Formative Assessment of Access to Sexual and Gender-Based Violence Services in Ethnic Areas in Kayin State - In Collaboration with the Karen ...
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Formative Assessment of Access
to Sexual and Gender-Based
Violence Services in Ethnic Areas
in Kayin State
In Collaboration with the Karen Department of Health and
Welfare and the Karen Women’s Organization
January 2021
Empower communities. Transform lives.Community Partners International
Formative Assessment of Access to Sexual and Gender-Based Violence Services in Ethnic Areas in Kayin State
January 2021
LIST OF ABBREVIATIONS
BGF Border Guard Force KDHW Karen Department of Health
CPI Community Partners and Welfare
International KNU Karen National Union
CSO Civil Society Organization KWO Karen Women’s Organization
DKBA Democratic Karen Benevolent LNGO Local Non-Governmental
Army Organization
ECBHO Ethnic and Community-Based OSSC One-Stop Service Center
Health Organization PEP Post-Exposure Prophylaxis
EHO Ethnic Health Organization SRH Sexual and Reproductive
FGD Focus Group Discussion Health
GBV Gender-Based Violence SRHR Sexual and Reproductive
HIV Human Immunodeficiency Health and Rights
Virus STI Sexually Transmitted
INGO International Non- Infection
Governmental Organization WGF Women and Girls First
Program
CONTENTS
Executive Summary 3
Key Recommendations 4
Introduction 5
Methods 5
Findings 6
Care Seeking Pathways for GBV Services 7
Barriers to Care Seeking 8
Priorities for Improving GBV Services 9
Supporting Health Workers 10
Summary 11
Limitations 11
Acknowledgments 12
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Formative Assessment of Access to Sexual and Gender-Based Violence Services in Ethnic Areas in Kayin State
January 2021
EXECUTIVE SUMMARY
The findings from the assessment
In 2017, Community Partners International demonstrated that women and girls
(CPI) and the Karen Department of Health face risks including rape, sexual assault,
and Welfare (KDHW) coordinated to provide intimate partner violence, forced marriage,
the first program to integrate sexual and and emotional and psychological abuse.
reproductive health (SRH) and gender-based However, definitions of GBV in the
violence (GBV) services in ethnic areas of community were more likely to reflect
southeast Myanmar. This collaboration takes transgressions of social and gender norms,
a multi-sectoral approach to address the such as premarital sex and adultery. Intra-
specialized health, legal and social welfare marital rape and other forms of violence
needs of survivors of GBV, as well as the were often considered a “fact of marriage.”
SRH needs of women living in remote,
conflict-affected, and hard-to-reach areas. Typically, the only support that would be
sought for GBV would be mediation by
CPI established a One-Stop Service Center the village leader(s) between spouses, or
(OSSC) in Kyainseikgyi township, which acts negotiation of a financial settlement and/
as a walk-in SRH clinic, a referral center or marriage between a rape survivor and
for GBV cases identified by 13 upgraded the perpetrator. Parents and village leaders,
KDHW clinics, and a provider of outreach who were considered to be the first or only
services to remote villages in collaboration source of support for GBV survivors, often
with KDHW. CPI trained KDHW health staff acted as gatekeepers who would either
on case management for GBV survivors facilitate or prevent women from seeking
and syndromic management of sexually specialized care and support. Internalized
transmitted infections (STIs). CPI and KDHW shame was a powerful deterrent for women
have conducted community education and when it came to seek both general SRH
awareness raising sessions about SRH, GBV, services as well as GBV service needs.
and the existence of these targeted services.
Women reported that a survivor of GBV
Despite the high level of unmet need for would avoid seeking health care unless her
SRH and GBV services in the program’s life were threatened, for fear of bringing
implementation areas, the uptake of formal shame on herself or her family. For women
clinical services remained low in the first who did seek health care services for GBV,
year of implementation. In collaboration with they reported service gaps included mental
KDHW and Karen Women’s Organization health and psychosocial support, and
(KWO), CPI conducted a formative survivors emphasized the importance of the
assessment of the awareness, accessibility, availability of a female service provider and
and acceptability of these SRHR and GBV consultation rooms that ensure audio and
services through qualitative interviews and visual privacy.
focus group discussions with KDHW leaders,
KDHW health providers, GBV survivors The safety and security of women and their
and women of reproductive age in project children remained an ongoing concern
areas to better understand patterns of care beyond the immediate GBV programmatic
seeking for SRHR and GBV services and response, with fear of retribution and
strengthen SRH and GBV programming. The continued abuse by the perpetrator if he
assessment was conducted between May remained or returned to the village.
and September 2018.
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Formative Assessment of Access to Sexual and Gender-Based Violence Services in Ethnic Areas in Kayin State
January 2021
KEY RECOMMENDATIONS must be delivered in a way that
protects the safety and confidentiality
Based on the findings of the focus groups of GBV survivors, as well as the security
and interviews with women in Kayin State, of health care providers.
CPI makes the following recommendations:
• Community members need to be
• The provision of specialized and holistic better informed about which services
services for GBV case management by are available and how to access them.
