DRIVERS OF GENDER BASED VIOLANCE ( GBV ) AND HEALTH SYSTEMS RESPONSE

TO GBV AMONG WOMEN IN BUKEDI SUB REGION IN UGANDA. A CASE OF

PALIISA DISTRICT IN EASTERN UGANDA
INTRODUCTION

Gender Based Violence is undoubtedly one of the currently most discussed global health issues
many countries are facing. According to data by WH0,(2019), 1 in 3 women have suffered
physical and/or sexual violence worldwide and the principal characteristic of GBV is that it
frequently occurs against women precisely because of their gender and therefore recognized as a
fundamental violation of human rights and a significant public health concern worldwide.
(Aubert A &Flecha R, 2021).

According to United Nations, Gender based Violence is defined by the as “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 in private life” (UN, 1993) According to
Anyama.F and anjama.l,(2021), GBV is a significant contributor to health problems, limiting the
productivity of both women and men, creating a heavy burden on the resources intended for
health systems, and impacts negatively on well-being of families and communities (Oxfam
International, 2001). This situation makes it difficult to eradicate disease, poverty and ignorance
as envisaged at independence in 1963.

According to the World Bank, there is overwhelming evidence that GBV is a worldwide
pandemic that affects approximately 35 per cent of women during their lifetime. It takes several
forms, such that 35 per cent of women will have experienced physical and/or sexual intimate
partner violence or non-partner sexual violence. On average, seven per cent of women have been
sexually assaulted by someone other than a partner. In addition, international statistics show that
as many as 38 per cent of murders of women are committed by an intimate partner, (WHO,2020)
. Globally the proportion of women who experience GBV during their lifetime ranges from
seven per cent in Africa and overall and the GBV experience over a lifetime is highest in the
Caribbean, Africa and Latin America.

In Uganda, almost all women (95%) had experienced physical or sexual violence, or both, by
partners or non-partners, since the age of 15 years. Lifetime prevalence of intimate partner
physical violence among ever-partnered women is 51% and about 16% reported severe physical
violence.(UBOS,2021) In this report, GBV has a number of health effects to its victims which
include symptoms of ill health, physical injuries and emotional distress which affects the
wellbeing of its victims and thus a public health issue which needs to be addressed. This
compromises and slows down the attainment of Uganda’s Vision 2040, Sustainable
Development Goals (SDGs), the Africa Development Agenda 2063 and, most importantly, the
attainment of universal health care, one of the four priority areas in the "Big Four" agenda.
(Ansara and Hindin, 2010)

According to UNDP, 2015; OXFAM, 2018), the leading causes of GBV are poverty, alcoholism
for both women and men, cultural practices like early marriages, bride price, limited counseling,
peer pressure, drug abuse, among others by ( P. Ocheme ,2020 ). For Uganda in particular,the
major causes of violence in Uganda can be attributed to social inequality, the failure to develop
legitimate conflict resolution mechanisms, and factors that have influenced the domain and
patterns of conflict include lack of a common language, religious sectarianism, vigilante justice,
and gender inequality (Kasozi,1964).

Different types of violence against women are prevalent in Uganda and these include sexual
violence, physical violence, emotional and psychological violence, harmful cultural practices and
socio-economic violence (Akumu, ibid). However, physical and sexual violence are the most
common ((UDHS, 2016) and victims have physical injuries ranging from bruising to death as a
result of assault, for instance wounds, damage to sexual organs which may eventually lead to
death either as a result of injuries or disease contracted and also significantly higher levels of
anxiety, depression and psycho-sematic complaints than women who have not suffered such
abuse do. Defilement, child molesting, wife beating retards the emotional development of the
woman and child.(Ocheme.P,etal,2020)

In 1996, the World Health Assembly declared violence against women to be a major public
health problem that urgently needed to be addressed by governments and health organizations.
Studies conducted since the 1990s confirm that, while the prevalence of gender-based violence
varies across and within countries, it is a significant problem nearly everywhere.5 For example,
national surveys in 12 developing countries found that between 18 percent and 53 percent of
women had experienced violence by a spouse or intimate partner at some point in their
lives(Feldman,2013)

According to WHO, (2016), health-care providers are likely to be the first professional contact
for survivors of intimate partner violence or sexual assault. Statistics show that abused women
use health-care services more than non-abused women do and they are often the earliest point of
contact for survivors. Victims often seek health care for their injuries, even if they do not
disclose the associated abuse or violence and always identify health-care providers as the
professionals they would most trust with disclosure of abuse (Feldman et al, 2004).

Health systems therefore have a crucial role in a multisector response to violence against women.
They are often among the first and only points of contact for GBV survivors. Health care
providers not only offer immediate medical attention and first-line support but can link survivors
to other needed assistance including mental health and psychosocial support, social services,
legal aid, shelter/housing services, or livelihood support. Some countries have guidelines or
protocols articulating this role and health-care workers are trained in some settings, but generally
system development and implementation have been slow to progress (USAID,20012) Health-
care providers are in a unique position to create a safe and confidential environment for
facilitating disclosure of violence, while offering appropriate support and referral to other
resources and services(WHO,2016).

