research objectives on gender based violence

Gender-Based Violence (Violence Against Women and Girls)

Photo: Simone D. McCourtie / World Bank

Gender-based violence (GBV) or violence against women and girls (VAWG), is a global pandemic that affects 1 in 3 women in their lifetime.

The numbers are staggering:

• 35% of women worldwide have experienced either physical and/or sexual intimate partner violence or non-partner sexual violence.
• Globally, 7% of women have been sexually assaulted by someone other than a partner.
• Globally, as many as 38% of murders of women are committed by an intimate partner.
• 200 million women have experienced female genital mutilation/cutting.

This issue is not only devastating for survivors of violence and their families, but also entails significant social and economic costs. In some countries, violence against women is estimated to cost countries up to 3.7% of their GDP – more than double what most governments spend on education.

Failure to address this issue also entails a significant cost for the future.  Numerous studies have shown that children growing up with violence are more likely to become survivors themselves or perpetrators of violence in the future.

One characteristic of gender-based violence is that it knows no social or economic boundaries and affects women and girls of all socio-economic backgrounds: this issue needs to be addressed in both developing and developed countries.

Decreasing violence against women and girls requires a community-based, multi-pronged approach, and sustained engagement with multiple stakeholders. The most effective initiatives address underlying risk factors for violence, including social norms regarding gender roles and the acceptability of violence.

The World Bank is committed to addressing gender-based violence through investment, research and learning, and collaboration with stakeholders around the world.

Since 2003, the World Bank has engaged with countries and partners to support projects and knowledge products aimed at preventing and addressing GBV. The Bank supports over $300 million in development projects aimed at addressing GBV in World Bank Group (WBG)-financed operations, both through standalone projects and through the integration of GBV components in sector-specific projects in areas such as transport, education, social protection, and forced displacement.  Recognizing the significance of the challenge, addressing GBV in operations has been highlighted as a World Bank priority, with key commitments articulated under both IDA 17 and 18, as well as within the World Bank Group Gender Strategy .

The World Bank conducts analytical work —including rigorous impact evaluation—with partners on gender-based violence to generate lessons on effective prevention and response interventions at the community and national levels.

The World Bank regularly  convenes a wide range of development stakeholders  to share knowledge and build evidence on what works to address violence against women and girls.

Over the last few years, the World Bank has ramped up its efforts to address more effectively GBV risks in its operations , including learning from other institutions.

Addressing GBV is a significant, long-term development challenge. Recognizing the scale of the challenge, the World Bank’s operational and analytical work has expanded substantially in recent years.   The Bank’s engagement is building on global partnerships, learning, and best practices to test and advance effective approaches both to prevent GBV—including interventions to address the social norms and behaviors that underpin violence—and to scale up and improve response when violence occurs.  

World Bank-supported initiatives are important steps on a rapidly evolving journey to bring successful interventions to scale, build government and local capacity, and to contribute to the knowledge base of what works and what doesn’t through continuous monitoring and evaluation.

Addressing the complex development challenge of gender-based violence requires significant learning and knowledge sharing through partnerships and long-term programs. The World Bank is committed to working with countries and partners to prevent and address GBV in its projects. 

Knowledge sharing and learning

Violence against Women and Girls: Lessons from South Asia is the first report of its kind to gather all available data and information on GBV in the region. In partnership with research institutions and other development organizations, the World Bank has also compiled a comprehensive review of the global evidence for effective interventions to prevent or reduce violence against women and girls. These lessons are now informing our work in several sectors, and are captured in sector-specific resources in the VAWG Resource Guide: www.vawgresourceguide.org .

The World Bank’s  Global Platform on Addressing GBV in Fragile and Conflict-Affected Settings  facilitated South-South knowledge sharing through workshops and yearly learning tours, building evidence on what works to prevent GBV, and providing quality services to women, men, and child survivors.  The Platform included a $13 million cross-regional and cross-practice initiative, establishing pilot projects in the Democratic Republic of Congo (DRC), Nepal, Papua New Guinea, and Georgia, focused on GBV prevention and mitigation, as well as knowledge and learning activities.

The World Bank regularly convenes a wide range of development stakeholders to address violence against women and girls. For example, former WBG President Jim Yong Kim committed to an annual  Development Marketplace  competition, together with the Sexual Violence Research Initiative (SVRI) , to encourage researchers from around the world to build the evidence base of what works to prevent GBV. In April 2019, the World Bank awarded $1.1 million to 11 research teams from nine countries as a result of the fourth annual competition.

Addressing GBV in World Bank Group-financed operations

The World Bank supports both standalone GBV operations, as well as the integration of GBV interventions into development projects across key sectors.

Standalone GBV operations include:

• In August 2018, the World Bank committed $100 million to help prevent GBV in the DRC . The Gender-Based Violence Prevention and Response Project will reach 795,000 direct beneficiaries over the course of four years. The project will provide help to survivors of GBV, and aim to shift social norms by promoting gender equality and behavioral change through strong partnerships with civil society organizations. 
• In the  Great Lakes Emergency Sexual and Gender Based Violence & Women's Health Project , the World Bank approved $107 million in financial grants to Burundi, the DRC, and Rwanda  to provide integrated health and counseling services, legal aid, and economic opportunities to survivors of – or those affected by – sexual and gender-based violence. In DRC alone, 40,000 people, including 29,000 women, have received these services and support.
• The World Bank is also piloting innovative uses of social media to change behaviors . For example, in the South Asia region, the pilot program WEvolve  used social media  to empower young women and men to challenge and break through prevailing norms that underpin gender violence.

Learning from the Uganda Transport Sector Development Project and following the Global GBV Task Force’s recommendations , the World Bank has developed and launched a rigorous approach to addressing GBV risks in infrastructure operations:

• Guided by the GBV Good Practice Note launched in October 2018, the Bank is applying new standards in GBV risk identification, mitigation and response to all new operations in sustainable development and infrastructure sectors.
• These standards are also being integrated into active operations; GBV risk management approaches are being applied to a selection of operations identified high risk in fiscal year (FY) 2019.
• In the East Asia and Pacific region , GBV prevention and response interventions – including a code of conduct on sexual exploitation and abuse – are embedded within the Vanuatu Aviation Investment Project .
• The Liberia Southeastern Corridor Road Asset Management Project , where sexual exploitation and abuse (SEA) awareness will be raised, among other strategies, as part of a pilot project to employ women in the use of heavy machinery. 
• The Bolivia Santa Cruz Road Corridor Project uses a three-pronged approach to address potential GBV, including a Code of Conduct for their workers; a Grievance Redress Mechanism (GRM) that includes a specific mandate to address any kinds gender-based violence; and concrete measures to empower women and to bolster their economic resilience by helping them learn new skills, improve the production and commercialization of traditional arts and crafts, and access more investment opportunities.
• The Mozambique Integrated Feeder Road Development Project identified SEA as a substantial risk during project preparation and takes a preemptive approach: a Code of Conduct; support to – and guidance for – the survivors in case any instances of SEA were to occur within the context of the project – establishing a “survivor-centered approach” that creates multiple entry points for anyone experiencing SEA to seek the help they need; and these measures are taken in close coordination with local community organizations, and an international NGO Jhpiego, which has extensive experience working in Mozambique.

Strengthening institutional efforts to address GBV  

In October 2016, the World Bank launched the  Global Gender-Based Violence Task Force  to strengthen the institution’s efforts to prevent and respond to risks of GBV, and particularly sexual exploitation and abuse (SEA) that may arise in World Bank-supported projects. It builds on existing work by the World Bank and other actors to tackle violence against women and girls through strengthened approaches to identifying and assessing key risks, and developing key mitigations measures to prevent and respond to sexual exploitation and abuse and other forms of GBV. 

In line with its commitments under IDA 18 , the World Bank developed an Action Plan for Implementation of the Task Force’s recommendations , consolidating key actions across institutional priorities linked to enhancing social risk management, strengthening operational systems to enhance accountability, and building staff and client capacity to address risks of GBV through training and guidance materials.

As part of implementation of the GBV Task Force recommendations, the World Bank has developed a GBV risk assessment tool and rigorous methodology to assess contextual and project-related risks. The tool is used by any project containing civil works.

The World Bank has developed a Good Practice Note (GPN) with recommendations to assist staff in identifying risks of GBV, particularly sexual exploitation and abuse and sexual harassment that can emerge in investment projects with major civil works contracts. Building on World Bank experience and good international industry practices, the note also advises staff on how to best manage such risks. A similar toolkit and resource note for Borrowers is under development, and the Bank is in the process of adapting the GPN for key sectors in human development.

The GPN provides good practice for staff on addressing GBV risks and impacts in the context of the Environmental and Social Framework (ESF) launched on October 1, 2018, including the following ESF standards, as well as the safeguards policies that pre-date the ESF: 

• ESS 1: Assessment and Management of Environmental and Social Risks and Impacts;
• ESS 2: Labor and Working Conditions;
• ESS 4: Community Health and Safety; and
• ESS 10: Stakeholder Engagement and Information Disclosure.

In addition to the Good Practice Note and GBV Risk Assessment Screening Tool, which enable improved GBV risk identification and management, the Bank has made important changes in its operational processes, including the integration of SEA/GBV provisions into its safeguard and procurement requirements as part of evolving Environmental, Social, Health and Safety (ESHS) standards, elaboration of GBV reporting and response measures in the Environmental and Social Incident Reporting Tool, and development of guidance on addressing GBV cases in our grievance redress mechanisms.

In line with recommendations by the Task Force to disseminate lessons learned from past projects, and to sensitize staff on the importance of addressing risks of GBV and SEA, the World Bank has developed of trainings for Bank staff to raise awareness of GBV risks and to familiarize staff with new GBV measures and requirements.  These trainings are further complemented by ongoing learning events and intensive sessions of GBV risk management.

Last Updated: Sep 25, 2019

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Addressing Gender-Based Violence: A Critical Review of Interventions

Andrew Morrison (corresponding author) is a lead economist in the Gender and Development Group at the World Bank; his email address is [email protected] .

Mary Ellsberg is senior advisor for Gender, Violence, and Human Rights at PATH; her email address is [email protected] .

Sarah Bott is an independent consultant; her email address is [email protected] .

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Andrew Morrison, Mary Ellsberg, Sarah Bott, Addressing Gender-Based Violence: A Critical Review of Interventions, The World Bank Research Observer , Volume 22, Issue 1, Spring 2007, Pages 25–51, https://doi.org/10.1093/wbro/lkm003

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This article highlights the progress in building a knowledge base on effective ways to increase access to justice for women who have experienced gender-based violence, offer quality services to survivors, and reduce levels of gender-based violence. While recognizing the limited number of high-quality studies on program effectiveness, this review of the literature highlights emerging good practices. Much progress has recently been made in measuring gender-based violence, most notably through a World Health Organization multicountry study and Demographic and Health Surveys. Even so, country coverage is still limited, and much of the information from other data sources cannot be meaningfully compared because of differences in how intimate partner violence is measured and reported. The dearth of high-quality evaluations means that policy recommendations in the short run must be based on emerging evidence in developing economies (process evaluations, qualitative evaluations, and imperfectly designed impact evaluations) and on more rigorous impact evaluations from developed countries.

