Women and girls at the centre: Integrating health and gender-based violence programs in Cox’s Bazar

by 15th May 2020
Women and Girls Safe Space, Camp 12. CARE GBV staff pictured Left to Right: Ayesha Siddika (GBV Case Worker), Fouzia Akter (GBV Case Worker), Shefa Sikder (Technical Advisor), Tamanna Akter (GBV Response Officer) Women and Girls Safe Space, Camp 12. CARE GBV staff pictured Left to Right: Ayesha Siddika (GBV Case Worker), Fouzia Akter (GBV Case Worker), Shefa Sikder (Technical Advisor), Tamanna Akter (GBV Response Officer)

Our experience shows that integrating sexual reproductive health (SRH) and gender-based violence (GBV) services into community-led outreach programmes, which prioritise feedback and interaction, are key if we are to meet the needs of women and girls during a crisis. In Cox’s Bazar, women and girls sit at the heart of conflict and fragility as part of the largest stateless population in the world. A new Rapid Gender Analysis of the potential impact of COVID-19 in Cox’s Bazar shows that women and girls face significant risks of a rollback of their rights. A quarter of healthcare workers already report fewer women visiting health facilities, and 43% have heard of a pregnant woman or mother dying in the last week. CARE is calling upon donors and governments to fund SRH and GBV services, as essential services in the COVID-19 response, in line with the Minimum Initial Service Package (MISP).

Crises often lead to negative coping behaviours that particularly affect women and girls including child/forced marriage, trafficking, and sexual violence. When nearly one million Rohingya refugees fled into Bangladesh in 2017, a CARE gender analysis documented extreme sexual violence, physical assault, and mutilation during the influx, with rape used as a weapon in the conflict. Marginalisation was compounded for women and girls with disabilities, those who are pregnant, and female-headed households which are already at higher risk of poverty and exclusion from services. CARE was one of the first humanitarian organisations to provide SRH services during the initial emergency, and based on the need to integrate services, we began to provide multi-sectoral programmes for SRH and GBV support.

The effects of COVID-19 threaten to cause further constraints on women’s mobility, autonomy, and decision-making power in Cox’s Bazar. Unpaid care work performed by women and girls has increased due to COVID-19. This work includes parenting responsibilities, collecting water, and maintaining household hygiene. Most frontline health workers are also women, and they are at increased risk of exposure to the virus as they perform their duties. The key findings of the recent rapid gender analysis include:

  • Women are being blamed for COVID-19, resulting in a rollback of women’s rights, including mobility, access to services and information. Some men, women, and community leaders are blaming women’s “dishonorable” behaviour as the cause of the virus, resulting in a backlash against women’s rights. Women are experiencing more behaviour policing, mobility restrictions, and GBV.
  • Mobility restrictions and the reallocation of health resources to COVID-19 response is reducing women’s access to lifesaving services. A quarter of all healthcare workers report fewer women visiting health facilities, and 43% have heard of a pregnant woman or mother dying in the last week. Potential closure of women’s safe spaces and restricted access for humanitarians means that women and transgender people are afraid to report GBV and fear that perpetrators will act with even more impunity.
  • Women are largely excluded from decision-making systems in the community, and their lack of access to reliable information, consultations, and feedback mechanisms limits their ability to influence both prevention and response plans.

Given the vulnerability of women and girls to adverse consequences during crisis, continuing the provision of SRH and GBV services remains crucial. Intentional integration of SRH/GBV services allows programmes to leverage health services and safe spaces as entry points to comprehensively meet the needs of women and girls. A new case study from CARE details key practices and lessons learned in implementation of integrated approaches. Key findings include:

  • Combining outreach through static centres, mobile clinics, and community and household visits makes it possible to integrate SRH/GBV services in a fragile context.
  • It is critical to engage refugees and host communities in services and outreach.
  • Supportive supervision, adaptive management, and standardized messages are key to streamlining and integrating services.
  • Community interaction is key: using outreach models to address concerns and answer questions improves community acceptance of a wider range of services to meet women’s health needs.

In the context of COVID-19, recommendations include:

  • Maintain SRH/GBV services. These are currently recognised by the Cox’s Bazar Humanitarian Response as essential services and must continue.
  • Include messaging on the availability of services and COVID-19 information as part of existing community outreach model, where households are visited by host community staff and Rohingya volunteers. These channels are considered safe and accessible for women.
  • Continue to track rumors and misconceptions and develop targeted messages that address stigma for outreach teams to use when engaging households.
  • Ensure all women frontline workers have sufficient information, services and tools to protect themselves and their families.

To address immediate needs of women and girls in Cox’s Bazar and other contexts during COVID-19, CARE is calling upon donors and governments to fund SRH and GBV services as essential services in line with the Minimum Initial Service Package (MISP). In addition, all actors involved in COVID-19 response must make efforts to implement gender-transformative programmes which promote equal gender and power dynamics. For example, CARE’s programmes with the Rohingya population in Myanmar address support for positive gender norms among men and boys and promote women’s livelihoods and economic empowerment. Through this crisis and others, it remains vital to centre responses around the needs of women and girls through integrated services and ongoing outreach and engagement.

Further information is available in these publications:

Author: Shegufta Shefa Sikder, with contributions from Milkah Kihunah (CARE USA GBV Global Advocacy Director) and Emily Janoch (CARE USA Knowledge Management Director)

Shegufta Shefa Sikder

I have worked with CARE USA a Senior Technical Advisor since 2018. For 2 years I was located in Bihar to support CARE India’s programs to strengthen government health programs, specifically for reproductive health and gender-based violence prevention. 

I previously worked with USAID’s Office of Population and Reproductive Health as a Senior Technical Advisor for bilateral health investments in India, Bangladesh, Nepal, Afghanistan, Myanmar, and East Africa. Prior to that, I worked in northwest rural Bangladesh studying emergency obstetric care, reproductive health and maternal morbidity. I completed my PhD in Epidemiology from the Johns Hopkins Bloomberg School of Public Health.

I am passionate about advancing social norms for gender equality, particularly for vulnerable populations.

Twitter: @sssikder