Intersecting Paths of Sexual and Reproductive Health and Sexual and Gender-Based Violence

Written by Ajita Vidyarthi, Senior Advisor Gender Equality and Inclusion at Plan International Canada, Deborah Dahan, Gender Equality Officer at CanWaCH and Rebecca Boyce, Gender Equality and Social Inclusion Advisor at the Canadian Red Cross

Sexual and gender-based violence (SGBV) is one of the most pervasive human rights violations in the world. It can take multiple forms, including intimate partner violence (IPV) and non-partner perpetrated sexual violence (NPSV), female genital mutilation/cutting (FGMC), and child early and forced marriage (CEFM) among others. As of 2021, an estimated 736 million women around the world have been subjected to physical and/or sexual intimate partner violence, non-partner sexual violence, or both at least once in their life.  

Gender inequality, harmful gender norms and uneven power dynamics increase women and girls’ risk of SGBV. Ending all forms of SGBV is a critical step to advancing the agenda for sustainable development and achieving gender equality. As the 16 Days of Activism against Gender Based Violence campaign begins this week, we join the global call for action to increase awareness, promote advocacy, and create opportunities to discuss challenges and solutions. 

Over time, multiple sectors have taken up the call to end SGBV. Despite the significant strides the health sector has made in creating guidance for integrating SGBV, it remains one of the five neglected areas of sexual and reproductive health and rights (SRHR). This blog discusses the links between SRHR and SGBV and points to the need to prioritise prevention and response to SGBV in the push for universal access to SRH.

Reframing SGBV as a health issue

SGBV used to be a private matter relegated to the domestic sphere, and in some instances still is. Under banners like the “Personal is Political,” global feminist movements succeeded in bringing this issue into the public spotlight and securing its place within politico-legal systems worldwide. This led to significant victories in multiple countries, resulting in legal protections for battered women, some of which were enshrined in the 1995 Belém do Pará Convention. 

Recognizing the limitations of politico-legal protections, there has been a noticeable shift towards reframing the problem again – this time as a public health concern. This approach could potentially gather support and garner more advocates, similar to the COVID-19 Shadow Pandemic Campaign, which called for IPV to be declared a public health emergency. 

SGBV and sexual and reproductive health are intimately linked. SGBV can be used to undermine women and girls’ decision-making power, autonomy and control over decisions regarding their sexual and reproductive health. Reproductive coercion and abuse, including forced pregnancy, contraceptive sabotage, forced sterilization, forced abortion or forced continuation of pregnancy, are all forms of SGBV, which can lead to sexually transmitted infections (STIs), unwanted pregnancies, unsafe abortions and trauma. 

SGBV perpetuates negative health outcomes

Following a life cycle approach underscores how the absence of responsive health service delivery can perpetuate gender-based discrimination and SGBV. For example, in some South and East Asian communities and their diaspora, female selective abortion (linked to male/son preference) is enabled through illegal use of prenatal sex-determination technology. Between 1970 and 2010, 62 million girls in China and 43 million in India were aborted¹ for son preference – a direct outcome of clients and licensed health providers colluding to uphold harmful gender norms.

Female genital mutilation and cutting (FGM/C)² and child, early and forced marriages (CEFM) are two common examples of SGBV, practiced widely during early childhood and adolescence in large parts of Africa and Asia. FGM/C – affecting more than 200 million girls – has lifelong implications for women’s health, including negative SRH outcomes such as genital and reproductive tract infections, lower sexual desire and satisfaction, earlier pregnancies and pregnancy complications. Safeguarding children from FGM/C is a community effort and the duty of health providers. 

On CEFM, numerous studies have established the links between child marriage and poor SRH outcomes. Victims/survivors of CEFM are more likely to experience physical or sexual IPV,  early/forced pregnancy, pregnancy-related complications and unsafe abortions, contributing to high adolescent maternal mortality rates. More than 650 million women alive today were married as children. Reducing CEFM is necessary to improve the SRHR of women and girls. 

IPV, affecting one in three ever-partnered girls and women, starts during adolescence and continues across all ages. It adversely impacts women’s physical, mental, sexual and reproductive health. Globally, 38% of all murders of women are by intimate partners. IPV is a global epidemic that warrants a health sector response. 