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

• First Online: 18 February 2021

Cite this chapter

• Sanne Weber 3 &
• Siân Thomas 3  

2 Citations

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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Gender-Based Violence: Research Methods and Analysis

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.

This program aims to enhance participants’ ability to conduct technically rigorous, ethically-sound, and policy-oriented research on various forms of gender-based violence. Individuals working on and interested in the areas of sexual and reproductive health, maternal and child health, adolescent health, HIV, mental health and substance use will most benefit from taking this program.

The program will cover the following topics:

• Conceptualizing and researching various forms of gender-based violence;
• Developing conceptual frameworks for violence and health research;
• Ethics and safety;
• Survey research on violence and questionnaire design;
• Intervention research: approaches and challenges;
• Qualitative research on violence;
• Violence research in healthcare settings

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

Competencies

Participants will learn:

• Current gold standard methods to conceptualize and measure gender-based violence;
• Validity and reliability of GBV measures;
• Tool development and validation methods;
• Ethical and safety issues in GBV research;

Intended Audience

Participants interested in investigating gender-based violence as part of a quantitative or qualitative study or an intervention evaluation will find it particularly relevant.

Required knowledge/pre-requisites

Participants are expected have some prior familiarity or experience with conducting research.

Discounts available—visit our FAQs page to learn more.

Low-cost, on-campus housing is also available. Contact us for more information.

The Summer Institute process was very easy and well organized

Nafisa Halim

is a sociologist with expertise in monitoring and evaluation of public health programs. As a PI/Co-I, Halim served on twelve evaluation studies, and conducted a wide range of activities including data processing and analysis; sampling and sample size calculations; database development and management; and study implementation and field training. Halim has consulted with WHO, served on research projects funded by USAID, NIH, the Medical Research Council (South Africa) and private foundations, and partnered with several implementing organizations including Pathfinder, Pact Save the Children, World Education Initiatives, icddr,b. Halim was recognized for her excellence in teaching in 2016.

Monica Adhiambo Onyango

has over 25 years’ experience in health care delivery, teaching and research. Her experience includes Kenya Ministry of Health as a nursing officer in management positions at two hospitals and as a lecturer at the Nairobi’s Kenya Medical Training College, School of Nursing. Dr. Onyango also worked as a health team leader with international non-governmental organizations in relief and development in South Sudan, Angola, and a refugee camp in Kenya. In addition to her teaching engagement, she also takes up consultancies on health care delivery, management and research in relief and development contexts. In 2011, Dr. Onyango co-founded the global nursing caucus, whose mission is to advance the role of nursing in global health practice, education and policy through advocacy, collaboration, engagement, and research.

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Reporting of sexual and gender-based violence and associated factors among survivors in Mayuge, Uganda

Reporting of Sexual and Gender-Based Violence (SGBV) allows survivors to access support services to minimize the impact of the violence on their lives. However, research shows that most SGBV survivors do not report.

We aimed to determine the proportion of survivors of SGBV in Mayuge District, Uganda, who report SGBV and the factors associated with reporting.

Using a cross-sectional study design, we analyzed data of SGBV survivors in eight villages in Mayuge district collected in a baseline survey of a larger experimental study. Data were analysed using Modified Poisson Regression.

Of the 723 participants, 65% were female. Only 31.9% had reported the SGBV experienced. Reporting was 43% lower among survivors aged 45 years and older (p-value = 0.003), and 41% lower among survivors with higher than a primary school education (p-value = 0.005). Likewise, reporting was 37% lower among survivors who relied on financial support from their partners (p-value = 0.001). Female survivors were also 63% more likely to report (p-value = 0.001), while survivors who were separated/widowed were 185% more likely to report than those who were never married (p-value = 0.006).

Conclusions

Reporting of SGBV by survivors in Mayuge was found to below.

Sexual and Gender-Based Violence (SGBV), especially against women, remains a major public health problem worldwide. The term SGBV encompasses different forms of violence including sexual violence; physical and emotional violence by an intimate partner; harmful traditional practices; and socio-economic violence 1 . Globally, about 1 in 3 women aged 15 years and older have ever experienced physical and/or sexual intimate partner violence during their lifetime 2 . In Uganda, 22% of women and 8% of men have ever experienced some form of sexual violence 3 .

This violence is more prevalent in the rural and poorer parts of the country like Mayuge district 3 . It is fuelled by society attitudes and practices that promote gender inequality and put women in a subordinate position in relation to men 1 . In all its forms, SGBV is a violation of human rights and undermines the health and dignity of its survivors. Among women, intimate partner violence has been shown to be associated with HIV, sexually transmitted infections 4 , depressive symptoms and suicide attempts 5 . These effects are often worse if survivors do not report or seek help.

Reporting allows survivors of SGBV to access the medical, psychosocial and legal services they need to minimize the impact of the violence on their health and also allows perpetrators to be held accountable. Moreover, formal reporting of SGBV, for example to medical personnel, legal officers or community leaders, allows accurate estimation of the prevalence of the violence. This enables proper resource allocation towards interventions to reduce SGBV and provide appropriate care to survivors. However, data from Demographic and Health Surveys of 24 countries worldwide showed that only 7% of all women who had experienced gender-based violence reported to a formal source 6 . In Uganda, among survivors of sexual and physical violence, only 33% of the female survivors and 30% of the males were reported to have sought help, while 51% of the women and 49% of the men neither sought help nor told anyone about the violence 3 .

The barriers to reporting of SGBV include shame, guilt and stigma associated with, especially, sexual violence; lack of access to medical care 7 ; concerns about confidentiality and being believed 8 ; and barriers specific to seeking help from police like the fear of reprisal resulting from reporting 9 . Similarly, poverty and the costs associated with reporting of SGBV such as transport for the complainant also sometimes hinder reporting and lead to settling cases out of court 10 . Gender inequality has also been cited as a barrier to reporting of SGBV, especially among female survivors. This is because it renders a lot of women submissive and economically dependent on their male partners who may at times be the perpetrators of the violence. 11

However, most previous research on SGBV reporting has focused on sexual and intimate partner violence, overlooking emotional and socio-economic violence. Other studies have only focused on specific vulnerable groups like the women 6 , the disabled 12 , and refuge populations 13 , leaving the reporting behaviour of some groups ununderstood. This study, therefore, aimed to determine the proportion of survivors of emotional, physical, socio-economic and sexual violence who report the violence experienced and to determine the factors associated with reporting. This information will guide the design of interventions to enhance reporting of SGBV experienced.

Study design

A cross-sectional study design was used. The study used baseline data collected in a larger experimental study testing a community intervention to reduce SGBV in Mayuge (14).

Study setting

Data were collected in October 2019 from eight villages in Mayuge, a district in the Eastern part of Uganda. The 2014 National Population and Housing Census put the total population of the district at 473,239 people, with 51.6% of the total population being female and the majority (58.7%) aged between 0 to 17 years 15 .

Participants

The study included men and women aged 18 years and older who reported experiencing at least one form of SGBV. Those aged 15 to 17 years were also included if they were considered emancipated minors who were already married, had children or were pregnant. Participants were only included if they normally resided in the visited households; were domestic servants who had slept in the households for at least five nights a week; or were visitors who had slept in the household for at least the past four weeks.

Sampling procedure

For the larger experimental study, all villages in Mayuge were stratified as either rural or urban and a random sample of four villages was drawn from each stratum. Quota sampling was then used to select an equal number of men and women from each village, with one eligible person per household randomly selected for interview. 14 To select participants for inclusion in this cross-sectional study, all those who reported at least one form of SGBV in the baseline survey of the experimental study were included in the analysis.

A total of 995 participants were included in the larger experimental study 14 . Data of all 723 participants who reported experiencing at least one form of SGBV in their lifetime in the larger study were included in this study.

Participants were considered to have experienced SGBV if they had experienced either physical violence by an intimate partner, emotional violence by an intimate partner, sexual violence or socio-economic violence in their lifetime. Physical, emotional and sexual violence were assessed using questions adopted from Garcia-Moreno, Jansen 16 . Socio-economic violence was used to refer to the denial of access to social and economic rights based on one's gender 1 . It was defined as: the respondent being denied access to education, health assistance or remunerated employment because of their gender; being denied property rights because of their gender 1 ; being prohibited by their partner from getting a job, going to work, trading or earning money; or their partner taking their earnings against their will 17 .

The outcome of interest, reporting of SGBV was assessed using the question: “Have you told anyone about the violence you experienced?” Participants who responded “Yes” were further asked who they had told, and those who had reported to a health worker, police, social services organisation, local leader, religious leader or a counsellor were considered to have reported formally. Survivors who reported to friends, family members and neighbours were considered to have reported to informal sources.

Potential covariates identified from previous literature were also measured. These included; the participants' age, gender, education, marital status, residence, perceived availability of support from their family of birth, their main source of financial support and their attitudes towards wife-beating. The attitudes towards wife-beating were assessed using the question, “In your opinion, is a husband justified in hitting or beating his wife in the following situations: if she goes out without telling him; if she neglects the children; if she argues with him; if she refuses to have sex with him; or if she burns the food”. Respondents who answered “Yes” to at least one of the scenarios were coded as having attitudes accepting of SGBV. 3

Data collection

Data on SGBV, its reporting and the covariates were collected using an interviewer-administered electronic questionnaire through a household survey. This questionnaire was administered in Lusoga, the language predominantly spoken in the area. The interviews were conducted by male and female research assistants, depending on the respondents' preference.

Statistical analysis

Data were analysed using Stata Version 14 (StataCorp LP, TX, USA). Modified Poisson Regression with robust standard errors was used for both bivariate and multivariable analysis, and associations were presented as prevalence ratios and adjusted prevalence ratios (APRs) with their 95% confidence intervals (CIs). Only variables with p-values less than 0.2 at bivariate analysis were considered for inclusion in the multivariable model. A p-value of less than 0.05 was considered statistically significant for all analyses.

Ethics approval and consent to participate

Ethical approval for the study was sought from Makerere University School of Public Health Institutional Review Board (Protocol Number: 702) and the Uganda National Council for Science and Technology (Reference Number: HS457ES). Written informed consent was also sought from all study participants. Data were collected according to the World Health Organisation's Ethical and Safety Recommendations for Research on Domestic Violence Against Women 18 .

Participant characteristics

Of the 723 participants who reported having experienced at least one form of SGBV in their lifetime, 65% were female ( Table 1 ). Only 16% of the women and 30.4% of the men had attained education higher than primary school. The majority, 78.7% of the women and 80.6% of the men, were married or living with their partners. Most of the men (93.3%) derived their main source of financial support from their incomes, while 45.5% of women relied on their partners for financial support. Among the women, 48.1% found wife-beating justifiable in at least one situation as compared to 26.5% of the men. The commonest type of violence among both sexes was emotional while sexual violence was the least prevalent.

