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.

The Community Health Drive: A COVID-19 Innovation

Local, grassroots organizations have the pleasure of working on-the-ground and communicating directly with those they serve. They ensure that vulnerable populations receive the care, information, and sexual and reproductive health services they need.

How can we all (individuals, organizations, and governments) use innovation to adapt our work to the dynamic intricacies present in this COVID-19 world? And, how can we use the lessons learned during this pandemic as a stepping stone towards a more sustainable future? 

Innovation in Information Sharing

Creativity, innovation, and partnership are key elements in creating effective and engaging community outreach campaigns. 

Since March, Girl Up Initiative Uganda has been working tirelessly to build youth-friendly, community-centric, and innovative solutions to the complexities accompanying social-distancing and lockdown measures in Uganda. 

One of our main concerns is the rapid spread of harmful misinformation or the complete lack of access to reliable resources. This disproportionately affects vulnerable, hard-to-reach populations. 

UN Under-Secretary-General for Global Communications, Melissa Fleming, stated “COVID-19 is not just this century’s largest public health emergency, but also a communications crisis…”.  

An important point to also keep in mind is that this ‘communications crisis’ impacts girls and women more severely than men due to the gender digital divide present in most low and middle-income countries. 

In Africa, the proportion of women using the Internet is 25% lower than the proportion of men using the Internet. With an onslaught of information constantly being circulated without verification, people—mainly women and girls—are left in the dark, with many important questions unanswered. 

Mobility and Partnerships as a Solution: Community Health Drive

In response to the complex relationship of COVID-19 and information sharing (with the ability to spread faster than the actual virus itself), Girl Up Initiative Uganda decided to host our first-ever Community Health Drive through our Ni-Yetu Youth Program

The health drive consisted of our team driving in a special, colorful health van to reach the heart of urban communities. We shared health messages via loudspeaker and disseminated information materials.

Information included:

  • public health guidelines for COVID-19,
  • mental health,
  • sexual and reproductive health (SRH),
  • assistance for survivors of violence,
  • and more based on the community’s needs. 

Driving through the streets, we relayed health messages via loudspeaker and megaphone to not only share information. We also wanted to entice curious community members to come out and take a look at the action. 

And it worked! 

After months of lockdown, people were excited and happy to receive health services and resources straight to their doors. One-on-one conversations proved to be fruitful. They fostered openness and trust between Girl Up Uganda staff and community members. 

This was a powerful and fun way to reach people where they are. We were able to provide impactful community-based care to vulnerable populations. 

Our Director of Programs, Clare Tusingwire, stressed the importance of this Health Drive. She pointed out that it was a necessary way to learn what our communities are experiencing at this time. She also said it was a way to remind them that Girl Up Uganda is here to help and support them. 

“This is a key element to bringing about change. People are hungry for information in any way…We even had one parent reach out to us after the Community Health Drive with the hope that we could counsel her daughter.”

The Key of Partnerships

We cannot work alone, especially during these challenging times. 

Girl Up Initiative Uganda knows the importance of building community trust through key partnerships. This helps to assuage fears and promote genuine interest in receiving our information and messages. Therefore, we coordinated our health drive with the local authorities from the Kampala Capital City Authority to ensure safety and good health practices during the day. 

We also partnered with Action 4 Health Uganda and Naguru Teenage Information and Health Centre. These are two well-established and respected organizations supporting the rights of adolescents to sexual and reproductive health services in Kampala. 

With the permission of city officials and partnerships with other organizations, we were able to innovatively disseminate critical information to those most in need. 

There has never been a greater need for access to valid and scientifically-sound information. 

Fighting the spread of misinformation about COVID-19 does not require the use of sophisticated technologies. It requires empowering communities with accurate information, dispelling fears, and promoting togetherness. 

Our Health Drive was a beautiful example of using innovative approaches to further our mission – to create a vibrant movement of confident advocates, using their voices and knowledge to support and mentor others.   

 

COVID-19 is Leaving More Girls at Risk of Female Genital Mutilation and Child Marriage

The global COVID-19 pandemic is taking a particularly heavy toll on girls and young women across Africa.