EHO clinics is an important resource for Given that village leaders are important
women in remote and conflict-affected entry points for services, there needs
areas. However, GBV-related service to be stronger engagement of village
availability and accessibility are not leaders as well as local authorities to
sufficient in settings where health clinics support women with clear and accurate
are generally under-utilized and health information about the scope of services
care seeking is universally low. Provision available.
of specialized services must to be part
of broader health system strengthening • As frontline providers, EHO health
for EHOs to provide high-quality, workers need to be empowered to
comprehensive, and integrated primary provide effective awareness raising
health care to increase overall trust in messages about GBV and the
and utilization of the clinics. availability of GBV services. Specific
recommendations include replacing
• Opportunities for patients and flipcharts and vinyl posters with
beneficiaries to participate in program educational videos featuring actors who
design and implementation should speak local languages.
be increased to ensure that services
are accessible and appropriate. The key
recommendations from GBV survivors in
this assessment highlighted the need for
trusted (preferably female) providers who
can speak local languages and private
patient care settings. Mental health and
psychosocial support services for GBV
survivors also need to be strengthened
as an urgent priority. Safety and security
remain long-term and unmet needs for
GBV survivors and their families.
• Outreach services remain an essential
tool for reaching adult women and
especially adolescent girls who may
have limited access to clinics and should
be combined with health education
activities to increase awareness of the
available health, social, and legal support
services for GBV. Outreach services
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Formative Assessment of Access to Sexual and Gender-Based Violence Services in Ethnic Areas in Kayin State
January 2021
INTRODUCTION METHODS
In 2017, Community Partners International From May to September 2018, CPI
(CPI) and the Karen Department of Health conducted a formative assessment using
and Welfare (KDHW) coordinated to qualitative data collection methods.
provide the first program to integrate Separate FGDs were organized for
sexual and reproductive health (SRH) and unmarried women aged 18 to 24 years old
gender-based violence (GBV) services and married women aged 25-49 years old
in ethnic areas of southeast Myanmar. in order to understand how SRH needs
This collaboration takes a multi-sectoral and perceptions of GBV services may differ
approach to address the specialized health, based on age and marital status, and to
legal and social welfare needs of survivors ensure that the voices of younger women
of GBV, as well as the SRH needs of women would be heard in a setting where younger,
living in remote, conflict-affected, and hard- unmarried women may have less power and
to-reach areas. authority to speak about their experiences in
front of married women.
CPI established a One Stop Service Center
(OSSC) in Kyainseikgyi township, which acts CPI and KDHW coordinated with village
as a walk-in SRH clinic, a referral center administrators, religious leaders, and clinic
for all GBV cases that are identified by 13 staff to select FGD participants. Through
upgraded KDHW clinics, and a provider four FGDs, CPI spoke to 36 women in four
of outreach services to remote villages in villages in Kyainseikgyi and Kawkareik
collaboration with KDHW. CPI trained KDHW Townships. FGDs were conducted in
health staff on case management for GBV Burmese with the assistance of a translator
survivors and syndromic management of for Karen languages. A semi-structured
sexually transmitted infections (STI). CPI interview guide was developed to capture
and KDHW have conducted community general experiences of marriage for women
education and awareness raising sessions and girls, the types of violence experienced
about SRH, GBV, and the existence of these by married women and girls, and the
targeted services. availability of and access to services and
support for SRH and GBV needs.
Despite the high level of unmet need for
SRHR and GBV services in the program’s To safely and confidentially reach GBV
implementation areas, the uptake of formal survivors, CPI partnered with Karen Women’s
clinical services remained low in the first Organization who identified and interviewed
year of implementation. In collaboration with nine women (ages 33 to 52 years) who
KDHW and Karen Women’s Organization were willing to speak to KWO about their
(KWO), CPI conducted a situational experiences accessing health, social, and
analysis of the awareness and perceived legal services for GBV. All interviews with
appropriateness of these SRHR and GBV GBV survivors were conducted in the local
services through qualitative interviews and language of the respondent and in a private
focus group discussions with KDHW leaders, location chosen by the respondent. The
KDHW health providers, survivors of GBV semi-structured interview guide focused on
and women of reproductive age in project the decision-making around care seeking for
areas to better understand the patterns of GBV services rather than the history of the
care seeking for SRHR and GBV services and GBV incident(s) itself.
how services can be improved.
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Formative Assessment of Access to Sexual and Gender-Based Violence Services in Ethnic Areas in Kayin State
January 2021
To understand the challenges of delivering “They don’t understand this to be GBV. This
SRHR and GBV services in the program is fate.”
area and the specific health system -Interview, GBV Survivor
strengthening needs to better respond to
GBV cases, CPI also interviewed 10 KDHW While social media (i.e., Facebook) was
leaders in Mae Sot (Thailand) and Hpa-An, believed to play a positive role in raising
and conducted two FGDs with 17 KDHW awareness about GBV in Karen communities,
clinic- and community-based health care it was also perceived to contribute to forms
providers from Kyainseikgyi, Kawkareik, of (locally defined) GBV including early
Myawaddy, and Hlaingbwe townships who dating, premarital sex, and early marriage.
had been trained by CPI to deliver SRH and
GBV services under the Women & Girls First The taboo nature of discussing GBV
project. played out at the communal level, with
some variation between FGD groups.
