Sexual Violence During COVID-19: Insights from an Addis Ababa Healthcare Professional

Hiwot Girma is a 26-year-old clinical pharmacist in Addis Ababa, Ethiopia. Together with Amref Health Africa, she is campaigning to end sexual and gender-based violence, particularly at a time when COVID-19 puts women and girls at even greater risk.

“My name is Hiwot. I’m a clinical pharmacist working at Ghandi Memorial Hospital as a drug information focal person. This is a specialised hospital that focuses on maternal and neonate childcare.

I also volunteer at the hospital’s sexual violence centre where I provide guidance, care and comfort for survivors of rape and sexual assault, along with medical advice.

I currently live with my brother and father because girls and women cannot leave their family household before they marry, even in the capital city. Although most people are stuck at home, I must still go out for work.”

What work do you do with Amref Heath Africa?

“I work as a youth volunteer in the AYAP (Amref Youth Advisory Parliament), which advocates for meaningful youth involvement in project implementation. I’ m also the new FGM Champion, meaning I visit other Amref projects and share information about this practice.

Fortunately, I haven’t gone through FGM because my mum and dad knew about the negative consequences. Many people still do not know about the complications. Just because I did not go through the cut, it does not mean that I should not fight for my sisters”.

How has COVID-19 affected your area, especially in terms of sexual violence?

“In Addis Ababa sexual violence largely centres around rape. In more rural areas, FGM is also performed on girls.  Lately it has been crazy in Addis Ababa – women and girls are getting raped, and the violence is increasing.

I think sexual violence during COVID-19 has risen, but the government doesn’t know the official reasons yet. Is it because everyone is at home or other factors? The Ministry of Women, Children and Youth Affairs is currently researching why the rape of women and girls is rising”.

How has COVID-19 affected you and your work with women and girls?

“At work, we have emergency triage corners set up. A nurse will take your temperature and test expecting mothers for COVID-19 when they enter. We always wear masks and gloves to give out medication, so nothing has changed there.

As I mentioned, sexual violence during COVID-19 is increasing.

My role is listening to women and girls about their experiences and the emotional impact. They are supposed to take HIV prophylaxis – a medication intended to help prevent the spread of HIV – as well as medicines to treat possible exposure to other STDs. So I also share information about those medicines and counsel them on their use”.

What motivates you to be an FGM Champion and fight against sexual violence?

“Because girls and women, I believe, should have equal opportunities. FGM is taking women and girls back – FGM causes sexual dysfunction, complications during childbirth, and things like anaemia. It also increases the risk of HIV due to exposure to unhygienic conditions.

We shouldn’t forget the medical side of it either. I heard from another medical professional that sometimes young women do not even know that they have been cut. One young woman did not know until she met a guy and decided to have a sexual relationship. Shockingly, sexual intercourse resulted in her bleeding to death. This could have been avoided.

It’s not fair that women go through these things; there’s no need. We need to make it safer for women and girls.

If we cannot protect and include women, we cannot achieve the things we want to accomplish as a country or a continent.

That is why I am passionate about participating.

We should not be afraid to fight FGM. Everyone should be responsible – whether they live in cities or the countryside. I believe everybody should say no to GBV, and everybody should come together to fight it”.

Hiwot joins four other pan-African champions in Amref Health Africa’s No More Violence: Daring to Speak Up campaign, designed to raise awareness about increasing rates of sexual violence during COVID-19.

Covid-19 and the Rise of Sexual & Gender-Based Violence

We are in the midst of a pandemic. One way to slow down the spread of coronavirus is to implement lockdown and quarantine measures, which means confining yourself to your home with your family. For some people, this includes an abuser. 

Pandemics often exacerbate existing inequalities for women and girls, who are often most vulnerable to violence and abuse in the home. Charities are already seeing a sharp rise in domestic violence reports since the outbreak of COVID-19. Pandemics also exacerbate discrimination of other marginalized groups, including LGBTQ+ people, people living with disabilities, older people, migrants, refugees and those in extreme poverty. 

Increased Violence 

In China, an anti-domestic violence charity in Hubei province reported that intimate partner violence have nearly doubled since cities had been put under lockdown. The same organization has reported that the police station in Jianli County registered three times more cases in February 2020 than in the same time in 2019. 

There have been huge increases in different forms of sexual and gender-based violence (SGBV), including intimate partner violence, in many other countries including the UK, Brazil, Germany, Italy, Spain and the United States. In the UK, it is reported that there has been a 120% increase in incidents of domestic violence. 

Self-isolation for women in coercive or violent relationships means being trapped (often without the means of accessing support) with a perpetrator who may become more abusive when there is no other outlet. Lockdowns also mean medical services and support to people affected by sexual and gender-based violence may be cut off or considered lower priority in healthcare structures overburdened by responding to COVID-19 cases.

