research methodology on gender based violence

Engaging in Gender-Based Violence Research: Adopting a Feminist and Participatory Perspective

• First Online: 18 February 2021

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• Sanne Weber 3 &
• Siân Thomas 3  

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Researching gender-based violence involves different challenges for both participants and researchers, including risks to their mental well-being and physical safety. The possibilities of such research having adverse effects for participants are often stronger in cross-cultural research, since researchers are not always well aware of the locally and culturally specific sensitivities in relation to the issue of gender-based violence. The unequal power relations between researcher and participants, which can exist in all settings, may be exacerbated in contexts of cultural difference. To mitigate these risks and instead attempt to make research a beneficial or even transformative experience for participants, researchers can consider adopting feminist and participatory approaches. After explaining in more detail the risks of gender-based violence research, this chapter describes how feminist and participatory research methods respond to these risks, highlighting particularly the scope for creative approaches to such research.

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Weber, S., Thomas, S. (2021). Engaging in Gender-Based Violence Research: Adopting a Feminist and Participatory Perspective. In: Bradbury-Jones, C., Isham, L. (eds) Understanding Gender-Based Violence. Springer, Cham. https://doi.org/10.1007/978-3-030-65006-3_16

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Nafisa halim, phd, ma(s) , research assistant professor, global health, busph, monica adhiambo onyango, phd, rn, mph, ms (nursing) , clinical assistant professor, global health, busph, program description.

Gender-based violence affects people around the world every day. This violence, mainly towards women, reinforces power dynamics and impacts overall health, including physical and psychological development.

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The program will be taught through a series of interactive lectures, practical exercises, group work and assigned reading.

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• Validity and reliability of GBV measures;
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Participatory approaches and methods in gender equality and gender-based violence research with refugees and internally displaced populations: a scoping review

• Michelle Lokot 1 ,
• Erin Hartman 1 &
• Iram Hashmi 1  

Conflict and Health volume  17 , Article number:  58 ( 2023 ) Cite this article

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Using participatory approaches or methods are often positioned as a strategy to tackle power hierarchies in research. Despite momentum on decolonising aid, humanitarian actors have struggled to describe what ‘participation’ of refugees and internally displaced persons (IDPs) means in practice. Efforts to promote refugee and IDP participation can be tokenistic. However, it is not clear if and how these critiques apply to gender-based violence (GBV) and gender equality—topics that often innately include power analysis and seek to tackle inequalities. This scoping review sought to explore how refugee and IDP participation is conceptualised within research on GBV and gender equality. We found that participatory methods and approaches are not always clearly described. We suggest that future research should articulate more clearly what constitutes participation, consider incorporating feminist research methods which have been used outside humanitarian settings, take more intentional steps to engage refugees and IDPs, ensure compensation for their participation, and include more explicit reflection and strategies to address power imbalances.

Introduction

Within research, ‘participation’ has often been understood as the process of directly involving people who are affected by a particular issue, in the process of research [ 1 ]. Humanitarian actors, including international non-governmental organisations (NGOs), UN actors and local NGOs assert the importance of participation of populations affected by crises—refugees and internally displaced persons (IDPs)—in humanitarian activities. The Humanitarian Accountability Partnership’s (HAP) 2013 standard—a key humanitarian guideline—positions participation as vital to humanitarian accountability. HAP defines participation as: ‘listening and responding to feedback from crisis-affected people when planning, implementing, monitoring and evaluating programmes, and making sure that crisis-affected people understand and agree with the proposed humanitarian action and are aware of its implications’ [ 2 ].

The concept of ‘participatory research’ is sometimes used when discussing how to enhance participation in research. Caroline Lenette and colleagues suggest that when talking about participatory research, there is a difference between taking a ‘holistic approach’ within a broader ‘participatory paradigm’ and using methods identified as ‘participatory’ such as PhotoVoice, that is, a difference between methodology (or approach) and method [ 1 ]. In this paper, we use their framing of approach versus method to distinguish between efforts to embed participatory strategies within research holistically, in contrast with using participatory research methods, while also recognising that both of these framings may co-exist within a research project. Examples of taking a holistic approach include ‘community-based participatory research’ (CBPR) and Participatory Action Research (PAR). CBPR has been used to ensure refugees/IDPs are involved at every stage of the research process, and focuses on ensuring that research practices address unequal power hierarchies and adhere to ethical principles [ 3 , 4 ]. PAR also represents a research paradigm/approach focused on working with populations affected by an issue to generate momentum for change. Scholars urge that care is taken with implementing PAR, because of the risk of creating false hope that action will be taken based on the research [ 5 ]. Research may be labelled as using PAR without real meaning: ‘The trend of putting the terms “participatory” and “action” before “research” has led to co-option: not every project labelled PAR is “participatory” research…’ [ 6 ]. Different to this holistic approach, certain research methods are often associated with being participatory, for example PhotoVoice, theatre or arts-based methods. Scholars have observed the ‘glorification’ of arts-based methods, which may be implemented blindly because they are seen as participatory, creative and innovative—without consideration of the relevance of these methods for affected populations [ 7 ].

The concept of participation has become more common within the humanitarian sector as a result of how it has been operationalised within international development, including through the work of practitioners such as Robert Chambers [ 8 ]. In the development sector, participation was a means of shifting power back to communities, for example, through approaches like ‘participatory rural appraisal’ [ 9 ]. Some have critiqued these efforts, labelling them unsuccessful in shifting power dynamics within international development [ 10 ]. Others point to external shifts that have decreased the focus on hearing directly from affected populations, including mandates from donors that development and humanitarian actors deliver impact and value for money [ 11 ]. Despite participation sometimes being connected to improving efficiency [ 12 ], in humanitarian settings the capacity to be participatory is often pitted against the urgency of responding to crises. For example, taking the time to listen to refugees/IDPs is seen as too challenging with the limited funding offered by short-term emergency projects [ 13 ]. There may also be a distinction between listening to refugees/IDPs and actively involving them in design and analysis of research, especially when listening occurs in an extractive way [ 7 ]. Further complicating matters, the term ‘participation’ is sometimes used interchangeably with other terms, such as inclusion, engagement and involvement [ 14 , 15 ]. Outside of international development and humanitarian action, participatory approaches and methods are recognised as holding important potential for shifting power [ 1 , 16 ], transforming knowledge production [ 17 ], increasing equity [ 18 , 19 ], ensuring marginalised populations are reached [ 20 , 21 , 22 ], and enabling innovative research practice and methods [ 21 , 23 , 24 ].

Humanitarian actors have sought to create processes to enhance the participation of refugees and IDPs within humanitarian activities, including research. Research with refugees and IDPs may be conducted by academic or humanitarian actors, and may include baselines, assessments, evaluations and specific research studies. Within such research, efforts to promote participation may include training refugees and IDPs to collect data themselves, consulting them on their needs, and ensuring that they share their perspectives during evaluations. Humanitarian actors invoke the concept of participation to varying degrees: in instrumental ways to achieve better outcomes, and in practical ways such as through their relationships with refugees and IDPs [ 25 ].

Efforts to enhance refugee/IDP participation in research have been criticised for being tokenistic, stemming from the concept of participation being ‘externally imposed’ [ 15 ]. Involvement of refugees within research has been described as ‘exploitative’, whereby refugees are treated as merely sources of data rather than as individuals [ 26 ]. Conflict-affected populations have expressed frustration with being convened for ‘consultations’ when humanitarian actors have already made decisions about their needs and identified solutions [ 27 ]. Humanitarian actors have also been criticised for only promoting women’s participation to improve efficiency [ 9 ] and for failing to recognise how gender, age, ethnicity, economic status and other power hierarchies might constrain participation in humanitarian settings [ 28 ], which increases the influence of power-holders like refugee elites [ 29 ]. These critiques are not necessarily new, but demonstrate there is lack of clarity on what it means for research to reflect ‘refugee voices’ [ 30 ]. Efforts to be ‘participatory’ often lack clarity on what this means [ 31 ].

Critiques of poor implementation of participation have not specifically been applied to gender equality research. Gender equality research—which includes research on gender-based violence (GBV)—often involves consideration of power dynamics, thus often positions participation as a pre-cursor for gender equality [ 9 ]. Participatory research and feminist research share common goals of empowering marginalised populations [ 1 ]. Understanding how participation occurs within research on gender equality may provide important lessons for how participation is being used in research which already uses power as a key lens. For example, while not among refugees and IDPs, recent examples of feminist participatory research with other populations have considerably advanced scholarship through piloting new methods such as body mapping to understand inequity [ 32 ], digital mapping to conceptualise street harassment [ 33 ] and participatory video to provide new insights on gender inequalities [ 34 ]. Feminists have provided critical new insights for participatory research, such as through emphasising not just women’s voices but also their silences during the research process [ 35 ], and reframing ethics from women’s perspective [ 36 ]. Evaluation practice has also been transformed through use of feminist participatory action research approaches that position evaluation participants as co-researchers, challenging the power dynamics often built into evaluation processes [ 37 , 38 ]. Feminist participatory research has provided particular insights for research on violence, including agenda-setting on the use of trauma-informed approaches [ 39 , 40 ], integrating feminist principles into quantitative studies on violence [ 41 ] and using indigenous feminist approaches to reframe women’s safety [ 42 ]. Feminist research approaches and methods continue to push the boundaries of what it means to be ‘participatory’ in diverse settings [ 43 ].

This scoping review explores academic and grey literature on gender equality and GBV among refugees and IDPs which describes itself as ‘participatory’. Specifically, the objectives of this review were to: (1) describe the contexts, approaches and methods used in gender and GBV research with refugees and IDPs; (2) outline the rationale and impacts of promoting refugee/IDP participation in research; (3) describe how refugee/IDP participation is conceptualised, including how participatory approaches and methods are used in research.

We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) to conduct and report on this scoping review [ 44 ]. We conducted a scoping review rather than a systematic review to recognise that the body of evidence on refugee/IDP participation in research on gender and GBV is still emerging, and to acknowledge that we must understand how the literature defines participation, what methods are used and what evidence currently exists on the topic. Since we were focused on understanding the concept of participation rather than addressing effectiveness or appropriateness [ 45 ], a scoping review was deemed the best approach. In line with Chang’s approach for scoping reviews [ 46 ], instead of summarising and assessing the quality of evidence, we explored the literature, identified key definitions and themes and identified the type and nature of evidence available.

Search strategy

We searched five academic databases (Medline, PsycINFO, Academic Search Complete, Web of Science and Scopus) in February 2022. The database searches included search terms related to three main concepts: (1) gender equality and GBV, (2) refugees/IDPs, and (3) participation. Table 1 outlines the key search terms used for each database.

We supplemented the academic database search by searching Google and Google Scholar using the following search strings: “refugee participation” AND gender; “refugee participation” AND gender-based violence; refugee AND gender AND participatory research; displaced AND gender AND participatory research. We limited results for Google and Google Scholar to the first 200 hits per search and cleared browsing data after each search. All searches were conducted without signing into Google to prevent tailoring of results by location and search history [ 47 ]. We searched institutional websites of organisations working on gender, GBV and refugee/IDP research, specifically: UNFPA, UN Women, UNHCR, Women’s Refugee Commission and International Center for Research on Women. We also asked practitioners and researchers in this field to send articles that may fulfill inclusion criteria through the Sexual Violence Research Initiative and Forced Migration mailing lists. We hand-searched the reference lists of included papers to identify additional records for inclusion. In order to prevent publication bias and avoid excluding knowledge produced by non-academic actors, we intentionally searched sources outside of academic databases [ 48 ].

Inclusion and exclusion criteria

Articles in English from any time period and country involving empirical research with refugees/IDPs on gender equality or GBV were included. We included high-income settings where refugees are resettled like the United States, Australia, European countries and Canada, recognising firstly that there has been considerable investment in participatory research and emerging scholarship on what it means to be ‘participatory’ from these settings; and secondly that the challenges in active conflict and humanitarian settings would likely prevent participatory research from occurring.

Screening occurred in two stages using Covidence. First, we screened titles and abstracts, excluding non-empirical research, studies unrelated to gender equality or GBV and studies that collected data only amongst host populations or amongst practitioners, rather than refugee/IDP populations,were also excluded. During the full-text review, we narrowed our criteria to search full texts for descriptions of efforts to promote participation of refugees/IDPs. Studies that did not incorporate this term or various forms of it (e.g. ‘participatory’ and ‘involvement’) were excluded. Where multiple records by the same author existed for the same research, only the earliest record was included. During the title/abstract screening and full-text review process, all articles were double-screened with regular meetings held between the three researchers to reach consensus. The first author reviewed all articles at both stages. Table 2 outlines the inclusion and exclusion criteria.

Data analysis

For each included article, we extracted information on: (a) study design (country, type of population, nationality of refugees/IDPs, sample size, research methods), (b) type of gender equality or GBV issue, and (c) participation (level of focus on participation, definitions of participation, rationale for participatory approach, recommendations for future participatory research, impacts of participation). For population type, we classified based on how the populations were described in the study, rather than using legal definitions of refugees, IDPs, migrants or asylum seekers. We defined ‘gender equality’ using UN Women’s definition as ‘equal rights, responsibilities and opportunities of women and men and girls and boys’ [ 49 ]. We initially classified studies on three levels according to the degree to which the participation was a focus: (1) low: participation in research is mentioned in passing/without further discussion or explanation, (2) medium: participation in research is referenced only in the methods section, or (3) high: participation in research is referenced in the methods section as well as throughout the paper.

Data was extracted using Covidence. Each article was extracted by two authors, with the first author extracting every article. We analysed extracted data to identify: whether and how participation was defined and to what extent it was a focus; the types of methods and strategies used to ensure participation of refugees/IDPs in research; the rationale for promoting participation, including how power dynamics were framed; the impacts of participation; and recommendations for improving participation.

Limitations

Our review has a few limitations. Firstly, due to time and staffing constraints, we only searched for a few key concepts related to participation in academic databases, rather than specifically searching for methods or methodologies commonly identified as participatory. This may have limited the studies that were identified in the database search. Secondly, our review is limited by whatever content authors chose to include in their papers, which may not have been fully representative of the holistic approach taken to participation or to the participatory methods used. Authors may have been constrained by their journal requirements, and may not have been able to include the full level of detail. In at least two cases [ 50 , 51 ], methods sections were shorter because the authors subsequently published a solely methods-focused paper—which fell outside the scope of our review. As with any review, our analysis is confined to what authors describe, which may only be a snapshot of what occurred in their research. Finally, our ranking approach was not a straight-forward process and often required judgments be made about the level of content on participation included by authors. While we made decisions about rankings together, it is possible that the lines between categories are more blurred.

Final sample

Out of 2641 results from five academic databases, 1092 were duplicates, resulting in 1549 unique records being screened.

Alongside the academic database records, 88 additional records were identified and screened from Google Scholar (n = 50), Google (n = 26), institutional websites (n = 1), practitioners (n = 7) and through hand-searching references from included papers (n = 4). After screening, 35 of these were included in the full-text review and 8 of these were deemed eligible.

We assessed 244 full-text papers from academic databases for eligibility. Of these, 206 studies (84%) were excluded due to not being empirical research (n = 11), not including refugees/IDPs (n = 3), not being about gender/GBV (n = 34), or not mentioning referencing being participatory in approach or using a participatory method (n = 158). Among studies from other sources, 27 studies (77%) were excluded due to not being about gender/GBV (n = 17) or not being about promoting participation (n = 10). In total, 46 studies were included, specifically 38 from academic databases and 8 studies from other sources. Figure  1 outlines the scoping review process at different stages using an adapted PRISMA framework.

Adapted PRISMA framework

Study types and design

Out of the 46 included studies, 39 adopted a qualitative design and the remaining seven employed quantitative (n = 3) and mixed methods (n = 4). The qualitative studies utilized various methods, including semi-structured interviews, focus group discussions (FGD), ‘participatory group discussions’, and participatory mapping and ranking approaches. In total, eight studies used photography as a research method, with three explicitly mentioning using ‘PhotoVoice’ and the rest adopting a participatory and ethnographic photographic approach. Quantitative studies mainly used surveys, whereas mixed method studies employed interviews and FGDs in addition to surveys. Table 3 shows the characteristics of the studies in this review.