Experiences of violence toward marginalized women, including those with disabilities, Black, Indigenous, People of Colour (BIPOC), LGBTQ2S+, sex workers, incarcerated women and pregnant women are often of a hypersexualised nature and range from forced pregnancy, to sexual violence, to forced sterilisation. Such violence can lead to lifelong trauma, negative coping mechanisms, increased risk of HIV and other STIs, unwanted pregnancies, pregnancy complications and induced abortions. Elderly women often experience neglect, abuse and undignified care. Failing to apply an intersectional lens to public health policy exposes diverse women and girls to continued risk of SGBV.

However, very few programs explicitly unpack and draw connections between the two, and instead work in silos. It is critical to find ways to better integrate SGBV and SRHR while ensuring that health systems prioritize SGBV and don’t leave it on the sidelines, even when other health emergencies arise. 

Towards integrated SRHR programming

In many places, SGBV is socially accepted and even normalized. Despite the countless women and girls, in all their diversity, who suffer in silence, many will eventually seek health services. Health professionals are socially respected in many societies and SRH services can be an early point of contact for survivors/victims of SGBV. That puts health professionals in a unique position to offer integrated, comprehensive SRH care that includes SGBV services under a socially acceptable banner.

Guidelines and joint statements have been made widely available to help ensure the integration of SGBV and SRHR. Despite these efforts, gender equality practitioners still find themselves advocating for space and resources for SGBV in SRHR programming. 

In addition to preparing yourself with facts about SGBV, the following key messages may be helpful to share with health colleagues and decision-makers in your organisation: 

• SGBV prevention and response is life-saving. The Minimum Initial Service Package (MISP) must be included and budgeted for.  
• Do not divert SGBV prevention/response resources and efforts to immediate health relief efforts (i.e., COVID-19, Ebola, cholera).
• Work on expanding health and health care access to survivors/victims of SGBV in a holistic manner that includes mental health support, regardless of legal status or gender identity.
• Create partnerships for survivor-centred coordinated care models serving survivors/victims of SGBV (for example “one-stop centres”). 
• Offer continuous training for healthcare providers and policy makers on human rights, non-discrimination and SGBV clinical protocols as laid out in the World Health Organisation’s RESPECT framework. 

There is no question that prevention of SGBV hinges on the social determinants of health and well-being. SGBV and poor SRHR are often rooted in harmful social norms and gender hierarchies. Health programs need to address these root causes that perpetuate SGBV. To help achieve this, health teams can advocate for 

• Comprehensive sexuality education programs that explicitly look at gender norms and decision-making power in relationships, 
• Awareness-raising campaigns that promote agency and women’s bodily autonomy, 
• Community-level interventions to increase support from power holders, including men and boys, around SRHR and SGBV prevention, 
• Inclusive health systems and joint referral pathways, 
• Multisectoral integration to ensure personal security, economic stability, education, jobs and community support, and 
• Health programs that secure funds for and invest in women’s rights movements to ensure the demand for SRHR includes prevention of SGBV. 

The 16 days of activism to end violence against women and girls is an annual reminder to refocus our efforts and demonstrate our commitments to preventing and responding to SGBV in all sectors. SRHR programming must continue to implement its policy frameworks towards a full SGBV and SRHR integration. This is particularly crucial at a time of frequent and protracted humanitarian crises that both increase the risks of SGBV and limit access to SRHR services.

As this issue is at once global and local, it is also essential that we in the CanWaCH membership support the implementation of the 2022 National Action Plan to end GBV, the result of major political pressure by the Truth and Reconciliation Commission, and the National Inquiry into Missing and Murdered Indigenous Women and Girls (MMIWG) commission along with women’s rights advocates nationwide and the Ministers responsible for Women and Gender Equality (WAGE).

1. While a woman’s right to abortion should remain uncontested, female-selective abortions have the potential to put entire social structures into an imbalance with long-term consequences for gender equality goals.  An example of long term consequence is evidence from India where there now exist villages in the northern states of Punjab and Haryana, with far reduced female population, resulting in trafficking of women from other, often poorer parts of the country, for purposes of marriage, sex, and reproduction. ↩︎
2. Partial or total removal of the external female genitalia or other injury to the female genital organs for nonmedical reasons. ↩︎