Help-Seeking Pathways and Barriers for ... - EngenderHealth

2. Common Structural Barriers
Gender inequality is perhaps the most pervasive structural barrier that Tanzanian women
experience across multiple domains of their lives. Many of the socio-cultural barriers
described above—women’s economic dependency, societal norms that undermine women’s
agency and dictate acceptable behaviors, expectations around marriage, etc.—contribute to
gender inequality at the macro-level. Inequality systemically constrains women’s options for
responding to violence (and also propagates GBV in the first place).
The interviews and participatory focus groups also revealed a more specific set of structural
barriers affecting survivors of GBV in the study areas. Cost, corruption, distance, gaps in
services, and lack of quality care were commonly reported by participants as posing
significant barriers for GBV. This sub-section describes these findings as they relate to both
help-seeking and service delivery.
Poverty and inability to pay
Respondents offered compelling testimony on the multitude of ways in which costs curtail
help-seeking and also negatively influence a woman’s ability to obtain services.
Respondents identified both direct costs (e.g., costs of registering at the hospital and
receiving treatment) and indirect costs (e.g., transport fees, costs of medical supplies, etc.).
These costs act as a structural barrier that cuts across provider types including the local
government, police, and healthcare system. The excerpts below demonstrate the
pervasiveness of cost as a barrier to seeking help for GBV. The final quote in the series
below further illustrates some of the hidden costs that further reduce the affordability of
obtaining care, especially for poor and/or economically dependent women. These are in
addition to indirect costs such as transport, which can be prohibitively high, especially in
rural areas.
Few of them [seek help] because of their education level, and the second thing is that …
a person is unable to cover the financial costs. Thus many of them just end up maybe
saying, “ If I go there, I will be asked to pay and I do not have any money.” That also is
an obstacle for people when seeking help.
Service provider, Dar es Salaam
There are also challenges at a police station. Yes, they might ask for some money… [if]
she doesn’t have a single cent, what will she do
Female PFG participant (18-24 years old), Dar es Salaam
Nothing is for free, from the card, medications, syringes—even the intravenous
infusions—have to be bought.
Female PFG Participant (18-24 years old), Dar es Salaam
Help-Seeking Pathways and Barriers for Survivors of GBV in Tanzania March 2013
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