Study settings, populations and funders

Included studies were conducted in 29 countries, with the most studies conducted in the United States (n = 8), followed by Australia (n = 7) and Uganda (n = 5). Most studies were conducted in only one country (n = 40) only, while a smaller number were conducted in three countries (n = 2) or two countries (n = 2). One study was conducted in 8 countries and another in 5 countries. According to geographical region, North America (n = 12), Australia/Asia (n = 13) and sub-Saharan Africa (n = 13) were the most (and equally) represented, followed by Europe/Caucuses (n = 12), and the Middle East and North Africa (n = 8). Only two studies were conducted in South America, both in Colombia.

Overall, close to half the studies (n = 21) collected data solely from refugees. A further 17 studies included some combination of refugees with other populations such as IDPs, (n = 2), practitioners (n = 3), practitioners and other stakeholders (n = 2), migrants (n = 1), asylum seekers (n = 3), undocumented migrants and asylum seekers (n = 1), immigrants (n = 3), immigrants and practitioners (n = 1), and IDPs and practitioners (n = 1). In total 6 studies focused solely on IDP populations, while a further 2 focused on IDPs and practitioners (n = 1) and IDPs, practitioners and other stakeholders (n = 1).

Study methods

Studies employed several different, and sometimes mixed, research methods.

Qualitative methods were most commonly used (93% of included studies used qualitative methods alone or in combination with other methods), and were predominantly structured as interviews or focus group discussions. Interviews were conducted with refugees/IDPs or other community-based actors and took the form of in-depth, semi-structured or biographical interviews. Focus group discussions were formal and informal, stratified by age and gender, or designed as workshops or anecdote circles. Researchers employed varied—and creative and participatory—methods within such interviews and focus group discussions to collect data and learn about the nuances of refugee/IDPs lives and experiences. These techniques included: storytelling, oral histories, and vignettes, safety, community, dream, and body mapping, free listing, timelining, ranking, sorting, and venn-diagramming, art making, document analysis, photo-elicitation, diaries and role play. Studies also used qualitative methods such as observations and methodologies such as ethnographies.

Studies also employed PhotoVoice (or derivatives of participant or auto-photography) and artistic co-creation. Through the taking of photos and their presentation and discussion, photo-based methods enable community strengths, issues, and concerns to be documented and can promote critical dialogue [ 55 ]. Types of artistic co-creation included song, written tests, deejay sets, ‘Grindr poetry’, video poetry, performance, drag, and graphic design [ 67 ].

Researchers also utilised quantitative or mixed-qualitative and quantitative methods for data collection. Three studies used quantitative methods alone, including a knowledge, attitudes and practices survey, a randomised household survey with ‘heads of households’ [ 79 ] and an attitude survey incorporating the ‘Gender Equitable Men’ scale [ 85 ]. Two of these quantitative studies described their participatory approach as involving the creation of advisory groups consisting of refugees who were involved in decision-making about the research [ 71 , 85 ], however the third mentioned using a ‘participatory approach’ and ‘participatory method’ without further explanation [ 79 ]. Further, in this third study, only sampling household heads is limiting as this often results in over-representation of men, limiting women’s participation as research participants. Mixed methods included prioritization exercises (with numerical rankings) and the use of the ‘Sensemaker’ method, which documents micro-narratives of refugees/IDPs lived experiences and, then from these narratives, using a signification framework, participants then create their own set of questions to analyze such narratives [ 78 ].

As will be discussed in later sections, some of these methods were explicitly framed as being participatory. These research methods are distinct from the broader participatory approaches employed.

Gender and GBV focus

In total, 68% of included studies (n = 32) focused on GBV. This included 14 studies that focused solely on GBV, and 18 studies which looked at GBV along with other themes specifically: GBV and adolescent girls (n = 4), GBV and LGBTQIA + (n = 4), GBV and sexual and reproductive health (n = 2), and various combinations of GBV with other topics including economic development, maternal and child health, economic development, division of labour/gender roles, decision-making/leadership and masculinities.

The remaining 32% of included studies (n = 15) focused on topics related to gender equality more broadly without discussing GBV. These topics included LGBTQIA + (n = 4), division of labour/gender roles (n = 2), sexual and reproductive health (n = 2), masculinities (n = 1), and various combinations of division of labour/gender roles with other topics (n = 6). The greater proportion of studies focused on GBV rather than gender equality more broadly may reflect the fact that researching GBV requires greater sensitivity and care (which participatory approaches and methods may help with). For included papers focusing on humanitarian settings (rather than high-income countries hosting refugees), the emphasis on gender equality may also reflect the greater focus within the humanitarian sector on GBV compared to other gender-related issues.

Definitions of participation and ‘participatory’ research

Across all included studies, no definition of the core concept of ‘participation’ was discussed, despite recognition that participation is important. Existing frameworks and definitions were not referenced in these studies.

However, included studies do describe or define different participatory approaches to research. For example, Lenette and colleagues [ 73 ] describe participatory research as research that ‘begins from a social, ethical and moral commitment not to treat people as objects of research but rather, to recognise and value the diverse experiences and knowledges of all those involved (…) Participatory research is often seen as a method that promotes cultural continuity and values gender-specific standpoints’ (757). Feminist participatory research is described by Thompson [ 92 ] as ‘a conscious break with research programs grounded in empiricism (…) Feminist participatory research, then, is not just neutral on the topic of women. It is instead openly committed to a diverse range of women's experiences and women's struggles. It is guided by feminist critiques of science and employs methods that preserve women's experiences in context’ (31).

The concept of ‘Participatory Action Research’ (PAR) was also described in several studies, with a focus on principles of PAR [ 50 , 51 , 52 , 60 , 65 ]. Community-based participatory research (CBPR) principles were also discussed in a few studies [ 64 , 68 , 69 ]. Other concepts that were described were PhotoVoice [ 74 ], action research [ 66 ] and ‘community participatory methodology’ [ 57 ].

Rationale for promoting refugee/IDP participation

Reviewed papers provided several rationales for promoting participation of refugees/IDPs in their research including: their identity as a refugee/IDP, their gender, and their position within power hierarchies. For example, various papers (n = 9) voiced that the experiences and qualities that are intrinsic to refugee/IDP status mandated their active participation in research. With a consensus that there is an overall lack of attention to this population [ 64 ], coupled with their rapidly increasing numbers [ 74 ], authors believed it was especially important to include those with “local, individual and marginalized viewpoints” [ 59 ] that are often outside of traditional “Western” research [ 68 , 69 ], in order to capture a holistic view of their lives [ 94 ]. Authors also viewed their participation as an empowering process, which could counter act often romanticized perceptions and representations of their lives, such as that they are all traumatized [ 95 ]. Participatory research was also positioned as responding to the fact that research with refugees does not use strengths-based approaches [ 55 ]. Thompson believed participation—via the recall and collection of their stories—could help participants to reconstruct their lives [ 92 ].

Further, several reviewed papers (n = 8) cited feminist theory as a rationale for promoting participation amongst research with refugees/IDPs [ 28 , 55 , 67 , 70 , 74 , 77 , 92 , 94 ]. Most referred to encouraging women and girls to join the research process. However, one paper purposely included adolescent boys so to understand their perspectives on issues around gender inequality and marriage [ 78 ] and a few purposely included LGBTQIA + refugees/IDPs (n = 2). Overall, rationales for including women and girls were two-fold. First, they either conceptualized knowledge as a (feminist) process of emancipation and social change [ 95 ], and thus, included women and girls to address gender stereotypes that persist in research [ 74 ]. For example, they recognized that women and girls are less likely to participate in mixed-gendered research spaces and that their contributions to knowledge are often viewed as less valuable [ 95 ]. Secondly, the rationale used for including women and girls was in order to ensure that research recommendations would be centred on their specific needs and experiences, for example, to ensure that their specific safety concerns would be included.

Moreover, many studies (n = 10) sought to include refugees/IDPs within the research process to address the power imbalances that are often present within research and ensure more democratic equitable research. This often included descriptions of how power dynamics can make research ‘exploitative’ [ 95 ]. In Pangcoga and Gambir’s study, the Sensemaker method made the research more ‘democratic’, enabling participants voices to be centred while addressing power imbalances [ 78 ], while others identified how their choice of methods such as participatory photography, visual methods and production of artistic outputs helped to reduce power dynamics [ 28 , 67 , 94 ]. In both ‘Empowered Aid’ studies, PAR was stated as a means of recognising and tackling power imbalances [ 50 , 51 ]. Other studies also took a holistic approach to being participatory through strategies such as asking open-ended questions [ 28 , 73 ], reflecting on power and positionality [ 28 , 92 , 94 ], spending more time with refugees and thinking about how best to represent their lives [ 28 , 72 , 94 ]. Studies acknowledged that it was challenging to fully address power imbalances [ 95 ].

Level of focus on participation

As part of the extraction process, we classified included studies according to how authors’ described their study’s focus on on participation. This was driven by our recognition—also discussed in literature—that the concept of participation has often been co-opted by authors [ 6 ] when describing their methods, without due consideration to the fidelity and robustness of participation. Firstly, we classified 15% of studies (n = 7) as having ‘low’ content on participation—describing studies where being participatory was mentioned in passing only, without further explanation. We then used the framing by Lenette et al. [ 1 ] to contrast the use of a participatory ‘approach’ (i.e. a holistic process made up of multiple strategies to embed participation across the research process), and the use of a participatory ‘method’ (i.e. the use of a specific research method such as PhotoVoice or video). We created three categories to classify the studies that were not categorised as ‘low’: studies that only use participatory method(s), studies that only use a participatory approach, or studies that use both a participatory method and participatory approach. We suggest that simply using a participatory method is not always sufficient to address power hierarchies within research, rather using a more holistic participatory approach encompassing multiple strategies is more helpful.

Content classified as ‘low’ (n=7) tended to involve singular references to participation or being participatory without any further explanation [ 61 , 79 , 80 , 81 , 86 , 96 , 97 ]. For example, using the term ‘participatory qualitative design’ only in the abstract with no additional reference in the text [ 61 ], or referring to a ‘participatory approach’ or ‘participatory research’ without further explanation [ 79 , 86 , 97 ].

One study classified as low referred to ‘ethnographic participatory fieldwork’ [ 81 ] and listed classroom interactions and language portraits as examples, without explaining these methods further. It is unclear if the methods alone were the reason for using the term ‘participatory’ or if something related to the methodology of the ethnographic fieldwork was participatory. Similarly, another study mentioned ‘participatory FGDs’ and said this involved drawing and poetry, but did not provide further detail on this approach [ 96 ], seeming to reflect Ozkul’s [ 7 ] critique that arts-based methods are sometimes automatically assumed to be participatory.

Some of these examples may reflect what Cornwall and Brock [ 98 ] refer to as ‘buzzwords’. Using the term participation or participatory may invoke positive associations without resulting in refugees or IDPs meaningfully participating in research processes. However, we also recognise that the level of content included to describe participatory approaches and methods are not always reflective of whether studies actually used these approaches. For example, disciplinary styles of writing, journal requirements and feedback from peer reviewers may all result in less (or more) description being added about methods.

Studies that only use participatory approaches

In total, 17 studies used a holistic participatory approach in isolation—without also mentioning use of a participatory method. The table below outlines the types of strategies used to enhance participation. We took a broad approach in categorising these studies as taking a participatory approach, recognising that not all practices were explicitly labelled as participatory. For example, one study [ 72 ] only mentioned the word ‘participatory’ in passing, yet the practices described in the methods (including having an advisory committee that was connected to the community) align with participatory approaches.

In a few cases, it was not clear if studies also used a participatory method. For example, two studies included community members at each stage of the research as part of the broader participatory approach, but it was unclear if the use of video-elicitation within the FGDs constituted a participatory method [ 68 , 69 ]. In another case where a feminist participatory approach was described, it was not clear if the use of ‘dream narratives’ may constitute use of a participatory method [ 92 ].

Studies that only use participatory methods

In total, 11 studies used participatory methods in isolation [ 53 , 54 , 55 , 59 , 62 , 63 , 74 , 83 , 84 , 87 , 89 ]. The methods chosen included participatory photography including participatory mapping [ 84 , 89 ], PhotoVoice [ 62 ] and participatory ranking methodologies [ 53 ]. A few studies did not fully explain their use of participatory methods. One study mentioned the use of ‘participatory workshop methods’ multiple times without explaining what this meant [ 83 ]. One study used PAR meetings with refugees to gather data [ 54 ] and another used ‘participatory learning and action’ (PLA) [ 59 ], but neither outlined in detail the PAR and PLA approaches, though Akash & Chalmiers noted that they describe their methodology in another paper [ 54 ].

In a few cases, studies were stated as using a participatory approach, however in reality these described methods and were counted within the ten studies above that only talked about methods. In two studies, CBPR was stated as the methodology but only PhotoVoice [ 55 ] or only PhotoVoice and interviews [ 74 ] were used as the method—and there was no other indication that a broader CBPR approach was taken. Elsewhere PAR was stated as the methodology, but in one study only the use of photo-ethnography as method rather than PAR more broadly was evident based on the paper description [ 87 ]. Another study mentioned the use of PAR meetings which were also described as creating space for women ‘to enable women to flexibly tell their own stories of marriage using a life events-narrative approach’ [ 54 ]—which sounds less like a participatory method and more like a life history interview.

Studies that use both participatory methods and participatory approaches

In total, 11 studies clearly stated the use of both a participatory approach as well as a participatory method [ 28 , 50 , 51 , 56 , 58 , 67 , 73 , 78 , 82 , 91 , 94 ].

Strategies used to enhance participation

The most common strategy used within the 27 studies that took a participatory approach was involving participants in design, data collection and analysis (including through an advisory group), which 17 studies mentioned. Other strategies included refugees/IDPs only participating in design/influencing the research agenda (n = 5), refugees/IDPs only participating in analysis/feedback (n = 3), using peer data collectors (n = 4) and providing in-kind or financial compensation for refugees/IDPs who participated (n = 3) (Table 4 ).

While this list (which is not mutually-exclusive) represents a helpful indication of the ways in which GBV and gender equality research has sought to promote refugee/IDP participation, it is important to note the challenges in using these strategies which many studies discussed. The time and financial cost associated with participatory approaches can be significant; and it is not always possible to compensate refugees/IDPs for their time [ 66 ]. Even if researchers intend to promote participation, refugees/IDPs may not always be accustomed to or comfortable with participating and may not engage as much as hoped [ 95 ]. Efforts to enable participants to co-create outputs may not always be successful as participants may be not used to having more autonomy and voice [ 67 ]. These challenges complicate efforts to promote refugee/IDP participation.

Impacts of participation of refugees/IDPs in research

Some studies explicitly commented on the impacts of using participatory methods and strategies. For example, studies stated that using this approach to research increased participants’ well-being and confidence [ 55 , 94 ]. Participants reported feeling heard [ 64 ]. Participatory research also created opportunities for socialisation amongst participants [ 73 ]. Engaging communities throughout the research enabled communities to create knowledge and develop local strategies for change [ 66 ].

Other studies did not specifically comment on concrete impacts but discussed the potential of participatory methods and strategies to contribute towards increasing solidarity [ 95 ], creating transformative experiences for participants [ 74 ], preventing research fatigue [ 95 ], and improving research rigour and ethics [ 69 ].

This scoping review explored how the concept of participation is operationalised in research with refugees and IDPs. Our review highlights how despite recognition that participation of refugees/IDPs is important for research, the concept of participation continues to be used tokenistically, as a ‘buzzword’ [ 98 ] that is misappropriated to describe a myriad of research approaches and methods.

In our study, we found that while many studies use gender (including specifically drawing on feminist theory), or refugee/IDP status to explain the reason for taking a participatory approach, in many cases there was not a concerted effort to understand and outline the reasons why participation is important—and even less effort to document the impacts of using participatory approaches and methods. The power hierarchies within research more generally do provide a strong incentive for researchers to tackle imbalances inherent within the research process, however these dynamics were not often discussed in included papers. We suggest that conducting power analysis more broadly—including analysing power dynamics within research, gendered power dynamics and dynamics between refugess/IDPs and researchers—may provide stronger rationale for promoting participation, making it easier to identify concrete opportunities for refugee/IDP participation in research.

