According to the United Nations, one in three women globally will experience physical and/or sexual intimate partner violence or sexual violence by a non-partner at some point in their lives. This number is staggering – and more sobering still, the figure is even higher in some parts of the world.
In Haiti, sexual and gender-based violence (SGBV) against girls and women is a serious health and human rights issue. Thirty-four percent of women in relationships report having experienced physical, emotional or sexual partner violence. Women who have been sexually or physically abused are more than twice as likely to have an abortion, twice as likely to experience depression, and 1.5 times more likely to acquire HIV when compared to women who have not experienced partner violence. Addressing the root causes and outcomes of SGBV is part of an overall emphasis on women’s health and empowerment.
Access to care, health and psychosocial services and legal remedies are severely limited by a lack of resources, political will, economic insecurity, gender power imbalances and widespread poverty. There is a need for evidence-based action that addresses the multiple drivers of SGBV in Haiti.
Over the past four years, Partners In Health Canada has been working with Haitian sister organization Zanmi Lasante on a comprehensive approach to prevention and treatment of SGBV. Thanks to a new project funded by Canada’s International Development Research Centre (IDRC) and launched in 2018, we now have an opportunity to make evidence-based improvements that build on previous and existing work.
“IDRC is supporting Zanmi Lasante and Partners in Health Canada to combat the drivers of SGBV in Haiti that keep women and girls from reaching their full potential. At the heart of this support is our commitment to research and action to transform the unequal gender relations at the root of this violence. With this new grant, Zanmi Lasante will continue its locally grounded efforts with communities, government, and providers of health, legal, and social services to address the issue of SGBV holistically.” – Jean Lebel, President of IDRC
The three-year implementation research study — with a focus on learning-based evaluation – is titled ‘Improving the Quality of Sexual and Gender Based Violence (SGBV) Services for Haitian Women and Girls’ and has the potential to transform norms and practices through approaches grounded in the local context. The research is intended to: i) document the prevalence of SGBV and improve the capacity of existing data and other systems to capture these events; ii) improve the timeliness, accessibility and quality of SGBV services by examining the current program and practices; and iii) assess the validity and effectiveness of inter/multi-sectoral approaches.
“We are proud of the important work we do to care for and support survivors of SGBV, but the need in Haiti is immense and we want to do more,” said Dr. Wesler Lambert, Director of Medical Education, Research and Strategic Information at Zanmi Lasante. “IDRC’s support has come at a critical time, and will enable us to develop and refine a proven model of care and community engagement which can be expanded to reach more women and girls and contribute to broader social change.”
Much has been learned since Zanmi Lasantes’s formal SGBV activities began in late 2014. We know the incidence of sexual violence among girls is devastating:
- Of 271 victims of sexual violence seen at ZL facilities between October 2017 and September 2018, nearly half (127) were girls under the age of 15.
- Public attitudes around SGBV, including whether acts of domestic violence should be considered crimes, vary across the project catchment area, suggesting the need for more targeted education.
- Poverty and gender imbalances play a role in women’s decision to access treatment in a timely fashion.
- The project pays transportation costs for victims to travel to health facilities, yet despite sustained public messaging, only 44 percent of victims of sexual violence who eventually sought medical care did so within the critical 72-hour window of an assault. Seventy-two hours is the period of time when women can benefit from emergency contraception and HIV prophylaxis and when physical evidence can be collected for use in legal proceedings.
On the treatment side, Zanmi Lasante’s existing project makes use of community health workers, social workers and women’s organizations to link victims of physical violence and rape to medical and psychosocial services at Zanmi Lasante-supported hospitals and health facilities. Doctors, nurses and social workers receive training on protocols for SGBV care and follow-up, including pathways for women to access the legal system to pursue justice against perpetrators.
Prevention activities have included the formation of dedicated SGBV surveillance commissions, which discuss SGBV cases in communities and raise awareness of SGBV among community leaders, police, and health representatives. Public messaging around SGBV is disseminated through radio campaigns, large events to celebrate the International Day for the Elimination of Violence Against Women (Nov. 25), and more recently through outreach in schools and churches.
Still, there is much more we need to learn in order to ensure our programming is as effective as it can be in treating and preventing SGBV. Results from the IDRC-supported research are expected to improve how Zanmi Lasante implements existing SGBV services. The project also seeks to develop new knowledge around how SGBV programs in Haiti can be more effectively designed and delivered, with stronger coordination among Haitian public sector and civil society organizations.
