Gender-based violence is defined as ‘any harmful act that is perpetrated
against a person’s will، and that is based on socially-ascribed (i.e.
gender) differences between males and females. Gender based violence manifests in
form of Sexual violence (rape، sexual assault، sexual harassment), Physical violence
(hitting، slapping، beating), Emotional violence (psychological
abuse), Economic violence (denial of resources) and Harmful traditional
practices (forced marriages، female genital mutilation).[1]
Gender based violence is one of
the most severe forms of gender inequality and discrimination in Uganda and
remains a critical Public health global health problem and one of the most
pervasive human rights violations of modern time. It is an issue that affects
women disproportionately, as it is directly connected with the unequal distribution
of power between women and men thus, it has a profound effect on families,
communities, and societies as a whole[2].
These Gender inequalities limit the ability of women and girls to fully
participate in, and benefit from development programmes while formal and
informal institutions, such as religion, family, marriage as well as social and
cultural practices play a major role in perpetuating gender inequalities in
Uganda.[3]
Gender based violence undermines the health, dignity, security and
autonomy of its victims, yet it remains shrouded in a culture of silence. Violence
often remains hidden, as survivors fear for their safety or are stigmatized. Victims
of violence can suffer sexual and reproductive health consequences, including
forced and unwanted pregnancies, unsafe abortions and miscarriages, traumatic
fistula, sexually transmitted infections (STIs), preterm birth and stillbirth. [4] It is also associated with
mental health outcomes, including posttraumatic stress disorder, anxiety and
depression, and an increased risk of ideated or attempted suicide, or suffer
other health consequences.
Physical, sexual, or psychological harm by a spouse or partner is a
major factor in maternal and reproductive health[5].
Women suffering from intimate partner violence are less likely to adopt
contraception and are 46 to 69 percent more likely to have an unintended
pregnancy. Abusive partners are 83 percent more likely to coerce a pregnancy,
through forced intercourse or birth-control sabotage, and women in abusive
relationships are 2.7 times more likely to seek an abortion.[6]
Women suffering from abuse are twice as likely to have a miscarriage and their
children are 3.9 times more likely to have a low birth weight, while infant
diarrheal diseases are 38 to 65 percent more common in children born to mothers
suffering from abuse.[7] As CEHURD, we believe that
Improving the equity and value of women and girls is a very important means of
improving population health.
According to the UDHS for 2011 and 2016, the trends show that sexual
violence is higher among the women. While Current husbands were found to be the
leading perpetrators of both physical and sexual violence. Major improvements in GBV are
attributed to increased awareness campaigns by both state and non-state actors
in enforcement of the GBV policy. However, more needs to be done to further
fight both sexual and physical violence (DFID, 2016).[8]
STATE PROGRESS
Uganda is a state party to nearly all international human rights
conventions as well as relevant regional protocols with explicit provisions for
gender equality and recognize Gender based violence as a form of
discrimination. The 1995 constitution and broader normative and legal and
policy frameworks reflect global standards, are strongly supportive of Gender
Equality (GE) and, within recent policy documents, address gender-based
violence (GBV) explicitly.
Uganda was active in the post 2015 development process; it was one of
first countries to integrate the principles and goals of the Sustainable
Development Goals (SDGs) into its National Development Plan (NDP) even before
the global documents had been finalized. Both gender equality and GBV are
featured in Uganda’s second NDP and evident in diverse sectoral plans. The
government signed onto, endorsed and ratified principles which are enshrined in
the UN convention on elimination of all forms of discrimination of women
(CEDAW), The Beijing platform for action, Global Agenda 2030 Sustainable
Development Goals (SDGs). The women’s access to SRHR is integrated in Uganda’s
vision 2040, and it adopted the National GBV policy and Action plan 2016, and
the national male engagement strategy in 2017.