Sadly, many girls in Africa are disenfranchised from birth.

They are born into poverty and vulnerable to inequalities in health and education, along with socio-economic and gender inequalities. Access to health and education is not automatic. Many girls remain marginalized throughout their lives, both geographically and economically. This exposes girls to collateral risks associated with poverty – and, at the moment, with COVID-19.

I have been lucky to be able to pursue my passion for the health and rights of women and girls for a number of years now. My work has focused on sexual and reproductive health, gender-based violence, female genital mutilation or cutting (FGM/C), and child, early and forced marriage. My experience has mainly been built by working with marginalized communities in Kenya that practice FGM/C – including the Maasai, Samburu, Kalenjins, Meru, and Somali communities.

Education Opens Horizons

In 2016, in the early years of my work in Kenya, I visited a rescue center in Samburu County. I was devastated by the reality of life for many Samburu children. Living a nomadic lifestyle in geographically vast areas, basic infrastructure to support health and education was lacking.

It took us a whole day to drive to the main town, Maralal, where the center was located. Along the road, I saw children herding cattle and goats within the national park, which is full of wild animals such as lions, elephants, giraffes, zebras, and antelopes.

The perplexing thing was that among the children were many girls, the youngest of whom looked about six years of age. Spending their days and evenings herding cattle in the woods away from home. Outside the protection of adult family members, means these girls are exposed to sexual and gender-based violence.

While visiting the center the next day, we found a newly rescued nine-year-old girl. She was rescued from forced child marriage to a seventy-year-old man who already had multiple wives. The young girl had just undergone FGM/C. Her wounds were still raw. She was brought to the center to heal and attend school, since she hadn’t previously had the chance to receive an education.

My colleagues and I were left debating how a girl will ever make it in life without an education, good health, or any future economic opportunities. For many girls in Kenya and elsewhere, their progress is curtailed and their horizons limited from childhood as a result of traditional practices which are linked to livelihoods.

Co-existing Crises Leave Girls at Risk

I can only imagine how much harder life is for girls in Samburu in the face of COVID-19. I have heard many horrific stories from my colleagues about how lockdown measures, combined with school closures and the subsequent dwindling of family resources and general livelihoods, have left more girls exposed to FGM/C and child marriage.

They are forced by their circumstances to be “sold” into marriage, either for money or cattle.

Unfortunately, in Kenya the COVID-19 crisis has also been accompanied by many natural calamities including a locust invasion, drought and flooding in many parts of the country, meaning that food is scarce.

Nomadic communities like the Samburu have been hit particularly hard. They rely on markets to sell their animals for money to satisfy their basic needs. When markets are closed, as they are currently, they cannot sell. The food crisis is likely to lead to even more girls being married in exchange for food for their families and a semblance of security.

At the same time, the focus of law enforcement in Kenya has been on stopping the spread of the coronavirus. This has resulted in many cases of gender-based violence, FGM/C and child marriage being shoved onto the back burner. As if they are not a crisis that deserves immediate attention.

Community activists working in Samburu have reported feeling powerless and hopeless. They are between a rock and a hard place, sometimes having to choose between reporting cases to the authorities and their lives being threatened.

Listening to Communities is More Important Than Ever

The Kenyan government has not embraced a multi-sectoral approach in dealing with the overall impact of COVID-19. Instead, they’ve taking a rather narrow approach to public health. Because of the focus on curbing transmission, fostering strategic engagement that includes stakeholders working in gender-based violence, FGM/C, and child marriage has been sidelined.

Including community systems in the prevention of and response to FGM/C and child marriage is more important than ever. More women and girls are now at risk of harmful practices and gender-based violence.

These strategies should include:

  • working closely with community advocates and activists,
  • working with community health workers who can play a significant role in surveillance of at-risk girls,
  • mapping them and linking them up with healthcare and legal services, and
  • setting up rescue homes and centers that could house them temporarily until the COVID-19 crisis subsides.
The majority or all of the safe centers or homes were ordered to close as part of the lockdown measures. The girls and women being housed in those centers were asked to return home in the midst of Covid-19. A doubly tragic situation for them.

