In Mozambique, an adolescent searches for a way out of the isolation of young pregnancy. In Guinea, a mother, abandoned by her family, looks to her community for help. In Nepal, a woman subjected to brutal beatings by her husband seeks relief through the support of a trained community health volunteer. Gender inequality can put women’s health and, potentially, lives at risk, as these three stories illustrate. Jhpiego is working to prevent gender inequality at home, in the health system and throughout communities.
Worldwide, one in three women experiences gender-based violence (GBV), which can lead to death, disability, HIV and other sexually transmitted infections, depression and suicide. GBV knows no social or economic boundaries. It affects women and girls of all socio-economic backgrounds in developing and developed countries.
In 13 countries, Jhpiego engages women, men, health care providers and communities in recognizing the impact of gender disparities on women and families and in developing policies, practices and processes to improve women’s abilities to act in their own best interest. This work involves building health care providers’ understanding of GBV and skills to prevent and address it, incorporating GBV screening into health services, and monitoring and improving the quality of GBV services.
The three snapshots that follow show the impact of gender disparity at home and in the community, and Jhpiego’s efforts to ensure that women and girls can access the care and support they need.
Mozambique: Delivering DREAMS by ensuring that adolescent girls and young women get the care they need
For Joana, a 17-year-old single mother living in Beira, Mozambique, the expectation that women and girls alone are responsible for their reproductive health cost her.
“When I became pregnant …. My family blamed me, and my boyfriend didn’t talk to me anymore, saying I had not been taking care of myself,” Joana recalled. “I felt abandoned and isolated.”
After her son’s birth, Joana received postnatal care and HIV testing and counseling through a youth-friendly clinic at the Ponta-Gêa Health Center. With her consent, her information was entered into a secure software layering platform as a part of the DREAMS program—helping adolescent girls develop into Determined, Resilient, Empowered, AIDS-free, Mentored and Safe women. Jhpiego developed the platform to record use of DREAMS-supported services by adolescent girls and young women, their male sexual partners and referrals and to enable follow-up. Jhpiego developed the platform to record use of DREAMS-supported services and referrals for adolescent girls, young women and their male sexual partners to enable follow-up.
In the 10 sub-Saharan African countries with the highest global HIV prevalence, DREAMS works to reduce the risk of HIV infection for adolescent girls and young women, who make up 74% of those newly infected with HIV in sub-Saharan Africa. In Mozambique, which has 4 million girls ages 10–24 (approximately 18% of the country’s population), DREAMS has collaborated with 13 implementing partners in the country’s six districts with the highest HIV prevalence.
Through US Centers for Disease Control and Prevention-funded HIV prevention programs in Mozambique, Jhpiego trained 2,628 health care providers to deliver post-GBV care, such as treatment of injuries, emotional support, HIV testing and counseling, post-exposure prophylaxis, emergency contraception and safety planning. The providers reached 10,678 GBV survivors from 2015 to 2018. Ten public health facilities for post-GBV care were established as demonstration sites, where Jhpiego uses HIV testing and voluntary medical male circumcision as opportunities to raise awareness of GBV among clients.
At her follow-up DREAMS visit, Joana said she wanted to continue her education, but hadn’t attended school in 3 years. Secondary school enrollment for young Mozambican women is at about 19%, and more than 46% of 15- to 19-year-olds are pregnant or have children. With the help of World Education and other implementing partners, Joana enrolled in seventh grade.
Joana is now on the path to providing for herself and her child without running the risk of falling into risky relationships, potentially compromising her health. With DREAMS, Joana is learning to rely on herself.
“Without DREAMS, this would not have been possible,” Joana said.
Guinea: A volunteer brings a community together for a mother and her children
Adama Bentè Sow was visiting the village of Thiangel Bory, Guinea, as a community educator when a young woman with two small children in tow approached her.
“I was forced into a marriage against my will,” the mother told Sow, visibly upset. Her husband had instructed her to take their children and return to her family, but her uncles were pressuring her to rejoin her husband.