The National Health Sector Plan reflects a rights-based approach and
acknowledges international conventions. The National Action Plan on Elimination
of Gender Based Violence in Uganda (2016-2020) frames the issue of GBV as an
urgent development priority and factor to address in achieving Uganda’s
development goals for 2020. Similarly, the interconnected work on ending child
marriage and teenage pregnancy is framed by the new dialogue on leveraging for
development the demographic dividend of a large, youthful population.[9]
The government of Uganda has developed
the National SRHR/HIV/GBV Integration and Linkages Strategy to guide
integrated programming and resource mobilization. The strategy highlights
opportunities and entry points for SRH/HIV/GBV integration. An Assessment and
studies on integration including the National SRHR/HIV/GBV Linkages and
Integration Rapid Assessment; a facility assessment on SRHR/HIV /GBV
integration and an assessment on SRHR/HIV/GBV integration in Global Fund
programming. Results of these assessments are being used to inform resource
mobilization efforts, revision of the national SRHR/HIV/GBV Integration and
Linkages Strategy and development of standard tools and job aides to support
service delivery.
GAPS
IN INTERLINKING GBV AND SRHR
However, despite the strong normative framework on Gender inequality,
including regulations, guidelines, protocols and even district level laws and
ordinances, actual implementation of the policies has been challenging. The
SDGs can only be achieved if Uganda as a state understands and accepts their
ultimate responsibilities to fulfil obligations to international treaties and
agreements and must performs them in good faith, state obligations entails
compliance by government units across different sectors. Eliminating gender
based violence requires the obligation of states on the principles to Respect rights
of women, Protect rights of women, Promote rights of women, Fulfil rights of
women and Obligation of means and
results.
There is a challenge in implementation of existing laws and policies,
several laws remain pending while others require amendment and other
development of comprehensive implementing policies and regulations. To more
effectively protect the rights of women and girls, address discriminatory implementation
of laws and ensure effective SGBV /SRHR integration.
- Marital
rape is not criminalized under the laws of Uganda due to delays in passing the
marriage bill 2017 which bill was initially the marriage and divorce bill 2009.
- The
laws of evidence and penal code provide that for any allegation of sexual
assault there must be corroboration by the third party making it very hard for
women to prove husbands assault of his wife in the private space like bed
rooms.
- The HIV
prevention and control act requires all victims of sexual violence, pregnant
women and the partner of a pregnant woman to undergo routine HIV testing, which
is a barrier to many women accessing SGBV and SRHR services and can expose
women to increased violence particularly intimate violence.
Allocation of resources to implement laws policies and regulations,
institutional and staff capacity and accountability mechanisms remain weak. The
development of the social development sector plan (SDSP) provided a framework
or all ministries, departments and agencies including health, justice, police
among others to priorities integration of gender equality issues in their
annual plans and budget reinforced by gender and equality certificate. However
ministries departments and agencies and the decentralized structure [10]do not adequately priorities financial
resources for GBV SRHR integration and there is a gap in the budget allocations
for gender equality.
The national SRHR guidelines and service standards were revised but were
recalled at ministerial level. While the national sexuality Education framework
does not cater for girls outside of formal education and resources for its
implementation have not yet been secured.
There is a Gap in the legal literacy capacity of ministries, departments
and agencies and the sub national governments to engage in participatory
–planning and gender – responsive budgeting and to implement GBV legislation
and services. The lack of multi –sectorial mechanisms, with linkages to civil
society, to oversee financing and accountability for GBV /SRHR programming
hinders implementation.
There is a weak implementation of the right based approaches and insufficiencies
in programming and implementation of gender responsive interventions for access
to justice. Health and police personnel
at sub national level are still not aware of the changes to the PF3 form, and
lack training in filling of the form yet
in many service points, the police forms 3A and 24 are not available
State actors working around GBV prevention and response remains under
funded, with further work needed to build capacities of institutions to deliver
GBV response and prevention programmes and integrate SRHR services. This lack
of capacity continues to hamper efforts to implement legislation and policy.
Funding is often allocated at the national level and does not trickle down to
sub national levels. This has been evidenced by police officers being
constrained with fuel to facilitate arrest or investigate GBV cases. Health
workers running out of emergency contraceptives and cotton swabs to facilitate
examination of SGBV survivors yet still
the long distance from communities to courts of law is often prohibitive to the
optimal access to these services.
