Tackling Gender-based Violence (GBV) Against Women and Girls Is Key to Achieving Universal Health Coverage

Gender-based violence (GBV) refers to harmful acts directed at an individual based on their gender. It is rooted in gender inequality, the abuse of power, and harmful norms. GBV is a serious violation of human rights and a life-threatening health and protection issue. 

In the backdrop of the campaign on 16 Days of Activism against Gender-Based Violence, Dr. IniAbasi Nglass, the Deputy Chief of Party, U.S. President’s Malaria Initiative for States (PMI-S), speaks with Martha Murdock, MSH’s gender expert, on the challenges facing the fight against GBV and what the PMI-S team is doing to address them to create access to malaria services for women and girls. 

Why should we focus on preventing and addressing GBV against women and girls in a malaria program? 

Pregnant women, as well as girls under the age of five, are particularly vulnerable to malaria. We cannot begin to talk about treatment or prevention approaches without talking about the issues that hinder the ability of women and girls to access malaria services. Indeed, we can only achieve universal health coverage by ensuring that anything that systematically hinders access to health service delivery, like GBV, is addressed head-on. 

If we are to address malaria issues among women and girls, it’s vital to have discussions about GBV among policymakers, health officials, and health facilities, from the national to the sub-national and down to the community level. These discussions must include not only malaria but also health service delivery areas specific to women. For example, access to antenatal care is linked to malaria services through intermittent preventive treatment of malaria during pregnancy. If a pregnant woman feels she cannot access antenatal care due to stress from GBV, she may not have the opportunity to access malaria preventive services. The implication of this is the increased likelihood of her getting exposed to and being sick from malaria, ultimately leading to negative pregnancy outcomes such as anemia, stillbirth, or low birth weight of the baby. 

Why do you think it’s important to build the capacity of malaria providers to address GBV? What are the best entry points for reaching these providers? 

Building capacity will provide the right information to support behavioral change among health care workers. There is a knowledge gap on GBV and how it affects health-seeking behavior among women and girls. Health care workers may not view GBV as their core responsibility and may not be willing to volunteer for the cause. But with sensitization, we’ve seen skilled health care workers attending to women’s needs in this area and volunteering their time to address GBV. The health workers also know where to refer women when there is a need for GBV services. 

In addition to sensitization, addressing gaps in knowledge and skills has enabled health care workers to understand the signs of GBV and provide information to those affected. They also understand how to support women and girls to prevent GBV and provide them with proper care when they need it. One of the best entry points for getting health workers’ support in addressing GBV is to help them acquire critical skills on how to educate GBV survivors and what support to provide them. If they identify the need for proper care, they should be able to make the right clinical management decisions to appropriately address the severity of the case. 

Could you share a concrete example of how a training on GBV helped improve the quality of health care a woman is receiving? 

What I have observed during my work in this space is when health care workers are trained on gender issues, identification of GBV, and quality of care provision, they are better equipped and empowered in the provision of care, including identification of signs of GBV, provision of first-line support, clinical management of rape, provision of psychosocial support and counseling of GBV survivors, provision of basic mental health services, and giving support to survivors on how they can report cases and where to access services and referrals. After these trainings, we’ve seen health care workers volunteer as GBV ambassadors for their health facilities, hold talks on GBV for women and girls who are affected, and provide information and support. We have had several women go to the health facility to report cases of GBV after the training and sensitization sessions. There was a remarkable report of cases and improved quality of care provided. Because of improved care, other women who were silent and even some of their relatives have come to access services. They also benefited from the provision of other health care services, including malaria. This is part of the strategy we’re implementing in the PMI-S project. 

What are some of the immediate results you hope to see after the PMI-S project is done conducting trainings? 

As an immediate result, we want to see more awareness created. We also want to see more women access health care services because they are better informed. These include increased and early registration for antenatal care, which will provide them the opportunity to benefit from malaria preventive interventions like the provision of free bed nets and intermittent preventive therapy in pregnancy. These services offer protection against malaria for both the mother and the unborn child and ultimately a better pregnancy outcome. Accessing these services can also help reduce the depression and feelings of helplessness that victims of GBV may face and help manage stress and disorders that can be caused by GBV. At the end of the training, we want to see health workers and health volunteers going into the community to create this sensitization in our malaria programs. 

What specific activities are going on under the PMI-S project to prevent GBV in its malaria programs? 

PMI-S carried out a gender analysis and assessment and came up with a gender strategy that ensures we include gender-sensitive activities in the project’s activities. This includes starting with ourselves by sensitizing our staff on gender-related issues like preventing sexual exploitation and abuse among staff and partners. We’re also looking at the GBV reporting mechanism in Nigeria, specifically focusing on how other organizations report GBV cases and how we can learn from that process. 

PMI-S is joining a coalition of implementing partners for USAID to look at how we can integrate ideas about gender into our meetings and trainings. Beyond that, we’re building the capacity of the gender focal person at the National Malaria Elimination Program to ensure she drives the process at the national level in our malaria programs. PMI-S is also looking at how to drive the process in our focal states to integrate the idea of gender into our community programs. 

What last word do you have on the issue of GBV? 

We need to educate everyone on the prevention of GBV; inequality; and the root causes of violence, especially against women and girls. People need to know that GBV goes beyond physical violence and can include psychological, emotional, and financial violence we well. If you deny a girl education and give a boy the opportunity over her, that is educational violence. We need to have equality play out everywhere. Educating people, as the PMI-S project does, is the key to breaking this chain of violence and protecting future generations from this pain.