While only a small number of studies were classified as having limited/passing references to being participatory, those that did include references to either using participatory methods or participatory approaches more broadly, at times did not fully explain what exactly was participatory about the research. Methods like FGDs were described as being participatory, without it being clear what made this approach participatory. Even when approaches like CBPR or PAR were referenced, the descriptions of research practices were sometimes limited. Some of this gap is due to journal and peer reviewer expectations, as well as practices within research disciplines—rather than necessarily reflecting that participatory methods and approaches are not being used. Thus, we recommend more robust descriptions of how researchers action participation within research outputs, so that the wider research community can learn not only what they have accomplished, but how they accomplished it.

Where participatory approaches were used, we found that the use of specific strategies to promote participation tended to focus on involving refugees/IDPs in providing advice across the research process—a positive sign. In some cases, refugees were engaged as ‘peer researchers,’ though this strategy has also been critiqued by others as containing potential for exploitation [ 26 , 99 ]. Importantly, engaging refugees/IDPs during analysis was less common, representing a gap in current strategies to promote participation, which others have also identified [ 100 ]. Thus, we suggest aiming to involve refugees and IDPs more in analysis, all whilst recognising also the additional burden on this engagement might place on refugees by seeking to find less time-intensive ways of seeking input on the findings and ensuring renumeration for this participation. Moreover, providing some kind of incentive or benefit for refugees/IDPs to participate was only mentioned in a few studies, although this would have meaningful impact for refugees/IDPs. While this review highlights that among refugees and IDPs there are limited examples of the systematic use of both participatory approaches across a research process, and use of participatory methods, we suggest much can be learnt from feminist participatory research among other populations. Feminist participatory research continues to provide innovative ways of understanding power, challenging how knowledge is produced (and by whom) and framing issues from women’s perspective [ 33 , 36 , 43 ]. However, many of these methodological advancements are yet to be tested in settings with refugees and IDPs. We suggest that particularly in humanitarian emergencies, the default assumption may be that using innovative methods is less realistic. Indeed, the urgent nature of the humanitarian response has at times acted as a justification for not considering issues of power in sufficient depth or not spending enough time to understand issues before responding [ 28 , 101 ]. In the same way, the limited level of innovation within research methods among refugees and IDPs may be driven by assumptions about what is possible to implement within a humanitarian emergency. Notwithstanding the challenges in obtaining research funding for research in humanitarian settings that uses innovative methods, we suggest more work needs to be done to consider the value of participatory methods—beyond PhotoVoice—for research among refugees and IDPs.

We recommend that future research among refugees and IDPs should:

More explicitly detail how researchers sought to promote participation of refugees/IDPs, including clearer conceptualisations of what constitutes refugee/IDP participation and how they operationalised this.

Consider the use of innovative, feminist research methods that can challenge power dynamics and provide new opportunities for refugees and IDPs to share their lived experience. Learning from feminist participatory research methods used outside of refugee and IDP populations may provide important lessons to bring innovative research methods into the humanitarian sector.

Continue to engage refugees and IDPs in research design and analysis in particular, and use other strategies such as in-kind and financial compensation to recognise the contribution refugees and IDPs make towards research.

Include more explicit reflection on how power affects the research process and deliberately incorporate participatory approaches and methods to address this, including drawing on feminist and participation frameworks applied in other settings to ensure refugee/IDP participation is meaningful and not solely lip service. This should include consideration of how participatory approaches and methods align with key principles of rigorous, ethical research.

Seek to analyse the impacts of incorporating participatory approaches and methods on refugees/IDPs themselves, to help with documenting both positive impacts and unintended/negative impacts.

Availability of data and materials

All data generated or analysed during this study are included in this published article and its supplementary information files.

Change history

03 january 2024.

A Correction to this paper has been published: https://doi.org/10.1186/s13031-023-00559-0

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Lokot, M., Hartman, E. & Hashmi, I. Participatory approaches and methods in gender equality and gender-based violence research with refugees and internally displaced populations: a scoping review. Confl Health 17 , 58 (2023). https://doi.org/10.1186/s13031-023-00554-5

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Researching gender-based violence: methods and meaning.

Gender-based violence occurs globally and is prevalent in many forms, including intimate partner violence, rape and coerced sex, child sexual abuse, and human trafficking. Such forms of gender-based violence have serious impacts on individuals’ physical, sexual and psychological health, as well as their social and economic well-being.

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This is a specialised course focusing on methods to research gender based violence. Participants are expected have some prior familiarity or experience with conducting research, and relevant knowledge about the subject of gender based violence. Teaching will be conducted in English and participants will need sufficient language skills to read course materials and participate actively in group discussions. Participants will be expected to have an undergraduate degree and ideally, some post graduate training in research methods. Knowledge of computers and a basic knowledge of word for Windows and Excel is also essential.

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Injuries and /or trauma due to sexual gender-based violence among survivors in sub-Saharan Africa: a systematic scoping review of research evidence

Desmond kuupiel.

1 Faculty of Health Sciences, Durban University of Technology, Ritson Campus, Durban, 4001 South Africa

2 Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001 South Africa

Monsurat A. Lateef

Patience adzordor.

3 The John Wesley School of Leadership, Carolina University, 420 S. Broad Street, Winston- Salem, NC 27101 USA

4 UNiTED Projects, Kpando, Ghana

Gugu G. Mchunu

Julian d. pillay, associated data.

All data sources will be presented in a form of references.

Sexual and gender-based violence (SGBV) is a prevalent issue in sub-Saharan Africa (SSA), causing injuries and trauma with severe consequences for survivors. This scoping review aimed to explore the range of research evidence on injuries and trauma resulting from SGBV among survivors in SSA and identify research gaps.

The review employed the Arksey and O’Malley methodological framework, conducting extensive literature searches across multiple electronic databases using keywords, Boolean operators, medical subject heading terms and manual searches of reference lists. It included studies focusing on injuries and trauma from SGBV, regardless of gender or age, published between 2012 and 2023, and involved an SSA countries. Two authors independently screened articles, performed data extraction and quality appraisal, with discrepancies resolved through discussions or a third author. Descriptive analysis and narrative synthesis were used to report the findings.

After screening 569 potentially eligible articles, 20 studies were included for data extraction and analysis. Of the 20 included studies, most were cross-sectional studies ( n  = 15; 75%) from South Africa ( n  = 11; 55%), and involved women ( n  = 15; 75%). The included studies reported significant burden of injuries and trauma resulting from SGBV, affecting various populations, including sexually abused children, married women, visually impaired women, refugees, and female students. Factors associated with injuries and trauma included the duration of abuse, severity of injuries sustained, marital status, family dynamics, and timing of incidents. SGBV had a significant impact on mental health, leading to post-traumatic stress disorder, depression, anxiety, suicidal ideations, and psychological trauma. Survivors faced challenges in accessing healthcare and support services, particularly in rural areas, with traditional healers sometimes providing the only mental health care available. Disparities were observed between urban and rural areas in the prevalence and patterns of SGBV, with rural women experiencing more repeated sexual assaults and non-genital injuries.

This scoping review highlights the need for targeted interventions to address SGBV and its consequences, improve access to healthcare and support services, and enhance mental health support for survivors. Further research is required to fill existing gaps and develop evidence-based strategies to mitigate the impact of SGBV on survivors in SSA.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-024-01307-3.

The World Health Organization (WHO) reports that injuries are a growing global public health problem [ 1 ]. In 2021, unintentional and violence-related injuries were estimated to cause over 4 million deaths worldwide, accounting for nearly 8% of all deaths [ 1 ]. Additionally, injuries are responsible for approximately 10% of all years lived with disability each year [ 1 ]. While injuries can result from various causes such as road traffic accidents, falls, drowning, burns, poisoning, and acts of violence, including sexual and gender-based violence (SGBV) [ 1 , 2 ], SGBV remains a neglected cause of injuries that silently affects the lives of many, especially women [ 3 , 4 ]. Injuries due to SGBV refer to physical harm or trauma resulting from acts of violence perpetrated based on an individual’s sex or gender. These injuries can encompass a range of physical harm, including but not limited to bruises, cuts, fractures, internal injuries, and sexual trauma (psychological or emotional) [ 5 ].

Sexual and gender-based violence is a pervasive issue [ 6 – 10 ] with alarming rates globally, particularly in the WHO Africa and South-East Asia regions with 33% each compared to 20% in the Western Pacific, 22% in high-income countries and Europe, and 31% in the WHO Eastern Mediterranean region [ 8 ]. However, this statistic includes only physical and/or sexual violence by an intimate partner alone and does not include other forms of violence [ 8 ]. Sexual and gender-based violence encompasses various acts such as sexual assault, rape, intimate partner violence, and harmful traditional practices, all of which have severe physical and psychological consequences for women [ 9 , 11 , 12 ]. The sub-Saharan Africa region has witnessed numerous cases of SGBV perpetrated against vulnerable populations, such as women, children, refugees, and individuals with disabilities, with devastating impacts on their well-being and overall quality of life [ 13 – 32 ].

Understanding the extent and nature of injuries and trauma resulting from SGBV among survivors is crucial in formulating effective interventions, policies, and support systems. Research evidence plays a fundamental role in shaping responses to this pressing public health concern, guiding the development of targeted interventions and preventive measures. However, the available research on injuries and trauma related to SGBV in sub-Saharan Africa remains scattered and diverse, necessitating a comprehensive and systematic review to consolidate and analyse existing knowledge.

A scoping review study would support a valuable research approach to systematically map and describe the existing evidence on injuries and trauma related to SGBV against women in sub-Saharan Africa. In so doing, the scoping review would provide a broader overview of the literature to identify knowledge gaps, key concepts, and various study designs employed in the field, and inform more specific research questions that can be unpacked by way of a systematic review and /or meta-analysis quantitative studies or meta-synthesis of qualitative studies [ 33 , 34 ]. To our knowledge, current literature shows no evidence of any previous scoping review that has focused on injuries and trauma due SGBV. This study, therefore, conducted a systematic scoping review to explore the scope of research evidence regarding injuries and trauma stemming from SGBV among survivors in sub-Saharan Africa. This research sheds light on the prevalence, patterns, and factors associated with injuries and trauma resulting from SGBV in the region and their impact on survivors.

To achieve the objective of this scoping review, we utilised the Arksey and O’Malley methodological framework [ 35 ] as a guiding framework for mapping and examining the literature on injuries and trauma associated with SGBV in the context of sub-Saharan Africa. This framework comprises several key steps, including identifying the research question, identifying relevant studies, study selection, data charting and collation, and summarizing and reporting the results [ 33 , 34 ].

Identifying the research question

The primary research question guiding this scoping review is as follows: What is the scope of research evidence regarding injuries and trauma resulting from sexual and gender-based violence among survivors in sub-Saharan Africa in the last decade? To ensure the appropriateness and relevance of this question, we employed the Population, Concept, and Context (PCC) framework [ 36 ] as part of the study eligibility criteria, which is detailed in Table  1 . To comprehensively address the research objective, the scoping review explored the following sub-questions:

Study eligibility criteria

Literature searches

The purpose of our search was to identify relevant peer-reviewed papers that address the review questions. To accomplish this, a comprehensive search was conducted across several electronic databases, including PubMed, EBSCOhost (CINAHL, PsycInfo, and Health Source: Nursing/Academic Edition), SCOPUS, and Web of Science for original articles published within between 2012 and 2023. Additionally, a search using the Google Scholar search engine was performed to identify additional literature of relevance. For the database searches, we developed a search strategy in collaboration with an information scientist, ensuring the inclusion of relevant keywords such as “survivor,” “gender-based violence,” “sexual violence,” “injuries,” and “trauma.” We employed Boolean operators (AND/OR) and Medical Subject Heading (MeSH) terms to refine the search string (Please refer to Supplementary File 1 for the detailed search strategy). Adjustments were made to the syntax based on the specific requirements of each database. The information scientist also played a role in conducting website searches. In addition to electronic searches, we manually explored the reference lists of included sources to identify any additional relevant literature. At this stage, no search filters based on language or publication type were applied, however, the search results will be limited to publications from 2012 to 2023. This date limitation was to enable as captured recent and relevant studies to understand the current trend. All search results were imported into an EndNote Library X20 for efficient citation management.

Articles selection process

A study selection tool was developed using Google Forms based on the items outlined in the inclusion criteria (Table  1 ) and was subsequently pilot tested. The EndNote library was then examined for duplicates using the “Find Duplicate” function. Two authors (DK and ML) independently utilised the study screening tool to categorise titles and abstracts into two groups: “include” and “exclude.” Any discrepancies in their responses during this phase were resolved through discussion and consensus. The full-text articles of all titles and abstracts that met the inclusion criteria during the initial screening phase were obtained from using the Durban University of Technology Library Services, and independently screened by DK and ML following the eligibility criteria as a guide. In cases where there was a lack of consensus between DK and ML, a third author (PA) was consulted to resolve any discrepancies. The PRISMA flow diagram was utilised to document the article selection process, ensuring transparency and accountability.

Quality appraisal

The Mixed Method Quality Appraisal Tool (MMAT) Version 2018 [ 37 ] was utilised to assess the methodological quality and potential risk of bias in the included studies. This tool was employed to evaluate the appropriateness of the study’s objective, the suitability of the study design, participant recruitment methods, data collection procedures, data analysis techniques, and the presentation of results/findings. To determine the quality of the studies, a quality score based on established criteria was applied, where a score of 50% indicated low quality, 51–75% indicated average quality, and 76–100% indicated high quality. The total percentage score was calculated by adding all the items rated, divided by seven, and multiply by a hundred. This rigorous assessment is crucial for identifying any research gaps. Two authors (DK and ML) independently conducted the quality appraisal, and any disagreements were resolved by involving a third author (PA).

Data charting

Data extraction was conducted using a spreadsheet, which underwent a pilot test with 15% (3) of the included evidence sources to ensure its efficacy in capturing all relevant data for addressing the review question. Feedback from the pilot test was carefully considered, and necessary adjustments were made to the form. Upon a comprehensive examination of the full texts, two independent reviewers (DK and ML) extracted all pertinent data from the included studies. The data extraction process employed a hybrid approach, incorporating both inductive and deductive reasoning [ 38 ]. The process involved a thorough analysis of the extracted information to identify patterns, themes, and trends in the existing research evidence regarding injuries and trauma resulting from SGBV among survivors in sub-Saharan Africa. Key study characteristics, including author(s), publication year, study title, aim/objective, geographical location (country), study design and study population, were extracted. Additionally, the study findings pertaining to injuries and/or trauma resulting from SGBV were recorded.

Collating, summarising, and reporting the results

The results of the data extraction were collated and summarised in a narrative format. Descriptive analysis and narrative synthesis were utilised to present the findings in a comprehensive manner. The study outcomes included a comprehensive overview of the scope of research evidence on injuries and trauma due to SGBV among survivors in the region. This study was be reported in keeping with the Preferred Reporting Items for Systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) checklist [ 39 ].

Study selection

A total of 569 potentially eligible titles and abstracts across databases were screened and after excluding duplicates and those that did not meet this eligibility criteria, included 20 [ 13 – 32 ] studies for data extraction and analysis (Fig.  1 ).

PRISMA 2020 flow diagram

Characteristics and quality appraisal of the included studies

Of the 20 included studies, the majority ( n  = 4; 20%) were from South Africa, and mostly ( n  = 11; 55%) published between 2012 and 2022. The majority ( n  = 9, 45%) were cross-sectional studies, and mostly ( n  = 15; 75%) involved women. The mean quality score ± SD of the 20 included studies was 87% ± 13. All details on the characteristics and quality appraisal of the included studies are provided in Table  2 .

Characteristics and quality appraisal of the included studies ( N  = 20)

Study findings

Theme 1: physical injuries/trauma due to sgbv occurrence/prevalence, pattern, and associated factors.