So what can we do, in the face of these co-existing crises?

The greatest lesson that we can learn is that it is crucial to deliver multi-sectoral responses to FGM/C and child marriage. This means actors working together. A broader approach is needed. One that considers the wider socio-ecological aspects of livelihoods including education, health, emergencies, climate crisis and other factors which impact on the harmful practices of these communities.

State and non-state actors need to widen their nets and protect African children and girls in particular – who, as is so often the case, carry the heaviest burdens of poor health and well-being.

Dr Esho is the Director of the Amref Health Africa End-FGM/C Centre of Excellence; Secretary General, African Society for Sexual Medicine; and Associate Member, Africa Coordinating Centre for the Abandonment of FGM/C.

Accessing Safe Abortion during Lockdown in Africa

We have seen how pandemics negatively impact access to reproductive health services, especially access to safe abortion. As the pandemic spread globally, MAMA Network saw a growing demand for self-managed abortion and access to telemedicine across Africa.

As a Network we have seen how the COVID-19 pandemic disrupted availability and access to safe abortion medication and contraceptives. Transport is less accessible. Clinics have reduced hours or are closed. Services are more expensive and community activities are on hold.

MAMA Network is a regional movement of activists working to share evidence-based and stigma-free information about self-managed medical abortion.

Sexual and reproductive health and rights (SRHR) information is shared with women at the community level across Sub-Saharan Africa.

In 2016, MAMA network was founded by Trust for Indigenous Culture and Health (TICAH) in Kenya and Women Help Women. Over the years, the network has supported organizations in their efforts to increase access to safe abortion services and information. This is possible through mentorship, coaching, trainings, sharing of information, joint activism and creating spaces for linking and learning.

The pandemic led to an increase in demand for self-managed abortion, post abortion care, contraceptives and telemedicine or tele-counseling. In May 2020, we launched three hotlines in Cameroon, DRC and in Zambia. This brings the total of hotlines in the network to 9 including Nigeria, Kenya, Tanzania, Malawi and Uganda. MAMA Network’s approach to telemedicine and tele-counseling trusts women to have autonomy over their bodies.

In Kenya, Aunty Jane Hotline (launched in 2012) provides reliable, safe and confidential information to save women’s lives.

The hotline is toll-free since 2018. Recently women calling the hotline faced difficulties in accessing misoprostol in pharmacies due to global shortage of commodities. Women who accessed services, said they were asked to pay between $90 and $250. Before COVID-19, services in private clinics were $30. Online campaigns by Aunty Jane Hotline have intensified, including virtual meetings and strategies to strengthen collaboration with service providers.

In Nigeria, Ms. Rosy Hotline (launched in 2014) is toll-free since 2016 and operates 24 hours daily. The hotline has received approximately 135,000 calls from across Nigeria. Aunt Kaki was launched in Uganda in 2017. In Tanzania, Shangazi Shani was launched in 2018. Women Help Women’s online platform also exists to assist women and girls from all over the world.

In Uvira, DRC Congo, MAMA partner organizations have supported at least 10 women to access safe abortion in recent weeks. The rise in transportation costs has created barriers in accessing reproductive health services. With secure communication; a WhatsApp group is used to record community cases and refer to nearby healthcare providers and clinics. Community champions are doing home delivery of pills, one on one counseling, and follow ups. They have noticed a spike in the demand of pregnancy prevention methods in the Uvira region.

Changed Women Project in Zambia offers in-person services on a case by case basis. “Public hospitals are overwhelmed, women and girls are not going to hospitals. They are sent back due to congestion and go back to quacks because they can’t be helped,” a representative said. In the previous week a girl in the community unsafely induced an abortion and suffered serious complications. Changed Women stepped in and assisted her to go for post abortion care at a government hospital.

MAMA Network has remained active to shine a light on the importance of access to information and services for safe abortion.