Lockdowns and lack of prioritization of SGBV response services mean many women will face forced pregnancies. In turn, restricted access to abortion care facilities or pharmacies that provide medical abortions (i.e. misoprostol pills that can be taken at home) if quarantine periods are extended may lead to unsafe abortions and increased mortality among SGBV survivors. 

Another fear is that SGBV survivors may also face difficulties accessing contraception for HIV and STI prevention. Lack of timely treatment can put their health and life at risk. 

Prevention Measures 

Realizing the real danger to women’s lives, some countries have put measures in place to help mitigate SGBV. 

In China, survivors, activists, and organizations have launched a set of actions using social media to raise awareness and support survivors. Some of the actions included creating networks, publishing online manuals on intimate partner violence, and starting a hashtag: #AntiDomesticViolenceDuringEpidemic

After seeing the increase of SGBV cases in China and similar issues in Italy, the Ministry of Equality in Spain launched a national plan that acknowledged the exponential risks of SGBV due to the lockdown mitigation strategy adopted by the national government. 

The plan recognizes the difficulties faced by SGBV survivors in seeking help in confinement. It adapts services to prevent, address, and reduce these risks under the current circumstances. The services include, among other measures, emergency centers for the reception of victims at risks, safe accommodation for survivors, a hotline for information, and an emergency line to send alert messages with geolocation that will be received by state security forces. It has also been announced that an instant chat-messaging system for containment and psychological assistance will be activated. 

Other initiatives of local governments in Spain have caught national attention and will be replicated in different regions across the country. Survivors of SGBV or women at risk can go to a pharmacy and ask for a “Mask-19”. This tells staff at the pharmacy to activate protection services.

What can be done? 

It is clear that IPPF Member Associations have an important role to play by adapting how they provide services and supporting health authorities to adapt theirs. 

It is essential that sexual and gender-based violence helplines are available and that there is an option for women to access support. This could be hrough text message, call centers, or more sophisticated web/app systems, if available. We also want to see increased access to emergency contraception or other contraceptive methods, and for medical abortions to be made available for all women to use at home. 

Finally, we want all governments to recognize the fundamental human right to access sexual and reproductive healthcare. It is a life-saving, essential service for all, especially the most vulnerable and marginalized. 

Subscribe to IPPF’s newsletter for more engaging content about sexual healthcare. 

Turning the Tide on Sexual Violence

In 2017, I wrote a Girls’ Globe blog on how we can change a culture that normalizes and accepts sexual violence. Two years later, has anything changed?

We still live in a society that acknowledges violence against women as wrong, and yet accepts it as inevitable and therefore normalOur patriarchal culture has created a tense and treacherous space where no girl and no woman is truly safe. And out-creating the patriarchy is no small task.

Violence against women and girls continues to be accepted at the highest levels of our institutions, with an insidious trickling down to every echelon of society.

Perpetrators are emboldened. Laws are loosened. Misogynists have heroes in the most prestigious global offices, like the White House and US Supreme Court. And women and girls suffer.  

When I began this work, I felt that I was part of global progress toward ending violence against women and girls. Recently, I have felt more like I am part of global pushback against a powerful, misogynistic force. I feel as though I am one of many feebly standing against a tide that keeps rising and rising and rising.  

The statistics make it seem as if that tide is about to destroy us:  

  • Globally, an estimated 35% of women have experienced intimate partner physical and/or sexual violence. Some national studies show that number up to 70%.
  • The global number of women murdered has increased since 2012. Globally, 47% of women victims of homicide were killed by partners or family members. 
  • 40-60% of women in the Middle East and North African experience street harassment. When I worked in Egypt, I encountered girls who stopped going to school because of the threats they faced on their way there. 
  • One in five women living in the United States will be raped in her lifetime. Nine out of ten rape survivors are female whereas as over nine out of ten perpetrators are male

Behind these statistics are women and girls – individuals who could be you or me. As I move forward in the fight for the health, rights and dignity of all of us, I collect more and more memories of my time with survivors. The more memories I gather, the more often they crawl out from the corners of my mind when I’m least expecting them.

Blue tights drying on a space heater in Jordan, chipped pink nail polish on a woman in the DR Congo, the sound of a girl’s voice cracking.

Although I didn’t realize it at the time, these moments crystalized into isolated memories and became a part of me. More and more the memories came back, and behind the isolated moments the faces of human beings appear.  

And that must be our focus: the human beings. That is where I am putting my focus as I increase my efforts to hold back the tide and eventually outcreate the culture of violence.  

In May, I became an online hotline volunteer for RAINN, the largest anti-sexual violence organization in the US. RAINN created and operates the National Sexual Assault Hotline (800.656.HOPE, online.rainn.org or in Spanish rain.org/es). Supporting this organization, with either time or financially, matters. 