Several studies have explored the prevalence and factors associated with injuries/trauma due to SGBV (Table  3 ). Ssewanyana et al. highlighted the occurrence of genital trauma among adolescent girls resulting from sexual assault [ 14 ]. Apatinga et al. demonstrated that sexual violence was accompanied by physical abuse, leading to physical injuries among women [ 15 ]. Azumah et al. reported that visually impaired women who experienced gender-based violence faced a higher risk of injuries including genital injuries [ 16 ]. Amashnee et al. identified specific patterns in the occurrence of sexual assault injuries, with higher prevalence on Mondays (28%) and Fridays (27.3%), during specific months, and predominantly during working hours [ 17 ]. Abubeker et al. examined the impact of physical violence on female students, with findings indicating various injuries such as bruising, cuts, scratches, and fractures, leading to missed classes and fear of walking alone [ 19 ]. Biribawa et al. investigated the burden of GBV-related injuries and found a significant number of hospital visits in Uganda, with slightly declining injury rates (from 13.6 to 13.5 per 10,000 population) from 2012 to 2016 [ 18 ]. Umana et al. documented that 6.6% of undergraduate and postgraduate female students experienced sexual intimate partner violence, leading to injuries such as cuts, bruises, and sprains [ 20 ]. Mukanangana et al. reported the prevalence of virginal bleeding, genital irritation and urinary tract infection among women in reproductive age in Zimbabwe [ 21 ]. These findings collectively underscore the occurrence/prevalence physical injuries/trauma, pattern and specific associated factors associated resulting from SGBV.

Physical injuries/trauma due to SGBV occurrence/prevalence, pattern, and associated factors

Theme 2: consequences and impact on mental health

Several studies highlighted the significant consequences and impact of SGBV on mental health (Table  4 ). Ombok et al. found that sexually abused children had a high prevalence (49%) of post-traumatic stress disorder (PTSD), which was associated with the duration of abuse, severity of injuries sustained, parents’ marital status, and family dynamics [ 13 ]. Apatinga et al. demonstrated that sexual violence was accompanied by emotional abuse, leading to psychological problems, sexual and reproductive health issues, and suicidal ideations among women [ 15 ]. Azumah et al. reported that visually impaired women who experienced gender-based violence faced a higher risk of suicide attempts, and marital breakdown [ 16 ]. Liebling et al. found that women and girls who experienced SGBV frequently became pregnant and suffered from injuries, disability, and psychological trauma [ 22 ]. Morof et al. highlighted the high prevalence of violence and its association with PTSD symptoms and depression among women [ 23 ]. Nguyen et al. demonstrated that exposure to various forms of gender-based violence, including intimate partner violence and sexual harassment, was significantly associated with hypertension, mediated by depression, post-traumatic stress symptoms, and alcohol binge-drinking [ 24 ]. Abrahams et al. reported that women raped by intimate partners had higher levels of depressive symptoms compared to those raped by strangers [ 25 ]. Pitpitan et al. found a significant association between gender-based violence and increased alcohol use, as well as heightened levels of depressive symptoms and PTSD symptoms [ 26 ]. Okunola et al. revealed the complications experienced by survivors of sexual assault, including sexually transmitted infections, depression, and post-traumatic stress disorder [ 27 ]. Umana et al. identified the negative impact of violence on academic performance, with victims experiencing loss of concentration, self-confidence, and school absenteeism [ 20 ]. Roberts et al. highlighted the association between severe GBV and higher depressive symptoms, PTSD symptoms, disordered alcohol use, and more sex partners [ 29 ]. Tantu et al. emphasized the wide range of social, health-related, and psychological consequences resulting from gender-based violence [ 28 ]. Finally, Mukanangana et al. revealed that the majority of respondents who experienced rape suffered from psychological trauma, exposure to sexually transmitted infections, unwanted pregnancies, loss of libido, and illegal abortions [ 21 ]. These findings collectively demonstrate the significant impact of SGBV on mental health, including psychological trauma, depression, PTSD symptoms, and various adverse outcomes.

Consequences and impact on mental health

Theme 3: healthcare access and support services

The findings from the studies conducted in the Democratic Republic of the Congo and Togo highlight significant barriers and challenges faced by survivors of SGBV in accessing healthcare and receiving proper psychological care. In the Democratic Republic of the Congo, Scott et al. reported that SGBV survivors faced barriers to accessing healthcare, such as availability and affordability, in their study to evaluate community attitudes of SGBV and health facility capacity to address SGBV in the eastern part of the country [ 30 ]. Access to mental health care was difficult [ 30 ]. Witch doctors and other traditional healers provided mental health services to some survivors [ 30 ]. Burgos-Soto et al.‘s study in Togo, which sought to estimate the prevalence and contributing factors of intimate partner physical and sexual violence among HIV-infected and -uninfected women, found that lifetime prevalence rates of physical and sexual violence were significantly higher among HIV-infected women compared to uninfected women [ 31 ]. 42% of the women admitted to ever suffering physical harm as a result of intimate partner abuse [ 31 ]. Only one-third of the injured women had ever told the medical professionals the true nature of their injuries, and none had been directed to neighbourhood organizations for the proper psychological care [ 31 ].

Theme 4: rural vs. urban disparities

According to a study conducted in Nigeria by Na et al. to identify the trends in sexual assault against women in urban and rural areas of Osun State, completed rapes occurred 10.0% of the time in urban areas and 9.2% of the time in rural areas, while attempted rapes occurred 31.4% of the time in urban areas and 20.0% of the time in rural areas [ 32 ]. Rural women were more likely than urban women to endure repeated sexual assault and non-genital injuries [ 32 ]. This study findings suggest that sexual assault against women occurs in both urban and rural areas, with notable differences in the patterns and outcomes.

This scoping review study on injuries and trauma resulting from sexual and SGBV) in sub-Saharan Africa revealed key findings that shed light on this critical issue. The majority (15%) of the included studies were conducted in South Africa. Most (75%) of these studies adopted a cross-sectional design and focused on women as the population of interest. The overall mean quality score of the included studies was high, indicating robustness and reliability in the research.

The findings from the included studies collectively highlighted the prevalence of physical injuries and trauma resulting from SGBV in sub-Saharan Africa such as genital injuries, cuts, bites, scratches, abrasions, bruises, sprains, dislocations, fractures, vaginal bleeding, and genital trauma. The included studies provided insights into the consequences and specific factors associated with such violence, emphasising the urgent need for effective interventions and support services. Notably, the impact of SGBV on mental health was a recurring theme in the literature, with evidence pointing to psychological trauma, depression, PTSD symptoms, and other adverse outcomes experienced by survivors.

While the review identified limited research on healthcare access and support services for SGBV survivors, the available studies underscored significant barriers in accessing healthcare and receiving proper psychological care [ 30 , 31 ]. Challenges included limited availability and affordability of services, as well as survivors’ hesitancy to disclose abuse to medical professionals. These findings highlight importance healthcare gaps requiring interventions to ensure comprehensive support for survivors in sub-Saharan Africa.

Policymakers in sub-Saharan Africa should prioritise the implementation of comprehensive and evidence-based interventions to address injuries and trauma resulting from SGBV. The concentration of included studies from South Africa indicates the need to expand research efforts to include other countries in the region, ensuring that policies are tailored to meet the diverse needs and contexts of different nations. The limited research on healthcare access and support services for SGBV survivors underscores the urgency of improving healthcare systems and strengthening support services for survivors. Policymakers should consider investing in accessible and affordable healthcare services that provide specialised care for SGBV survivors, including mental health support. Additionally, addressing publication language bias by promoting research in multiple languages (e.g., French and Portuguese) can ensure that relevant findings reach policymakers across the sub-Saharan African region. Furthermore, this scoping review’s potentially can inform the development of targeted policies that address the specific risk factors, consequences, and contributing factors associated with injuries and trauma resulting from SGBV.

The scoping review findings highlight several avenues for future research on injuries and trauma as a result of SGBV in sub-Saharan Africa. Researchers should focus on conducting studies in countries with limited representation in the current literature to enhance the breadth and diversity of evidence available. Investigating the barriers and challenges faced by survivors in accessing healthcare and support services should be a priority to identify gaps and improve service delivery. Moreover, longitudinal studies could provide valuable insights into the long-term consequences of SGBV on survivors’ mental health and well-being. Researchers should also explore the effectiveness of various interventions, including those involving community-based support systems, to address SGBV-related injuries and trauma. Furthermore, incorporating qualitative research approaches could deepen the understanding of survivors’ experiences and help in tailoring interventions to their specific needs. Future research should also consider the perspectives of various stakeholders, including healthcare providers, community leaders, and policymakers, to develop comprehensive and context-specific strategies to prevent and respond to SGBV and its consequences. Overall, conducting rigorous research that spans diverse contexts and populations will contribute to a more comprehensive understanding of the multifaceted challenges posed by SGBV and inform evidence-based interventions that promote survivor support and well-being.

The scoping review’s strength lies in its comprehensive approach, encompassing a wide range of literature on injuries and trauma resulting from SGBV in sub-Saharan Africa. By considering various study designs and sources of evidence, the review offers a holistic view of the topic. Additionally, the study effectively identifies key themes and trends in the literature, leading to a deeper understanding of the prevalence, consequences, and specific factors associated with injuries and trauma resulting from SGBV in the region. The mapping of research evidence within the review proves to be a valuable resource for researchers, policymakers, and practitioners working in the field of SGBV. Furthermore, the review’s emphasis on studies with an overall high mean quality score (87% ± 13%) enhances the credibility and reliability of the findings, ensuring that the evidence presented is robust and trustworthy.

Despite these strengths, this scoping review has several limitations. The concentration of included studies from South Africa introduces a geographic bias, potentially limiting the generalizability of findings to other countries within sub-Saharan Africa. To enhance the review’s applicability, a more diverse representation of research from different regions in the area would be beneficial. Additionally, the paucity of studies investigating healthcare access and support services for SGBV survivors may restrict the review’s ability to provide comprehensive insights into this critical aspect of the topic. Despite these limitations, this scoping review provides a valuable overview of the available research evidence on injuries and trauma related to SGBV in sub-Saharan Africa, paving the way for further research and targeted interventions to address this critical issue. Researchers should acknowledge and consider these limitations when interpreting and applying the review’s findings.

In conclusion, this scoping review provides a comprehensive overview of the research evidence on injuries/trauma resulting from SGBV in the sub-Saharan African region. It underscores the urgent need for further research and targeted interventions to address this pervasive issue and support the well-being of survivors.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Acknowledgements

Author contributions.

D.K., G.M. and J.D conceptualised the study. D.K. wrote the manuscript and P.A., M.A., G.M., and J.D. did critical reviews. All authors approved the manuscript.

Not applicable.

Data availability

Declarations.

The authors declare no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

• Open access
• Published: 21 May 2024

Injuries and /or trauma due to sexual gender-based violence among survivors in sub-Saharan Africa: a systematic scoping review of research evidence

• Desmond Kuupiel 1 , 2 ,
• Monsurat A. Lateef 1 ,
• Patience Adzordor 3 , 4 ,
• Gugu G. Mchunu 1 &
• Julian D. Pillay 1  

Archives of Public Health volume  82 , Article number:  78 ( 2024 ) Cite this article

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Sexual and gender-based violence (SGBV) is a prevalent issue in sub-Saharan Africa (SSA), causing injuries and trauma with severe consequences for survivors. This scoping review aimed to explore the range of research evidence on injuries and trauma resulting from SGBV among survivors in SSA and identify research gaps.

The review employed the Arksey and O’Malley methodological framework, conducting extensive literature searches across multiple electronic databases using keywords, Boolean operators, medical subject heading terms and manual searches of reference lists. It included studies focusing on injuries and trauma from SGBV, regardless of gender or age, published between 2012 and 2023, and involved an SSA countries. Two authors independently screened articles, performed data extraction and quality appraisal, with discrepancies resolved through discussions or a third author. Descriptive analysis and narrative synthesis were used to report the findings.

After screening 569 potentially eligible articles, 20 studies were included for data extraction and analysis. Of the 20 included studies, most were cross-sectional studies ( n  = 15; 75%) from South Africa ( n  = 11; 55%), and involved women ( n  = 15; 75%). The included studies reported significant burden of injuries and trauma resulting from SGBV, affecting various populations, including sexually abused children, married women, visually impaired women, refugees, and female students. Factors associated with injuries and trauma included the duration of abuse, severity of injuries sustained, marital status, family dynamics, and timing of incidents. SGBV had a significant impact on mental health, leading to post-traumatic stress disorder, depression, anxiety, suicidal ideations, and psychological trauma. Survivors faced challenges in accessing healthcare and support services, particularly in rural areas, with traditional healers sometimes providing the only mental health care available. Disparities were observed between urban and rural areas in the prevalence and patterns of SGBV, with rural women experiencing more repeated sexual assaults and non-genital injuries.

This scoping review highlights the need for targeted interventions to address SGBV and its consequences, improve access to healthcare and support services, and enhance mental health support for survivors. Further research is required to fill existing gaps and develop evidence-based strategies to mitigate the impact of SGBV on survivors in SSA.

Peer Review reports

The World Health Organization (WHO) reports that injuries are a growing global public health problem [ 1 ]. In 2021, unintentional and violence-related injuries were estimated to cause over 4 million deaths worldwide, accounting for nearly 8% of all deaths [ 1 ]. Additionally, injuries are responsible for approximately 10% of all years lived with disability each year [ 1 ]. While injuries can result from various causes such as road traffic accidents, falls, drowning, burns, poisoning, and acts of violence, including sexual and gender-based violence (SGBV) [ 1 , 2 ], SGBV remains a neglected cause of injuries that silently affects the lives of many, especially women [ 3 , 4 ]. Injuries due to SGBV refer to physical harm or trauma resulting from acts of violence perpetrated based on an individual’s sex or gender. These injuries can encompass a range of physical harm, including but not limited to bruises, cuts, fractures, internal injuries, and sexual trauma (psychological or emotional) [ 5 ].

Sexual and gender-based violence is a pervasive issue [ 6 , 7 , 8 , 9 , 10 ] with alarming rates globally, particularly in the WHO Africa and South-East Asia regions with 33% each compared to 20% in the Western Pacific, 22% in high-income countries and Europe, and 31% in the WHO Eastern Mediterranean region [ 8 ]. However, this statistic includes only physical and/or sexual violence by an intimate partner alone and does not include other forms of violence [ 8 ]. Sexual and gender-based violence encompasses various acts such as sexual assault, rape, intimate partner violence, and harmful traditional practices, all of which have severe physical and psychological consequences for women [ 9 , 11 , 12 ]. The sub-Saharan Africa region has witnessed numerous cases of SGBV perpetrated against vulnerable populations, such as women, children, refugees, and individuals with disabilities, with devastating impacts on their well-being and overall quality of life [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ].

Understanding the extent and nature of injuries and trauma resulting from SGBV among survivors is crucial in formulating effective interventions, policies, and support systems. Research evidence plays a fundamental role in shaping responses to this pressing public health concern, guiding the development of targeted interventions and preventive measures. However, the available research on injuries and trauma related to SGBV in sub-Saharan Africa remains scattered and diverse, necessitating a comprehensive and systematic review to consolidate and analyse existing knowledge.

A scoping review study would support a valuable research approach to systematically map and describe the existing evidence on injuries and trauma related to SGBV against women in sub-Saharan Africa. In so doing, the scoping review would provide a broader overview of the literature to identify knowledge gaps, key concepts, and various study designs employed in the field, and inform more specific research questions that can be unpacked by way of a systematic review and /or meta-analysis quantitative studies or meta-synthesis of qualitative studies [ 33 , 34 ]. To our knowledge, current literature shows no evidence of any previous scoping review that has focused on injuries and trauma due SGBV. This study, therefore, conducted a systematic scoping review to explore the scope of research evidence regarding injuries and trauma stemming from SGBV among survivors in sub-Saharan Africa. This research sheds light on the prevalence, patterns, and factors associated with injuries and trauma resulting from SGBV in the region and their impact on survivors.

To achieve the objective of this scoping review, we utilised the Arksey and O’Malley methodological framework [ 35 ] as a guiding framework for mapping and examining the literature on injuries and trauma associated with SGBV in the context of sub-Saharan Africa. This framework comprises several key steps, including identifying the research question, identifying relevant studies, study selection, data charting and collation, and summarizing and reporting the results [ 33 , 34 ].

