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Address structural barriers to help-seeking by survivors of GBV. Strategies are required for removing key structural barriers, including direct service costs, distance to providers, and the circuitous nature of the system that responds to GBV. Eliminating the official corruption and bribery described by study participants will require a concerted and coordinated effort by each of the sectors involved (healthcare, police, local government), and the commitment of the legal sector to enforce penalties for providers or duty bearers who request bribes to facilitate services for survivors of GBV. Improve quality of care for survivors of GBV. To improve the quality of care received by survivors from all key sectors, the Government of Tanzania (GoT) and PEPFAR implementing partners will need to focus on improving the training provided, integrating GBV screening and comprehensive care into existing structures, and strengthening coordination among service providers and referral systems. Increase access to justice for survivors of GBV. These recommendations focus on eliminating two key barriers to help-seeking and receiving appropriate support through scaling up advocacy efforts to have coerced sex by partners (including marital rape) as an offense in the penal code, and expanding the range of providers who can complete a Police Form 3 (PF3), the primary legal document for reporting GBV. In tandem with legal reform, training will need to be widely instituted to raise awareness among government authorities, civil society, healthcare professionals, and the general public about the laws that protect women’s rights and punish perpetrators of violence. Help-Seeking Pathways and Barriers for Survivors of GBV in Tanzania March 2013 Page ix
Part I: Background A. Context of GBV in Tanzania During the last few decades, gender-based violence (GBV) has gained international recognition as a grave social and human rights concern. In Tanzania, GBV is widespread. In the 2010 TDHS, over 20% of Tanzanian women aged 15-49 years reported having experienced sexual violence in their lifetime and nearly 40% reported having experienced physical violence. 2 The same survey showed that 44% of ever-married women had experienced physical and/or sexual violence from an intimate partner in their lifetime. Disaggregated data for GBV among women in the regions examined in the current study are shown in Table 1. A nationally representative survey of violence against children also found that nearly 75% of girls and boys had experienced physical violence (either by an adult or intimate partner) by the age of 18 years, and that nearly 3 in 10 girls had experienced sexual violence before reaching adulthood. 3 Table 1: Prevalence of physical and sexual violence by region, women aged 15-49 years Region Ever experienced physical violence Ever experienced sexual violence All Tanzania 38.7% 20.3% Dar es Salaam 31.8% 24.1% Iringa 42.3% 26.5% Mbeya 48.8% 30.8% Source: NBS et al. (2011). Despite this high prevalence of violence, formal support services for survivors are inadequate. Although there is a growing awareness of GBV and increased efforts at a policy level to address the issue, survivors’ access to health, psychosocial, and legal services remains limited. For example, there are few known shelters for survivors in Tanzania and these are predominantly located in Dar es Salaam. 4 Moreover, an overall shortage of trained medical professionals in the country has implications for the availability of GBV-specific care. To increase the availability and quality of services available to survivors of GBV in Dar es Salaam, Iringa, and Mbeya, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has launched a multi-sectoral intervention based on five key pillars: 1) services; 2) prevention and community protection; 3) advocacy; 4) coordination; and 5) research and evaluation. 2 NBS et al. (2011). 3 United Nations Children’s Fund (UNICEF), Centers for Disease Control and Prevention (CDC), & Muhimbili University of Health and Allied Services (MUHAS). (2011). Violence against children in Tanzania: Findings from a National Survey 2009. Dar es Salaam: UNICEF, CDC, & MUHAS. August 2011. 4 Betron, M. (2008). Gender-based violence in Tanzania: An assessment of policies, programs, and promising interventions. Washington, D.C.: USAID Health Policy Initiative. Help-Seeking Pathways and Barriers for Survivors of GBV in Tanzania March 2013 Page 10
Page 2 and 3: Help-Seeking Pathways and Barriers
Page 4 and 5: Acknowledgments The authors would l
Page 6 and 7: List of Abbreviations AIDS Acquired
Page 8 and 9: included rape by a stranger, the th
Page 12 and 13: The Channeling Men’s Positive Inv
Page 14 and 15: have received $21 million, with the
Page 16 and 17: directory of service providers comp
Page 18 and 19: Part III: Results A. Community Perc
Page 20 and 21: In our area I have seen problems an
Page 22 and 23: Being humiliated in public Insults,
Page 24 and 25: 4. Differences in Participants’ P
Page 26 and 27: B. Existing Services and Sources of
Page 28 and 29: Table 2: LGA Service Providers Leve
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Page 32 and 33: C. Pathways of Help-Seeking Given t
Page 34 and 35: Figure 2: Map Drawn by Participants
Page 36 and 37: Local leaders serve as gatekeepers
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Page 46 and 47: 2. Common Structural Barriers Gende
Page 48 and 49: When I took my form [PF3] to the ho
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Page 54 and 55: Civil society organizations The key
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Page 58 and 59: efforts might be grounded in struct
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E. Increase Access to Justice for S
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Part V: Conclusion The results from
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Annex 2: Key Informant Interview Gu
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1. How do these requests differ by
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Annex 3: Key Informant Interview Gu
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4. Multi-sectoral coordination a. H
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Introduction (10 minutes) 1. Introd
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3. Perceived barriers to accessing
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Help-Seeking Pathways and Barriers
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