Systematic Literature Review Of Gender-Based Violence In .

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8/1/2018Systematic LiteratureReview of GenderBased Violence inEthiopiaMagnitude, Policies, and InterventionsBy: Marisa Cordon, Fatu Drame, Erica Schmidt, & Haley SteppIN PARTNERSHIP WITH SOCIAL IMPACT, INC.

AbstractBackground: Gender-based violence (GBV) a global concern with severe implications fordevelopment players. In Ethiopia, intimate partner violence, domestic violence, female genitalmutilation/cutting, sexual assault, rape, marriage by abduction, and child marriage areprevalent. At the request of USAID/Ethiopia, Social Impact, Inc. and consulting GeorgeWashington University master’s students conducted a literature review on GBV in Ethiopia.Research questions examined the magnitude of GBV in Ethiopia, GBV laws and policies andtheir enforcement, the implications of GBV for development work in Ethiopia, and the evidencebase for interventions addressing GBV.Methods: The researchers conducted a systematic review of peer-reviewed articles, crediblegovernment and university documents, impact evaluations, and rigorous analyses by aidorganizations related to violence committed against women and girls. The researchers usedspecific search terms related to the research questions to search for relevant articles in selecteddatabases, search engines, journals and development organizations resources. Theresearchers then read the identified articles and summarized findings related to each researchquestion.Findings: The Ethiopia Demographic and Health Survey (2016) shows that 33% of womenages 15-49 have experienced physical or sexual violence; domestic violence is the mostcommon form of violence towards women; around 65% of women between 15-49 have beencircumcised, and child marriage is still a significant problem in Ethiopia. Among women 15-49,10% have ever experienced sexual violence. While Ethiopia has laws to guarantee equal rightsand prohibits most forms of GBV, these laws have been ineffective in preventing GBV. Powerdynamics between men and women is the leading cause of GBV. While a few programs areworking on GBV, the impact of those programs is not well established.Conclusions/key messages: GBV continues to be a pervasive national issue in Ethiopia. Lawsprohibiting GBV exist, but there are substantial gaps in their enforcement due to social normsand lack of enforcement through local legal structures. Interventions that seek to enactsustainable change should target the causes of GBV, including power inequalities, and involvemen, women, and adolescents. Although sexual violence is prevalent, programs targetingsexual violence are lacking, which also calls for establishing programs to address anddestigmatize rape and sexual harassment victims. Development programs to increase womenand girls access to education, sexual and reproductive health education and poverty reductioncan empower them to resist FGM and child marriage.ii

Table of Contents1.Background .1Overview.1Ethiopia’s Demographics .1Defining Gender-Based Violence .2Summary of Interventions to Address GBV .22.Objectives.4Purpose .4Main Research Questions .43.Methods .5Selection Criteria for Systematic Review.5Study Search Strategy .5Initial Stages of Review .5Analysis Methods .6Limitations of Methods .64.Findings .8Magnitude of GBV.8GBV Laws and Policies and their Effectiveness .14Interventions on GBV .285.Conclusions .40Key Findings .40Recommendations .41Appendix 1: Sources Searched.46Appendix 2: Search Terms Used .47Appendix 3: Inclusion and Exclusion Criteria.48Appendix 4: Additional Tables .49Table 1.2: Regional Statistics of GBV in Ethiopia .49Table 3.1. Interventions to address IPV .52Table 3.2. Interventions to address FGM .55Table 3.3. Interventions to address Child Marriage .65Table 3.4. Interventions to address Sexual violence/Rape. 72Appendix 5: Flow Chart .75Appendix 6: References .76iii

List of AcronymsAIDSAcquired Immunodeficiency SyndromeARTAntiretroviral TherapyAWSADAssociation for Women’s Sanctuary and DevelopmentBIAAGBecause I Am A GirlCECommunity EngagementCEDAWConvention on the Elimination of Discrimination against WomenCMChild MarriageCSOCivil Society OrganizationDEVAWDeclaration on the Elimination of Violence Against WomenDHSDemographic Health SurveyEDHSEthiopia Demographic Health SurveyEPMESEthiopia Performance Monitoring and Evaluation ServiceFGM/CFemale Genital Mutilation or CuttingGBVGender-based ViolenceGEGroup EducationGWUGeorge Washington UniversityHAPCOHIV/AIDS Prevention and Control OfficeHIVHuman Immunodeficiency VirusHTPHarmful Traditional PracticeICRWInternational Center for Research on WomenIECInformation, Education, and CommunicationIPVIntimate Partner ViolenceKMGKembatti Mentti Gezzima-TopeLMAMLegal Minimum Age to MarryMNIMale Norm Initiativeiv