Identifying the research question

The primary research question guiding this scoping review is as follows: What is the scope of research evidence regarding injuries and trauma resulting from sexual and gender-based violence among survivors in sub-Saharan Africa in the last decade? To ensure the appropriateness and relevance of this question, we employed the Population, Concept, and Context (PCC) framework [ 36 ] as part of the study eligibility criteria, which is detailed in Table  1 . To comprehensively address the research objective, the scoping review explored the following sub-questions:

Literature searches

The purpose of our search was to identify relevant peer-reviewed papers that address the review questions. To accomplish this, a comprehensive search was conducted across several electronic databases, including PubMed, EBSCOhost (CINAHL, PsycInfo, and Health Source: Nursing/Academic Edition), SCOPUS, and Web of Science for original articles published within between 2012 and 2023. Additionally, a search using the Google Scholar search engine was performed to identify additional literature of relevance. For the database searches, we developed a search strategy in collaboration with an information scientist, ensuring the inclusion of relevant keywords such as “survivor,” “gender-based violence,” “sexual violence,” “injuries,” and “trauma.” We employed Boolean operators (AND/OR) and Medical Subject Heading (MeSH) terms to refine the search string (Please refer to Supplementary File 1 for the detailed search strategy). Adjustments were made to the syntax based on the specific requirements of each database. The information scientist also played a role in conducting website searches. In addition to electronic searches, we manually explored the reference lists of included sources to identify any additional relevant literature. At this stage, no search filters based on language or publication type were applied, however, the search results will be limited to publications from 2012 to 2023. This date limitation was to enable as captured recent and relevant studies to understand the current trend. All search results were imported into an EndNote Library X20 for efficient citation management.

Articles selection process

A study selection tool was developed using Google Forms based on the items outlined in the inclusion criteria (Table  1 ) and was subsequently pilot tested. The EndNote library was then examined for duplicates using the “Find Duplicate” function. Two authors (DK and ML) independently utilised the study screening tool to categorise titles and abstracts into two groups: “include” and “exclude.” Any discrepancies in their responses during this phase were resolved through discussion and consensus. The full-text articles of all titles and abstracts that met the inclusion criteria during the initial screening phase were obtained from using the Durban University of Technology Library Services, and independently screened by DK and ML following the eligibility criteria as a guide. In cases where there was a lack of consensus between DK and ML, a third author (PA) was consulted to resolve any discrepancies. The PRISMA flow diagram was utilised to document the article selection process, ensuring transparency and accountability.

Quality appraisal

The Mixed Method Quality Appraisal Tool (MMAT) Version 2018 [ 37 ] was utilised to assess the methodological quality and potential risk of bias in the included studies. This tool was employed to evaluate the appropriateness of the study’s objective, the suitability of the study design, participant recruitment methods, data collection procedures, data analysis techniques, and the presentation of results/findings. To determine the quality of the studies, a quality score based on established criteria was applied, where a score of 50% indicated low quality, 51–75% indicated average quality, and 76–100% indicated high quality. The total percentage score was calculated by adding all the items rated, divided by seven, and multiply by a hundred. This rigorous assessment is crucial for identifying any research gaps. Two authors (DK and ML) independently conducted the quality appraisal, and any disagreements were resolved by involving a third author (PA).

Data charting

Data extraction was conducted using a spreadsheet, which underwent a pilot test with 15% (3) of the included evidence sources to ensure its efficacy in capturing all relevant data for addressing the review question. Feedback from the pilot test was carefully considered, and necessary adjustments were made to the form. Upon a comprehensive examination of the full texts, two independent reviewers (DK and ML) extracted all pertinent data from the included studies. The data extraction process employed a hybrid approach, incorporating both inductive and deductive reasoning [ 38 ]. The process involved a thorough analysis of the extracted information to identify patterns, themes, and trends in the existing research evidence regarding injuries and trauma resulting from SGBV among survivors in sub-Saharan Africa. Key study characteristics, including author(s), publication year, study title, aim/objective, geographical location (country), study design and study population, were extracted. Additionally, the study findings pertaining to injuries and/or trauma resulting from SGBV were recorded.

Collating, summarising, and reporting the results

The results of the data extraction were collated and summarised in a narrative format. Descriptive analysis and narrative synthesis were utilised to present the findings in a comprehensive manner. The study outcomes included a comprehensive overview of the scope of research evidence on injuries and trauma due to SGBV among survivors in the region. This study was be reported in keeping with the Preferred Reporting Items for Systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) checklist [ 39 ].

Study selection

A total of 569 potentially eligible titles and abstracts across databases were screened and after excluding duplicates and those that did not meet this eligibility criteria, included 20 [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ] studies for data extraction and analysis (Fig.  1 ).

PRISMA 2020 flow diagram

Characteristics and quality appraisal of the included studies

Of the 20 included studies, the majority ( n  = 4; 20%) were from South Africa, and mostly ( n  = 11; 55%) published between 2012 and 2022. The majority ( n  = 9, 45%) were cross-sectional studies, and mostly ( n  = 15; 75%) involved women. The mean quality score ± SD of the 20 included studies was 87% ± 13. All details on the characteristics and quality appraisal of the included studies are provided in Table  2 .

Study findings

Theme 1: physical injuries/trauma due to sgbv occurrence/prevalence, pattern, and associated factors.

Several studies have explored the prevalence and factors associated with injuries/trauma due to SGBV (Table  3 ). Ssewanyana et al. highlighted the occurrence of genital trauma among adolescent girls resulting from sexual assault [ 14 ]. Apatinga et al. demonstrated that sexual violence was accompanied by physical abuse, leading to physical injuries among women [ 15 ]. Azumah et al. reported that visually impaired women who experienced gender-based violence faced a higher risk of injuries including genital injuries [ 16 ]. Amashnee et al. identified specific patterns in the occurrence of sexual assault injuries, with higher prevalence on Mondays (28%) and Fridays (27.3%), during specific months, and predominantly during working hours [ 17 ]. Abubeker et al. examined the impact of physical violence on female students, with findings indicating various injuries such as bruising, cuts, scratches, and fractures, leading to missed classes and fear of walking alone [ 19 ]. Biribawa et al. investigated the burden of GBV-related injuries and found a significant number of hospital visits in Uganda, with slightly declining injury rates (from 13.6 to 13.5 per 10,000 population) from 2012 to 2016 [ 18 ]. Umana et al. documented that 6.6% of undergraduate and postgraduate female students experienced sexual intimate partner violence, leading to injuries such as cuts, bruises, and sprains [ 20 ]. Mukanangana et al. reported the prevalence of virginal bleeding, genital irritation and urinary tract infection among women in reproductive age in Zimbabwe [ 21 ]. These findings collectively underscore the occurrence/prevalence physical injuries/trauma, pattern and specific associated factors associated resulting from SGBV.

Theme 2: consequences and impact on mental health

Several studies highlighted the significant consequences and impact of SGBV on mental health (Table  4 ). Ombok et al. found that sexually abused children had a high prevalence (49%) of post-traumatic stress disorder (PTSD), which was associated with the duration of abuse, severity of injuries sustained, parents’ marital status, and family dynamics [ 13 ]. Apatinga et al. demonstrated that sexual violence was accompanied by emotional abuse, leading to psychological problems, sexual and reproductive health issues, and suicidal ideations among women [ 15 ]. Azumah et al. reported that visually impaired women who experienced gender-based violence faced a higher risk of suicide attempts, and marital breakdown [ 16 ]. Liebling et al. found that women and girls who experienced SGBV frequently became pregnant and suffered from injuries, disability, and psychological trauma [ 22 ]. Morof et al. highlighted the high prevalence of violence and its association with PTSD symptoms and depression among women [ 23 ]. Nguyen et al. demonstrated that exposure to various forms of gender-based violence, including intimate partner violence and sexual harassment, was significantly associated with hypertension, mediated by depression, post-traumatic stress symptoms, and alcohol binge-drinking [ 24 ]. Abrahams et al. reported that women raped by intimate partners had higher levels of depressive symptoms compared to those raped by strangers [ 25 ]. Pitpitan et al. found a significant association between gender-based violence and increased alcohol use, as well as heightened levels of depressive symptoms and PTSD symptoms [ 26 ]. Okunola et al. revealed the complications experienced by survivors of sexual assault, including sexually transmitted infections, depression, and post-traumatic stress disorder [ 27 ]. Umana et al. identified the negative impact of violence on academic performance, with victims experiencing loss of concentration, self-confidence, and school absenteeism [ 20 ]. Roberts et al. highlighted the association between severe GBV and higher depressive symptoms, PTSD symptoms, disordered alcohol use, and more sex partners [ 29 ]. Tantu et al. emphasized the wide range of social, health-related, and psychological consequences resulting from gender-based violence [ 28 ]. Finally, Mukanangana et al. revealed that the majority of respondents who experienced rape suffered from psychological trauma, exposure to sexually transmitted infections, unwanted pregnancies, loss of libido, and illegal abortions [ 21 ]. These findings collectively demonstrate the significant impact of SGBV on mental health, including psychological trauma, depression, PTSD symptoms, and various adverse outcomes.

Theme 3: healthcare access and support services

The findings from the studies conducted in the Democratic Republic of the Congo and Togo highlight significant barriers and challenges faced by survivors of SGBV in accessing healthcare and receiving proper psychological care. In the Democratic Republic of the Congo, Scott et al. reported that SGBV survivors faced barriers to accessing healthcare, such as availability and affordability, in their study to evaluate community attitudes of SGBV and health facility capacity to address SGBV in the eastern part of the country [ 30 ]. Access to mental health care was difficult [ 30 ]. Witch doctors and other traditional healers provided mental health services to some survivors [ 30 ]. Burgos-Soto et al.‘s study in Togo, which sought to estimate the prevalence and contributing factors of intimate partner physical and sexual violence among HIV-infected and -uninfected women, found that lifetime prevalence rates of physical and sexual violence were significantly higher among HIV-infected women compared to uninfected women [ 31 ]. 42% of the women admitted to ever suffering physical harm as a result of intimate partner abuse [ 31 ]. Only one-third of the injured women had ever told the medical professionals the true nature of their injuries, and none had been directed to neighbourhood organizations for the proper psychological care [ 31 ].

Theme 4: rural vs. urban disparities

According to a study conducted in Nigeria by Na et al. to identify the trends in sexual assault against women in urban and rural areas of Osun State, completed rapes occurred 10.0% of the time in urban areas and 9.2% of the time in rural areas, while attempted rapes occurred 31.4% of the time in urban areas and 20.0% of the time in rural areas [ 32 ]. Rural women were more likely than urban women to endure repeated sexual assault and non-genital injuries [ 32 ]. This study findings suggest that sexual assault against women occurs in both urban and rural areas, with notable differences in the patterns and outcomes.

This scoping review study on injuries and trauma resulting from sexual and SGBV) in sub-Saharan Africa revealed key findings that shed light on this critical issue. The majority (15%) of the included studies were conducted in South Africa. Most (75%) of these studies adopted a cross-sectional design and focused on women as the population of interest. The overall mean quality score of the included studies was high, indicating robustness and reliability in the research.

The findings from the included studies collectively highlighted the prevalence of physical injuries and trauma resulting from SGBV in sub-Saharan Africa such as genital injuries, cuts, bites, scratches, abrasions, bruises, sprains, dislocations, fractures, vaginal bleeding, and genital trauma. The included studies provided insights into the consequences and specific factors associated with such violence, emphasising the urgent need for effective interventions and support services. Notably, the impact of SGBV on mental health was a recurring theme in the literature, with evidence pointing to psychological trauma, depression, PTSD symptoms, and other adverse outcomes experienced by survivors.

While the review identified limited research on healthcare access and support services for SGBV survivors, the available studies underscored significant barriers in accessing healthcare and receiving proper psychological care [ 30 , 31 ]. Challenges included limited availability and affordability of services, as well as survivors’ hesitancy to disclose abuse to medical professionals. These findings highlight importance healthcare gaps requiring interventions to ensure comprehensive support for survivors in sub-Saharan Africa.

Policymakers in sub-Saharan Africa should prioritise the implementation of comprehensive and evidence-based interventions to address injuries and trauma resulting from SGBV. The concentration of included studies from South Africa indicates the need to expand research efforts to include other countries in the region, ensuring that policies are tailored to meet the diverse needs and contexts of different nations. The limited research on healthcare access and support services for SGBV survivors underscores the urgency of improving healthcare systems and strengthening support services for survivors. Policymakers should consider investing in accessible and affordable healthcare services that provide specialised care for SGBV survivors, including mental health support. Additionally, addressing publication language bias by promoting research in multiple languages (e.g., French and Portuguese) can ensure that relevant findings reach policymakers across the sub-Saharan African region. Furthermore, this scoping review’s potentially can inform the development of targeted policies that address the specific risk factors, consequences, and contributing factors associated with injuries and trauma resulting from SGBV.

The scoping review findings highlight several avenues for future research on injuries and trauma as a result of SGBV in sub-Saharan Africa. Researchers should focus on conducting studies in countries with limited representation in the current literature to enhance the breadth and diversity of evidence available. Investigating the barriers and challenges faced by survivors in accessing healthcare and support services should be a priority to identify gaps and improve service delivery. Moreover, longitudinal studies could provide valuable insights into the long-term consequences of SGBV on survivors’ mental health and well-being. Researchers should also explore the effectiveness of various interventions, including those involving community-based support systems, to address SGBV-related injuries and trauma. Furthermore, incorporating qualitative research approaches could deepen the understanding of survivors’ experiences and help in tailoring interventions to their specific needs. Future research should also consider the perspectives of various stakeholders, including healthcare providers, community leaders, and policymakers, to develop comprehensive and context-specific strategies to prevent and respond to SGBV and its consequences. Overall, conducting rigorous research that spans diverse contexts and populations will contribute to a more comprehensive understanding of the multifaceted challenges posed by SGBV and inform evidence-based interventions that promote survivor support and well-being.

The scoping review’s strength lies in its comprehensive approach, encompassing a wide range of literature on injuries and trauma resulting from SGBV in sub-Saharan Africa. By considering various study designs and sources of evidence, the review offers a holistic view of the topic. Additionally, the study effectively identifies key themes and trends in the literature, leading to a deeper understanding of the prevalence, consequences, and specific factors associated with injuries and trauma resulting from SGBV in the region. The mapping of research evidence within the review proves to be a valuable resource for researchers, policymakers, and practitioners working in the field of SGBV. Furthermore, the review’s emphasis on studies with an overall high mean quality score (87% ± 13%) enhances the credibility and reliability of the findings, ensuring that the evidence presented is robust and trustworthy.

Despite these strengths, this scoping review has several limitations. The concentration of included studies from South Africa introduces a geographic bias, potentially limiting the generalizability of findings to other countries within sub-Saharan Africa. To enhance the review’s applicability, a more diverse representation of research from different regions in the area would be beneficial. Additionally, the paucity of studies investigating healthcare access and support services for SGBV survivors may restrict the review’s ability to provide comprehensive insights into this critical aspect of the topic. Despite these limitations, this scoping review provides a valuable overview of the available research evidence on injuries and trauma related to SGBV in sub-Saharan Africa, paving the way for further research and targeted interventions to address this critical issue. Researchers should acknowledge and consider these limitations when interpreting and applying the review’s findings.

In conclusion, this scoping review provides a comprehensive overview of the research evidence on injuries/trauma resulting from SGBV in the sub-Saharan African region. It underscores the urgent need for further research and targeted interventions to address this pervasive issue and support the well-being of survivors.

Data availability

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Ilaria Michelis talks about her research into gender-based violence, based on years of working in the humanitarian space

Knowledge alone is not enough to enact change. We need people to come together and push collectively to change things. We need to be able to develop tools that lead to meaningful action that changes some of the rules of the game. Ilaria Michelis

Ilaria Michelis [2019] was completely surprised when, earlier this year, she was awarded this year’s Journal of Gender Studies Janet Blackman Prize. The Prize celebrates scholarship on international feminist movements and trade unions/women in work. 

It was awarded for an article she published the year before in the Journal of Gender Studies based on an issue she covered in her PhD. Her article, Contesting gender: young women and feminist generations in gender-based violence services ,  argues that narratives of generational conflict, despite being frequently deployed by activists themselves, obfuscate a genuine struggle to redefine the subject of feminism and extend feminist solidarity to trans women and other marginalised groups. 