“Two days ago, my uncles threw me out. That’s why I’ve come to see you because it seems that you help people in trouble,” she told Sow.
Just the week before, Sow had been in a Jhpiego-supported training to learn how to deal with gender disparity and violence. Sow, a civil engineer and facilitator with the Directorate of Social Action in Labé, Guinea, was among community educators who participated in this training on helping GBV survivors. The timing couldn’t have been better.
“I think I received the best gift of my life,” Sow said of the training.
Sow told the GBV committee about the young woman’s predicament. The committee and other partners took action, and soon the local mayor had summoned the young woman’s parents and uncles. After speaking with the vice mayor, the young woman’s parents apologized to their daughter and agreed to let her return home.
Through the Maternal and Child Survival Program and its follow-on Health Services Delivery (HSD) Project funded by the US Agency for International Development, Jhpiego has progressively established networks of health providers, community educators and paralegals in three regions of Guinea for GBV prevention and management: 138 health care providers at 43 hospitals and health centers are better equipped to assist victims of violence and link them to other sources of support, including 30 paralegals, social protection services, etc. For prevention of GBV, 274 community educators, along with neighborhood committees carry out awareness raising talks and events. Between October 2015 and June 2019, 484 survivors of GBV were supported through these resources.
“I was able to help resolve this situation and make the whole family happy,” Sow said.
Nepal: A female community health volunteer intervenes to help a woman experiencing GBV
A 2011 national health study by the Nepalese government found that 22% of women ages 22–49 had experienced physical violence. One-third of married women described emotional, physical or sexual violence from their spouse.
In 2015, in partnership with Nepal’s Ministry of Health, Jhpiego developed a health response to GBV that included a national clinical protocol and training package for health professionals. The training focuses on clinical assessment, counseling and treatment, and includes information about legal support and social rehabilitation resources for GBV survivors. Through this initiative, nearly 2,700 GBV survivors across seven districts received counseling, treatment and referral services through May 2019. With Jhpiego training health care providers in 11 districts, Nepal’s National Health Training Center is scaling up this approach through other partners.
Jhpiego has also oriented female community health volunteers (FCHVs) in Mangalsen Municipality to identify and refer GBV survivors to health facilities and one-stop crisis management centers for GBV.
One example of how these initiatives have benefited communities was that of a trained FCHV in the municipality who helped a woman who had endured neglect and cruel beatings from her husband. The woman had given birth to two daughters, but no son. After the husband took a second, younger wife who gave birth to two sons and a daughter, he began neglecting the elder wife and physically abused her. When he discovered that his mother was sneaking food to the elder wife, he scolded his mother and violently beat his elder wife.
Learning of the woman’s dangerous and precarious situation, the FCHV intervened, warning the husband against beating his wife and explaining the legal consequences he could face. He rejected the FCHV’s suggestions. The FCHV then called for a mothers’ group meeting, accompanied by community leaders and social workers. After the group decided to take legal action against the husband, he agreed to provide his wife with financial compensation, including land and a buffalo, and committed to changing his behavior. The family now lives together peacefully.
The FCHV’s success with the family has bolstered her confidence to address gender inequality moving forward, with the goal of raising awareness and preventing violence.
Jhpiego addresses gender inequality and GBV as described in these personal stories at the global level by strengthening services and engaging communities to prevent violence, decrease survivor stigma, raise awareness about services and increase access to care for all individuals. Powerful women and girls are key to improving health in their families, communities and in the world. But we can’t tackle gender inequality in a vacuum. Women and girls need supportive families, communities and health systems to make healthy decisions, claim their power and achieve their fullest potential. Jhpiego’s efforts are helping to ensure that those touched by GBV can get the help and resources they need—one woman at a time—ultimately building a stronger health sector for all.
Alisha Horowitz is a Senior Editor for Communications, Jhpiego; Binta Nabe is a Senior Technical Advisor, Jhpiego Guinea; and Benilde Matsinhe is a Communications Officer, Jhpiego Mozambique. Myra Betron, Director for Gender, Jhpiego; and Sonia Abraham, former Editor with Jhpiego, also contributed to this story.