In 2013, WHO identified Violence as a health priority and developed WHO clinical and policy
guidelines and policy guidelines to guide health workers in responding to intimate partner
violence and sexual violence and 2016, WHO developed a Global Plan Of Action to strengthen
the role of the health system within a national multisectoral response to address interpersonal
violence, in particular against women and girls, and against children. Strengthening the health
systems approach to GBV also appeared as the 67th World Health Assembly resolution on
strengthening the role of the health system in addressing violence, particularly against women
and girls(WHO,2016).

As of 2017, 53% of countries in Sub-Saharan Africa have explicit laws against domestic
violence. These national commitments further evidence the important role of policymakers as
agents of change. In Uganda, the Constitution of the Republic of Uganda provides for strong
legal foundation for the National Policy on Elimination of Gender Based Violence (GBV) in
Uganda. It mandates the state to fulfil all fundamental rights for all Ugandans and further
instructs the government to enact laws to curb all human rights violation including GBV. Uganda
is also a signatory to regional and global agreements (SDGs, Maputo Protocol, CEDAW, UDHR
etc.) that require action to uphold women’s rights, including the fundamental right to live free
from violence. Nationally the Domestic Violence Act (DVA) 2010 and The National Policy on
the Elimination of Gender Based Violence in Uganda (NGBV) 2019, are the most instructive
legal and policy frameworks on VAW.

These policy measures are supported by a 5-year National Action Plan that provides a framework
to the health sector to operationalize such efforts and monitor the interventions undertaken in
Uganda to reduce violence, realize fundamental human rights and gender equality, and create a
healthier and more productive Uganda. The national action plan presents on four objectives:
strengthening health system leadership and governance, strengthening health service delivery
and health workers’/providers’ capacity to respond, strengthening programming to prevent
gender-based violence and violence against children, and improving information and evidence.

Since the heath sector is usually the first point of contact for violence victims, it’s important that
they are properly guided to effectively engage in response, mitigation and prevention of GBV.
( WHO,2016 ) this argument is supported by unicef,2021 report on GBV response which urges
that Health professionals who are not trained to recognize abuse may treat only the immediate
complaints and miss an opportunity to provide more comprehensive care.

The gender action plan was therefore intended to contribute to prevention and control of the
epidemic of violence in Uganda. Prevent and respond to GBV, spelling out the roles of various
state and non-state actors, the strategic actions that need to be undertaken, and monitoring
mechanisms at the national and local levels in the community and health centers (MOH, 2016).
This action plan was developed in 2019 and its now 5years of implementation but the prevalence
of GBV in Uganda is still worrying with the highest percentage in Bukedi sub region, with
central Uganda ranking the third according to UBOS,( 2016). GBV still remains an issue of
concern for women in both private and public life. According to the Uganda Demographic and
Health Survey (2016), more than half (56%) of women in Uganda aged 15-49 have experienced
physical and/or sexual violence. Among ever-married women 46% have experienced physical,
sexual, or emotional violence by their current or most recent spouse/partner and 46% of ever
married women say that they are afraid of their current or most recent spouse/partner “some” or
“most” of the time. Despite the effort by the government and non-state actors, GBV is still high
in the region.

It’s with this background that the researcher intends to find out the drivers of GBV in Bukedi sub
region and analyze the role of the health sector in the prevention, mitigation and response to
GBV based on the fact that they are first point of contact for violence victims.

Statement of the problem

Violence against women is a significant public health problem, as well as a fundamental

violation of women’s human rights. Overall, 35% of women worldwide have experienced either
physical and/or sexual intimate partner violence or non-partner sexual violence. While there are
many other forms of violence that women may be exposed to, this already represents a large
proportion of the world’s women; most of this violence is intimate partner violence. Worldwide,
almost one third (30%) of all women who have been in a relationship have experienced physical
and/or sexual violence by their intimate partner. In some regions, 38% of women have
experienced intimate partner violence;

The Government of Uganda, through the Ministry of Gender, Labour and Social Development
and ministry of health has developed policies, policy regulations like the Penal Code Act (2007),
The Domestic Violence Act,2010, and policies such as the Uganda Gender Policy (2007), The
National Policy on Elimination of Gender Based Violence in Uganda (2016) and standard
operating procedures for GBV and provided, support supervision to local governments and non-
governmental organizations’ Strategic partnerships for GBV prevention and response as well as
training and sensitization of duty bearers on their role in prevention and response to GBV has
also been undertaken. (MoLGSD,2017) Despite this enormous effort by the Government and
non-state actors Gender-based violence (GBV) is an everyday threat for Ugandan women and
girls and remains persistent. Prevalence of GBV in Uganda is still worrying with the highest
percentage in Bukedi sub region, with central Uganda ranking the third according to UBOS,
(2016). GBV still remains an issue of concern for women in both private and public life.
According to the Uganda Demographic and Health Survey (2016), more than half (56%) of
women in Uganda aged 15-49 have experienced physical and/or sexual violence. Among ever-
married women 46% have experienced physical, sexual, or emotional violence by their current or
most recent spouse/partner and 46% of ever married women say that they are afraid of their
current or most recent spouse/partner “some” or “ most” of the time.