Ilaria says she was completely surprised by winning the prize. “It was my first academic article from my PhD and as such it was very validating that the work I am doing is resonating,” she says. She feels the current divisions about the trans issue are wrapped up in a generational discourse that allows each side to dismiss the other without allowing a space where genuine conversations about how feminism can evolve .  

The issue is not central to her PhD thesis, but at the heart of it is finding a space for different viewpoints. “We need to have more of these conversations,” says Ilaria, “so everyone remains engaged.”

Humanitarian work

Ilaria’s PhD grew out of her 11 years working in humanitarian response, with the UN and international NGOs, and her previous academic studies. Most of her humanitarian work was focused on violence against women and women’s empowerment. Ilaria, from Italy, has lived in the Middle East and East Africa and has travelled widely. Having been to school in the UK and studied in the UK during her undergraduate degree through the Erasmus programme and her first master’s in Development Management from the London School of Economics and Political Science , she knew the UK well. 

In 2018 she opted to do a second master’s at the University of Cambridge in the Sociology of Marginality and Exclusion where she focused on the humanitarian system and started questioning how the concepts of intersectionality and inclusion were being understood and used in the humanitarian sector. She felt they were being used to cut costs, whereas she felt good intersectional work required more resources and more specialised services rather than less.

“Instead of having experts on gender-based violence, disability, child protection or religious-based violence they would just have an inclusion expert who had to cover everything,” she says. “There is value in seeing connections between these areas, but that was not what they were trying to do. They wanted to spend less money and the results were that women had lower quality services and less voice.” That meant the most marginalised became more disenfranchised.

Cambridge research

For her PhD in Sociology, which she began in 2019, Ilaria wanted to further explore the need for an intersectional approach to support female survivors of violence, to reconsider feminist approaches to dealing with gender-based violence and recognise any blind spots to delivering appropriate services for a wide range of individuals.

Ilaria had wanted her PhD to involve participatory research, with her embedded in an organisation she had worked for before in a refugee camp in Uganda. However, due to Covid, she shifted to working in organisations in Italy and Serbia and a lot of her research was done online, although she did get some time for participatory observation in both places. The two organisations work with refugee and migrant women and women from their local communities who are survivors of human trafficking or other forms of gender- based violence, including intimate partner violence and forced marriage. 

Most of the staff in her study considered themselves to be secular, but there was a sense that they had not reflected on their own cultural background so they were unable to address religion in either a positive or negative way. There were also assumptions underlying how workers approached issues such as women who didn’t want to take legal action against the perpetrators of violence against them or chose to prioritise motherhood over economic independence. Western ideas about being a strong, independent woman meant workers might not understand some women’s decisions and might judge them, says Ilaria.

“They have their ideas about what a liberated woman looks like. It’s a colonial mindset and they can struggle to think in different ways,” she states. “Intersectionality helps to guide their analysis of a situation and their actions and serves as a principle for a more collaborative way of working.”

Intersectionality

By introducing the concept of intersectionality she believes new conversations can be initiated. “It’s a good tool to use to challenge very long established feminist principles and ways of doing this work and to point to the gaps that exist,” says Ilaria. “The idea is to make the work these organisations do better.”

For her it was important that she worked with the organisations to close the gaps between theory and practice. “Too often practitioners get tired of researchers saying this is wrong and then leaving,” she says. “Knowledge alone is not enough to enact change. We need people to come together and push collectively to change things. We need to be able to develop tools that lead to meaningful action that changes some of the rules of the game.”

She adds: “No-one goes into this line of work to be exclusionary. When you are working with survivors you are busy all day doing practical things such as helping with health and housing needs. You are exhausted and frustrated seeing all the barriers women face. You don’t have the time or the energy to focus on the big structural issues. I wanted to work out how we recognise that without letting it be an excuse.”

* Top picture: Marc Nozell from Merrimack, New Hampshire, USA, c/o Wikimedia commons .

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Impacts of an abbreviated personal agency training with refugee women and their male partners on economic empowerment, gender-based violence, and mental health: a randomized controlled trial in Rwanda

• Naira Kalra   ORCID: orcid.org/0000-0001-9379-1355 1 ,
• Lameck Habumugisha 2 &
• Anita Shankar   ORCID: orcid.org/0000-0002-7071-2009 3  

BMC Public Health volume  24 , Article number:  1306 ( 2024 ) Cite this article

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Introduction

We assessed the impact of a personal agency-based training for refugee women and their male partners on their economic and social empowerment, rates of intimate partner violence (IPV), and non-partner violence (NPV).

We conducted an individually randomized controlled trial with 1061 partnered women (aged 18–45) living in a refugee camp in Rwanda. Women received two days of training, and their partners received one day of training. The follow-up survey where all relevant outcomes were assessed was carried out at 6–9 months post-intervention.

At follow up, women in the intervention arm were more likely to report partaking in income generating activities (aIRR 1.27 (1.04–1.54), p  < 0.05) and skill learning (aIRR 1.59 (1.39–1.82), p  < 0.001) and reported a reduction in experience of physical or sexual NPV in the past six months (aIRR 0.65 (0.39–1.07), p  < 0.09). While improved, no statistically significant impacts were seen on physical or sexual IPV (aIRR 0.80 (0.58–1.09), p  = 0.16), food insecurity (β 0.98 (0.93 to 1.03), p  = 0.396), or clean cookstove uptake (aIRR 0.95 (0.88 to 1.01), p  = 0.113) in the past six months. We found statistically significant reduction in physical and sexual IPV amongst those experiencing IPV at baseline (aIRR 0.72 (0.50 to 1.02), p  < 0.07). Small improvements in self-efficacy scores and our indicator of adapting to stress were seen in the intervention arm. Some challenges were also seen, such as higher prevalence of probable depression and/or anxiety (aIRR 1.79 (1.00-3.22), p  = 0.05) and PTSD (aIRR 2.07 (1.10–3.91), p  < 0.05) in the intervention arm compared to the control arm.

Our findings echo previous research showing personal agency training can support economic well-being of women. We also find potentially promising impacts on gender-based violence. However, there is some evidence that integration of evidence-based mental health support is important when enhancing agency amongst conflict-affected populations.

Trial registration number

The trial was registered with ClinicalTrials.gov, Identifier: NCT04081441 on 09/09/2019.

Key message

What is known?

• There are limited impacts of economic interventions in humanitarian settings on gender-based violence.

• Outside of humanitarian settings, agency-based training interventions, both with/or without male partner engagement, have been shown to improve economic impacts, however IPV impacts are not known.

• Integrated multi-component interventions that economically empower women and engage male partners hold promise in conflict-affected populations.

What are the new findings?

• An abbreviated two-day personal agency training for women and one-day training for their male partners led to significant increases in uptake of income generating activities and skill building for women.

• Promising trends suggest reduction in non-partner violence for the full study sample and a reduction in intimate partner violence for women who reported IPV at baseline.

• Increased rates of probable anxiety and/or depression and post-traumatic stress disorder (PTSD) were identified in the intervention group.

What do the new findings imply?

• Promising impacts on livelihoods and experience of violence are possible despite the abbreviated nature of this training.

• Despite improvements in livelihoods and reduction in experience of violence, more concerted efforts are needed to prevent the increased risk of anxiety, depression, and PTSD found in conflict-affected populations.

Peer Review reports

Economic insecurity, mental distress, and violence-related vulnerabilities are heightened amongst refugee women. Rates of violence perpetrated by intimate partners are higher than rates of wartime physical or sexual violence at the hands of non-partners [ 1 ]. It is estimated that nearly one in five female refugees has experienced physical and/or sexual violence by an intimate partner [ 2 , 3 ]. This experience of intimate-partner violence (IPV) is associated with adverse health and well-being outcomes, including injury, sexually transmitted diseases, and worsened mental health amongst women in refugee camps [ 4 , 5 , 6 ]. In addition to IPV, women in humanitarian settings also face violence from non-partners. For example, foraging for firewood for cooking needs in refugee camps has been identified as a prevalent risk factor for non-partner violence (NPV) [ 7 ]. The multiple challenges faced by women in such settings requires integrated, often multilayered interventions.

Economic distress is known to exacerbate violence and is viewed as a modifiable risk factor in refugee settings [ 8 ]. The refugee populations in Rwanda tend to be in a protracted situation i.e. have lived more than 5 years in the host country and despite having a right to work, struggle to integrate into the job market in the host community [ 9 ], thus experiencing economic distress. Prior research has focused on refugee women’s economic empowerment, largely through sustainable approaches such as microcredit or savings groups programs, with or without a social norms component, as a key approach to address economic insecurity, reduce women’s risk of experiencing IPV, and improve their mental health [ 10 ]. While some of these interventions were successful in improving livelihoods, gender attitudes, mental well-being, and economic well-being, these programs typically found no statistically significant impacts on women’s experience of physical and/or sexual IPV and did not assess impacts on non-partner violence (NPV) [ 10 , 11 ].

Another approach to addressing GBV shown to successfully reduce rates of IPV outside of humanitarian settings includes adapting programs that used group learning and engaged partners through community gender dialogues [ 12 , 13 ]. Recent evidence from the ‘safe at home’ trial in the Democratic Republic of Congo (DRC) finds that single-sex discussion groups for couples significantly reduced the risk of IPV for women and harsh discipline for children [ 14 ]. However, in another study amongst conflict affected populations in the DRC, similar gender dialogue trainings with men alone have not been found to reduce IPV [ 11 ]. Moreover, engaging men led to no promising impacts on women’s economic empowerment and did not address NPV. These interventions are also extremely resource and time intensive and require participants to attend upto 29 weekly sessions over a period of 6–8 months [ 14 ].

To find innovative, less resource intensive, and feasible solutions to address the complex problem of poverty and gender-based violence, we turned to qualitative research from Rwandan refugee camps which suggest that an empowerment approach is needed as part of any efforts to address violence as it strengthens women’s voice and agency, something that is lacking in current approaches [ 15 , 16 ]. The broader evidence outside of humanitarian settings also suggests that economic empowerment, and especially economic empowerment and social empowerment programs when combined can be effective in reducing IPV [ 17 , 18 ]. The ‘IMAGE intervention’ [ 19 ], tested a micro-finance program in South Africa paired with 10 one-hour sessions of participatory trainings on health, gender norms, communication, leadership, and gender-based violence called ‘sisters for life’ and showed a significant reduction in experiences of IPV. Similarly, an economic and social empowerment intervention implemented in 24 sessions over 12 months combined with a cash-transfer component in Afghanistan was successful in reducing IPV amongst those experiencing moderate food insecurity prior to the intervention [ 20 ] and in DRC a similar 12-month intervention was successful in reducing IPV amongst those at higher risk for IPV at baseline [ 21 ]. These interventions indicate the potential of empowerment interventions but did not unpack whether these effects would exist in the absence of the micro-finance and/or cash transfer component.

Agency-focused empowerment trainings, often referred to as personal agency or personal initiative trainings, have been previously shown to improve women’s personal and economic outcomes in populations not affected by conflict. Their effectiveness within conflict-affected populations and its impacts on GBV, especially IPV, and mental well-being remain understudied. These behavioral interventions, based on principles of psychology and neuroscience, have been shown to enhance the profits and psycho-social measures of agency in female entrepreneurs in both Kenya and Togo [ 22 , 23 , 24 ] and more recently, found to increase spousal support for business activities and improve partner relations [ 25 ]. A recent evaluation of the ‘ Adolescents: Protagonists of Development’, a personal agency and economic empowerment training paired with technical skills training found positive impacts on both economic well-being and reduced the risk of violence experienced by adolescent girls in Bolivia [ 22 ]. While this approach appears promising, with 64 h of training [ 22 ] some of these are also resource and time intensive programs that are potentially difficult to scale and sustain in a humanitarian setting. In addition to the need for efficient allocation of scarce rescources, feasibility testing of interventions with refugee population often results in abbreviating programs further indicating that longer programs are not desirable in this setting [ 26 , 27 ]. Additionally, despite shortening their intervention to just seven sessions, Greene et al., (2021) find that the participation continued to drop with every session and only 33% of refugee women attended all sessions [ 28 ].

Unlike approaches that involve shifting norms, some agency approaches can be delivered successfully in a shorter period of time [ 19 , 24 ]. Keeping in mind that some relatively shorter programmes that focus on agency building were also found to be effective in reducing IPV, we examined the impacts of an abbreviated personal agency training with women and their male partners on GBV and women’s social and economic empowerment. Our approach differs from other programs, both in content and duration. Compared with personal initiative interventions, deployed over several months and focused specifically on goal setting on one’s business, our program focused on using an abbreviated 2-day personal agency intervention with women followed by a 1-day personal agency training with their male partners to enhance multiple aspects of one’s life and targeted a multitude of GBV risk-factors. The intervention was structured to guide individuals through a process of self-reflection, identification of personal aspirations and strategies for action within their socio-cultural and contextual constraints. While this process was individualized, it was conducted within a group framework to leverage collective agency. The objective was to enhance collaboration between women and their male partners, who underwent separate reflective processes and foster more effective pursuit of shared goals upon reunification.

We included a gender-sensitive male engagement component in the refugee setting to counter men’s sense of failure and emasculation that might result from the perception of women’s enhanced economic empowerment that may have led to backlash [ 29 , 30 ]. This decision was informed by advice from refugee camp leaders and evidence from programs that integrate engaging partners and economically empowering women that may have promise in reducing GBV and improving livelihoods in conflict-affected settings compared to economic empowerment alone [ 31 , 32 ]. Other studies with similar populations, such as the Nguvu trial with female Congolese refugees in Tanzania, report participants suggesting that their male partners be involved in the intervention and that services be provided for men as well [ 27 ]. Based on their study in post-conflict Uganda, Green et al. (2015) suggest a light touch engagement of men in women’s empowerment interventions as they found a one day training for male household members on gender-relations, communication and problem solving was effective in improving the quality of the relationship [ 32 ]. Furthermore, we integrated exercises on task sharing and clean cooking adoption to address women’s risk of NPV.

Study setting and trial design

The Kigeme camp, located in Nyamagabe district about 150 km from Kigali, opened in 2012 and is home to 17,681 Congolese refugees in 3,366 households [ 33 ]. The camp is structured around two administrative layers, quarters and villages, each having its own elected representatives resulting in eight executive and quarter leaders and 27 village leaders. The camp is administered by MINEMA, which is responsible for the security and protection of the refugees in coordination with UNHCR. The study was carried out in collaboration with Plan International, Rwanda, which was responsible for social protection and GBV response in the camp at the time of planning the study (2018–2019). Multiple stakeholders provide additional services in the camp, including protection, food, WASH, GBV, education, and health [ 33 ].

Local staff in the refugee camp and UNHCR staff members in the local offices were apprised and consulted before and during key aspects of study implementation. Plan staff engaged local community leaders and presented both these studies to the community at their monthly meeting before any activities began and throughout the project. In collaboration with other international NGOs and service providers in the camp, a referral network for IPV and mental health support was established. All research activities were approved by the Institutional Review Board at the Johns Hopkins University, Bloomberg School of Public Health (USA) approval number IRB00009381 and the Rwanda National Ethics Committee (RNEC). Further approvals were obtained from the National Center for Science and Technology (NCST), the Ministry of Education (MINEDUC), and MINEMA, Rwanda, for every year the study was active.

We carried out a two-arm, individually randomized controlled trial with partnered women in Kigeme refugee camp in Rwanda to study the impact of an abbreviated personal agency-based intervention. All the women recruited into the study at baseline were randomized using a computer-generated list to either intervention or control arm on a 1:1 ratio (generated in SAS version 9.4; SAS Institute Inc. 2013. SAS® 9.4 Statements: Reference. Cary, NC: SAS Institute Inc.). This study was originally planned as a 2 × 2 factorial design with one RCT designed to examine the impacts of clean cookstove adoption on gender-based violence and another RCT where a smaller sub-set of partnered women were cross randomized to either the personal agency-based intervention or control group. This would have resulted in four groups: clean cookstove adoption + personal agency training, personal agency training alone, clean cookstove adoption and control/waitlist. However, internal changes in policy in the camp and delays in permit renewal led to a shift in the timeline. Clean cookstoves were offered to all residents of the camp by March 2019. This was just after the roll-out of the personal agency-based intervention. Therefore, at the time of the follow-up for this study in August/September 2019, both arms of this study had several months of equal access to adopting clean cooking solutions and for all practical purposes this acts like a two-arm trial.

