EXPERIENCES OF WOMEN SURVIVORS OF SEXUAL VIOLENCE IN SEEKING MEDICALCARE IN KIBAHA DISTRICT, COAST REGION, TANZANIA BY AISHA HAMIS MKUMBIPOLLY REG. NO: N69/77794/2015 A PROJECT PAPER SUBMITTED TO THE INSTITUTE OF ANTHROPOLOGY, GENDER AND AFRICAN STUDIES IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS IN GENDER AND DEVELOPMENT STUDIES OF THE UNIVERSITY OF NAIROBI. November 2017 ii DECLARATION This project paper is my original work and has not been submitted for examination in any other university. Signature ______________________ Date: ______________________ Mkumbipolly, Aisha Hamis (N69/77794/2015) This project paper has been submitted for examination with my approval as the university supervisor. Signature _________________________ Date: ______________________ Dr. Owuor Olungah iii DEDICATION This work is dedicated to my late mom, Fatma Mganga, for her tireless efforts in ensuring I achieved the best in my studies. Without you, I wouldn’t have reached this far. May our Almighty God rest your good soul in eternal peace. iv ACKNOWLEDGEMENT I wish to express my foremost sincere and unreserved gratitude to my supervisor Dr. Owuor Olungah for his close assistance, constant encouragement, academic guidance and constructive inputs in the entire research process. I humbly acknowledge all your efforts to make this project successful. Thanks are also due to Irish Embassy for the financial support. I also express my special thanks to the entire teaching staff of the Institute of Anthropology, Gender and African Studies, for their assistance and cooperation throughout the proposal development stages. My unrivalled gratitude goes to the Regional Administrative Officer of Pwani, District Executive Director and all the staff from DMOH and Community Development Office of Kibaha District Council, the Management of Tumbi One Stop Center, especially the Social Welfare Officer, Mr. Christopher, KIKODET and the Ward Executive Officers in Mlandizi, Magindu and Kwala wards for their endless support during data collection. I humbly thank you all. To all my study subjects, thank you and be blessed for the cooperation throughout the study period. I am extremely grateful to my dear family especially my husband, Mr. Zaharan Mwabila, my beautiful daughter Layfatty and lovely son, Faysal for their patience during my absence; their encouragement and persistent support. Thanks v are also due to my siblings for the unquenchable thirst to see me succeed in life, for all the financial assistance, emotional and moral support you have given me be blessed by the grace of God. Last but not least, my sincere thanks are to our Almighty God for protecting me and other people who played part in one way or another in the process towards the completion of this study. vi TABLE OF CONTENTS DECLARATION ................................................................................................ ii ACKNOWLEDGEMENT ................................................................................. iii LIST OF FIGURES ............................................................................................ x LIST OF ABBREVIATIONS AND ACRONYMS ......................................... xii ABSTRACT………………………………………………………………….xiv 1.0 CHAPTER ONE: BACKGROUND TO THE STUDY ............................... 1 1.1 Introduction................................................................................................... 1 1.2 Problem Statement ........................................................................................ 5 1.3 Objectives of the Study ................................................................................. 8 1.3.1 General Objective ...................................................................................... 8 1.3.2 Specific Objectives .................................................................................... 8 1.4 Assumptions of the Study ............................................................................. 8 1.5 Significance of the study .............................................................................. 9 1.6 Scope and Limitations of the Study ............................................................ 10 1.7 Definition of Key Terms ........................................................................... 12 2.0 CHAPTER TWO: LITERATURE REVIEW ............................................. 13 2.1 Conceptualizing SGBV .............................................................................. 13 2.1.1 Consequences of Sexual and Gender-based Violence ............................. 14 2.2 Sexual and Gender-based Violence in Tanzania context ........................... 16 2.2.1 Socio-cultural norms related to women sexuality ................................... 17 2.2.2 Policy Frameworks for SGBV in Tanzania ............................................. 19 2.2.3 Health sector’s Responses to sexual and SGBV ..................................... 22 2.3 The experience of SGBV Survivors in seeking medical care and support . 25 vii 2.3.1 Gender inequality and women’s economic dependency ......................... 25 2.3.2 Limited knowledge on women’s health rights and on existing GBV services ............................................................................................................. 26 2.3.3 Limited access to a health care location where SGBV services are available ............................................................................................................ 27 2.3.4 Community Acceptance of SGBV and social stigma limit women’s access to services .............................................................................................. 28 2.4 Challenges faced by the women survivors of SGBV in seeking medical care .................................................................................................................... 30 2.4.1 Unavailability of medical care services ................................................... 31 2.4.2 Discriminatory Socio-cultural norms and stigma towards survivors ...... 35 2.5 Theoretical Framework ............................................................................... 37 2.5.1 Relevance of the theory to the study........................................................ 38 2.5.2 Conceptual Framework ............................................................................ 39 3.0 CHAPTER THREE: METHODOLOGY ................................................... 42 3.1 Introduction................................................................................................. 42 3.2 Description of Research Site ...................................................................... 42 3.3 Research Design ......................................................................................... 46 3.4 Study population and Unit of Analysis ....................................................... 46 3.5 Sample and Sampling Procedure ................................................................ 47 3.6 Data collection methods ............................................................................. 47 3.6.1 In-depth Interviews .................................................................................. 47 3.6.2 Key Informant Interviews ........................................................................ 48 3.7 Data Processing and Analysis ..................................................................... 50 viii 3.8 Ethical Considerations ................................................................................ 50 3.9 Challenges Encountered in the Field .......................................................... 52 4.0 CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS ............ 53 4.1 Introduction................................................................................................. 53 4.2 Demographic characteristics of the Respondents ....................................... 53 4.2.1 Community Perceptions of sexual violence in Kibaha ............................ 54 4.2.2 Forms and spheres of SGBV in Kibaha ................................................... 56 4.2.3 The cultural justifications for violence of SGBV .................................... 59 4.3 Experiences of women survivors of sexual violence in seeking medical care .................................................................................................................... 60 4.3.1 Survivors Knowledge on the formal medical support systems ............... 60 4.3.2 Survivor Utilization of existing medical care .......................................... 62 4.3.3 Type of Medical care available to survivors of sexual violence ............. 63 4.3.4 Survivor’s satisfaction with services received ......................................... 67 4.3.5 Community support towards women survivors of SGBV ....................... 68 4.4 Challenges faced by sexually abused women while seeking medical care 69 4.4.1 Socio-economic and cultural barriers ...................................................... 70 4.4.1.1 Lack of awareness on women’s health rights ....................................... 70 4.2.2.3 Insufficient resources for GBV service ................................................ 74 5.0 CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS .................................................................................. 78 5.1 Introduction................................................................................................. 78 5.2 Discussion ..................................................................................................