MOWCYAMinistry of Women, Children, Youth AffairsNGONon-Governmental OrganizationPEPFARUS President’s Emergency Plan for AIDS ReliefSNNPRSouthern Nations, Nationalities, and People’s RegionSTISexually Transmitted InfectionTESFATowards Economic and Sexual Reproductive Health Outcomes forAdolescent GirlsUNFPAUnited Nations Population FundUNICEFUnited Nations International Children’s FundWAOWomen’s Affairs OfficeVAWGViolence against Women and GirlsVCTVoluntary Counseling and Testingv

Executive SummaryAbout the ReviewIn Ethiopia, gender-based violence (GBV) is a serious issue. Intimate partner violence, domesticviolence, female genital mutilation/cutting, sexual assault, rape, marriage by abduction, andchild marriage are just some of the forms of GBV that are prevalent in Ethiopia.1 These forms ofviolence against women and girls are human rights violations at the individual level and damagethe societal and economic structure of Ethiopia on a broad scale.This systematic literature review was commissioned by USAID/Ethiopia and Social Impact,Inc.’s Ethiopia Performance Monitoring and Evaluation Service (EPMES) Activity and wasconducted by consulting GW master’s students over the course of four months. The reviewpresents the magnitude of various forms of GBV in Ethiopia, the policies pertaining to thepractices, their effectiveness, and the impact GBV has on development work in the country. Thereview will help inform future projects in Ethiopia undertaken by USAID.Studies Included in this ReviewThis review includes 61 peer-reviewed journal articles, inception reports, impact evaluations,and program analyses that explore the prevalence of different forms of GBV, the policies thatsurround them and their effectiveness, and proven best practices for stopping GBV. All thesources deal specifically with the realities of GBV in Ethiopia as a whole or in specificzones/regions of Ethiopia.Magnitude of GBVFindings from this systematic review revealed that, although rates of GBV in Ethiopia havedecreased over time, GBV continues to be a pervasive national issue. Data from the Ethiopia2016 Demographic Health Survey (DHS) revealed that 33% of women ages 15-49 had everexperienced physical or sexual violence and that domestic violence is the most common form ofviolence that women experience. Data also shows that around 65% of women between theages of 15-49 have been circumcised in Ethiopia and that child marriage is still a significantproblem in the country, as around 58% of women ages 25-49 married before their 18th birthday.Lastly, among women aged 15-49, 10% reported having ever experienced sexual violence atsome point in their lives (from anyone).Effectiveness of Laws and PoliciesEthiopia has many laws in place at all levels of the legal system that guarantee equal rights andprohibit most forms of gender-based violence (GBV), including female genital mutilation (FGM),child marriage, most forms of rape, and some intimate partner violence (IPV). However, formany reasons, including the often-discordant levels of the formal and informal legal system, thegeneral culture of acceptance of GBV, the poor training of law enforcement and judges, and thelack of institutional support behind the enforcement of the bans, the policies are widelyineffective at preventing this violence.vi

Implications for Development Work in EthiopiaThere are a limited number of gender-based violence programs in Ethiopia that have impactevaluations readily available. However, based on these evaluations, this systematic review hasdetermined that inclusive, targeted programs have been proven to be the most effective inaddressing GBV. Every proven intervention included in this study was included because of eachintervention’s success in its desired outcome.While GBV occurs for many reasons, power dynamics between men and women is a root causeof the issue. This was seen in the Meseret Hiwott program that involved only women and girlsand resulted in an increase in sexual and domestic violence for some participants. Programsthat involved both men and women saw a decrease in physical violence but did not have aneffect on sexual violence. This could be because only shelter programs directly addressedsexual violence.In addition, programs that tried to address GBV broadly were more likely to have their messageconfused. For example, Phase II of the UNFPA Prevention and Management of Gender-BasedViolence in Ethiopia Programme saw an increase in underage pregnancy. Messages weretargeted for sexually active young adults, but youth misinterpreted the message of the projectand began having sex at an early age. Programs that focused on one aspect of GBV anddelivered targeted messages, such as the Male Norm Initiative (MNI) program or shelterprovision, saw better results.Programs focused on community awareness-raising with influential leaders as participants andmitigators of dialogue were proven to be successful in the reduction and prevention of FGM.Likewise, interventions focusing on education, cash and material incentives, communityengagement, and male involvement were successful in combating the practices of childmarriage and marriage by abduction.RecommendationsSince each type of GBV is experienced by women and girls in different ways and to varyingdegrees in regions across the country, development interventions should target the mostprevalent forms of GBV by region to most effectively decrease the high rates of violencetowards women and girls in those areas. Since reliable data on the overall prevalence of IPV,sexual violence, and the magnitude of child marriage by region is scarce, more research isneeded to better understand the current situation in the country. Research that gathers woredalevel data on the prevalence of GBV would also be useful to more accurately identify specificpopulations most at risk.Although there are many GBV laws currently in place in Ethiopia, there are substantial gaps inthe protection of women when it comes to IPV or marital rape. This should be rectified with thepassage of new legislation. Furthermore, all levels of government and courts, both formal andinformal, should collaborate on new legislation and the enforcement of current GBV laws to helpunify the fractured system that often fails to protect women. Improved enforcement of the GBVlaws and the criminal code will also require improved training of law enforcement and legalofficials. However, laws will be most effective in conjunction with a widespread change in theattitudes and expectations that people in Ethiopia have about GBV.In accordance with the findings of this review, interventions that seek to enact sustainablechange should target the root causes of GBV, including power inequalities, and involve men,women, and adolescents. Participants and community leaders also need to be actively involvedvii