Sample size

Sample size calculations used estimates of partner violence obtained by a prior study amongst Congolese refugees in Rwanda, reporting a prevalence rate of 22% for IPV [ 6 ] and were calculated to detect a 35% difference with an 80% power and significance level (alpha) of 0.05. Despite a short period of post-intervention follow-up, we anticipated attrition due to rapid movement from the camp and accounted for 20% drop-out, resulting in an estimate of 502 participants needed in each arm of our study.

Identification and selection of participants

Locally hired recruiters from within the refugee camp went home to home and in line with WHO’s ethical guidelines on measuring IPV, recruited one woman from each household based on eligibility criteria. Participants were informed that they would be participating in a research study and would be randomly selected to be offered a clean cookstove and/or be selected to participate in an upcoming empowerment training program. Eligibility criteria were as follows: participants were female, between 18 and 45 years, currently living in the refugee camp, and living there for the past year, with no intention to relocate in the next year. Only those who reported living with an intimate partner for the last six months or more were included in the agency-based training.

The study was implemented between August 2018 and September 2019, with a baseline conducted between August and September 2018. Households/women were recruited for both studies simultaneously. Separate random allocation (of the full sample) to both interventions (the encouragement to adopt clean cooking solutions intervention and the personal agency training intervention) of all eligible households/women was carried out prior to baseline data collection. All the women recruited to the study completed a baseline survey. We applied our eligibilty criteria to 2000 women. Of these, we removed one duplicate, 847 women reported that they did not currently have and intimate partner and 91 reported that they had not lived with their partner at all in the past six months. This sample of 1061 formed the baseline of the personal agency study and from amongst this sample, those already randomized to the personal-agency intervention after recruitment were invited to the training and the remaining formed the control group. The intervention was deployed between December 2018 and February 2019. Of those selected and offered the training, 9.7% did not attend the training. All women were provided referrals to mental health and GBV support services within the camp at the end of the survey.

A follow-up survey was to be carried out with the 1061 women who were eligible for the personal agency study six months after the last group of women received the intervention. However, 18.3% of our sample was lost to follow-up, primarily because the individuals could not be found, with no significant difference ( p  = 0.583) in drop-out between intervention and control groups. At follow-up, 66 women reported no longer being in a relationship and were subsequently not asked IPV questions. Figure  1 illustrates the flow of participants though the study.

Flow of participants through the study

Intervention

The Nimenye Mpinduke, Nigire (NMN) training is an adapted version of the personal agency training developed by the Self-Empowerment and Equity for Change Initiative (SEE Change), specifically designed for the Rwandan context. Its aim is to increase personal awareness of thoughts, beliefs, and past actions and their impacts on future behaviors, effectively enhancing personal agency. The study’s unique feature is the inclusion of male partners in a shortened one-day training, developed in collaboration with the Rwanda Men’s Resource Centre (RWAMREC) and focused on positive masculinity and male engagement approaches. The NMN intervention was adapted from SEE Change’s open-source Empowered Entrepreneur Training Handbook (EET). Adaptation of the original 32 h of personal agency and leadership content was done in a two step process. First, in collaboration with Rwandan colleagues at Plan International and RWAMREC, the team selected key exercises that would be applicable for a humanitarian context (approximately 20 h). We then engaged 14 Congolese female and 12 male refugees in Kigeme camp to serve as trainers, continuing to customize content over three weeks as part of the TOT activities in November 2018. This content was further abbreviated and outlined as two 6-hour sessions for women and one day for men. This included separate discussions with women and men to tailor the content to their specific needs. Joint sessions followed to deepen understanding to reflect the context of the refugees’ experiences in the camp. Trainers then piloted and refined the content before the intervention was deployed. Men and women attended separate workshops as the emphasis was on developing individual resilience and agency while exchanging personal experiences. In a mixed-gender workshop, prevailing power dynamics and societal norms might discourage participants, especially women, from freely sharing vulnerabilities and openly discussing such matters. While women were not asked about IPV or NPV directly, it was always possible that it came up. Therefore, we believed it was best that any disclosure did not happen in front of the partner.

The female participants underwent approximately 12 h of training conducted over two consecutive days, incorporating individual exercises and interactive group discussions drawn from positive psychology techniques such as cognitive behavioral therapy, mindfulness, and meditation. Based on previous pilots done in the region, we learned the content is best delivered in an intensive way (e.g. over one or two days consecutively) to allow individuals to experience their personal journey and reinforce the concepts by reflecting on various areas of their life, led by trainers were sourced from the community who understood the socio-cultural context and the lived experience of the participants. The training began with exercises designed to increase awareness of one’s life journey and hopes and dreams for the future. Participants learned tools to help reframe negative thought patterns and identify clear, doable actions to move forward within different life domains, reinforcing this positive focus in their communications and actions towards others. Male partners underwent a six-hour, shortened version of the NMN training with exercises developed in conjunction with RWAMREC, a local non-governmental organization (NGO) working with men and focused on the promotion of positive masculinity and male engagement approaches. This NGO had previously developed the intervention for two other successful gender dialogue programs in Rwanda [ 12 , 13 ]. The training began with a competition between two groups of participants to make tea using a traditional firewood stove and the clean cookstove and fuel system, followed by a discussion on gendered task divisions and benefits of clean cooking solutions. The training included exercises to examine one’s life, the ways their thoughts and beliefs influence their behaviors, and ways to reframe negative thought patterns. The workshop concluded with a session on positive communication within the household. One key aim of training male partners was to reduce the risk of NPV during firewood collection by supporting the improved uptake of clean cooking systems. Table  1 summarizes the key components of the intervention.

All trainers were selected from refugees currently residing in the camp, with female trainers trained for five days over the course of two weeks and male trainers trained for three days over the course of one week. The last half-day of training included a joint session with female and male trainers, allowing for the sharing of experiences, ideas, and discussions.

Table  2 summarizes the key outcomes assessed in the study. We registered the protocol at ClinicalTrials.gov (identifier: NCT04081441) in line with the original study plan, which was developed prior to beginning field activity. Some modifications were made prior to baseline data collection and randomization. The Generalized Health Questionnaire (GHQ) was removed from the survey to shorten its length. The Hopkins Symptom Checklist (HSCL-25) [ 34 ] and the Harvard Training Questionnaire (HTQ) [ 35 ] were retained, as these measures are more specific to domains of mental health problems particular to these settings and that these measures have been validated with this particular DRC population, by Bass et al., while the GHQ has not [ 36 ]. The food insecurity experience scale (FIES) was replaced with the household food insecurity access scale (HFIAS) [ 37 ], which reports food insecurity at the household level instead of the individual level. We replaced Duckworth et al.’s measure of Grit with the Shift and Persist measure, as the former references ‘projects’ and ‘shifting interests’ and hence did not apply well to the context of refugee camps [ 38 ].

Data analysis

Chi-squared tests were used to examine differences between intervention and treatment arm at baseline. At follow-up, an intention-to-treat analysis on the sample that was not lost to follow-up was carried out with all women who participated in both baseline and six months endline analysis. Generalized linear models (GLM) compared outcomes between control and intervention arms [ 43 ]. For binary outcomes, the econometric specification involved using a Poisson distribution and a log link. For continuous outcomes, a Gaussian specification with a log link was used. Robust standard errors were specified. We carried out both adjusted and unadjusted analysis. In the adjusted analysis, we adjust for woman’s age, education, and baseline value of emotional IPV, as these were imbalanced at baseline and likely to be associated with all outcomes assessed. We also adjusted for the baseline value of the outcome, except for the Shift and Persist score and the engagement in skill learning outcome, which were not assessed at baseline.

We included some key outcomes that had been explored in recent impact evaluations of socio-economic or couple’s interventions, such as impacts of the intervention on those experiencing IPV at baseline [ 13 ], impacts of the intervention on physical punishment towards children and sharing of childcare duties [ 12 ], and past month income [ 20 ]. In addition to making our study comparable with the latest literature, we also believed that IPV amongst those experiencing partner violence at baseline was a more meaningful measure as we expected empowerment to result in breaking the existing cycle of violence. Income was a relevant measure and one that would have changed directly because of women’s economic empowerment. We also believed that physical punishment towards children could change due to potential reduction in IPV, NPV and improvements in mental health [ 44 , 45 ]. Furthermore, since RWAMREC also developed ‘Bandebereho’ [ 12 ], sharing of traditionally female tasks such as child care duties remained a topic of focus for the ‘Gender Box’ activity and the gender role discussion, as well as for the gender core beliefs materials developed by them and hence was a meaningful outcome for this study as well. We used Stata (V.14) for the data analysis [ 46 ].

Table  3 describes the socio-demographic characteristics at baseline and Table  4 provides an overview of baseline values of outcomes for both intervention and control samples. Women in the intervention group were slightly older (33.4 years vs. 32.7 years) ( p  = 0.09) and slightly less likely to have completed secondary education compared to women in the control group (19.1% vs. 23.9%) ( p  = 0.07). All other demographic variables, including marital status, partner’s age, employment status, number of children and assets were balanced between the arms.

Most outcomes at baseline (Table  4 ) were balanced; however, there was a significant difference in reports of emotional IPV, with the control experiencing significantly less (38.2% vs. 29.9%) ( p  = 0.005) than the intervention group at baseline. Both groups reported some IPV in the last six months, with emotional IPV reported at the highest rates, followed by physical or sexual IPV and then reproductive coercion. Both groups reported instances of NPV, with harassment more common than physical or sexual NPV and had similar levels of IPV, NPV, cookstove uptake, income generating activities, mental health scores, food insecurity, self-efficacy scores, and Ryff social agency scores at baseline.

At six months post intervention, 81.72% of the study participants were located and surveyed by the research team before expiry of the RNEC research permit deadline of August 2019. Table  5 presents primary and secondary outcomes at six months post-intervention. No significant differences were noted in incidents of IPV in the past six months in the intervention vs. the control group. For NPV, however, there appears to be a trend toward reduced experience of physical or sexual NPV at six months post intervention, with 5.7% of women in the intervention arm reporting experiencing NPV in the past six months compared to 8.18% in the control arm (aIRR: 0.65, (0.39–1.07); p  = 0.091). In the assessment of mental health, we found significantly greater incidents of probable anxiety and/or depression (aIRR = 1.79 (1.00-3.22); p  = 0.05) and probable PTSD (aIRR: 2.07 (1.10–3.91); p  = 0.024) amongst women in the intervention group compared to the control group. The HSCL score was tested with a cut-off of 1.75 as suggested by Bass et al. [ 36 ] and found results remained significant at the 10% level.

Significant improvements were noted in self-reported engagement in income generating activities (aIRR = 1.25 (1.04–1.50); p  = 0.018) and engagement in skill building (aIRR = 1.56 (1.36–1.77); p  < 0.001). There were significant differences in measures of self-efficacy and the ability to manage stressful situations (Shift and Persist scale); however, the effect sizes were very small. No significant differences were seen between women in the intervention and control arm in their measures of social agency, food insecurity, experience of harassment, reproductive coercion, or uptake of clean cooking systems.

Table  6 reports outcomes beyond our primary analysis plan. The four ancillary analyses included physical and sexual IPV amongst those who experienced IPV at baseline, income in the past month for those working, women’s use of physical punishment towards children (amongst those with children), and women’s report of partner’s participation in childcare. These were exploratory in nature and reflect the change in literature that occurred between the initiation of the study and its endline analysis.

The ancillary analyses of individuals who had reported experience of IPV at baseline suggests a significant reduction in physical or sexual IPV because of the personal agency training, but no effects on preventing IPV amongst those who were not already experiencing IPV at baseline.

Past-month income amongst those working improved with the personal agency training. While use of physical disciplinary tactics and men’s participation in childcare was not initially planned for, this was also added as an exploratory outcome as this was assessed in a recent study by Doyle et al. (2018) [ 12 ]. At follow-up, 82% of women reported using at least one form of physical punishment against their child and overall, we find that the intervention arm reported a slightly greater use of physical punishment towards children. At the same time, we find that women in the intervention arm are more likely to report that their partner participated in childcare equally or took this responsibility most of the time.

Study limitations

This study faced several limitations due to being conducted in a humanitarian setting. Our research activities were often constrained due to security issues affecting entry of research staff into the camp and our contacts were limited to the field team at Plan International that had access to the camp. There were significant policy changes during this study including a ban on all firewood distribution and the institutionalization of a cash for fuel program. These changes can potentially mitigate our ability to measure the impacts of the intervention by changing the prevalence of outcomes such as cookstove uptake and IPV. The national regulatory authority overseeing all camp research and program activities moved from MIDIMAR to MINEMA, requiring a re-approval process for the study. Participants were able to move freely outside of the camp at a greater rate than originally anticipated, resulting in a larger loss to follow up than expected. Randomization was done at the individual level and due to the dense living arrangements for families within the camp, there is a risk of contamination between the study arms. Moreover, as the NMN trainers are residents of the camp, it is likely that non-participants may have learned about the training after the training deployment had been completed, that could result in an underestimate of effects. Moreover, many individuals had moved to other households due to marriage or change in their partnership status at follow-up leading to a large loss to follow-up.

Furthermore, some limitations were due to the limited funding for this study. The data was collected only six months after the intervention, restricting the conclusions regarding the longer-term impacts of the intervention on this population. Additionally, while the formative work and dialogue recognized that agency enhancement that excludes men may pose challenges for the women the program is intended to benefit, due to the small sample size, we were unable to cross-randomize and investigate the impact of the partner engagement component of the intervention.

Conclusions

With more than 80 million people forcibly displaced worldwide due to conflict or other forms of persecution [ 33 ], it is important that interventions targeted to enhance women’s empowerment consider the extent of the issue and the limited resources available to achieve this aim. By abbreviating and adapting the SEE Change agency-enhancing intervention with a gender dialogue component that addresses socio-cultural norms and harmful stereotypes, this study aimed to move us closer to building the evidence-base for an integrated approach to addressing key economic and social well-being concerns for women in refugee settings. This is the first large-scale evaluation of a personal agency training that includes a male engagement component conducted within a post-conflict setting.

Our approach makes three key contributions. The first is to fill the gap on impacts of an abbreviated agency-based interventions on economic and overall well-being of women in humanitarian settings. The focused deployment (two days for women, one day for male partners) contrasts to the IMAGE intervention [ 19 ] implemented in phases over 12–15 months or Save the Children’s program ‘ Adolescents: Protagonists of Development’ [ 22 ] which included 60 + hours of empowerment and health content, 70 h of business-related content, deployed over several months. The second contribution was to establish that an abbreviated version of a personal agency training demonstrated significant improvements to livelihoods, despite no additional business content or cash transfer component. And the third was to measure NPV and integrate components that address it, such as increasing women’s agency and increasing clean cooking uptake, which can reduce women’s risk of experiencing opportunistic violence from non-partners during firewood/fuel collection.

We find significant impacts on uptake of income generating activities and skill building despite no focused content on business tools or development, similar to what has been seen in previous studies examining the longer personal agency training [ 24 , 47 ]. Like Gibbs et al. (2020) [ 20 ], our exploratory analysis finds positive impacts on income generation, in line with increased income generating activities and skill building. However, little change was seen in self-efficacy or the Shift and Persist scores. Although significant, the percentage change in the Shift and Persist score was only 2%. Measures of social agency also did not change, in contrast to previous research showing positive impacts on psychometric measures. This lack of results on the pathway could be due to the abbreviated nature of the intervention or may be driven by the fact that these measures were not designed for this setting and lacked reliability and/or validity in this context.