On May 28th, the International Day of Action for Women’s Health, we ran a campaign receiving support from 10 countries and collected 56 photos of solidarity with the hashtag #AbortionBeyondLockDown. The purpose of the campaign highlighted that despite the lockdown, safe abortion remains an essential service.

MAMA Network has also continued to implement capacity building webinars, providing necessary tools to support activists and actively fundraise to support community based organizations. These efforts have been successful and we expect to launch 4 more hotlines in 4 countries in the coming weeks.

MAMA Network (Mobilizing Activists around Medical Abortion) is a collaboration of grassroots activists and feminist groups based in Sub-Saharan Africa. MAMA Network is a Safe Abortion Action Fund grantee partner.

Leading Youth Advocacy Movements in the Wake of COVID-19

Nobody ever prepares you adequately for the long and winding road of leadership. One has to be brave enough to quickly rise to the challenge. For Evalin Karijo, her youth leadership role at Amref Health Africa – especially during this time of the pandemic – has put those skills to the test.

When Y-ACT (Youth in Action) was set up a few years ago, it was Amref Health Africa’s first fully youth-led initiative. It was designed for and by the youth. We knew that this was going to be exciting. Three years down the line, the energy and creativity of the youth has been more than anyone ever imagined. Y-ACT has been operating at a time when the role of young people in decision-making processes on issues that affect them is at its highest. Y-ACT is now one of the fastest-growing youth advocacy networks in the region. It also hosts the Youth4UHC Pan-African youth movement.

Before taking on the mantle at Y-ACT, I had spent two years in different leadership roles at Amref. At the time, I was the youngest project lead in the organisation.

Youth and COVID-19

During this pandemic, my experiences in adapting to changing times and leading teams to do so has come in handy.

The youth – in Kenya and across Africa – are likely to bear the biggest burden of the effects of COVID-19. We’re experiencing:

  • rapidly rising cases of unemployment,
  • inadequate access to routine health services,
  • and increasing cases of sexual and gender-based violence among vulnerable adolescents and youth.

A study that we recently carried out with youth highlights how the pandemic is affecting the youth in Kenya.

Youth are great catalysts of change

While the youth are vulnerable in this crisis, it’s inspiring to see their innovation. Young activists and youth volunteers are constantly generating ideas in their spaces to contribute to ending this pandemic.

Young people want to be at the forefront. They want to feel heard and consulted about policies, services and systems that are developed for them.

To amplify the youth voices during the pandemic, Y-ACT is

  • working with youth advocacy movements to co-create solutions,
  • lead teams to work with policy-makers,
  • and ensure that youth are meaningfully engaged in the fight to end the pandemic.

The #ChampionsKwaGround campaign, launched by Y-ACT, has been amplifying voices and efforts of youth and youth-led organisations. They are making incredible contributions in the fight to end COVID-19.

The campaign features youth movements who have taken to digital media to make their voices heard. They spur collective action on COVID-19 and on their priorities, at a time when everybody needs collective action the most.

The campaign also features young health workers on the frontlines of ending the pandemic. It has featured grassroots youth-led organisations leveraging their creativity through arts, murals, and music to create awareness on COVID-19 and influence youth to adopt positive behaviour change to stop the spread of the pandemic.

Other youth advocates at grassroots level innovate and develop income-generating activities including manufacturing home-made soap and masks, while ensuring that they stay safe.

Youth-developed resources and tools: COVID-19 and beyond

Y-ACT has further developed an innovative info-site. It is designed by Kenyan youth and for youth to meet their growing needs as the pandemic continues to evolve. The info-site provides accurate and up-to-date opportunities for young people. It includes:

  • online resources, webinars, and training programmes,
  • helpline numbers set up by the government and partners,
  • employment opportunities,
  • protection services,
  • and COVID-19 youth-related advocacy campaigns.

The team is now co-designing a virtual innovation lab that will provide a platform for youth to co-create solutions to deal with the post-pandemic future.