in the creation and enactment of programs to increase their effectiveness. Due to a lack ofprograms targeting sexual violence in Ethiopia, we suggest the creation of more programs toaddress and destigmatize rape and sexual harassment.Due to the fact that GBV is a multifaceted social issue, even programs not targeted at GBVspecifically still can make a positive difference. For example, development programs gearedtowards increasing access to education, especially to sexual and reproductive health educationcan increase children’s agency and empower them to resist FGM and child marriage. Sincepoverty often drives child marriage, it is important for development programs to focus on jobcreation and financial security for poor, rural families which can reduce parents’ reliance on childmarriage as a form of economic investment. Evidence also shows that even health-focusedprograms can combat the rates of IPV and sexual violence. The evidence of this review alsosuggests that, overall, more programs should address gender inequality, women’sempowerment, and social norms with interventions targeted at both men and women.viii

Systematic Literature ReviewGender-Based Violence in Ethiopia1. BACKGROUNDOverviewMasters degree students enrolled in a Gender and Development course at The GeorgeWashington University have partnered with Social Impact’s Ethiopia Performance Monitoringand Evaluation Service (EPMES) Activity, funded by USAID/Ethiopia, to conduct a pro-bonosystematic literature review on gender-based violence (GBV) in Ethiopia. The systematic reviewwill help to guide USAID’s future programming activities related to their work in addressing GBVin Ethiopia.Gender-based violence is a direct violation of human rights, and additionally, is a major concernfor public health and development work. Global estimates show that approximately 1 in 3women have experienced physical or sexual violence in their lifetime (either by intimate partnersor non-partners).1 Therefore, it is important to understand the scope of GBV within thesociocultural and political context of Ethiopia, the many forms in which it manifests, and thevarying impact of GBV by region. It is also important to understand the impact of GBV ondevelopment outcomes to encourage more effective, gender-sensitive responses indevelopment.According to 2016 Demographic Health Survey (DHS) data, violence against women and girlscontinues to be a major challenge in Ethiopia. The emotional, psychological, sexual, andphysical violence that women and girls are exposed to greatly impacts their health, ability tomake a living, peaceful childhoods, education, and disrupts their relationships. Even thoughEthiopia has set legal and policy provisions that promote the rights of women and girls includingthe constitution, international and continental agreements, and criminal codes that address actsof violence, the incidence of GBV is still widespread in the country.Ethiopia’s DemographicsEthiopia is a diverse country located on the eastern side of the African continent. The republic iscomposed of nine national regional states referred to as Tigray, Afar, Amhara, Oromia, Somali,Benishangul-Gumuz, Southern Nations Nationalities and People’s Region (SNNPR), Gambella,and Harari and two city administrations named Addis Ababa and Dire Dawa.2,3 Figure 1 is apictorial description of the country with the labeled regions. The country’s terrain isgeographically diverse with mountainous highlands and tropical forests.3 It is the second mostpopulous country in Africa, with a steadily growing population.3 Of the current population ofapproximately 100 million people, approximately 80% reside in rural areas.4 There are over 80ethnic groups who speak more than 90 distinct languages,3 although nearly one-third of thepopulation speaks Oromo and the rest of the majority speaks Amharic, Somali, or Tigrigna.4Ethiopia’s GDP per capita is one of the lowest in the world, but it is rapidly growing in recentyears.3 Between 2005 and 2010, the percent of Ethiopians living in extreme poverty droppedfrom 38.7 to 29.6 percent.3 During this same time frame, there have been a lot of changes in thelegal structure and health systems of Ethiopia that have contributed to an overall improvementof health and development in Ethiopia, although there is still a long way to go to ensure a good,safe, free life for all citizens.31