Participant characteristics (N = 723)

Reporting of SGBV

Of the 723 survivors of SGBV, only 231 (31.9%) had reported the violence they had experienced to anyone, and of these, 12.5% had reported formally.

Factors associated with reporting of SGBV

At bivariate analysis, reporting of SGBV appeared to be more prevalent among females and among the separated/widowed, and less prevalent among survivors who had higher than a primary school education and those who did not find wife-beating justifiable in any situation. ( Table 2 )

Bivariate and multivariable analysis of factors associated with reporting to any source. (N = 723)

However, at multivariable analysis, the prevalence of reporting was found to be 43% lower among survivors who were aged 45 years and older as compared to those who were less than 25 years old, APR = 0.57 (95% CI: 0.39, 0.83; p-value = 0.003). Reporting was also 41% lower among those who had attained higher than primary school education, as compared to those with no education at all, APR = 0.59 (CI: 0.41, 0.85; p-value = 0.005). Likewise, reporting was 37% lower among survivors who relied on their partners for financial support as compared to those who relied on their incomes, APR = 0.63 (CI: 0.47, 0.84; p-value = 0.001).

On the other hand, reporting was 63% higher among females than males, APR=1.63 (CI: 1.22, 2.18; p-value = 0.001). Survivors who were separated from their partners or widowed were also more than twice as likely to report the violence experienced as compared to those who were never married, APR = 2.85 (CI: 1.35, 5.99; p-value = 0.006).

We found the level of reporting of SGBV among survivors in Mayuge to be low, even lower than the 39.9% reported for female survivors of gender-based violence in 24 developing countries, including Uganda. However, formal reporting in our study was higher than the 7% recorded for these survivors.6 Reporting was also found to be more prevalent among women. This could be related to the patriarchal nature of many societies in Uganda (19). These uphold masculinity idealisations that condition male survivors of SGBV to remain silent about the violence experienced 20. Similar underreporting of SGBV has been documented in conflict-afflicted Democratic Republic of Congo among male rape survivors because of feelings of shame, stigma and emasculation21. Such society ideals of what is expected of a man hinder reporting of SGBV.

We found reporting to be lower among survivors aged 45 years and older as compared to those younger than 25. This finding may imply that, because of awareness creation, survivors have gradually become more knowledgeable about the importance of reporting and the available reporting channels. And, because life-time experience of SGBV was used in the assessment, the younger survivors who had more recent experiences of SGBV may have been more likely to report than those 45 years and older who may have experienced violence over a longer period. However, this result is contrary to findings by Palermo, Bleck6 where increasing age was shown to be associated with an increased likelihood of reporting among female survivors of gender-based violence in developing countries.

Reporting was also lower among survivors who had higher than a primary school education as compared to those with no education at all. Older and educated community members are usually looked up to by others, and this lower reporting may be related to the need to uphold this social standing. However, education creates awareness about the available reporting channels and would be expected to increase reporting, although this is contrary to our findings. Palermo, Bleck 6 also found contradicting results about the effect of education on reporting of SGBV: in some countries like Nigeria, women with no education were less likely to report SGBV while in others like Tanzania and Philippines, women with higher education were less likely to report. Reporting was lower among survivors who relied on their partners for financial support as compared to those who relied on their income. In Uganda, employed women and men were found to be more likely than the unemployed to seek help to end violence 3 . Women's financial dependency on their partners was also cited as a barrier to help-seeking by abused women in Rwanda because their partners controlled the family resources and made decisions about how money could be spent 11 . In our study, more women reported relying on their partners for financial support than men, further highlighting the need for economic empowerment of those most vulnerable to SGBV to increase their autonomy in relationships and ability to report and seek help in case of violence.

Survivors who were separated from their partners or widowed had a higher prevalence of SGBV reporting than those who were never married. This is comparable to what Palermo, Bleck 6 found in 15 of 24 developing countries, where formerly married women were more likely to report the violence experienced than currently married women. The 2016 UDHS also found separated and divorced men and women to be most likely to seek help for the violence experienced, as compared to the married and those who were never-married 3 . This could be related to the ignorance among the married about the fact that marital rape is a crime that needs to be reported 11 . Umubyeyi, Persson 11 also reported that family matters, including violence and abuse against women, in Rwanda were considered secrets to be retained within the family, which also affected reporting and help-seeking among survivors of intimate partner violence. As such, divorced and separated survivors may feel less bound by such expectations of secrecy and may be more open to speaking out about the violence experienced both in and outside marriage. We, however, did not observe any statistical difference in reporting between the married and those who were never married.

Limitations

Since a quantitative cross-sectional study design was used, we were unable to establish temporality between the exposure variables and reporting. We were therefore limited in our understanding of the true relationship between variables like marital status and the reporting of SGBV. Furthermore, we were limited in our ability to understand the institutional barriers to reporting. More research using qualitative methods is recommended to further explore and understand the barriers to SGBV reporting.

Additionally, because SGBV is a sensitive issue, underreporting of the violence experienced by the study participants could have occurred. We, however, minimised this by training research assistants to conduct interviews in private spaces, away from any interruptions to encourage accurate reporting.

The reporting of SGBV was found to be low among survivors in Mayuge. Reporting was more prevalent among female survivors and those who were separated from their partners or widowed. On the other hand, it was less prevalent among survivors aged 45 years and older, those with higher than a primary education and among those who received their main source of financial support from their partners.

We recommend interventions that promote dialogues about SGBV and its reporting, especially among the men, older survivors and the educated to encourage reporting and promote help-seeking to stop the violence and to increase utilisation of the available support services for survivors. We also recommend economic empowerment for those most vulnerable to SGBV to increase their autonomy in relationships and ability to report the violence experienced.

Additionally, leaders at the community level, such as the religious and local leaders, should be empowered with information and resources to effectively provide support to survivors of SGBV in their communities, as these are sometimes the survivors' first points of contact.

Acknowledgements

We thank all study participants and the research assistants for their contribution to the data collection procedures.

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Release of the National Plan to End Gender-Based Violence: Strategies for   Action

May 25, 2023

Today, the White House released the first-ever U.S. National Plan to End Gender-Based Violence: Strategies for Action . When President Biden issued the Executive Order establishing the first-ever White House Gender Policy Council , he called on the Gender Policy Council to develop the first U.S. government-wide plan to prevent and address sexual violence, intimate partner violence, stalking, and other forms of gender-based violence (referred to collectively as GBV).  

Gender-based violence is a public safety and public health crisis, affecting urban, suburban, rural, and Tribal communities in the United States. It is experienced by individuals of all backgrounds and can occur across the life course. Though we have made significant progress to expand services and legal protections for survivors, much work remains.

Through this National Plan to End Gender-Based Violence (National Plan), the Biden-Harris Administration is advancing a comprehensive, government-wide approach to preventing and addressing GBV in the United States. The National Plan identifies seven strategic pillars undergirding this approach: 1) Prevention; 2) Support, Healing, Safety, and Well-Being; 3) Economic Security and Housing Stability; 4) Online Safety; 5) Legal and Justice Systems; 6) Emergency Preparedness and Crisis Response; and 7) Research and Data. Building upon existing federal initiatives, the National Plan provides an important framework for strengthening ongoing federal action and interagency collaboration, and for informing new research, policy development, program planning, service delivery, and other efforts across each of these core issue areas. It is guided by the lessons learned and progress made as the result of tireless and courageous leadership from GBV survivors, advocates, researchers, and policymakers, as well as other dedicated professionals and community members who lead prevention and response efforts.

And while the Plan is focused specifically on federal action, it is designed to be accessible and useful to public and private stakeholders across the United States for adaptation and expansion—because all communities are vital to ending GBV.

The priorities in this National Plan to End GBV, as well as those included in the 2022 update to the U.S. Strategy to Prevent and Respond to Gender-Based Violence Globally , reflect our nation’s ongoing commitment to advancing efforts to prevent and address gender-based violence both at home and abroad. As stated in the National Plan, “Ending gender-based violence is, quite simply, a matter of human rights and justice.”

While the National Plan provides a roadmap to guide future efforts, addressing GBV has been a core priority since the start of the Biden-Harris Administration, as reflected in the highlights below of recent and longer-term actions undertaken to prevent and address GBV.

Recent Federal Initiatives to Prevent and Address GBV in the United States Include:

• Elevating the Office of Family Violence Prevention and Services : The Assistant Secretary of the Administration of Children and Families (ACF) at the Department of Health and Human Services (HHS) established the Family Violence Prevention and Services Act (FVPSA) Program as its own office under the ACF Immediate Office of the Assistant Secretary in March 2023, now known as the Office of Family Violence Prevention and Services (OFVPS) . The establishment of OFVPS reflects the importance of work to prevent and address intimate partner violence, domestic violence, dating violence, and sexual assault; to coordinate trauma informed services and support across ACF, HHS, and the federal government; and to strengthen attention to policy and practice issues relating to addressing the needs of survivors. 
• Establishing New FVPSA Discretionary Grant Programs:   Funding for FVPSA programs increased by 20% in the FY 2023 federal budget. In addition to allocating increased funding for existing FVPSA programs, the OFVPS is publishing four new competitive discretionary notice of funding opportunities in May 2023. This includes $7.5 million to fund thirty cooperative agreements to support Culturally Specific Domestic Violence and Sexual Assault grants for community-based organizations to build and sustain organizational capacity in delivering trauma-informed, developmentally sensitive, culturally relevant services for children, individuals, and families affected by sexual assault and domestic violence. It also includes for the first time cooperative agreements in the amount of $500,000 each to fund two Sexual Assault Capacity Building Centers to provide national technical assistance to states, territories, and tribal governments in supporting comprehensive services for rape crisis centers, sexual assault programs, culturally specific programs, and other nonprofit, nongovernmental organizations or tribal programs that provide direct intervention and related assistance to victims of sexual assault, without regard to age.
• Announcing Grant Awards for the Domestic Violence Prevention Enhancement and Leadership through Alliances Initiative : On May 3,the Centers for Disease Control (CDC) announced funding awards for thirteen state domestic violence coalitions under the Domestic Violence Prevention Enhancement and Leadership Through Alliances (DELTA): Achieving Health Equity through Addressing Disparities (AHEAD) initiative . DELTA AHEAD recipients will work to decrease risk factors and increase protective factors related to intimate partner violence by addressing social determinants of health and health equity.
• Launching the  HRSA Strategy to Address Intimate Partner Violence : On May 16, the Health Resources and Services Administration (HRSA) of the Department of Health and Human Services launched the 2023-2025 HRSA Strategy to Address Intimate Partner Violence . The agency-wide Strategy identifies strategic objectives and activities for HRSA Bureaus and Offices to undertake that will contribute to these aims to enhance HRSA coordination of efforts to strengthen infrastructure and workforce capacity to address intimate partner violence and promote prevention through evidence-based programs.
• Expanding Support for the Administration of Grants to Tribes: OFVPS recently expanded staffing to support the implementation of FVPSA and American Rescue Plan grant programs. This includes hiring for the first time a Tribal Program Manager, and five Tribal Program Specialists who will lead OFVPS training, technical assistance, support, and engagement of the 252 tribes that receive FVPSA and ARP funding to meet the needs of American Indians/Native Americans and Alaska Natives surviving violence, trauma, and abuse.
• Allocating Increased Funding for Department of Justice VAWA Programs: Since the start of the Biden-Harris Administration, the Justice Department’s Office on Violence Against Women (OVW) has administered close to a billion dollars (approximately $480 million and 750 awards in both FY 2021 and FY 2022) to implement the Violence Against Women Act (VAWA) across states and territories to reduce and address domestic violence, dating violence, sexual assault, and stalking by strengthening services to victims and holding offenders accountable. In FY 2023, OVW received $700 million through the bipartisan omnibus appropriations (a 20% increase over the FY’ 22 appropriations), and the President’s budget for FY 2024 calls for $1 billion to implement VAWA programs.
• Providing HUD Funding for DV Projects and Establishing New VAWA Technical Assistance Grants: In March 2023, the Department of Housing and Urban Development (HUD) announced $2.76 billion in FY 2022 awards to help people experiencing homelessness. These awards included over $54 million in new grants to support domestic violence (DV) projects. This spring, there will be another round of $52 million available for DV projects in the FY 2023 Continuums of Care (CoC) Program Competition. Additionally, this summer, HUD will announce the recipient(s) of $5 million in new VAWA technical assistance funding through the agency’s Community Compass Technical Assistance and Capacity Building program. The VAWA Technical Assistance Providers will provide comprehensive training, technical assistance, and other support to HUD’s grantees, housing providers, and other stakeholders on VAWA implementation issues. 
• Announcing the Fostering Access, Rights and Equity (FARE) Grant Program: The U.S. Department of Labor (DOL) Women’s Bureau announced the 2023 Fostering Access, Rights and Equity (FARE) Grant opportunity in April, which assists underserved and marginalized low-income women workers who have been impacted by gender-based violence and harassment in the world of work (including activities that occur in the course of, are linked with, or arise out of work), and helps them understand and access their employment rights, services, and benefits. These grants provide crucial outreach, education, and improved benefits access.
• Advancing Promising Practices to Prevent Harassment in the Federal Sector: The Equal Employment Opportunity Commission (EEOC) issued a new technical assistance document in April 2023 entitled Promising Practices for Preventing Harassment in the Federal Sector . The document builds upon existing EEOC guidance and is intended to serve as a resource to help federal agencies prevent and remedy harassment, including sexual harassment, and to assist agencies as they work to update or revise their anti-harassment policies and programs. Most of the practices identified, such as those related to conducting investigations and addressing online harassment, may also be helpful to practitioners outside of the federal government.
• Issuing a Presidential Memorandum Establishing Safe Leave for Federal Workers : President Biden issued a Presidential Memorandum in February 2023 directing the Office of Personnel Management (OPM) to provide recommendations regarding federal employees’ access to paid leave for purposes related to seeking safety and recovering from domestic violence, dating violence, sexual assault, or stalking—including to obtain medical treatment, seek assistance from service organizations, seek relocation, and take legal action.
• Establishing the Humanitarian, Adjustment, Removing Conditions and Travel Documents (HART) Service Center : The U.S. Citizenship and Immigration Services (USCIS) of the Department of Homeland Security opened the Humanitarian, Adjustment, Removing Conditions and Travel Documents (HART) Service Center in February 2023, which focuses on the adjudication of humanitarian-based immigration relief, including VAWA self-petitions and U-visas for victims of eligible crimes. HART will significantly increase the number of adjudicators for these cases in order to positively impact the timeliness and scale of USCIS’ humanitarian processing abilities.
• Expanding the OSHA U/T Visa Certification Program: The Department of Labor expanded its T and U visa certification program in March 2023, to include the Occupational Safety and Health Administration (OSHA). For the first time, OSHA will be able to issue these visa certifications – during its workplace safety investigations – when the agency identifies qualifying criminal activities, including sexual assault and human trafficking. The authority will provide the agency with a critical tool for protecting immigrant and migrant worker communities regardless of their lack of immigration status or temporary employment authorization. While OSHA and the Wage and Hour Division have the authority to issue U and T visa certifications, U.S. Citizenship and Immigration Services determines whether an applicant qualifies for the visa.
• Addressing Sexual Assault in the Military Service Academies. The Secretary of Defense announced in March 2023 a series of significant actions to address sexual violence in the Military Service Academies (MSAs), including requiring On-Site Installation Evaluations at each of the Academies, adapting and applying recommendations from the Independent Review Commission on Sexual Assault in the Military to the MSA context, enhancing prevention efforts, and informing cadets and midshipmen of the significant changes to the military justice process scheduled to take effect in December 2023.
• Implementing VAWA Changes to Grants: Solicitations for FY 2023 OVW grant programs include numerous improvements to legal tools and expansions of grant programs addressing domestic violence, dating violence, sexual assault, and stalking, as a result of the Violence Against Women Act Reauthorization Act of 2022 (VAWA 2022), which was enacted in March of 2022.
• Developing the White House Task Force to Address Online Harassment and Abuse Initial Blueprint : The White House Task Force to Address Online Harassment and Abuse released a summary of the  Initial Blueprint for Action in March 2023, which includes a broad range of new and expanded commitments from Federal agencies to address technology-facilitated gender-based violence across four main lines of effort: Prevention, Survivor Support, Accountability, and Research. The FY 2023 omnibus law allocates $7 million for DOJ to fund two new programs authorized in VAWA 2022, including the establishment of a National Resource Center on Cybercrimes Against Individuals, and grants to provide training and support to State, Tribal, and local law enforcement, prosecutors, and judicial personnel to assist victims of cybercrimes. Additionally, as part of the federal government’s efforts to increase accountability, DOJ’s OVW will launch an initiative, with the funding allocated in the FY 2023 bipartisan omnibus, focused on the prosecution and investigation of online abuse.
• Announcing a Call for Concept Papers for Restorative Practices Training and Technical Assistance : DOJ’s OVW recently released a new solicitation to offer training and technical support to implement restorative practices. Projects will protect survivor safety and autonomy, working to offer survivors options to seek justice and healing, in alignment with the requirements outlined in Section 109 of VAWA 2022 and the Consolidated Appropriations Act of 2022.
• Issuing Regulations Governing the Special Tribal Criminal Jurisdiction (STCJ) Reimbursement Program : OVW issued an interim final rule to implement a new program authorized under VAWA 2022 to reimburse Tribal governments for expenses incurred in exercising STCJ over non-Native individuals who commit certain covered crimes on Tribal lands. This rule implements the new Tribal Reimbursement Program by providing details on how it will be administered, including eligibility, frequency of reimbursement, costs that can be reimbursed, the annual maximum allowable reimbursement per Tribe, and conditions for waiver of the annual maximum.
• Developing the Integrated Primary Prevention Workforce (IPPW) : DoD developed a model for a dedicated and capable workforce focused on preventing sexual assault, harassment, suicide, domestic abuse, child abuse, and retaliation. In January 2022, the Department launched a phased approach to hiring a primary prevention workforce. The Department has begun hiring the Integrated Primary Prevention Workforce (IPPW) at installations across the world and released DoDI 6400.11 (“ DoD Integrated Primary Prevention Policy for Prevention Workforce and Leaders ”) in December 2022 to outline guidance.  While both prevention and response are necessary to decrease the impact of harm and violence in our military community, the Department sees prevention as the best way to ensure future harm and violence never occur.  Efforts are underway to staff the new IPPW, which will be staffed with 2,000 skilled professionals who promote the health of their military community and work with leaders to change policies and implement prevention activities.
• Announcing National Institute of Justice FY23 Research and Evaluation on Violence Against Women: DOJ’s National Institute of Justice (NIJ) strives to support the development of objective and independent knowledge and validated tools to reduce violence against women, promote justice for victims of crime, and enhance criminal justice responses. NIJ’s new solicitation for FY 2023 will provide grant funding to conduct research and evaluation projects examining a broad range of topics, including the crimes of domestic and family violence, intimate partner violence, rape, sex trafficking, sexual assault, stalking, and teen dating violence, also known as adolescent relationship abuse, along with the associated criminal justice system response, procedures, and policies.

These recent actions build on the Biden-Harris Administration’s longstanding commitment to addressing GBV, including by:

• Reauthorizing the Violence Against Women Reauthorization Act : President Biden signed into law the Violence Against Women Act Reauthorization Act of 2022 (VAWA 2022) in March 2022, critical legislation that expands access to safety and support for survivors and increases prevention efforts. The Administration is swiftly implementing the new and strengthened VAWA, including targeted actions to support Native survivors through the expansion of special criminal jurisdiction of Tribal courts, updating HUD’s guidance on expanded VAWA housing protections, improving access to sexual assault medical forensic examinations, and enhancing grant programs to support LGBTQI+ survivors, survivors of technology-facilitated abuse, and those in marginalized or underserved communities, including rural communities
• Enacting the Bipartisan Safer Communities Act : President Biden signed into law the Bipartisan Safer Communities Act in 2022, the most significant legislation to reduce gun violence in 30 years. The law will save lives by strengthening the background check system; narrowing the “boyfriend loophole” to keep guns out of the hands of convicted dating partners; investing $250 million for community-based violence intervention programs; providing $750 million for states to implement crisis interventions, such as extreme risk protection orders (also known as “red flag laws”); and expanding mental health services and safety initiatives in schools and communities.
• Improving Protections for Survivors of Sexual Assault and Sexual Harassment in the Workplace : In 2022, President Biden signed into law the Ending Forced Arbitration of Sexual Assault and Sexual Harassment Act ,which amended the Federal Arbitration Act for disputes involving sexual assault and sexual harassment in order to stop employers and businesses from forcing employees and customers out of the court system and into arbitration. The President also signed into law the   Speak Out Act , which enables survivors to speak out about workplace sexual assault and harassment by prohibiting the enforcement of pre-dispute nondisclosure and non-disparagement clauses regarding allegations of sexual harassment or assault
• Increasing Resources for Survivors of Crime, Including Gender-Based Violence .  President Biden signed into law the VOCA Fix to Sustain the Crime Victims Fund Act of 2021 which passed Congress with bipartisan support and expanded the allocation of resources for the Crime Victims Fund. This has already resulted in an increase of hundreds of millions of dollars of non-taxpayer funding for essential and lifesaving services to crime victims around the country, including survivors of gender-based violence.
• Allocating $1 Billion in Supplemental Funding for DV/SA Services Through the American Rescue Plan: The Office on Family Violence Prevention and Services (OFVPS) has been administering the nearly $1 billion in supplemental funding for domestic violence and sexual assault services and support allocated through the American Rescue Plan (ARP).
• Addressing GBV in the Military : At the direction of President Biden, Secretary of Defense Lloyd Austin ordered a 90-Day Independent Review Commission (IRC) on Sexual Assault in the Military to take bold action to address sexual assault and harassment in the armed forces. Since the creation of the IRC, President Biden has signed into law the National Defense Authorization Act of 2022 and 2023, both of which included important reforms to the military justice system and adopted core recommendations of the IRC, as called for by President Biden. These historic, bipartisan reforms fundamentally shift how the military prosecutes and investigates sexual assault, domestic violence, sexual harassment, and other serious crimes, and will increase prevention initiatives and support for survivors. Additionally, in January 2022, President Biden signed an  Executive Order  to establish sexual harassment as a specific offense under the Uniform Code of Military Justice (UCMJ), and fully implement changes to the UCMJ to criminalize the wrongful broadcast or distribution of intimate images.
• Proposing Amendments to Title IX Regulations : The Department of Education proposed amendments to its Title IX regulation s to advance Title IX’s goal of ensuring that no person experiences sex discrimination in education, that all students receive appropriate support as needed to access equal educational opportunities, and that school procedures for investigating and resolving complaints of sex discrimination, including sex-based harassment and sexual violence, are fair to all involved.
• Launching a Task Force on Sexual Violence in Education : The Department of Education, in collaboration with DOJ and HHS, launched the VAWA-mandated Task Force on Sexual Violence in Education in September 2022, submitted a report to Congress , and has initiated a process to develop recommendations on many aspects of sexual violence prevention and response.
• Improving Law Enforcement Response to Sexual Assault and Domestic Violence by Identifying and Preventing Gender Bias: The Department of Justice released updated guidance in 2022 on Improving Law Enforcement Response to Sexual Assault and Domestic Violence by Identifying and Preventing Gender Bias . This guidance is designed to help law enforcement agencies recognize, mitigate, and prevent gender bias and other bias from compromising the response to, and investigation of, sexual assault, domestic violence, and other forms of gender-based violence. The guidance provides a set of eight basic principles that – if integrated into LEAs’ policies, trainings and practices – help ensure that gender bias, either intentionally or unintentionally, does not undermine efforts to keep survivors safe and hold offenders accountable.
• Addressing GBV in American Indian and Alaska Native Communities : In November 2021, President Biden issued an Executive Order that tasked federal agencies with addressing the crisis of missing and murdered Indigenous peoples, which most often impacts women, girls, LGBTQI+ people in the community, and Two-Spirit Native Americans. The Biden-Harris Administration has also worked to implement the Not Invisible Act of 2019, which established the Not Invisible Act Commission, a cross jurisdictional advisory committee led by the Secretary of the Interior and Attorney General and composed of law enforcement, Tribal leaders, federal partners, service providers, family members of missing and murdered individuals, and most importantly — survivors. Additionally, in 2021, the United States relaunched the North American Trilateral Working Group on Violence Against Indigenous Women and Girls (Trilateral Working Group), in collaboration with the governments of Canada and Mexico, and with the participation of Indigenous women leaders from all three countries.  The White House issued a report following the Fourth Convening of the Trilateral Working Group , which highlights many key regional and federal agency activities intended to prevent and address all forms of GBV, including trafficking in persons and Missing and Murdered Indigenous People (MMIP), with a focus on the disproportionate impact on Indigenous women and girls, as well as other LGBTQI+ persons.
• Establishing Culturally Specific Sexual Assault Capacity Building Centers and a Native Hawaiian Resource Center : HHS, through the Family Violence Prevention and Services Program, awarded grant funding in 2022 to support three new cooperative agreements for Culturally Specific Sexual Assault Capacity Building Centers (CSSACs) to provide capacity building resources, training, and technical assistance for culturally specific sexual assault programs serving survivors from culturally specific populations, underserved communities, and historically marginalized communities. The new CSSACs are funded to provide training and technical assistance to states, territories, Tribes, coalitions, and culturally specific organizations to help meet the needs of sexual assault survivors. In September 2022, OFVPS also awarded a $1 million cooperative agreement to establish for the first time a Native Hawaiian Resource Center on Domestic Violence for the Native Hawaiian Communities. Pouhana O Na Wahine is specifically designed to provide capacity building resources, training, and technical assistance for culturally specific family violence, domestic violence, and dating violence programs serving survivors from the Native Hawaiian populations.
• Addressing Online Harassment and Abuse: The Biden-Harris Administration has led efforts to prevent and address online harassment and abuse in the U.S. and globally. To tackle this scourge, President Biden established the White House Task Force to Address Online Harassment and Abuse in 2022, with a mandate to identify concrete actions in a Blueprint for Action to prevent and address online harassment and abuse, provide support for survivors, increase accountability, and expand research. In 2022, the Administration also launched the Global Partnership for Action on Gender-Based Online Harassment and Abuse , which was announced at the first Summit for Democracy and formally launched at the Commission on the Status of Women at the United Nations. Since its start in March 2022, the Global Partnership has grown to 12 countries, and has brought together international organizations, civil society, and the private sector to better prioritize, understand, prevent, and address the growing scourge of technology-facilitated gender-based violence.
• Issuing a Presidential Memorandum on Promoting Accountability for Conflict-Related Sexual Violence : In November 2022, President Biden signed a Presidential Memorandum to strengthen the U.S. government’s efforts to combat rape as a weapon of war. This Presidential Memorandum directs the State Department, Treasury Department, and other federal agencies to leverage sanctions authorities, assistance restrictions, and other tools to promote accountability for perpetrators of conflict-related sexual violence (CRSV). With this executive action, U.S. departments and agencies are, for the first time, being directed to ensure equal consideration of acts of CRSV when identifying appropriate targets and preparing designations under applicable sanctions authorities.
• Expanding the Safe from the Start Initiative : Safe from the Start ReVisioned , an expansion of the flagship initiative that began in 2013, aims to ensure that GBV prevention, mitigation, and response is prioritized, integrated, and coordinated across humanitarian responses globally, and to shift funding, influence, and decision-making power to women and girls within humanitarian response systems. Safe from the Start ReVisioned aligns with the priorities outlined in the Presidential Memorandum on Promoting Accountability for Sexual Violence in Conflict , which calls for programming and assistance that prioritizes the immediate needs of survivors.

Read the U.S. National Plan to End Gender-Based Violence: Strategies for Action here: https://www.whitehouse.gov/wp-content/uploads/2023/05/National-Plan-to-End-GBV.pdf

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• Introduction
• Article Information

TGD indicates transgender and gender diverse.

The figure shows estimated means for the Beck Depression Inventory for Youths (BDI-Y) total score at each wave. CIS indicates cisgender; TGD, transgender and gender diverse.

eFigure. Flowchart of Participation in the Study: Final Analytic Sample

eAppendix 1. Additional Details About Participants and Procedures

eAppendix 2. Detailed Information on Measures

eTable. Sensitivity Analysis

Data Sharing Statement

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Gonzales Real A , Lobato MIR , Russell ST. Trajectories of Gender Identity and Depressive Symptoms in Youths. JAMA Netw Open. 2024;7(5):e2411322. doi:10.1001/jamanetworkopen.2024.11322

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Trajectories of Gender Identity and Depressive Symptoms in Youths

• 1 Department of Human Development and Family Sciences, The University of Texas at Austin
• 2 Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

Question   Are gender identity trajectories and changes in youth-reported gender identity associated with depressive symptoms over time?

Findings   In this cohort study involving 366 sexual and/or gender minority youths (aged 15-21 years), 1 in 5 (18.2%) reported a different gender identity over time. Youths transitioning to a transgender or gender diverse identity reported higher levels of depressive symptoms at baseline; depressive symptoms disparities were explained by exposure to lesbian, gay, bisexual, and transgender violence, but frequency of gender identity variability was not associated with the level or changes in depressive symptoms.

Meaning   In this study, changes in gender identity were not associated with depressive symptoms, suggesting that gender identity exploration is a normal part of adolescent development for some youths.

Importance   Concerns about the mental health of youths going through gender identity transitions have received increased attention. There is a need for empirical evidence to understand how transitions in self-reported gender identity are associated with mental health.

Objective   To examine whether and how often youths changed self-reported gender identities in a longitudinal sample of sexual and gender minority (SGM) youths, and whether trajectories of gender identity were associated with depressive symptoms.

Design, Setting, and Participants   This cohort study used data from 4 waves (every 9 months) of a longitudinal community-based study collected in 2 large cities in the US (1 in the Northeast and 1 in the Southwest) between November 2011 and June 2015. Eligible participants included youths who self-identified as SGM from community-based agencies and college groups for SGM youths. Data analysis occurred from September 2022 to June 2023.

Exposure   Gender identity trajectories and gender identity variability.

Main Outcomes and Measures   The Beck Depression Inventory for Youth (BDI-Y) assessed depressive symptoms. Gender identity variability was measured as the number of times participants’ gender identity changed. Hierarchical linear models investigated gender identity trajectories and whether gender identity variability was associated with depressive symptoms over time.

Results   Among the 366 SGM youths included in the study (mean [SD] age, 18.61 [1.71] years; 181 [49.4%] assigned male at birth and 185 [50.6%] assigned female at birth), 4 gender identity trajectory groups were identified: (1) cisgender across all waves (274 participants ), (2) transgender or gender diverse (TGD) across all waves (32 participants), (3) initially cisgender but TGD by wave 4 (ie, cisgender to TGD [28 participants]), and (4) initially TGD but cisgender by wave 4 (ie, TGD to cisgender [32 participants]). One in 5 youths (18.3%) reported a different gender identity over a period of approximately 3.5 years; 28 youths varied gender identity more than twice. The cisgender to TGD group reported higher levels of depression compared with the cisgender group at baseline ( Β  = 4.66; SE = 2.10; P  = .03), but there was no statistical difference once exposure to lesbian, gay, bisexual, and transgender violence was taken into account ( Β  = 3.31; SE = 2.36; P  = .16). Gender identity variability was not associated with within-person change in depressive symptoms ( Β  = 0.23; SE = 0.74; P  = .75) or the level of depressive symptoms ( Β  = 2.43; SE = 2.51; P  = .33).

Conclusions   These findings suggest that gender identity can evolve among SGM youths across time and that changes in gender identity are not associated with changes in depressive symptoms. Further longitudinal work should explore gender identity variability and adolescent and adult health.

Gender identity refers to one’s inner sense of being a man, a woman, or something else. 1 Transgender and gender diverse (TGD) people are those for whom gender identity does not align with societal expectations based on their sex assigned at birth. Recent studies 2 , 3 show that 1.4% to 1.8% of US youths identify as TGD.

