Baseline Surveys: Identifying Knowledge, Attitude and Practices to Gender Based Violence
Baseline surveys were conducted to determine existing knowledge, attitudes and proactices among front line service providers (SPs) in Nepal and Bangladesh on gender-based violence within a SRH setting. The sample included clinical and non-clinical health SPs from both Member Associations (MAs) and governments of Nepal and Bangladesh. A few NGOs were also included in Bangladesh.
These findings will provide valuable baseline data to support project reviews and monitoring. The findings will also provide important benchmarks to measure project impact.
Key findings of the baseline surveys are given below. A more detailed synopsis of both surveys is also available form IPPF SARO and locally from both MAs.
NEPAL
KNOWLEDGE: 41 percent clinical and 72 percent non-clinical FPAN SPs and 58 percent from the government were unaware of the existence of laws addressing domestic violence. The majority of all health providers were also unaware of their legal obligations towards women subject to violence and abuse. In addition, 84 percent of SPs had not participated in any GBV training with 63 percent expressing inability to provide adequate support to women because of lack of training.
ATTITUDES: Attitudes towards women and GBV
Several findings indicate that SPs blame women for instigating the violence. 59 percent of clinical workers (FPAN), 50 percent of government SPs and FPAN non-clinical SPs cited a woman's own inappropriate behaviour as one of the causes of domestic violence. A many as 67 percent of FPAN clinical workers stated that girls and adolescents who report sexual abuse may have fantasized it.
However, a majority of all SPs agreed that forced sexual relations within marriage should be considered rape. A clear majority of all SPs also agreed that it is never acceptable for a husband to resort to violence if his wife refuses to have sex with him, disobeys him, or is unfaithful.
Yet, a significant number of SPs believed that violence is always or sometimes acceptable under certain circumstances. For instance, 44 percent of clinical workers (FPAN), about a third non-clinical (FPAN) and government SPs agreed that it is always or sometimes acceptable for a spouse to be violence when his wife has been unfaithful or rude to her in-laws.
RESPONSIBILITY AS HEALTH PROVIDERS: The majority of SPs agreed they have as much responsibility to ask about GBV as they would with any other related health problem and 75 percent government SPs disagreed that domestic violence is a private matter. However, almost half of all SPs agreed or strongly agreed they were uncomfortable asking about domestic violence and sexual abuse.
PRACTICE
Screening: Findings indicate that screening for GBV is limited among many SPs. The majority of respondents (63%) stated that they preferred not to question their clients directly about GBV. Furthermore, 65 percent of SPs questioned their clients on GBV only because physical signs of abuse were present or because something the client said aroused suspicion or concern.
Services Provided: About three quarters of all health SPs reported taking care of client's injuries upon detecting abuse. Over half of FPAN clinical staff stated providing medical or emotional support or other community services. About half of all health providers have referred clients to other health personnel, followed by referrals to social workers and NGOs (42 percent of SPs), lawyers (37 percent) and the police (29 percent.
Referrals and follow-up: Half of all SPs were unaware of any system within their organizations for follow up for individual GBV cases. In addition, over 80 percent of SPs in FPAN and government reported the absence of an effective system for follow up of clients referred to other organisations.
Recommendations: Service providers, especially those working directly in the community requested further training on all aspects of support, including screening and conducting danger assessments, providing referrals, creating safety plans, and follow up. They also identified the need for increased collaboration between health workers, police, lawyers and local NGOs.
BANGLADESH
KNOWLEDGE: The findings show that the majority of SPs have not received any training on GBV. Only 10 percent of clinical professionals, 8 percent of paramedics, and 6 percent of field workers report having received any relevant training. Furthermore, when asked about the availability of training opportunities for both clinical and non-clinical personnel, the majority of program managers stated that such training was unavailable. Within FPAB, only 2 out of 8 program managers cited having taken advantage of training opportunities.
In addition, 79 percent of SPs were aware of the existence of laws to prevent violence against women and children although they acknowledged a lack of awareness about detailed provisions of the laws. The remaining 21 percent were unaware of the existence of any law on the matter.
PRACTICE:
Screening: No comprehensive formal screening system exists in clinics, although 71 percent of SPs reported questioning their clients on the symptoms and causes of violence for diagnostic pruposes. However, only 55 percent of all SPs went beyond preliminary screening to further investigate the situation or provide support.
Services provided: Only 22 percent of all SPs stated their clients to take action to prevent future violence. Most commonly, SPs supported clients to seek legal assistance by referring women to lawyers. In contrast, less than 10 percent of SPs reported the incidence to the police or counselled clients on how to prevent furure abuse. Three-quarters of all SPs in Bangladesh reported ensuring privacy and confidentiality while working with women.
A quarter of all SPs identified difficulties in assessing the causes of GBV. The two most cited constraints were the existence of social and cultural barriers preventing women from disclosing violence and/or abuse and resistance from family members discouraging women from disclosing their experiences.
Recommendations: 83 percent of SPs in Bangladesh expressed dissatisfaction with the current services available to GBV victims, with only 12 percent stating that they were at least somewhat sufficient. Service providers identified two key areas to improve services to women. First, a request was made for increased logistical support such as medicine, equipment and facilities. Second, additional resources were needed to provide direct financial aid to women such as legal aid.