Systematic Literature ReviewGender-Based Violence in EthiopiaFigure 1. A pictorial description of Ethiopia and subdivided regions adopted from UN OCHA5Defining Gender-Based ViolenceWhile men and boys can also be victims of gender-based violence, this research focuses onviolence against women and girls, as it is the most common presentation of GBV. Therefore, wewill use GBV synonymously with violence against women and girls.Violence against women is defined as any act of violence that can result in sexual,psychological, or physical harm and suffering of women.6 Such physical/psychological/sexualviolence can be perpetrated by an intimate partner within a relationship, by other familymembers, by acquaintances, or by the general community.This systematic review on GBV in Ethiopia will primarily focus on intimate partner violence, childmarriage, sexual violence, and female genital mutilation/cutting. These were selected becauseour initial research indicated that they were some of the most significant, prevalent, andcomplex forms of GBV for Ethiopian women and girls. The underlying issue of gender inequalitywill be addressed as it pertains to the aforementioned topics. Domestic violence is one of themost common but underreported forms of violence in Ethiopia and is defined as physical,sexual, or psychological abuse that takes place within a household, and in which the perpetratoris often an intimate partner.6 Female genital mutilation or cutting (FGM/C) refers to theprocedures involved in the partial or total removal of external portions of the female genitalorgans for non-medical purposes,7 and while this practice remains under-researched, existingdata indicate that a large proportion of Ethiopian women have undergone FGM/C.6 Sexualviolence is a broad category including acts ranging from unwanted sexual comments,unsolicited sexual touching, or forced or coerced penetration. Research indicates that rates ofthis form of GBV are high in Ethiopia.8 Lastly, the practice of child marriage is also common inEthiopia and is defined as any marriage before the age of 18 years old.6Summary of Interventions to Address GBVMany organizations have created and implemented programs to reduce the magnitude andimpact of various forms of GBV. Evaluations of these programs and of the known risk factors of2

Systematic Literature ReviewGender-Based Violence in EthiopiaGBV allow researchers to discern between practices that have either proven or failed to beeffective. Identifying these best practices, in turn, has major implications for development workin Ethiopia. Proven strategies can be integrated into USAID’s gender programming so as tomore effectively reduce risks and incidence of GBV in Ethiopia. This systematic reviewexamined impact evaluations of programs that addressed intimate partner violence, femalegenital mutilation, child marriage, and sexual violence. Proven interventions were determined bythe intervention’s success in its desired outcome. Because of the limited information availableon GBV interventions in Ethiopia, this study does not prove interventions on replicability, costeffectiveness or other measures. Examples of interventions strategies that were proven to besuccessful included community awareness-raising campaigns, group education, school-basedapproaches, and community outreach. The Tables found in Appendix 4 detail the interventionsand evaluations included in this review.3

Systematic Literature ReviewGender-Based Violence in Ethiopia2. OBJECTIVESPurposeThe purpose of this systematic literature review was to develop a situational analysis and guidefor USAID. It will allow USAID to create a communications piece regarding the prevalence ofGBV in Ethiopia, help elucidate the effectiveness of legal mechanisms surrounding GBV in thecountry, and help USAID to redefine their education, advocacy, and gender programmingactivities in Ethiopia to reduce GBV.Main Research QuestionsThe following research questions guided the research process for this systematic literaturereview:1. What is the magnitude of GBV in Ethiopia?2. What laws and policies related to GBV are in place and how well are they enforced inEthiopia?3. What implications does GBV have for development work in Ethiopia and what are somepromising, evidence-based strategies for addressing GBV?4

