Using reproductive health services to address sexual and gender-based violence in post-conflict northern Uganda.

Abstract

Background Sexual and gender-based violence (SGBV), including rape and child sexual abuse, remains a significant challenge in post-conflict northern Uganda, including within refugee settlements. Many victims have never sought help from health-related services. Consequently, the scale of the problem is unknown, and SGBV victims’ injuries, both psychological and physical, remain undetected and unaddressed. We hypothesized that health workers in rural Reproductive Health Services could provide a valuable resource for SGBV screening and subsequent referral for support. Methods Our project had three elements. First, Reproductive Health Service workers were trained in the knowledge and skills needed to screen for and identify women who had experienced SGBV, using a questionnaire-based approach. Second, the screening questionnaire was used by reproductive health workers over a 3-month period, and the data analysed to explore the scale and nature of the problem. Third, victims detected were offered referral as appropriate to hospital services and/or the ActionAid SURGE (Strengthening Uganda’s Response to Gender Equality) shelter in Gulu. Results 1656 women were screened. 778 (47%) had a history of SGBV, including 123 victims of rape and 505 victims of non-sexual violence. 1,254 (76%) had been directly or indirectly affected by conflict experiences; 1066 had lived in IDP camps. 145 (9%) were referred at their request to Gulu SGBV Shelter under SURGE. Of these, 25 attended the shelter and received assistance, and a further 20 received telephone counselling. Conclusion Undetected SGBV remains a problem in post-conflict northern Uganda. Reproductive Health Service workers, following specific training, can effectively screen for and identify otherwise unreported and unassisted cases of SGBV. Future work will explore scaling up to include screening in hospital A&E departments, incorporate approaches to screening for male victims, and the impact of taking both screening and support services to rural communities through local clinics with mobile teams.