While coordination and referral mechanisms exist, they are often in
operative and unfunded at sub national level and ineffective in ensuring
continuum of support for survivors of Gender based violence. The district
chain- linked committees (DCC) coordinate action within the JLOS sector, including
cases of Gender based violence, but are often in active at the district level
due to insufficient funding.
Stock out of SRHR commodities and Lack of access to SRHR services and
essential medical services for survivors of Gender based violence. Most up
country health facilities across the country lack necessary medical supplies
and capacity to treat survivors of violence, particularly sexual violence. This
includes shortage of rape kits, PEP, emergency contraception and pregnancy
kits, and medication for treatment for STI.
Yet girls and Women and girls
usually lack access to information and experiences on the barriers and stigmas
which exclude the from receiving essential services which leaves them and
adolescent girls vulnerable to unwanted pregnancies, unsafe abortions and
exposure to other sexually transmitted infections.
Structural weaknesses within the health sector and lack of human
resources make it difficult for it to fulfil the requirement under the law. Few
licensed medical practitioners are willing to appear in court as expert
witnesses yet still they are a rarity in rural and urban Uganda and they have
so far generally been unprepared and unforthcoming to fulfil their new
additional duties as expert witnesses before the Courts. There is a lot of
bureaucracy in terms of facilitating the health workers to court to testify and
the burden is shifted to the poor survivors who cannot afford such charges
leading to frustration of cases.
The country has few operational GBV shelter homes for rehabilitating
victims of gender-based violence (GBV).and worse still those available are
facing financial constraints and closing temporary. In the shelters, survivors get legal aid,
psychosocial services, temporary accommodation and referral to GBV survivors’
services. Government through the MGLSD should recommend for should CFPU
reception centers to upgrade to shelters and allocate budget for the same to
have them furnish and offers services to GBV survivors.
Recommendations
- Ensure
the implementation of the various legislation and policies on GBV and SRH at
the national and sub national levels. This requires joint actions between
non-state actors addressing the links between gender-based violence and SRH
working together with state institutions to advocate for the implementation of
the same all levels.
- Social, economic and legal gender inequalities
in Uganda need to be addressed in line with the Bill of Rights as provided for
the constitution of the republic of Uganda. Doing so would reduce the
disproportionately high levels of GBV affecting the reproductive health of
women in Uganda.
- Government response should be more strategic
and holistic in order to safeguard the lives of Ugandans with effective early
warning systems. The mitigation strategies should include the health sector and
provision of psychosocial support to the survivors. Mechanisms to rehabilitate
the perpetrators of violence should be defined, tested and evaluated for
feasibility and sustainability. The government should take the lead in
implementing these measures.
- Safe houses for GBV survivors to recover or
as transitional stops have been reported to respond to the immediate needs of
survivors. One-Stop-Centers such as those found in Rwanda, Malawi and South
Africa which include a police station, hospital and a safe house for survivors
all under one roof should be emulated.
- Incorporate
a health sector response within the inter – sectorial response to gender-based
violence. A health sector response that is comprehensive and based on women`s
rights is an essential and strategic delivery point to respond to gender based
violence. This will enable early screening and detection of gender based
violence and quicker intervention.
- Provide
treatment and care for victim- survivors who are at the crisis point and reduce
maternal deaths and the burden of disease caused by gender based violence.
Health sector responses to gender based violence can be systematic within
health facilities. Every health service provider should under g a regular and
consistent gender sensitization to appreciate issues of gender based violence
- The
government should ensure universal access to family planning information and
services and invest in a country wide sensitization program on reproductive
information.
- The
state should remove all legislative barriers that prohibit young people
especially unmarried young women from accessing sexual and reproductive health
services and family planning.