Systematic Literature ReviewGender-Based Violence in Ethiopia3. METHODSSelection Criteria for Systematic ReviewSubject AreaThe papers included in this review all substantially pertain to one or more of the forms of GBVexperienced by women in Ethiopia. Each source discusses either the statistical magnitude ofthat form of violence in the country or an area of the country, the preventive or punitive policiesin place to reduce the prevalence of the violence, or ways in which this violence affectsdevelopment work and the proven strategies to combat the issue.Study TypeThis review included studies put out by peer-reviewed journals, credible government anduniversity documents, impact evaluations and analyses released by reputable aid organizations.Due to the multiple research questions we are addressing, we included various study types.Some studies employed quantitative research including experimental or cross-sectionaldesigns, while others used qualitative research based on group discussions and interviews.TimingOnly studies published after 2006 were included in this review.PopulationWe limited our sources to those studying the violence committed against Ethiopian women andgirls in Ethiopia. Some men and boys were included in the programs and policies seeking toreduce GBV, but the prevalence of GBV is reported strictly as the prevalence of gender-basedviolence against women and girls in Ethiopia.Study Search StrategyThe databases and search engines which were browsed during the research process, as wellas the journals and organizations from which the sources in the final product were found, arelisted in Appendix 1. The search terms were used to search for relevant articles within the listeddatabases are also listed in Appendix 2. These keywords follow a rough PI(C)O format(Population/Problem, Indicators, and Outcomes). Each search was done by utilizing one ormore of the key phrases to locate articles relevant to our specific needs.Initial Stages of ReviewAfter concluding our initial searches, our first step was to eliminate the duplicates and nearduplicates. To do this, we utilized RefWorks Legacy software. Afterward, the sources outsidethe acceptable publication date range were eliminated. After these eliminations, we screenedthe remaining sources for relevance based on the titles and abstracts. The criteria we used todecide whether to keep or delete sources at this stage were whether they fit the inclusion and5

Systematic Literature ReviewGender-Based Violence in Ethiopiaexclusion criteria in Annex 3. The next stage was to assess the remaining sources further forrelevance and quality based on full-text readings. At this step, we considered the inclusion andexclusion criteria as well as whether the information provided pertained to one of our threeresearch questions and whether the information provided was sufficient for inclusion in the finalsystematic literature review. Upon the recommendations of Dr. Fink of GWU and Jade Lamb ofSocial Impact, additional sources were added after the initial search. These sources wereautomatically read and assessed in their entirety.The final cut of articles and reports that were deemed worthy of inclusion in our review by thesystematic process described above were then used to write an annotated bibliography. Theywere then sorted based on the research question(s) and type(s) of GBV they addressed. Thiswas submitted to Dr. Fink and Jade Lamb for approval and evaluation before continuing on towrite this review.Analysis MethodsUsing the 61 studies identified for this review, we summarized the magnitude of each of our fourcore types of GBV (IPV, FGM, sexual violence, and child marriage). To the extent that the dataavailable allowed, we did this at the national and at the regional levels for different populationsof women and girls. We also present the various laws pertaining to the forms of GBV and theireffectiveness at reducing the violence. Lastly, we used our sources to present a summary ofmany programs and interventions that have been proven effective in Ethiopia in combatingGBV. All of this information is presented in tables as well as in the body of the text.Limitations of MethodsType of StudyDue to regional and provincial differences in Ethiopia, program placement and populationselection may bias studies. The team included both region-specific and nationwide statistics,laws, and programs, but we have noted the regional information so as not to prematurelyassume that the specific data applies nationwide.Furthermore, we included a variety of sources with a variety of design methods in our study,ranging from quantitative RCTs to qualitative interviews, as per our inclusion criteria. While thisvariety was necessary to sufficiently be able to answer the three unique research questions, italso posed a potential problem because the findings from each are not equal or necessarilycomparable. However, the team assessed each source for quality and ensured they met aminimum standard of rigor. The team also did not presume to compare findings from dissimilarstudies but instead presented the findings independently. Therefore, the methods of eachshould make a minimal difference when assessed in this review.Limited DataThere are some gaps in available data, including limited research specific to Ethiopia. Forexample, there were numerous sources analyzing GBV interventions that took place inneighboring countries, but due to the nature of this study, we were limited to examiningprograms that are already proven to be effective in Ethiopia. Many other countries also havemore effective GBV laws, but these were outside the scope of this paper. As a result, thenumber of sources that were applicable to our narrow parameters was limited.6

Systematic Literature ReviewGender-Based Violence in EthiopiaIn addition, based on the literature reviewed we have determined that there is a lack ofdifferentiation between different forms of GBV in the data, incomplete information on the existingstate or customary laws, and some uneven amounts of research on the different forms of GBVthat we have identified. FGM, IPV, child marriage, and sexual violence do not all have equalnumbers of quality studies analyzing their magnitude, laws, and impacts. In particular, thereappeared to be substantially less reliable data on and fewer interventions targeted at IPV.Another gap in the data was marital rape, due to the fact that in most Ethiopian laws andstandard definitions, marital rape is not considered rape. Furthermore, the quantitative dataregarding the magnitude of GBV in any study is almost always limited and frequentlyunderestimates the ac

Washington University master’s students conducted a literature review on GBV in Ethiopia. Research questions examined the m agnitude of GBV in Ethiopia, GBV laws and policies and their enforcement, the implications of GBV for development work in Ethiopia

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