According to WHO, 2016, health-care providers are likely to be the first professional contact for
survivors of GBV violence or sexual assault. Statistics show that abused women report to health
centers with physical injuries, sexual/reproductive issues, and psychological problems and
therefore abused women use health-care services more than non-abused women do and they are
often the earliest point of contact for survivors. Victims often seek health care for their injuries,
even if they do not disclose the associated abuse or violence and always identify health-care
providers as the professionals they would most trust with disclosure of abuse (Feldman et al,
2004). But is the health sector well equipped to prevent, mitigate and respond to the increasing
rate of GBV in Uganda and most especially in central Uganda?

It’s with this background that the researcher intends to find out the drivers of GBV in Bukedi sub
region and analyze the role of the health sector in the prevention, mitigation and response to
GBV based on the fact that they are first point of contact for violence victims.

Research questions

Research will be guided by the following questions

1. What’s the prevalence of GBV among women in Bukedi Sub region in Uganda?
2. What are the drivers of GBV among women in Bukedi Sub region in Uganda?
3. What’s the status of implementation of GBV response, mitigation and prevention strategies
by the health sector?
4. Is there an association between GBV prevalence and health systems response to GBV in
Bukedi Sub region in Uganda?
Objective of the study

General objective of the study

To carry out an analysis of drivers of GBV and health system’s approach to GBV prevention,
mitigation and response among women in Bukedi Sub region in Uganda

Specific objectives

1. To determine the prevalence of GBV among women in Bukedi Sub region in Uganda
2. To describe the factors associated with GBV among women in Bukedi Sub region in Uganda
3. To describe the status of implementation of GBV response, mitigation and prevention
strategies by the health sector
4. To establish whether there is an association between GBV prevalence and health systems
approach to GBV among women in Bukedi Sub region in Uganda

Conceptual framework

INDEPENDENT VARIABLE INTERVENENING VARIABLE DEPENDENT VARIABLE

Drivers of GBV Gender Based Violance

Heallth systems
 Social Norms  Physical
 Leadership and
 Illiteracy  Psychological
governance
 Sexual
 Poverty  Health service
 Social economic
deliverly
 Behaviors  Verbal
 Prevention
programs  Domestic
 Information  Sexual
collection harassement
Significance of the study

 To contribute to the knowledge on drivers of Gender Based Violence on women’s health.

 The study will expose gaps in health systems’ approach to GBV response in Bukedi Sub
region in Uganda
 It will suggest recommendations on health systems approach to GBV and this inform policy
makers and other implementers on how to improve health systems response to GBV

Methodology

The study will use a descriptive cross sectional study design employing the use of both qualitative
and quantitative study approaches

Study population

The study will be carried out in Bukedi sub-region of Eastern Uganda. This region comprises of 6
districts that is Palliisa, Kibuku,Budaka,Butalejja,Tororo And Busia. The population is engaged in
various economic and social activities such as crop farming, animal husbandry, petty trading,
stone quarrying, brick making and sand mining. The other section of the population is employed
in schools, hospitals, factories, recreation centers, and hotel.

Sampling technique

In order to obtain the 95% confidence level for the cross-sectional study, the sample size
will be calculated using the formula described by Cochran (Cochran, 1977) with a 5% level of
precision.
No =Z2Pq
e2

Using the formulae, optimal sample size will be 384 people.

Data Collection Methods

Primary data will obtained directly from women from 2subcounties in paliisa district using
Questionnaire method for collection of quantitative data whereas key informants’ interview will
be used to collect qualitative data from respondents at the district, town council, village level,
health staff working in both private and health centres in Paliisa district

Data Analysis
Data collected will be sorted, edited, coded and entered on database using Statistical Package for
Social scientists (SPSS). The analysis of the data will be done at three levels, namely; Univariate
analysis, bivariate analysis and multivariate analysis.
Ethical Considerations

Research activities will be reviewed and approved by supervisors in Nkumba University after
getting approval from a Research Ethics Committee.

Each participant will be provided with a copy of a consent form.

REFERENCES

World Health Organization . Violence Against Women Prevalence Estimates 2018. World
Health Organization; Geneva, Switzerland: 2019.

United Nations . Declaration on the Elimination of Violence against Women. United Nations;
San Francisco, CA, USA: 1993

Aubert A, Flecha R. Health and Well-Being Consequences for Gender Violence Survivors from
Isolating Gender Violence. Int J Environ Res Public Health. 2021

World Health Organization. Global and regional estimates of violence against women:
prevalence and health effects of intimate partner violence and non-partner sexual violence.

Shajobi-Ibikunle , G., & Zuwena, N. . (2020). A Critical Overview of Gender –Based Violence
in Uganda. American Journal of Humanities and Social Sciences, 8(1). Retrieved from

Mingude, A.B., Dejene, T.M. Prevalence and associated factors of gender based violence among
Baso high school female students, 2020. Reprod Health 18, 247 (2021).
https://doi.org/10.1186/s12978-021-01302-9

Anyama.F and anjama.l,(2021)