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Global best practices addressing Gender-based violence (GBV) in reproductive health (RH) programs

Global best practices addressing Gender-based violence (GBV) in reproductive health (RH) programs. Sarah Bott, Consultant to the Futures Group. Why Should RH Programs Address GBV. Prevention: Can reframe GBV as a public health problem Can apply public health approaches to prevention

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Global best practices addressing Gender-based violence (GBV) in reproductive health (RH) programs

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  1. Global best practices addressing Gender-based violence (GBV) in reproductive health (RH) programs Sarah Bott, Consultant to the Futures Group

  2. Why Should RH Programs Address GBV Prevention: • Can reframe GBV as a public health problem • Can apply public health approaches to prevention Response: • Can identify women in danger before violence escalates • Increase access to comprehensive survivor services • Reduce negative health outcomes of GBV • Assist survivors to access help / services/ legal protections Improve SRH outcomes: • Improve t he effectiveness of HIV prevention • Improve sexual/ reproductive health programs for youth • Provider better quality, integrated health care for women

  3. What Do We Mean By Best Practices? • Growing number of initiatives • Limited evidence of effectiveness • Lack of investment in rigorous evaluation • Methodological challenges, e.g.: -Hard to define / measure indicators of success -Results often require long term follow-up -changing violence levels hard to measure/interpret -Unclear whether attitudes proxy for behavior

  4. At Least 4 Different Levels • Laws and public policies • Institutional reform: health services • Mobilizing communities • Communication for behavior change / changing gender norms

  5. Health Services: Common Problems • Health professionals not trained to recognize GBV as a public health issue • Providers share negative attitudes about women and GBV common in society • Health care orgs not equipped with infrastructure policies, training, supplies, referral networks • Legal protections and social services for survivors often lacking in low-income countries

  6. The Systems Approach • Institutional commitment • Sexual harassment policies • Infrastructure that allows privacy • Policies to protect confidentiality • Staff training and support • Referral networks to community services • Care Protocols for survivors • Supplies such as EC and STI prophylaxis • Data collection systems

  7. Bottom Line: GBV Issues are Integral to Women’s Health Attention to GBV needs to be incorporated into: • University training of health professionals • Efforts to improve SRH quality of care • SRH care protocols, including HIV/AIDS and SRH programs for adolescents • Tools for monitoring and evaluating quality of women’s health care

  8. Routine Screening / Enquiry • Issue consumes much of the literature • Worldwide controversy on risks / benefits • Definitive evidence of net benefit probably unrealistic (example of mammograms) Two clear lessons: • Institutional reforms should come first • All RH programs should be prepared to respond to GBV, not just those that screen

  9. Role of SRH Programs in Improving Laws and Public Policies • SRH programs can reframe GBV as public health • Educate / train policy makers, law enforcement • Advocate to improve policies specific to SRH: • Survivors’ access to EC, forensic exams, STI/HIV prophylaxis; • Sensible reporting laws for providers; • Coordinate law enforcement and medical services • Improve the medico-legal system

  10. SRH Policy Reform: Medico-Legal System, South Africa • Researchers documented dysfunctional system • Advocates lobbied for legal and policy reform • The government changed laws and regulations • Government implemented forensic nursing system and other reforms • Evaluation of impact is pending . . .

  11. Community Mobilization • Has been shown effective for prevention • Appears to be essential for improving the service response for survivors • Best if takes a multi-sectoral approach • Best known / well documented here today • So what is role of RH programs? • Some documented successes used PLA in SRH framework (Reprosalud, Stepping Stones) • RH programs can frame GBV as public health

  12. Promising Examples of Communication for Social Change • Education-entertainment (Soul City, South Africa/ Sexto Sentido, Nicaragua) • Life skills education for youth (New Visions, Egypt) • HIV/AIDS prevention programs that address gender-norms (Program H, Latin America)) Unfortunately, many youth SRH / HIV prevention programs for youth assume that sexual activity is a voluntary “decision”; fail to address sexual coercion

  13. Lessons re: Communication for Social Change • Easiest to change norms and behavior among youth • HIV/AIDS prevention more effective if address GBV—e.g. sexual coercion • Essential to target boys and men as well as girls and women • Prevention focused solely on potential victims generally fails

  14. Evaluation Challenges: Prevention • Hard to separate contribution of multiple strategies • Changing violence levels hard to measure and interpret • Attitudes easier to measure than behavior, but may not be adequate proxy for perpetration • Individual outcomes easier to measure than community-level changes

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