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1. Addressing Gender-based Violence through USAID’s Health Programs: A Guide for Health Sector Program OfficersAn Overview [SPEAKERS NAMES] [DATE]

2. Overview • Assists USAID program officers to integrate GBV activities into the health sector portfolio during • Project design • Implementation • Evaluation • Complements literature review of promising GBV interventions (Guedes, 2004)

3. Design of Guide • Focus on health sector programs • Why should programs address GBV? • How can programs support GBV activities? • Range of programs • Community mobilization • Communication for social and behavior change • Health service delivery • Health policy • Youth • Humanitarian • Monitoring and evaluation Preventing and responding to GBV requires a multisectoral approach

4. Guiding Principles in GBV Programming Underlying principle—“Do no harm” • Respect survivors’ safety and autonomy • Ensure relevance and appropriateness of interventions to local setting

5. Guiding Principles in GBV Programming (continued) • Employ public health and human rights perspectives • Encourage multisectoral interventions at multiple levels • Invest in evaluation—assess results and protect survivors’ safety

6. Rationale and Actions

7. Why should Community Mobilizationprograms address GBV? • Can change community norms about gender and the acceptability of violence • Can improve the community response to gender-based violence • Dispels myth that violence is a family affair • Encourages help seeking by women • Encourages providers to offer support • Can promote collaboration among service-providing organizations and the broader community • Ensures referral networks are in place • Improves women’s access to a range of services

8. How can Community Mobilizationprograms address GBV? • Support initiatives that integrate community mobilization around GBV into existing health and development projects • Support initiatives that reduce tolerance for GBV through work with boys and men • Invest in programs that mobilize all parts of the community • Mobilize partnerships across all levels of communities • Support efforts to improve survivors’ access to services • Provide long-term financial support to ensure time for change

9. Why should Communication for Social and Behavior Change (CSBC) programs address GBV? • Raising awareness and changing attitudes and cultural/gender norms are essential to sustainably address GBV • CSBC programs can be more effective by recognizing that health focus areas are linked to GBV • CSBC forms a key part of other strategies to address GBV, such as: • Advocacy with decisionmakers • Sensitization and training of providers • Community mobilization

10. How can Communication for Social and Behavior Change programs address GBV? • Support activities that aim to change gender norms and acceptability of violence • Integrate GBV into existing CSBC programs • Link communication and GBV activities • Work to improve norms and attitudes among boys and men

11. How can Communication for Social and Behavior Change programs address GBV? (continued) • Use multiple media to address wide audiences • Invest in evaluation studies of CSBC initiatives

12. Why should Health Service Deliveryprograms address GBV? • GBV is a major cause of death and disability among women. • Health programs can be more effective if they recognize reproductive health (RH) implications of GBV. • Health providers who do not ask about gender-based violence may misdiagnose survivors or offer inappropriate care. • Providers may be the first point of contact for women. • Providers can assist women, rather than inadvertently putting women at further risk. • Healthcare organizations can raise awareness of GBV as a public health problem.

13. How can Health Service Deliveryprograms address GBV? • Use a “systems approach,” which entails: • An institutional commitment to GBV • Sexual harassment policies • Patient privacy and confidentiality • Awareness of local GBV laws • Ongoing training and support for staff • Referral networks to link survivors to legal aid, counseling, shelters, etc. • Protocols for the care of survivors • Emergency supplies such as STI prophylaxis, post-exposure prophylaxis (PEP), and emergency contraception (EC), where supported by the government • Educational materials on GBV for clients • Data collection systems • Monitoring and evaluation of quality of care

14. How can Health Service Deliveryprograms address GBV? • Support efforts to fully integrate attention to GBV within existing health programs, such as • Long-term efforts to sensitize and train health professionals about GBV; • “Routine screening” or “routine enquiry” policies ONLY when programs have basic protections for women; and • Participation of healthcare organizations in broader prevention efforts, referral networks, advocacy campaigns.

15. How can Health Service Deliveryprograms address GBV? (continued) • Consider economic sustainability before launching specialized social services: • Do not to duplicate services that already exist. • Health programs should try to identify the most economically feasible, cost-effective, and sustainable social services to provide.

16. Why should Health Policyprograms address GBV? • Assist in drafting policies and approaches for the health service response to GBV. • Reframe the policy debate about GBV as a public health and human rights issue • Produce and use research on magnitude of GBV to convince policymakers that • They should address GBV; and • Gaps exist in the legal and civil codes. • Standardize health sector policies/protocols and appropriate GBV interventions at the institutional level

17. How can Health Policy programs address GBV? • Research and dissemination of GBV findings • Public and private coalitions that design and implement GBV public policy approaches • Efforts to educate key groups and broader population about GBV as a public health problem • Advocacy efforts to change specific laws and policies • Efforts to reform and strengthen public agencies’ institutional policies

18. Why should Youth Programsaddress GBV? • Substantial proportions of girls and young women experience sexual violence around the world: -Ranges from 7 percent in New Zealand to 46 percent in the Caribbean • Physical violence by intimate partners often begins within the first years of dating and marriage. • Sexual abuse in childhood and adolescence has been linked to numerous poor health consequences. • Youth sexual activity is not always voluntary or consensual. • Youth programs are an ideal opportunity to further GBV prevention because attitudes gender and violence are still forming.