I have vamped up Enhance Worldwide, a nonprofit organization I co-founded to protect, engage and empower adolescent girls in Ethiopia. Two girls recently joined our program. They are 11 years old and survivors of child marriage. Engaging in work with organizations like RAINN and Enhance Worldwide creates an impact.  

I continue to write for Girls’ Globe. I continue to find circles of women – and men – doing this work. We can all speak out in support of survivors and against violence. We can all unite in a desire for justice. 

I’ve come to terms with the fact that we live in a global society that normalizes violence against women. And I’ve come to terms with the fact that my ability to stop sexual violence is minimal. I know this. I do. But I also know that individual impact matters.

Together, we can keep pushing back the tide until we’re strong enough to turn it.   

Justice for Evelyn in Landmark El Salvador Abortion Trial

Evelyn Beatriz Hernandez is 21 years old. She has spent almost 3 years in prison in El Salvador with 27 left on her sentence. Her crime? Suffering from a stillbirth after being raped.

Yesterday, in a landmark retrial that was the first of its kind in the country, Hernandez was declared innocent and cleared of all charges. With tears rolling down her cheeks, she walked out of the courtroom with her mother and lawyer into a crowd of cheering supporters.

In July 2017, Hernandez was convicted of aggravated homicide after falling unconscious and giving birth to a baby who later died. Despite maintaining that she had not known she was pregnant, she was accused of deliberately killing her baby and sentenced to 30 years in prison.

Due to lack of evidence, Hernandez’s conviction was overturned in February this year and a retrial was ordered. Despite ferocious pressure from prosecutors, the judge concluded “there was no way to prove a crime.”

In El Salvador, sexual and reproductive health legislation is harsh and inhumane. Abortion is illegal in all circumstances, including instances of rape, incest and risk to life. Women who suffer from obstetric emergencies like miscarriages or stillbirths are routinely suspected of intentionally ending their pregnancies and accused of murder. Convictions are pursued aggressively and sentences are severe.

It is estimated that since 1998, over 600 women have been imprisoned under El Salvador’s abortion laws, many serving up to 40 years in jail.

Paula Avila Guillen, human rights expert and Director of Latin America Initiatives at the Women’s Equality Center, explains: “El Salvador violates the human rights of women, not only because of the total prohibition of abortion but because of the arbitrary and erroneous application of the law that sends women to prison.”

Sentencing a teenage rape victim to 30 years in prison sends a direct message from those with all the power to those with very little: we set the laws, we decide what happens to you, we are in control.

But times are changing.

Last year, 20-year-old Imelda Cortez was released from prison after almost 2 years awaiting trial for attempted homicide. Like Hernandez, Cortez became pregnant as the result of rape. Like Hernandez, she hadn’t known she was pregnant. And like Hernandez, Cortez woke the world up to the reality of El Salvador’s absurd and cruel criminalization of vulnerable women and girls.


Miscarriage is not a crime. Still birth is not a crime. Abortion is not a crime. What is criminal is using the law to force women and girls to bear children against their will.

What better way to restrict women’s power and agency than to lock them into child bearing. And if they appear to resist, what better way to punish them than to simply lock them up.

In our current climate, where abortion rights continue to be denied and progress is not only slow but actively reversing, Evelyn Hernandez’s release is a welcome reminder that activism works. Her case offers hope to all those still imprisoned under heinous laws and to all those currently denied human rights. Hernandez’s retrial gives new hope for reform and for a deeper understanding of the catastrophic human and social impact of abortion bans.

Evelyn’s story, like Imelda’s, is about far more than a debate on the morality of abortion. It’s a story about systematic persecution by unjust justice systems that treat victims as perpetrators and women as less than human. And like recent stories of women in Argentina, Chile, Northern Ireland and Alabama, it’s a story about fighting to defend human rights.

Speaking outside the courtroom yesterday, 21-year-old Evelyn told the crowds of supporters: “My future is to keep studying and achieve my goals… There are many women who are still locked up and I call for them to be freed soon, too.”

Activism, social pressure, solidarity – they work. But we have to keep going, in every case, in every country. Evelyn finally has justice, who’s next?

#JusticiaParaEvelyn, #OjosEnElSalvador, #JusticeForEvelyn, #EyesOnElSalvador

Meet Alice: the feminist activist fighting for change

Alice Ackermann is twenty years old – she’s the youngest IPPF executive committee member. Her convictions on women’s rights and sexual health are visceral. “I am angry,” Alice says when asked what drives her, “but, it is a positive anger.”

An Early Introduction to Injustice

Alice was born in Strasbourg, France to a Jewish Orthodox family. “It was so obvious to me, from the onset, that my three brothers and I were not treated in the same way,” she says. She explains how the religious rites of passage – circumcision and bar mitzvah – gave importance to the different stages of her brothers’ development. For girls, there was nothing.