For most people, gender identity is a stable aspect of the self 4 , 5 ; development or change in gender identity over time is less understood. Several studies 6 - 9 have explored whether children who met criteria for gender identity disorder (GID; an obsolete diagnostic criteria used in the Diagnostic and Statistical Manual of Mental Disorders [Fourth Edition]) in childhood still meet GID criteria in adolescence or adulthood. Approximately 85% of the children in these studies came to identify as a sexual minority without GID in adolescence or adulthood. 10 These studies refer to persistence and desistance of gender incongruence. However, interpretation from these studies are limited because a substantial proportion of study participants were subthreshold for GID diagnosis in childhood, 11 and using such outdated diagnostic criteria is problematic because one could meet GID in childhood criteria without necessarily identifying as TGD. 12 Nonetheless, recent work 13 , 14 indicates that a large majority of socially transitioned TGD children still identified as TGD 2.5 to 5 years later. Similarly, a UK study 15 found that among TGD youths, 91.7% continuously identified as TGD while being followed up by a gender clinic for minors.

For some, however, understanding of one’s gender may vary over time. 16 Some scholars refer to this variability as dynamic gender presentations, 16 gender journeys, 17 retransition, or detransition, 18 although there is no consensus on definitions of detransition. 19 Of note, Olson et al 13 found a 7.3% retransition rate among socially transitioned TGD children, indicating retransitions are not common in this group. Among adolescents and adults, it is estimated that 1% to 13% may experience retransition or detransition. 18 - 21 A recent longitudinal study 22 using a national probability sample found that approximately 1% of the US population reported different gender identities over a period of 4 years, a pattern more prevalent in younger than older generations. Importantly, among TGD people who reported past detransitions, external factors such as social rejection are often reported as reasons associated with detransitioning. 18 Little is known about gender identity variability among adolescents and young adults.

Recently, a controversial theory of rapid onset gender dysphoria (ROGD) was developed based on a survey of parents of TGD youths who transitioned in adolescence. 23 In the ROGD framework, gender dysphoria experienced by adolescents and young adults without prior indicators would be due to social contagion and compromised mental health and would disproportionately affect youths assigned female at birth. These youths would also experience a decline in mental health and functioning after transitioning. 23 The original publication has been criticized because of biased sampling and misleading interpretation 24 - 26 ; furthermore, a correction of the original work by Littman et al 23 emphasized that ROGD is not a formal diagnosis. 27 Recent cross-sectional studies 28 - 30 do not support the ROGD hypothesis. Longitudinal, community-based studies are needed to investigate whether people who transition to a TGD identity in adolescence report compromised mental health before gender identity transition or worsening mental health after. The only study, 22 to our knowledge, which explores how gender identity variability may affect health found that individuals whose gender identity varied over time engaged in more health-related risk behavior.

The current study assesses trajectories of gender identity in youths from a community-based sample, aged 15 to 21 years, over 4 assessment points, examining variability or changes in gender identity over time. Given that TGD youths often seek hormone therapy to treat gender dysphoria 31 , 32 and because exposure to lesbian, gay, bisexual, and transgender (LGBT) violence is associated with the mental health of TGD youths, 33 , 34 our analyses account for hormone and puberty blocker use and exposure to LGBT violence. Analyses investigated whether depressive symptoms varied across distinct trajectories of gender identity among youths, and associations of frequency of gender identity variability with depressive symptoms over time.

This cohort study was approved by the institutional review boards of New York University and the University of Arizona and followed the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guideline. Data come from a community-based longitudinal study of sexual and/or gender minority (SGM) youths between the ages of 15 and 21 years at baseline (4 waves of data collection, every 9 months [2012-2015]). 35 See the flowchart of participants included in the study across waves in the eFigure in Supplement 1 . Community leaders recruited youths who identified as SGM from community-based agencies and college groups for SGM youths. Recruitment also occurred through referrals from other participants. Data were collected in 2 large cities in the US (1 in the Northeast and 1 in the Southwest) (eAppendix 1 in Supplement 1 ). Parental consent was waived for participants younger than 18 years to assure safety for youths who were not out to their parents; an independent representative was present to ensure youths participants’ assent. Those older than 18 years provided written informed consent. Participants received financial compensation. To capture gender identity variability, we focused on youths who participated in at least 3 waves of the study. At each wave, participants were coded as TGD when their gender identity did not match their sex assigned at birth.

A 2-step approach was used to assess youths gender identity. 36 First, sex at birth was assessed at wave 1 (male and female). Second, at waves 1 to 4, participants were asked, “What is your Gender Identity?” (response options included “man,” “woman,” “genderqueer,” “trans-woman,” “trans-man,” and write-in). Write-in responses were coded as either cisgender, binary transgender (ie, transgender woman or transgender man), or genderqueer and nonbinary. Examples of write-in responses included “woman, queer,” “gender non-conforming,” and “gender-fluid.” At each wave, the 2 measures were paired, and participants were categorized in 1 of 3 gender identities: (1) binary transgender, (2) genderqueer and nonbinary, or (3) cisgender.

A variable indicating the gender identity variability compared with the previous wave was generated for waves 2 to 4. Frequency of gender identity variability was measured as the number of times participants’ gender identity changed across the 4 waves of the study (from 0 to 3).

Depressive symptoms were measured utilizing the Beck Depression Inventory for Youth (BDI-Y), which assesses negative thoughts, sadness, and depressive symptoms. 37 A sum score was calculated, with higher scores indicating more depressive symptomatology (average internal consistency across waves of α = .94). Sum scores of 13 or less are considered normal; scores of 14 or greater may indicate mild to severe depressive symptoms.

Based on prior research, demographic characteristics described below were included in the adjusted models. They were included as possible confounders between factors and the outcome. 38 - 42

Time invariant demographic variables were collected at wave 1 and included age at baseline, sex assigned at birth (0 = male; 1 = female), receipt of free lunch in high school (0 = no; 1 = yes; 2 = not reported), and race and ethnicity (0 = non-Latino White; 1 = non-Latino Black; 2 = Latino; 3 = other race or ethnicity or did not report), and recruitment site (0 = Southwest; 1 = Northeast). The other race and ethnicity included Asian, Pacific Islander, American Indian or Alaska Native, and multiracial individuals, and was created due to small sample size of each of the individual categories. Race and ethnicity were included in the study to account for health disparities that may be associated with social determinants and societal marginalization. See Appendix 2 in Supplement 1 for detailed information on the measures utilized for this study.

Given that youths identifying as TGD tend to report more exposure to LGBT violence 43 and often seek puberty blockers and hormone therapy to reduce gender dysphoria 34 , 44 and that these factors are known to be associated with mental health, 31 , 33 , 34 these measures were included in final models as possible explanatory variables between transition and depression. Alternatively, exposure to LGBT violence could be a confounding variable between gender identity changes and depressive symptoms; prior work has suggested that TGD individuals may detransition as a response to stigma, 18 and exposure to LGBT violence is also associated with more depressive symptoms. 33

At waves 2 to 4, participants reported history of hormone therapy and puberty blocker use. Participants were asked, “Have you ever taken (a) hormone replacement therapy? or (b) puberty blockers?” (0 = no; 1 = yes).

Exposure to violence due to LGBT identity was assessed using a 6-item scale in which participants reported how often they had experienced different forms of LGBT violence (0 = never; 3 = at least 3 times). 45 At wave 1, participants were asked to consider these experiences in their lifetime. In subsequent waves, participants were asked to consider only the past 9 months. At each wave, a mean score was computed. To obtain a cumulative score, the sum score was calculated by adding the scores from the previous waves to each measure of exposure to LGBT violence across time.

Data were managed and analyzed using Stata 18.0 (StataCorp). First, we conducted analyses of variance to test group differences in frequency of gender identity variability. Bonferroni adjustments were applied to adjust for multiple group comparisons (significance for these analyses were set at P  < .008). Hierarchical level modeling (HLM) was used to analyze trajectories of depressive symptoms. To estimate within- and between-person effects, time-varying factors (ie, cumulative exposure to LGBT violence and frequency of gender identity variability) were decomposed into 2 components; between-person (BP) components (level 2) are assessed by the person mean across waves; and within-person (WP) components (level 1) are assessed by the individual deviation from their own mean across waves. 46 Thus, the BP component contrasted depressive symptoms of youths who had more gender identity variability with other youths who had less or no gender identity variability, whereas the WP component contrasted depressive symptoms when a participant had more gender identity variability with other periods in which the same participant had less or no gender identity variability.

An empty mean model (ie, without factors included) was tested to estimate the degree to which depressive symptoms variation was associated with BP factors (intraclass correlation [ICC]). Unadjusted and adjusted models examined whether the trajectory of depressive symptoms varied across gender identity trajectory groups (model 1 and model 2, respectively). Based on model 2, model 3 investigated whether the frequency of gender identity variability was associated with depressive symptoms in both BP and WP levels, while also accounting for hormone and puberty blocker use and cumulative exposure to LGBT violence. Significance testing for HLM analyses were set at a 2-tailed P  < .05. Given that missingness in key variables was substantively low (<3%), we addressed missing values with listwise deletion (at the waves participants had missing values) due to the low impact in the sample size (see the eTable in Supplement 1 for sensitivity analysis). HLM uses a mixed-effects model that works with all data available in longitudinal analyses. Data analysis was conducted from September 2022 to June 2023.

The analytic sample included 366 SGM youths (mean [SD] age, 18.61 [1.71] years; 181 [49.4%] assigned male at birth and 185 [50.6%] assigned female at birth; 149 Latino [40.7%]; 84 non-Latino Black [23.0%]; 75 non-Latino White [20.5%]; 58 [18.9%] other race or ethnicity or not reported) of whom 274 (74.9%) identified as cisgender at all waves and 92 (25.1%) identified as TGD at some point in the study. Descriptive statistics of the study participants are described in Table 1 . The majority of participants were recruited in the Northeast site (254 participants [69.4%]) and 196 participants (53.6%) had received free lunch in high school, indicating possible lower socioeconomic status. Trajectory patterns were categorized into 4 groups, including participants who were (1) cisgender across all waves (274 participants), (2) TGD (including binary transgender and genderqueer or nonbinary) across all waves (32 participants), (3) cisgender at wave 1 or 2 but by wave 4 identified as TGD (ie, cisgender to TGD [28 participants; 26 of these participants (92.9%) identified as cisgender at wave 1]), and (4) TGD at any wave but by wave 4 identified as cisgender (ie, TGD to cisgender [32 participants]). Overall, 1 in 5 participants (18.3%) reported a different gender identity over the study period.