19. How can Youth Programs address GBV? • Require all reproductive health programming for youth to address sexual coercion and abuse • Support initiatives that improve family, peer, and community environments, such as • Efforts to promote gender-equitable norms and nonviolence among young men • Efforts to empower girls • Efforts to improve the institutional response to young survivors of GBV • Efforts to increase safety of girls and young women in educational settings

20. Why address GBV in Humanitarian Programs? • Women and girls often experience violence in conflict settings. • Levels of physical and sexual violence against women are significant during and after armed conflict and natural disaster. • Women and girls also are at risk of GBV during reconstruction.

21. How can Humanitarian Programsaddress GBV? Interventions: • Prioritize girls’ and women’s safety and security • Implement the minimum initial service package for RH needs of populations in humanitarian crisis • Integrate GBV response into all primary healthcare and HIV services

22. How can Humanitarian Programsaddress GBV? (continued) Approaches: • Comply with international guidelines regarding GBV in conflict in conflict settings • Ensure that organizations collaborate to avoid gaps • Support efforts to pilot initiatives in natural disaster settings • Change and adapt programs as situations stabilize

23. Why invest in Monitoring and Evaluationof GBV interventions? • Expand the knowledge base about effective ways to prevent and respond to GBV • Improve program designs to ensure GBV interventions benefit women as intended • Correct flaws in program design that may place women/girls at increased risk of GBV • Provide evidence to policymakers and donors about GBV approaches that work

24. How can USAID-funded programs invest in Monitoring and Evaluation? • Support efforts to improve research and evaluation methods related to GBV • Require all GBV programs to have a strong M&E component • Ensure that evaluations of health programs consider GBV • Support scientific evaluations of GBV programs funded by other donors • Invest in intervention research designed to build the evidence base about effective GBV prevention and response

25. Want to know more? • Key resources section includes • Academic research • Tools, manuals, guidelines • Case studies • Works cited • Access Addressing Gender-based Violence through USAID’s Health Programs: A Guide for Health Sector Program Officers at: http://www.igwg.org/Publications.aspx Available in English, French, and Spanish

26. References Bott, S., A. Morrison, and M. Ellsberg. 2005. Preventing and Responding to Gender-based Violence in Middle and Low-income Countries: A Global Review and Analysis. World Bank Policy Research Working Paper 3618. Washington, DC: World Bank. Dunkle, Kristin, Rachel Jewkes, Heather Brown, Glenda Gray, James A. McIntyre, and Sioban D. Harlow. 2004. “Prevalence and Patterns of Gender-based Violence and Revictimization among Women Attending Antenatal Clinics in Soweto, South Africa.” American Journal of Epidemiology 160(3): 230–239. Enarson, E. 1998. Surviving Domestic Violence and Disasters. Vancouver, BC: Simon Fraser University. Garcia-Moreno, C. and C. Watts. 2000. “Violence Against Women: Its Importance for HIV/AIDS.” AIDS 14 (Suppl. 3):S 253-265. Guedes, A. 2004. Addressing Gender-Based Violence from the Reproductive Health/HIV Sector: A Literature Review and Analysis. Washington, DC: USAID, Bureau for Global Health. Heise, L., M. Ellsberg, and M. Gottemoeller. 1999.“Ending Violence Against Women.” Population Reports XXVII Number 4, Series L, Number 11. Human Rights Watch. 2004. World Report 2004: Human Rights and Armed Conflict. New York: Human Rights Watch.

27. References, continued IASC Task Force on Gender and Humanitarian Assistance. 2005. Guidelines for Gender-Based Violence Interventions in Humanitarian Emergency Settings: Focusing on Prevention of and Response to Sexual Violence in Emergencies. Geneva: IASC Task Force on Gender and Humanitarian Assistance. International Rescue Committee (IRC). 2004. Gender- Based Violence Program Strategy: From Service Delivery to Social Change. New York: International Rescue Committee. Krug, E.G., L. L. Dahlberg, J. A. Mercy, A.B. Zwi, and R. Lozano. 2002. World Report on Violence and Health. Geneva: World Health Organization. Maman, Suzanne, Jacquelyn Campbell, Michael D. Sweat, and Andrea C. Gielen. 2000. “The Intersections of HIV and Violence: Directions for Future Research and Interventions. Social Science and Medicine 50(4):459-478. United Nations High Commissioner for Refugees (UNHCR). 2003. Guidelines for Prevention and Response: Sexual and Gender-Based Violence against Refugees, Returnees and Internally Displaced Persons. Geneva: UNHCR. World Health Organization (WHO). 2001. PuttingWomen First: Ethical and Safety Recommendations for Research on Domestic Violence Against Women. Geneva: World Health Organization.