Her elementary education in a Jewish school was delivered in the same spirit: “we were considered lesser pupils.” She rebelled from a very young age – before she turned ten she was called a feminist as an insult. Alice says this experience shaped what still drives her today: a clear conception of the injustice that is done to women and their rights.

She was later, at her own demand, transferred to a secular school. Here, she was confronted with “something more violent.”

“When we were teenagers, my friends were sharing their experiences of being kissed without consent, and so many girls talked about being raped, but were not calling it that because it was so hard to put a name on it,” Alice recalls. After hearing about her friend’s experiences, she was determined to do something about it.

Starting a Feminist Club

When the local sexual and reproductive healthcare organization gave a sexuality education session at her school, Alice asked if she could join as a volunteer but was told she was too young.

Never one to be discouraged easily, Alice began organising demonstrations and awareness raising campaigns in Strasbourg on topics such as street harassment or the different shapes and sizes of vulvas.

When she started high school a year later, she created a feminist club and organized debates and open conferences on the history of the sexual and reproductive health and rights (SRHR) movement. That’s also when she started doing peer-to-peer sex education with other student members of the club. It was immediately effective: “the students felt free to ask questions, debate among themselves and talk about what they witnessed.”


Peer-to-Peer Education Works

Alice says the reason peer-to-peer education works so well has to do with empowerment. “When you are young and being discriminated against, you are very vulnerable,” she explains. “What happens with peer-to-peer is that people look at you and realise that they can take action and have knowledge too. Every time I do a session people come to me afterwards and say ‘you are so young, how can you be doing this? How can I do it too?’.”

The sessions worked so well that the local sexual and reproductive healthcare organization in Strasbourg got on board. They provided her with training and she became, at sixteen years old, their youngest volunteer. Alice continues to work as a comprehensive sexuality educator and she holds a paid job as a counsellor at one Le Planning Familial’s call centres in Paris.

SRHR on a Global Scale

At last year’s G7 conference, Alice worked with other feminist activists to influence the recommendations put forward by attending governments. “It’s hard,” she admits. “What’s harder is that, on the global scale, things don’t always appear to be changing for the better.”

She says during the G7 conference, American and Italian governments were not interested: “it’s really simple, if you talk about SRHR during a meeting, they just walk out. Donald Trump did it in Canada last year.”

As someone whose commitment to feminism is motivated by her own life experience, Alice is acutely aware of the importance of coordinating international advocacy to a grassroots approach. That’s why she’s not considering quitting counselling or peer-to-peer education anytime soon.

“I wish I were less of an exception, we need to have more young people involved in every level of the organization.” As a newly appointed IPPF executive committee member, she is on a mission to change that.

As a regional youth representative of IPPF and a member of several feminist organisations, Alice Ackermann advocates for women’s reproductive rights and youth empowerment at the national and international level. She’s also studying history at Paris University.

The Pattern of Domestic Violence

Like every tsunami, it starts small. A slap here, a hit there. Nothing to worry about. He apologizes, says it will never happen again.

But it does.

It happens again. Harder this time, perhaps a punch or two. It becomes a pattern.

Beat, repent, repeat.

The physical abuse.

The pattern.

OR

It is completely inconspicuous. Almost invisible to the outside world and sometimes, to the victim, too. Charming dominance turns into irrational jealousy and possessiveness. Endearing neediness becomes suffocating. You find yourself trying to stay out for as long as you can. You know it’s coming.

The emotional abuse.

The pattern.

According to the World Health Organization, almost one third of women who have been in a relationship report that they have experienced some form of physical and/or sexual violence by their intimate partner in their lifetime.

Not everyone has the courage to fight back against abuse and violence. It’s not simply about being ‘brave’ – it becomes almost impossible to have courage if you don’t have a voice. Sometimes, even those who do are stifled by the fear of humiliation and social stigma surrounding gender-based violence.

Not everyone has a loving family or friends to fall back on. Not everyone can simply wake up one day, decide they have had enough, and leave. It’s not that easy, oh how I wish it was, but it isn’t.

Although, it’s also not impossible.

You might wonder, why must they stay? Is it the children? Or the familiarity? Or worst of all, the tainted love? It’s generally an amalgamation of all of these reasons along with many more. Of course, none of them can ever justify the destruction of lives, hearts, and a place that now detestably resembles home but is far, far from it.

The more you take, the less you can give to yourself or those you love. You deserve a safe environment. Children deserve a safe environment.

Make a safety plan. You can break the pattern and protect yourself and others. It will be hard, but it will be worth it.

“Break the pattern before it breaks you.” – Colleen Hoover, It Ends With Us

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