Despite the economic outcomes, we found no overall significant impacts of the NMN intervention on experience of IPV in the last six months in the full sample. Descriptive statistics show that the overall rates of IPV reduced substantially during the study period, from 38 to 23%, as did rates of prevalence of depression and/or anxiety and PTSD. This is likely due to a simultaneous shift in cash-for-fuel policy deployed during the study period; previous research has shown that cash transfers can reduce rates of violence [ 48 ]. While our study was initially powered to detect a 35% reduction, this reduction in prevalence could be responsible for our study being underpowered to detect a reduction in IPV. These mixed results could be due to the overall reduction in GBV within the camp during the time that the study, or that the abbreviated nature of the intervention wasn’t sufficient to create the necessary change in behaviors with the study sample. However, the exploratory analyses demonstrate a significant reduction in experience of IPV on those who reported IPV at baseline. This finding is in line with findings by Dunkle et al. (2020) [ 13 ], who showed that at 24-months post follow-up, a couple intervention impacted IPV only amongst those who reported experiencing IPV at baseline. Similarly, Angelucci et al. (2022) [ 21 ] find impacts of their cash plus empowerment intervention on IPV only amongst those at high risk for IPV at baseline. Therefore, while the abbreviated intervention may not prevent IPV, it appears to reduce rates in those already experiencing it. These findings have implications for who should be targeted and who may be at increased risk for backlash from empowerment interventions.

The potential lack of effect of the empowerment intervention on cookstove uptake, while disappointing, is not surprising. The results could be driven by the possibility that due to our intervention women were potentially using the fuel cash transfer towards business generation. Alternatively, the intervention may have been too mild to impact uptake in the remaining 36% who were not using clean cooking solutions despite the cash for fuel policy. Increasing uptake of clean cookstoves is a complex matter, and within a humanitarian setting, even more so. Competing efforts from the multiple stakeholders (including UNHCR, NGOs, and MINEMA) supporting the camp gave rise to inconsistent and incomplete distribution of goods and services, making uptake of any one opportunity, such as clean cookstoves and fuels, more complicated.

Despite the lack of impact on clean cookstove uptake, NPV did seem to decrease in the intervention arm. As the effects did not come from increased cookstove uptake pathway, like Gulesci et al., (2021) [ 22 ] suggest, we can only hypothesize that these effects could come from a myriad of sources such as reduced exposure perhaps due to increased task sharing with their intimate partner (NMN resulted in greater engagement in childcare), greater social networks that help protect women from non-partner abuse, or through learning soft-skills such as better decision-making and planning that allows them to avoid potentially dangerous situations or being more assertive and self-confident when dealing with potential abusers.

Along with some positive findings, we also captured some unintended consequences such as a potential increase in use of harsh disciplinary approaches towards children and worsened mental health. Unlike Doyle et al. (2018) [ 12 ], who find a couples intervention with an emphasis on positive parenting resulted in reduced physical punishment towards children, our study which did not focus on parenting finds a slight increase. The percentage of women reporting use of any form of physical discipline against their child was significantly greater in the intervention arm compared to the control arm. In this population, use of force was common for the majority of respondents interviewed. The slight increase (6%) may be a function of increased stress due to women’s time spent on income generating activities. As this was not measured at baseline, we are unable to explore a change in score, nor can we confirm that at baseline there was no imbalance on this outcome. Given the overall high prevalence of such disciplinary tactics in this setting, we would like to highlight this as an area of future research.

Our findings also support previous literature where Green et al. (2015) hypothesize that despite extensive economic gains, their intervention too failed to improve mental health in conflict affected Uganda, due to the stress induced by generating business activities [ 32 ]. Our findings also reveal that for refugee populations that have experienced significant trauma, personal agency training may exacerbate mental health symptoms compared to the control group, for whom the prevalence of probable PTSD and depression and/or anxiety appear to have reduced over time. This outcome is rarely measured in studies that evaluate socio-emotional skills training with the aim of increasing income generation and is particularly important to measure amongst conflict-affected populations. Greater personal agency and motivation are likely resulting in greater introspection and a desire to achieve goals. This may potentially exacerbate symptoms of anxiety. We note that our sample consists of refugees in a protracted situation who have had time to settle into the camp and have also had access to mental health services which probably resulted in the low prevalence of probable PTSD [ 36 ], depression and/or anxiety that we see in our sample. While we do not know the history of mental health interventions received by our sample, we do know that the level of trauma experienced by the women in this population in the past is high. The act of psychological reflection and activities, such as the ‘Letting Go’ exercise, can trigger revisiting this trauma. Given that this training necessitates substantial self-reflection, we consider it appropriate for implementation in protracted refugee settings. However, we advise exercising caution when introducing these concepts in acute humanitarian settings. Still, these results provide important evidence that personal agency interventions deployed in conflict-affected populations must be adapted to include more trauma-informed exercises and be accompanied by sufficient psychological support systems.

Overall, we recommend integrating personal agency interventions, along with socio-emotional and business empowerment interventions, with psychosocial support and evidence-based mental health interventions for refugee women. With refugee populations, the evidence-base for shorter, transdiagnostic, group-based, indicated mental health prevention programs that are implemented by non-specialists is emerging. For example, recent evidence supports the effectiveness of Self-Help Plus, a five-session acceptance and commitment therapy-based intervention with refugees in Uganda [ 49 ]. The intervention promotes psychological flexibility and helps people identify and behave in line with their values, which has similarities to the approaches used in NMN to enhance personal agency. A recent review emphasizes the necessity for interventions to be firmly rooted in the local context that facilitate exploration of the complexity of each woman’s situation to address her multifaceted needs across various life domains [ 50 ].

The lack of overall reduction in IPV may be due to the short duration of the intervention. It may also be due to the fact that agency training may reduce existing cases of IPV but cannot prevent IPV amongst those who were not experiencing it at the time of receiving the training. It is also possible that for women experiencing an increase in PTSD symptoms, particularly those related to re-experiencing, this intervention may increase their perpetration of psychological IPV towards their partner and hence increase women’s own risk of IPV revictimization [ 51 ] resulting in an average null effect of the intervention on IPV. These findings, however, strongly suggest that trauma-affected populations continue to be at increased risk of mental illness, and any intervention with these populations must assess and address mental health. This study highlights the need for innovative behavioral interventions designed for low-resource settings that promote livelihoods and address social challenges. It is essential to assess potential negative outcomes within personal agency interventions, to monitor and address any issues that may arise during the program. In addition, it would be useful to consider extending the intervention, either by expanding its content or supplementing the program with follow up sessions. Future research should focus on developing effective interventions that integrate mental health and psychosocial support to promote long-term empowerment and reduce the risk of IPV in refugee populations.

Data availability

Due to the sensitive nature of the data, the dataset used and/or analyzed during the current study can be made available from the corresponding author on reasonable request and after IRB approval has been obtained.

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Acknowledgements

We would like to gratefully acknowledge the contributions of the field and program staff as well as the multiple governing institutions that supported this study. Luis Garcia, from Plan International, Spain was instrumental as part of the leadership team in conducting the project. Liberata Muhorakeye, working with Plan International, Rwanda was instrumental connecting the research team with the community and identifying the pool of trainer applicants. We are grateful to RWAMREC for their support in adapting the male engagement component of the intervention. Of course, this study would not have been possible without the support of the Ministry in charge of Emergency Management (MINEMA) and the Rwandan UNHCR office in Huye as well as the Plan International, Rwanda leadership and staff who helped support all aspects of project implementation. We would also like to acknowledge Claire Silberg, from Johns Hopkins University (JHU) who supported the cleaning of the dataset as well as the Institute for Clinical and Transactional Research (ICTR) at JHU whose team provided excellent statistical guidance on this study.

The study was funded by the Sexual Violence Research Initiative and the Clean Cooking Alliance (CCA). Some of NK’s time was funded by the World Bank Umbrella Facility for Gender Equality (UFGE). The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors. They do not necessarily represent the views of the CCA, SVRI, International Bank for Reconstruction and Development/World Bank and its affiliated organizations, or those of the Executive Directors of the World Bank or the governments they represent.

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NK and AVS were the principal investigators of the study. They designed the study and oversaw the acquisition of the data. LH was responsible for acquisition of the data at the field level. LH checked data quality and day-to day management for the study. NK conducted the data analysis, and all authors interpreted the results. NK wrote the first draft of the paper. All authors reviewed and contributed to the draft paper and approved of the final submission.

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Kalra, N., Habumugisha, L. & Shankar, A. Impacts of an abbreviated personal agency training with refugee women and their male partners on economic empowerment, gender-based violence, and mental health: a randomized controlled trial in Rwanda. BMC Public Health 24 , 1306 (2024). https://doi.org/10.1186/s12889-024-18780-8

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A minute’s silence is fine but when it comes to violence against women, being quiet isn’t enough

Associate Professor Sport Management and Sport Integrity Lead, University of Canberra

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Sport has a role to play in creating a culture of respect, yet women in sport are often seen as “less than” on almost every measure: salaries, sponsorship, broadcasting, leadership, access, media, coaching, officiating, uniforms and support.

Research shows three out of four Australian men are gender equality supporters, but very few (17%) prioritise taking any action.

As Australia grapples with a “ national crisis ” of violence against women, what can men in sport do to help?

What does the research tell us?

Rigid gender norms can play a part in fuelling male violence against women and children. And sport is an arena, excuse the pun, where rigid gender norms flourish.

When it comes to sport and gendered violence, a special level of toxic attack and misogyny is reserved for women who “dare” to play , watch and work in sport , and this is particularly heightened for women of colour and/or presumed to be from the LGBTQI+ community, whether identifying or not.

Sport also regularly promotes alcohol and gambling, with evident impacts on women and children – whenever there are big sporting events, violence against women by spectators increases .

Players, coaches, commentators and officials repeatedly avoid sanctions, or get a slap on the wrist, and go on to secure leadership roles in sport, sometimes despite allegations of serious gender-based offences.

The message this sends to younger players and fans is that misogyny is acceptable and that “heroes” are beyond reproach. This green-lights sexism , and completely undermines any messages around equality.

Tracey Gaudry has held a trifecta of roles relevant to this discussion. Not only was she previously a former champion cyclist, and former CEO of Hawthorn Football Club, she has also been Respect Victoria’s CEO.

Back in 2020 she nailed the confluence of issues :

“Gender inequality is a driver of violence against women and it can start out small. Because sport comes from a male-dominant origin, those things build up over time and become a natural part of the sporting system and an assumed part.”

What are sports codes and teams doing?

Professional sport organisations and clubs have been trying to address abusive behaviour towards women for decades. Both the AFL and NRL began developing respect and responsibility programs and policies 20 years ago, yet the abuse, and the headlines, continue – against both women in the game, and at home.

There are also opportunities for clubs to take action even if their governing bodies don’t. Semi-professional rugby league club the Redfern All Blacks, for example, are showing leadership: players who are alleged to be perpetrators are banned from playing until they’re prepared to talk about it openly, and prove they are committed to changing their behaviour.

Education is also vital.

At the elite level, most codes are trying to educate those within their sports – the NRL’s Voice Against Violence program, led by Our Watch, is the same organisation the AFL has recently partnered with .

The NRL also implements the “Change the Story” framework in partnership with ANROWS and VicHealth, which includes a zero tolerance education program for juniors transitioning into seniors.

What more should be done?

The AFL’s recent minute silence gesture to support women affected by violence does not go far enough.

Men, especially those in leadership positions, can take action by actively dishonouring the men who have abused women.

Some of the men we celebrate around the country for their service as players, presidents, life members and coaches have been abusive towards women and children.

Recently, the AFL demanded Wayne Carey – who has a long history of domestic violence allegations and assault convictions – be denied his NSW Hall of Fame Legend status . The next step is to see Carey struck off his club and AFL honour rolls.

The same treatment should apply to other convicted abusers such as Jarrod Hayne and Ben Cousins – the list goes on.

To take a stand on violence against women, award winners who have been convicted for, or admitted to, abuse against women should be explicitly called out with an asterisk next to their names – “dishonoured for abuse against women”.

And current and future awards must be ineligible to abusers. Serious crimes should mean a life ban for all roles in sport.

If there is a criminal conviction, or an admission of disrespectful behaviour (abuse, sexism, racism, ableism or homophobia), then action must immediately be taken to strip them of their privileges.

What about the grey area of allegations?

One tricky challenge for sport organisations is how to deal with allegations that don’t result in criminal convictions.

The legal system has systematically failed to protect women from sexual predators, so we can’t rely solely on a conviction to act.

In 2019, the NRL introduced a discretionary “no fault, stand down” rule for players charged with serious criminal offences, and/or offences involving women and children. Under this rule, players must stand down from matches until the matter is resolved.

All sports should, as a baseline starting point, be following suit.

Where to from here?

It’s time sport organisations and fans acknowledged two things can be true: good, even great, athletes, coaches or administrators can be bad humans.

Sporting codes need a zero-tolerance approach for abuse of women which should apply to fans, players, coaches, umpires, referees and administrators.

All codes should strongly consider implementing the “no fault, stand down” rule similar to the NRL. Perpetrators should not be allowed back into high-profile roles. Supporters must also be held to account – if fans can be banned for racism , they can be banned for sexism.

At all levels and across all sports, we must send the message from the ground up: misogyny is unacceptable and the consequence for your bad behaviour is that you are no longer welcome.

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• Sports and culture
• Sport and Society

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Home > ETD > Masters > 1133

Masters Theses

Narrative activism: strategic storytelling for women’s advocacy.

Lili G. Morgan , Liberty University Follow

College of Arts and Sciences

Master of Arts in Composition (MA)

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storytelling, gender inequality, advocacy

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Rhetoric and Composition

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Morgan, Lili G., "Narrative Activism: Strategic Storytelling for Women’s Advocacy" (2024). Masters Theses . 1133. https://digitalcommons.liberty.edu/masters/1133

The COVID-19 pandemic has drastically widened existing spheres of gender inequality, increasing disparities related to poverty, forced marriage, maternal mortality, gender-based violence, economic vulnerability, and illiteracy. For organizations aiming to rectify these areas of inequality, storytelling is a powerful tool for advocacy. This thesis investigates the intersection of storytelling and advocacy, focusing on the writing strategies utilized by leading gender-equality-oriented organizations. Utilizing Grounded Theory (GT) methodology, this thesis explores the emerging patterns and themes that arise in organizational storytelling strategies across differing contexts. An introduction chapter provides insights into the subject matter, highlighting existing knowledge gaps and rationalizing this study’s contribution to modern scholarship. A comprehensive literature review provides insights into contemporary gender inequality, advocacy, and storytelling, highlighting existing research relevant to this investigation. The methodology chapter outlines the implementation of GT, including research design, data collection, and coding, while the results chapter presents the key findings emerging from this study: a Storytelling Framework for Gender Equality. The discussion section offers both a narrative explanation and theoretical application of this framework and a discussion of research limitations and avenues for additional scholarship.

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Ending Gender-Based Violence

CDC affirms its commitment to preventing and responding to violence during the 16 Days of Activism Against Gender-Based Violence campaign. The campaign is observed annually from November 25 to December 10.

With support from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), CDC works with partners in 46 countries to achieve global targets to end the HIV epidemic. Although progress is being made, some people, including adolescent girls and young women, bear a disproportionate burden of HIV.

Women with a history of physical and/or sexual abuse are more likely to be living with HIV, especially if that abuse started during childhood. HIV-related stigma, discrimination, and violence restrict access to prevention and treatment services for those most at risk. These challenges serve as persistent barriers to ending the HIV epidemic.

Violence against youth is also a global public health problem. One in eight young people reported having experienced sexual abuse. The results can be devastating—leading to long-term psychological, social, and physical harm.

Violence prevention and response for youth is a global priority . It is complementary to efforts to eliminate all barriers to HIV treatment and prevention and accelerate progress toward ending the HIV epidemic.

What is gender-based violence?‎

The 2023 campaign highlighted the urgent call to " End inequalities. End HIV ." by breaking down barriers posed by gender disparities and violence. Stories featured had a keen focus on:

• Engaging young people for youth-led solutions to address stigma
• Strengthening youth's skills and economic empowerment
• Using Violence Against Children and Youth data to create actions that measurably reduce violence
• Focusing on health equity by putting people at the center of our efforts

Starting with the 16 Days of Activism, we invite you to explore the stories and learn how CDC works with our local partners to and respond to gender-based violence as part of our commitment to end inequalities and end AIDS. By amplifying voices worldwide, CDC aims to continue to increase awareness of gender-based violence—and ultimately save lives.

Empowering Young People in Mozambique and Zambia

Empowering Women through Visual Storytelling

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Renewed Focus on Ending Gender-Based Violence to End HIV/AIDS

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