By focusing on the immediate needs of the youth and co-creating solutions towards a brighter post-pandemic future, Y-ACT is leading the youth to be in a position of authority and influence. This provides the ability to spur different outcomes based on youth creativity, and innovation, during this time of the pandemic.

Evalin Karijo is Project Director of Y-ACT (Youth in Action), an initiative of Amref Health Africa that aims to mentor, support and increase the capacity of youth advocates to influence policy and resource priorities in the areas of gender equality and sexual and reproductive health and rights (SRHR).

3 Gendered Impacts of the Coronavirus Pandemic

The World Health Organisation officially classified COVID-19 as a pandemic on 11 March 2020.

While the full impact of this pandemic cannot be fully articulated yet, evidence from previous global crises indicates that the impacts of disease outbreaks are not gender-neutral.

Crises such as pandemics and natural disasters can exacerbate already existing gender inequalities. Successful efforts to address and mitigate the consequences of the pandemic will require considerations of its gendered impacts.

Here are 3 possible gendered impacts of the coronavirus pandemic.

1. Increased Burden of Care

In many societies, women and girls are responsible for the majority of domestic work and caregiving responsibilities within the family. According to estimates, women work (both paid and unpaid) 30 minutes to one hour more per day than men.

With schools closing and turning to online learning as a measure to limit the spread of the disease, women may have increased responsibilities in caring for their children and their education. Many will also have to manage a full-time job at the same time.

The traditional caregiving role of women also goes beyond the home. Women account for the majority of health care workers in many parts of the world.

Globally, 70% of the health care workforce are women. More than 90% of health care workers in the Hubei province in China, where the virus was first identified, are women.

As such, women are at the forefront of the fight against the disease and risk exposing themselves, as well as their families, to the virus. 

2. Lack of Access to Sexual and Reproductive Health Services

During disease outbreaks, sexual and reproductive health services are not a common priority, as resources go towards dealing with emergencies. 

However, a number of organizations such as the World Health Organization (WHO) and the American College of Obstetricians and Gynecologists have stated that reproductive health care, including abortions, are essential services that should remain available during emergencies. 

According to the WHO’s recommendation, sexual and reproductive health care should be available regardless of a woman’s COVID-19 status:

“Women’s choices and rights to sexual and reproductive health care should be respected irrespective of COVID-19 status, including access to contraception and safe abortion to the full extent of the law.”

The consequences of lack of access to sexual and reproductive health care services can be devastating, as previous disease outbreaks show. 

During the Ebola outbreak in West Africa, the maternal mortality rate rose by 70% as maternal health clinics in the region were forced to close.

Marie Stopes International explain that in the 37 countries where they operate, COVID-19 is causing delays in production and delivery of condoms and contraceptives, They estimate that this can lead to 11,000 pregnancy-related deaths, 2.7 million unsafe abortions, and 3 million unintended pregnancies.

3. Increased Risk of Gender-Based Violence

Countries in every corner of the world are seeing an increase in reports related to domestic violence – from India to France to the United States.

In Singapore and Cyprus hotlines have seen an increase in calls of 33% and 30%, respectively. Argentina has seen a 25% increase in domestic violence-related emergency calls since the start of the lockdown.

In a webinar about gender and COVID-19, UN Women’s Anita Bhatia highlighted this grim reality:

“Domestic violence is what we’re calling a shadow pandemic… We are asking for shelters to be designated as essential services [during COVID-19] and for police to receive additional gender-sensitive training.”

As the global economy struggles through the pandemic, gender-based violence can exacerbate financial issues. Violence against women and girls costs about 1.5 trillion U.S. dollars globally. 

These are just some of the many possible impacts of the current coronavirus pandemic related to gender. While authorities attempt to stop the spread of the virus, they cannot ignore the secondary impacts of this outbreak. 

Fighting for the lives of those infected must remain a priority. But deaths caused by gender-based violence, unsafe abortions, and childbirth also need to be considered. Disease outbreaks and global crises tend to exacerbate existing gender inequalities. The gendered impacts of COVID-19, then, must be an integral part of current and future efforts to address this pandemic.