While 20 of 32 participants (62.5%) in the TGD group reported hormone use, only 6 of 28 participants (21.4%) in the cisgender to TGD group, and 1 of 32 participants (3.1%) in the TGD to cisgender group had used hormones. Use of puberty blockers was reported by 12 of the 92 participants who identified as noncisgender (ie, binary transgender or genderqueer and nonbinary) during the study; the majority were from the TGD group. Table 2 displays cumulative exposure to LGBT violence scores for the 4 gender identity trajectory groups. Participants presented mild levels of depression across all waves (mean [SD], 13.61 [11.02]). 37

Figure 1 displays the proportion of gender identities for each trajectory group across waves. For participants from the cisgender to TGD and TGD to cisgender groups (ie, the groups defined by gender identity change), when they identified as TGD, they most often identified as genderqueer or nonbinary. The TGD group, nonetheless, most often identified as binary transgender (ie, transgender woman or transgender man). Changing gender identities at least twice was relatively common among noncisgender youths during the study (28 of 92 participants [30.4%]). The majority of youths in the TGD to cisgender group (19 of 32 participants [59.4%]) reported a different gender identity at least twice across waves. Youths in the TGD group reported fewer gender identity changes than the other 2 groups, but the TGD to cisgender and cisgender to TGD groups did not differ from one another.

The ICC results showed 58.5% of the variance of depressive symptoms was at the BP level, and 41.5% was at the WP level (ICC coefficient, 0.585; 95% CI, 0.536 to 0.633). HLM unconditional models indicated that depressive symptoms had a linear trajectory accounting for random effects. HLM analyses assessing trajectories of depressive symptoms show that at baseline (intercepts) in the unadjusted model (model 1), participants from the TGD and the cisgender to TGD groups reported higher levels of depression when compared with the cisgender group ( Β  = 3.91; SE = 1.98; P  = .048; vs Β  = 4.66; SE = 2.10; P  = .03) ( Table 3 and Figure 2 ). However, in the model adjusted for demographic characteristics (model 2), only the cisgender to TGD group statistically differed from the cisgender group ( Β  = 4.82; SE = 2.10; P  = .02). In this model, post hoc group comparisons indicated that the cisgender to TGD group also reported more depressive symptoms at baseline when compared with the TGD to cisgender group, but this finding was not significant ( Β  = 6.02; SE = 2.30; P  = .05). There were no gender identity trajectory group differences in the rate of change of depressive symptoms over time (slopes), and there were no differences based on post hoc group comparisons. Importantly, the baseline difference in depressive symptoms between cisgender to TGD group and cisgender group was not significant after accounting for exposure to LGBT violence (model 3, Β  = 3.31; SE = 2.36; P  = .16).

Lastly, tests of the association of gender identity variability with depressive symptoms over time (model 3) showed that, at the BP level, patterns of depressive symptoms did not differ for youths who reported more variability in gender identity compared with their counterparts who reported less or no gender identity variability ( Β  = 2.43; SE = 2.51; P  = .33). Furthermore, WP estimates indicated that youths did not report more depressive symptoms at times when they reported more gender identity variability compared with other periods when they reported less or no gender identity variability ( Β  = 0.23; SE = 0.74; P  = .75).

Gender identity is complex, and typically characterized as stable, or as a movement from cisgender to TGD (and for some, back to cisgender). Even longitudinal studies typically ask participants about their gender identity only once, overlooking ways that understanding of gender identity may vary or change for youths over time. Although a few longitudinal studies 13 , 14 have examined whether gender identity varies among socially transitioned TGD children, trajectories of gender identity in samples of youths are still not well understood. 47 , 48 In this community-based longitudinal cohort study, 1 in 5 (18.3%) youths reported a different gender identity over a period of approximately 3.5 years (the majority reported the same gender identity over time). Almost one-third of the youths who reported a different gender identity did so more than twice. These findings differ from clinical samples where the majority of TGD youths consistently identified as TGD, 15 but complement recent longitudinal work 48 revealing that while gender identity is stable for the majority of youths, shifts in gender identity are not uncommon and should not be considered abnormal. Our findings empirically support the idea that gender identity can be fluid or in development for some youths. 11 , 17 , 48 - 51 Importantly, while changes in gender identities can be driven by developmental gender identity exploration, 52 prior work has indicated that it can be driven by a social adaptation to stigma. 18

Much scientific and public attention has focused on mental health for TGD youths; our findings show that youths who reported the most change in gender identities during the study period (TGD to cisgender) were in one of the groups with the lowest levels of depression across all waves. It is possible that positive mental health can help youths feel comfortable exploring gender identity, despite societal stigma. Notably, depressive symptoms among participants in this group were stable over time. This stability might be a result of floor effects. Also, for this group, identity variability was typically between nonbinary and cisgender identities; they may have had less nonconforming gender expressions, which perhaps relates to their lower exposure to LGBT violence relative to other TGD groups. Furthermore, gender identity variability was not associated with more depressive symptoms, either between participants (BP) or for individuals over time (WP). Thus, youths who reported more changes in their gender identities were no different in terms of their mental health compared with those with fewer changes, and longitudinally, youths were not more depressed after a shift in their gender identities. These findings are more consistent with an explanation of adolescent gender identity exploration and development, rather than arguments that gender identity changes would be associated with compromised or worsening in mental health. 11

Our examination of groups based on gender identity trajectories (consistently cisgender or TGD, or reported changes to or from cisgender and TGD) showed that youths who reported the most change in gender identities over time (the cisgender to TGD and TGD to cisgender groups) tended to often identify as genderqueer or nonbinary, consistent with prior studies that show that youths more often identify with nonbinary gender identities. 29 , 48 , 53 It may be that youths who identify as genderqueer or nonbinary may be more comfortable with gender identity exploration.

Concerns about youths who identify as TGD have been raised in the past decade, particularly due to reports of greater numbers seeking treatment, 54 in particular by youths assigned female at birth. 47 , 54 , 55 Results from this study offer insight into several debates.

ROGD proponents suggest that the rising numbers of TGD-identifying youths are due to compromised mental health and social contagion. 23 Results of recent studies 28 , 29 are not consistent with these claims. Psychological well-being and demographic characteristics of youths referred to transgender clinics have been mostly consistent for more than a decade (except for sex ratio). 55 Furthermore, in a cross-sectional study, 28 later transgender identity acknowledgment was not associated with more compromised mental health among TGD youths. Findings from our study are also inconsistent with the ROGD hypothesis in at least 2 ways. First, although youths whose identities changed from cisgender to TGD reported higher levels of depressive symptoms when compared with consistently cisgender youths, these differences disappeared when we accounted for exposure to LGBT violence. Of note, they also experienced more exposure to LGBT violence than youths who identified consistently as cisgender, possibly due to higher gender nonconformity. 56 Second, our study indicates that youths who transitioned to TGD during the study (cisgender to TGD) experienced stable levels of depressive symptoms over time, a marked contrast with the argument that youths who identify as TGD in adolescence and early adulthood will experience worsening mental health. 23 , 24 Yet, despite being stable, youths from the cisgender to TGD group reported sustained high levels of depressive symptoms over time. In addition to the accumulation of exposure to LGBT violence among this group ( Table 2 ), transitioning to a more stigmatized identity may be mentally taxing because of exposure to new types of violence 57 (eg, gender-based violence), expectation of rejection from family and others, 1 , 45 and loss of support.

Despite substantial strengths of this study, including its community-based, longitudinal design, there are several limitations. While solely relying on self-reported gender identity, we were unable to examine, for example, which participants met the criteria for gender dysphoria. However, scholars have pointed out the importance of having youths report their own gender, 12 including providing not only binary options. 58 Furthermore, youths were not asked to explain variation in their gender identities. While transitions are part of developmental gender identity exploration for many youths, 52 prior work has shown that external pressures are often associated with detransitioning from a TGD identity. 18 , 59 We also do not know what proportion of these TGD youths went through social transitions (ie, changed pronouns or gender presentation to align with experienced gender); TGD youths may be more targeted for exposure to LGBT violence when they present themselves as TGD or in gender-nonconforming ways. Our findings may not be representative of all youths because our sample was recruited in part from SGM-focused community organizations. It could be that youths involved in these groups have a more positive sexual and gender identity development and receive more support in general. Additionally, the data from this study are more than a decade old, and much has changed in prevalence and visibility, care and affirmation, and political debates regarding TGD youths. 60 New prospective, community-based studies are needed to understand gender identity development and change, and associations with mental health for cisgender and TGD youths.

This cohort study documented a diversity of gender identity trajectories in adolescence and early adulthood. Changes in gender identity were not associated with depressive symptoms. Furthermore, the group of youths who reported the most change in gender identities were among those with the lowest level of depressive symptoms. These findings suggest a pattern in which gender identity exploration is a normal part of adolescent development for some youths. 48 , 52 Acknowledgment of this by health care clinicians 22 may help alleviate anxiety related to treating TGD youths whose gender identity may change across time. Although youths who changed from a cisgender to a TGD identity reported higher levels of depressive symptoms at baseline compared with consistently cisgender youths, these differences were explained by higher exposure to LGBT violence. Health care clinicians should pay particular attention to youths transitioning to TGD identities; additional support in this process can help mitigate the adverse effects of exposure to LGBT violence from peers or family rejection. Moreover, delays in providing care can result in more stress for these youths. 61 Ultimately, more longitudinal studies are needed to understand gender identity trajectories and health.

Accepted for Publication: March 8, 2024.

Published: May 22, 2024. doi:10.1001/jamanetworkopen.2024.11322

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2024 Gonzales Real A et al. JAMA Network Open .

Corresponding Author: André Gonzales Real, MD, MSc, Department of Human Development and Family Sciences, The University of Texas at Austin, 108 E Dean Keeton St, Austin, TX 78712 ( [email protected] ).

Author Contributions: Drs Gonzales Real and Russell had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Gonzales Real, Russell.

Drafting of the manuscript: Gonzales Real, Russell.

Critical review of the manuscript for important intellectual content: All authors.

Statistical analysis: Gonzales Real.

Obtained funding: Russell.

Administrative, technical, or material support: Russell.

Supervision: Lobato, Russell.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by the National Institutes of Mental Health (grant No. R01MH091212).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Mental Health.

Data Sharing Statement: See Supplement 2 .

Additional Contributions: The authors thank Jack L. Turban, MD, MHS (University of California, San Francisco), for providing insightful feedback on the manuscript, and Sae Hwang Han, PhD (The University of Texas at Austin), for consultation regarding statistical analyses. None of these individuals received compensation for their contributions.

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How we’re implementing the National Plan to End Gender-Based Violence

The Women’s Bureau co-led the shaping of the Plan’s economic security and housing stability pillar, which aims to change harmful work cultures, address the root causes of gender-based violence in the world of work, and improve economic security for workers and survivors experiencing gender-based violence and harassment. Many of the actions outlined in this pillar drew inspiration from the International Labour Organization's (ILO) Convention on Violence and Harassment (Convention 190) . While the U.S. has not ratified Convention 190 and it is not binding on U.S. employers, it is the first international treaty to recognize the right to a world of work free of violence and harassment. 

