women and men
Varies from one society to the
next, depending on age, class,
religion, economy, politics, etc.
Subject to change and evolution
as society evolves

Gender is
Relational relationships between women and men
Hierarchical deals with power
Historical factors change over time & space
Contextually specific variations due to ethnicity, age,

Institutionally structured upheld by social systems,

values, legislation

HIV/AIDS

Overall HIV Prevalence in Uganda by Sex

and Age

Adult HIV Prevalence by age

HIV Prevalence by age at first sex

Early sexual
debut is
strongly
associated
with risk of
HIV infection
especially
among
women,
though this is
not seen
among men

Differences in sexual
transmission of HIV/AIDS
Several studies have shown that it is easier for a women to
contract HIV/AIDS from a sexual contact with an infected
man than it is for a man with an infected woman
Coerced sex increases risk of micro-lesions; more frequent
for women, although also important in young boys
The presence of an untreated STI can make that person up
to 10 times more likely both, to catch and to transmit HIV
those infections do not give rise to any symptoms in women
so they are often not recognised or treated

Why does work on gender

focus on women?
Gender inequalities yield a disproportionate burden
on women.
But! Social norms can also negatively impact upon
men's health.
Conclusion? Gender is an important determinant of
health for BOTH women and men.

Gender analysis in health

contributes to the understanding
of:
Differences in risk factors,
Exposures and manifestations of disease;
Differences in the severity and frequency of diseases
among men, women, boys and girls; and
The responses of the culture, society and health system
to these problems.

Some basic questions:

Gender Analysis
Where are the women, men, girls and boys?
What are the effects of gender norms, roles and activities?
What are the effects of access to, and control of, resources?
What are the effects of biological differences between the
sexes?

PUBLIC HEALTH ISSUE

SEXUAL AND GENDER BASED VIOLENCE
IS A MAJOR PUBLIC HEALTH CONCERN IN
UGANDA
Reflected in both the National Health Policy and
the health sector strategic plan

CRIME RATE
The police defines serious crime to include murder,
rape, defilement and aggravated robbery
Defilement and Rape have been indicated as the most
serious crimes with defilement cases
numbering15,385(2006) 17,031(2007) and 750
(2006),809 (2007) out of the total of 20,768 (2006) and
22,313 (2007)

Magnitude of SGBV in Uganda

Most Ugandans have experienced interpersonal violence in their
lives, whether physical, sexual, or emotional. Directed against
women, most violence is gender basedthat is, it occurs
because of womens subordinate status in the society.

Gender-based violence is an obvious and dangerous violation of

human rights with serious consequences for womens health and
well-being.

Magnitude continues
Although both women and men experience violence in Uganda,
women are more likely to suffer every form of violence and to
experience it more frequently.
According to the 2006 UDHS, six in ten Ugandan women
(including married and unmarried) have experienced physical
violence since they were 15 years of age. One-third of women
(34 percent) had experienced it in the 12 months preceding the
survey including 7 percent who said they faced it often.
Men are somewhat less likely than women to have ever
experienced physical violence (53 percent)

Magnitude
Almost four in ten women (39 percent) aged 15-49 have ever
experienced sexual violence, compared to one in ten men (11
percent).
Sexual Violence against women is most common among women
who are divorced, separated, or widowed, at 55 percent, followed
by 43 percent among women currently married or living together,
and 18 percent among never-married women.
Overall 44 percent of women who have experienced sexual
violence say their current husband or partner was responsible,
while another 22 percent cite a former husband or partner.

Magnitude of SGBV conti- Sexual violence often begins the first time a woman has
sexual intercourse. One quarter of women age 15-49
(24 percent) say their first sexual intercourse was forced
against their will.
As might be expected, this percentage is highest among
women whose first sexual experience was before
marriage, and among women whose first sexual
experience occurred before the age of 15.

MEN and VIOLENCE

Men are less likely than are women to experience
spousal violence. Twenty percent of ever-married men
age 15-49 report having experienced physical violence,
Fewer than one in ten have experienced sexual
violence,
While 35 percent have experienced emotional violence
by their wife or partner

Seeking Help for Violence

The 2006 UDHS asked all women and men who had
experienced physical or sexual violence from any
source about the help they may have sought.
Only 35 percent of women and 34 percent of men who
have experienced physical or sexual violence seek any
help.
Most frequently, women seek help from their own family
or from in-laws.