- The
state should come up with concrete plans for training health service providers
and implementing the Standards and Guidelines for the Reduction of Maternal
Morbidity and Mortality from Unsafe Abortion in Uganda
CONCLUSION
Prevention campaigns on GBV/SRHR conducted in Uganda often do not
adequately consider the reality of the daily lives of Ugandan women and the
difficulties they face in gaining control over their own sexual lives. The
rampant spread of HIV/AIDS and the high prevalence of GBV can only be stemmed
if the subordinate position of women is acknowledged and addressed. The study
results indicate that adolescents and women, among other sub-groups are more
vulnerable to GBV. Inefficiencies within
the supply chain system which limit effective delivery of both GBV and SRH
commodities, with frequent stock outs of commodities experienced across health
facilities, Inadequate training of health workers and Community Health
Extension workers in integrated SRHR/ GBV services delivery, Socio-cultural
barriers including harmful cultural practices and value systems which over look
violence against women and girls, limited coordination and effort by health
workers to offer services beyond what clients seek for at health facilities and
inadequate referrals, Inadequate Human resource to support GBV/SRHR integration
should be addressed to effectively integrate GBV and SRHR
The relation between Sexual reproductive health and GBV is mainly through
intimate relations that are influenced by socio-cultural factors including
gender power imbalances. It is evident that social factors such as the unfavorable
economic position of women, and the inability to insist on condom use make
Ugandan women unable to negotiate the timing of sex and the conditions under
which it occurs. Thus, they are rendered powerless to protect themselves against
HIV infection and other sexually transmitted infection, unwanted pregnancies.
REFERENCES
- The
national male involvement strategy for the prevention and response to gender
based violence in Uganda.
https://uganda.unfpa.org/sites/default/files/pub-pdf/15_03_18_%20MALE%20INVOLVEMENT%20STRATEGY%2024%20JULY%202017.pdf
- Understanding
the critical linkages between Gender based violence and sexual reproductive
health rights. www.arrow.org.my .
- The
World Bank. Pp 219-244. 3. Amuyunzu-Nyamongo, M. & Kiragu, K. (2005) Gender
roles and sexual behavior in Africa. AIDS in Africa: Scenarios for the Future,
UNAIDS.
- Bourdieu,
P. (1998). La domination masculine. Paris: Editions du Seuil.
- Cornell, R. W. (1995). Masculinities.
Cambridge: Polity Press.
- Cornwall, A. & Lindisfarne, N. (1994).
Dislocating masculinity: gender, power and anthropology. In A. Cornwall, &
Lindisfarne (Eds.), Dislocating masculinity. Comparative ethnographies (pp.
11-47). London and New York: Routledge.
- Spotlight
initiative to eliminate violence against women and girls. country programme
document.
- WHO/UNAIDS/UNICEF
(2010) ‘Towards universal access: Scaling up priority HIV/AIDS interventions in
the health sector the country- Progress Report 2010.
- WHO/UNAIDS/UNICEF (2011) ‘Global HIV/AIDS
Response: Epidemic update and health sector progress towards Universal Access
2011.
- The
state of sexual reproductive health and rights in Uganda emerging issues JS8_UPR26_UGA_E_Main.pdf.
Compiled by Nakalembe Judith Suzan
Community Empowerment Programme
CEHURD.
[1] https://www.unfpa.org/sites/default/files/pub-pdf/-Facilitator1s_Guide_English_InDesign_Version.pdf
[2] ASIAN PAIFIC RESOURCE AND RESEARCH CENTER FOR WOMEN
.WWW.ARROW.ORG
[3] (World Health Organization، Global
and Regional Estimates of Violence against Women، 2013، http://bit.ly/1oTfGVG ).
[4] Ibid
[5] https://www.wilsoncenter.org/event/the-impact-violence-against-women-maternal-health
[6] Ibid
[7]
Ibid
[8] https://www.ubos.org/wp-content/uploads/publications/03_2019UBOS_Gender_Issues_Report_2019.pdf
[9]
[10] The government decentralized policy and local government act (1997) transfers responsibility and authority for delivery of many public services to the district local government including health.
By Judith Nakalembe – Programme officer and Lawyer at Center for Health, Human Rights and Development (CEHURD).