Here are four key actions the Women’s Bureau has taken to implement the Plan:

In September 2023, the Women’s Bureau awarded the first Department of Labor grants exclusively focused on ending gender-based violence and harassment in the world of work . Over $1.5 million was awarded to five community organizations working across 14 states to build awareness of gender-based violence and harassment in the world of work, connect workers and survivors to their workplace rights and benefits, and implement worker- and survivor-driven strategies to shift workplace norms and culture. The grant program, Fostering Access, Rights and Equity (FARE), is now accepting Fiscal Year 2024 applications through May 28, 2024 .

Shortly after the Plan was released, the Women’s Bureau  signed a memorandum of understanding with the ILO Office for the U.S. and Canada to engage in joint events and activities concerning gender-based violence and harassment, including uplifting the principles of Convention 190 in U.S. policies, programs and practice. Together we are engaging stakeholders around the country and across sectors to discuss effective worker- and survivor-driven solutions to eliminate gender-based violence and harassment in the world of work. Since announcing our partnership, the Women’s Bureau has held about 40 regional convenings that have brought together workers, employers, unions, worker advocates, government representatives and others.

The Women’s Bureau also partnered with the Department of Labor's Occupational Safety and Health Administration on a webinar series that emphasized that gender-based violence and harassment is a workplace safety and health issue that has psychological and physical impacts on workers. The series featured discussions with workers, worker advocates, employers, and representatives from unions and the Equal Employment Opportunity Commission.

Finally, the Women's Bureau created a webpage on gender-based violence and harassment and published fact sheets, issue briefs and blogs throughout the year. Our fact sheet on gender-based violence and harassment in the world of work discusses key terminology, lists examples and outlines the key initiatives in this space. It is available in English and  Spanish . 

Carrying out the vision of the National Plan will take continued effort, action and coordination for many years to come. We all have an active role to play in making our world of work, and our society as a whole, safer and more equitable. The Women’s Bureau is committed to implementing this vision by engaging with survivors, workers, unions, employers and government agencies to address and prevent gender-based violence and harassment in the world of work. 

Amy Dalrymple and Kate Miceli are Policy Analysts at the Women’s Bureau. Katrin Schulz is the Branch Chief of Grants, Communications & Planning at the Women’s Bureau.

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• 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.

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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.

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Desmond Kuupiel, Monsurat A. Lateef, Gugu G. Mchunu & Julian D. Pillay

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Kuupiel, D., Lateef, M.A., Adzordor, P. et al. Injuries and /or trauma due to sexual gender-based violence among survivors in sub-Saharan Africa: a systematic scoping review of research evidence. Arch Public Health 82 , 78 (2024). https://doi.org/10.1186/s13690-024-01307-3

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Terms of reference for a study on gaps and challenges in techonological facilitated gender-based violence case management in kenya.

• Coalition on Violence Against Women

The Coalition on Violence Against Women(COVAW) is an organization that is focused on influencing sustained engagement on violations conducted against women and girls in Kenya, with emphasis on Gender-Based Violence. COVAW’s envisions a society where women and girls enjoy equal rights, freedoms and thrive in safe spaces. In doing so, we focus on 5 Key areas of Access to Justice, Access to Comprehensive GBV and SRHR services, Women in Economic Empowerment, Women’s Leadership Development and Institutional Development.

COVAW’s interventions deliberately address norms, attitudes, laws, policies, and practices that affect women and girls’ safety and well-being in general. This is done through the implementation of gender progressive practices and supporting the development of regulatory and institutional frameworks. Additionally, COVAW fosters consistent engagement with different actors to prevent and respond to VAWG and to hold perpetrators of these violations accountable.

COVAW is guided by its core values of respect, integrity, solidarity, and commitment in improving the lives of its primary beneficiaries - women and girls. View COVAW strategic plan from here

• Project Description

About Transform: Transform is a three-year USAID funded global pilot initiative, which seeks to support practical approaches to preventing, mitigating, and responding to Technology-Facilitated Gender Based Violence (TFGBV), with a focus on addressing violence impacting women in politics & public life.

COVAW is implementing the Transform project in Kenya alongside other partners. Key activities to be implemented include developing an advocacy brief on legislative interventions for effective management of TFGBV cases, and supporting review of existing legislation to recognize TFGBV as a form of sexual violence, among other activities.

TFGBV is an act of violence perpetrated by one or more individuals that is committed, assisted, aggravated, and amplified in part or fully by the use of information and communication technologies or digital media, against a person on the basis of their gender [1]

TFGBV undermines women's rights to participate in key decision-making processes, exacerbating their underrepresentation in civic spaces. A foundational landscape assessment by Transform in 2023 reviewed global evidence of TFGBV against Women in Political and Public Life (WIPPL), highlighting its impact on women's public and political participation. [2] One key finding revealed that women in politics and public life face numerous intersectional individual-level risks, such as hate speech and gendered disinformation. According to Pollicy's Byte Bullies Report (2023), 55.7% of women candidates in the 2022 Kenya general elections experienced online violence on Facebook. GBV report by the Media Council of Kenya for example, reveals that three-quarters of women in the media have been exposed to online violence.

Addressing these issues is significantly hindered by weak systemic responses and inadequate enforcement to hold perpetrators accountable. Currently, no law in Kenya explicitly criminalizes TFGBV. The Sexual Offences Act does not recognize online sexual violence as a form of sexual violence. A limited percentage of TFGBV, such as the spread of disinformation and hate speech, have been captured in the Computer Misuse and Cyber Crimes Act. However, other numerous TFGBV forms remain under-reported and unaddressed due to the inadequacy of laws that criminalize offences under TFGBV. Additionally, the normalization of these vices and the burden bone by survivors to prove the elements of TFGBV in their cases frustrates the reporting processes, case management and compromises the quality of evidence.

Law enforcement officers often struggle to admit reports and collect and preserve evidence. Furthermore, technology companies frequently fail to flag online violence perpetrated in local languages due to language barriers. The weak monitoring and reporting measures within these platforms have created an enabling environment for the perpetrators of TFGBV leading to a surge in online violence against women.

• Purpose of The Consultancy

The purpose of this consultancy is to conduct a study on gaps and challenges in the management of Technologically Facilitated Gender-Based Violence (TFGBV) cases in Kenya and generate legislative recommendations to address these gaps. An Intersectionality approach will be a crucial concept to understanding the multiple layers of challenges that women may face based on their gender, ability, ethnicity, language, age, and geographic location.

• Research objectives
• To understand challenges in collection and storage of evidence for TFGBV cases.
• To analyze challenges faced during the litigation and prosecution processes of TFGBV and its admission in court.
• To develop comprehensive legislative proposals aimed at addressing the identified gaps in TFGBV case management, and amendments to the Sexual Offences Act TFGBV cases particularly on WIPPL
• Methodology

The research methodology proposed by the consultant(s) should include a suitable sampling strategy, participatory tools and a suitable mix of quantitative and qualitative data collection methods. The analysis of participatory qualitative and quantitative data collection should be well presented and focus on the three study objectives.

Data collection, analytical methods, and presentation of findings, conclusions, and recommendations should be sensitive to and differentiate relevant gender, age, diversity dimensions and other relevant markers to allow precise analysis of women, in different locations, and on different age groups and stakeholders throughout the studies.

• Deliverables and Timelines.

The required consultancy deliverables are;

• One detailed inception report including a time-bound outline of the study, detailed work plan, detailed methodology for both data collection and analysis, sample size calculations, data collection tools
• A comprehensive, clearly cited report on the findings including accurately analyzed data against the evaluation questions, lessons learned, and recommendations. The report should not be more than 30 pages.
• An advocacy brief on the Legislative Interventions under the Sexual Offences Act for effective and efficient management of TFGBV Cases

The consultant will also be responsible for,

• Holding an inception meeting (remotely if required) with COVAW staff and reviewing any relevant documentation to gather background information
• Drafting an inception report (as above) - Incorporating feedback on inception report into planned approach and activities
• Organizing the field travel in collaboration with the COVAW team
• Supervising and quality-assuring field data collection and entry
• Analyzing and synthesizing qualitative data and preparing a report
• Submitting draft report and policy brief, with accompanying data analysis to COVAW contact staff for feedback
• Incorporating feedback and submitting a final report and policy brief that provides findings that respond to the project's key objectives, as well as specific, useable, and tailored recommendations that can be directly applied to COVAW’s programming
• Providing the typed raw data to COVAW contact staff

COVAW will be responsible for,

• Availing all necessary project documents to the consultant
• Holding an inception meeting with the consultant to provide background information and to finalize the research work plan, timelines, and expectations
• Provide oversight for data collection.
• Reviewing the inception report and data collection tools and providing the consultant with specific and timely feedback
• Facilitating access to the respondents
• Reviewing the draft study report and providing the consultant with specific and timely feedback
• Managing and supporting the consultant throughout the research process
• Approving the final study report and Policy Brief

The is anticipated to take a maximum of 30 days:

• Start***-*** 3rd June 2024
• End**- 3rd July 2024**

Specific timelines will be agreed upon with the successful consultant.

The consultant must submit a soft copy of the study report and advocacy brief to the organization point of contact person.

• Skills and Qualifications of Consultant
• Bachelor’s degree in Law, Research, or related field**.**
• A Master in Law with a bias in human rights, criminal law, or related will be an added advantage

Required Experience and Skills

• At least 8 years’ experience in conducting thorough research/surveys, human rights/SGBV issues.
• Comprehensive understanding of the criminal justice system in Kenya, criminal law SGBV, Human Rights, and Social norms.
• Proven research and report writing skills and facilitation experience.
• High level of professionalism and ethics

[1] UN Report. (2021). Technology-facilitated Gender-based Violence: Making All Spaces Safe. https://www.unfpa.org/sites/default/files/pub-pdf/UNFPA-TFGBV-Making%20 All%20Spaces%20Safe.pdf

[2] Technology-Facilitated Gender-Based Violence as an Attack on Women’s Public Participation https://www.irex.org/Technology-Faclitated-Gender-Based-Violence-Review-of-Global-Evidence.pdf

How to apply

Interested consultants/firms must submit the following documents:

• Technical proposal which must include the following:
• Proposed program and methodology to be used for the research not more than 5 pages
• Consultants' past experience in the thematic area, supported by at least two soft copies of relevant reports in PDF
• Financial proposal (budget) in MS Excel in Kenya Shillings.

Note: The documents must be arranged as serialized above

• CV of the applicant with contact details for three referees; if the applicant intends to work in a team, she/he should indicate all team members and attach CVs. Highlight the Team leader.
• Two soft copy samples of previous related work undertaken.

All documents must be submitted not later than 5.00 pm, Friday, 31st May 2024 via email to [email protected] with the subject**: “A STUDY ON GAPS AND CHALLENGES IN TFGBV CASE MANAGEMENT IN KENYA.”** Applications will be reviewed on a rolling basis. Only applicants that meet all the above criteria will be considered and contacted.

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