Seeking Help for Violence

Only 18 percent seek help from a social service
organization and 6 percent from the police.
Although their own family is also the predominant
source of help for men, men are more likely than
women to seek help from social service organizations
(23 percent) and the police (12 percent).

Factors linked to Sexual and Gender

Based Violence

Alcohol
Power relations
Drugs
Ritual murders
Myths about HIV cure?
Adventure as in Adolescents
Juvenile delinquency etc
Male relatives

Factors linked to Sexual and Gender

Based Violence
Harmful cultural values/beliefs/practices such early
marriage, widow inheritance, dowry,etc
Conflicts
Pornography

Key Issues in the Management of

SGBV
Police Form 3 is regularly out of stock at many police posts yet it
serves as an entry point to both medical and legal redress
PEP unavailability -ARVs, Emergency contraception and drugs
for management of STIs
Inadequately trained service providers
Systematic denial of care by some service providers who do not
want to be involved with the legal process or who insist that
police form 3 must be filled first

Access to justice and medical

treatment: WHO FILLS PF3?
There is no clarity amongst the public and service
providers on who has the legal authority to complete
police form 3. If there is a practice guide it is unknown to
the majority of us
There is inconsistence of interpretation and
understanding of who is supposed to fill PF3
There are very few doctors at the levels where the
victims/survivors of rape are let alone very few willing
doctors to examine the survivor

Access to justice and medical

treatment: WHO FILLS PF3?
The implications are that without documentation the perpetrators
are released by the police as the procedural evidence is lacking
It is the highest medical ranking official in an area, who is the only
person authorised to provide medical testimony accepted by the
court
Sometimes the survivors are expected to pay for the services
rendered to them in public institutions
I am made to understand that the questions and language on the
PF3 are unethical and out of line with internationally recognised
standards for the treatment of survivors

Access to justice and medical

treatment DENIED
By the end of october 2007 in some of the northern
districts the average fee requested for PF3 was 25,000UGX
Survivors can also be asked to pay for the transport of
the perpetrators, his accommodation and for the arrest
warrant or for the transport of the police officer to
investigate

Access to justice and medical

treatment DENIED
Doctors also have issues with the courts:

Rude
Time wasting
Not paid for time spent
Disorganised judiciary who sometimes cancel hearings
without informing the medical personnel

Major National concerns on

SGBV
Very Negative Impact on Health for victims/survivors death, HIV,
unwanted pregnancy , unsafe abortion
Negative development issues- school dropouts, street children,
increased hospital costs
Inadequate management
High SGBV in conflict areas

Conclusion and
Recommendations
A culture of silence surrounds the topic of gender based
violence. A woman who suffers at the hands of her
intimate partner, teacher, colleague , employer, father ,
brother is understandably reluctant to seek help or even to
talk about her experience because she is afraid or ashamed.
Health programmes can become better aware of the
widespread problem of violence against women, girls and
adolescents and sensitively encourage clients to discuss
their experience

Recommendations
Government should provide protection for women
in situations of sexual and domestic violence.
Ultimately, society must lift the veil of silence and
no longer condone gender-based violence or
excuse abusive men from responsibility for their
actions- teachers , policemen, bosses, employers
Sensitise communities about health risks and
dangers of SGBV and what legal avenues are
possible

What can we do?

Form networks amongst the various professionals
involved to develop a comprehensive prevention and
management programme for SGBV
Identify the current legal barriers at policy and
implementation level and address them at the various
levels
Clearly define training needs for the various
professionals involved and equip them with the
necessary knowledge, skills and competencies

 Identify infrastructural needs simple locable cupboards,

stationary
Develop Regional sites for comprehensive one stop centre
management

What is the Ministry of Health

Doing?
Development of Trainee/Trainer Materials
Supervision Guidelines
IEC materials for use by both health workers and
communities
Trained some service providers
Linking with the other stakeholders such as police,
lawyers and Ministry of Gender

SGBV is complex
It originates and is supported by factors at various levels:
individual, relationships, community and society, Legal
frameworks, politics etc , therefore all sectors must take part in
this multi-sectoral response we are trying to address

THANK YOU