All participants gave informed consent to Some FGD groups reported that there was
participate in the study. no incidence of GBV of any kind in their
village, “though it may happen elsewhere,”
FINDINGS while other FGD groups reported that GBV
was very common, with “8 or 9 out of 10
Even in project areas and among trained households” having household members
GBV service providers, “GBV” was who experienced GBV.
considered to be a “Western” or “urban”
term that is difficult for individuals to engage Despite these reported differences
with, both because it has no salient local in perceived prevalence, there were
meaning and because abuse of any kind can widespread reports of non-consensual sex
be difficult to discuss openly in Karen and between married partners in all FGD groups.
Burmese culture. Non-consensual sex between married
partners did not appear to be considered
There was a lack of common understanding rape by any of the participants, and was
of what the term “GBV” referred to. Reported discussed as “a fact of marriage.” Similarly,
incidences of GBV within respondents’ there were widespread reports of men
villages tended to reflect transgressions controlling or influencing a woman’s ability
of societal and cultural norms—such as to use family planning, which reflects that
premarital sex, adultery, (a wife’s) desire some women in these communities did not
to prevent pregnancy, (a wife’s) infertility, have agency to consent to protected sex
or verbal disrespect of parents by their due to prevailing gender norms.
children—rather than forms of physical,
sexual, verbal, psychological, or economic “Men have to earn money. Women have to
abuse. For women who had experienced stay at home and look after the children. He
GBV, they reported the prevailing definition has to earn money to feed his wife, so she
of the physical, sexual, and emotional has to listen to what he has to say.”
abuses that they had experienced: -FGD, health workers for the WGF program
in Kayin State
“The community or the neighbors don’t see
this as GBV. They say this is karma.” Intra-household conflict also reflected
-Interview, GBV Survivor prevailing gender norms. Respondents
described that most tension arose because
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Formative Assessment of Access to Sexual and Gender-Based Violence Services in Ethnic Areas in Kayin State
January 2021
men could not or would not provide person a woman who has experienced GBV
financially for their family or because will contact is the Village Head, or she will
women were perceived to be neglecting first seek advice from her parents who will
their childcare responsibilities. Some then contact the Village Head on her behalf.
women reported being the primary or sole Parents, especially, are sought out first
breadwinner for the family, yet arguments because they are perceived to be the most
and physical abuse could arise if the woman likely to keep the information confidential
complained when her husband spent due to a perceived mutual interest in
the earnings outside of the home against protecting the “dignity of the family.”
her wishes. Discordance over pregnancy
intentions was another commonly reported Village Heads were generally perceived
source of tension that could trigger verbal to be effective mediators who can usually
or physical abuse. Physical abuse against “solve the problem.” If the Village Head
women and girls was almost always cannot resolve the marital dispute, the
perceived to be tied to alcohol use by men. woman, or more typically, the Village Head
on her behalf, will go to the Village Tract
“If the man is addicted to alcohol, the Group. If the Village Tract Group cannot
marriage will not be happy. The economy, bring about an acceptable solution, the
the schooling, the children, and the woman can seek justice at the Township
livelihoods will all be affected. level by consulting the Township Police and
It [violence against women] is almost Township Women’s Affairs.
impossible if you are not drunk.”
-KII, KDHW Leadership Justice systems for addressing both sex and
sexual assault outside of marriage tended
CARE SEEKING PATHWAYS FOR to be similarly informal and were highly
dependent on whether a girl or woman was
GBV SERVICES a virgin at the time of assault and whether
she became pregnant as a result of the
Among women, there was no reference to
assault. As noted above, discussions on
GBV as a “health issue” or as a phenomenon
GBV tended to incorporate ideas outside of
which has health consequences. Instead,
the traditional definition of GBV, including
GBV was described universally as a
premarital sex between boyfriends and
“family issue,” a phenomenon which has
girlfriends. For both premarital sex and rape,
consequences for the marriage and
the man or boy was expected to go house-
reputational risks for children. The difference
to-house, “confessing” his wrongdoing.
between GBV as a “family issue” instead of
a “health issue” was reflected in the choice
According to FGD respondents in one
of a confidante/counselor, if a woman
village, in the case of premarital sex, the
sought outside help at all. When prompted,
male partner would pay the female partner’s
respondents agreed that a woman might
family one million MMK (US$760) to 30
go to the nearest clinic if she sustained
million MMK (US$1520) if she became
severe or life-threatening injuries, however
pregnant, with the amount conditional on
they also expressed that most women who
whether the couple would later marry. In the
experienced physical or sexual abuse would
case of rape, the perpetrator would pay the
prefer to “get better by themselves.”
survivor’s family 50 million MMK (US$3,800),
and if the rape resulted in a pregnancy, he
Instead, respondents reported that the first
would also be responsible for paying for the
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Formative Assessment of Access to Sexual and Gender-Based Violence Services in Ethnic Areas in Kayin State
January 2021
child’s living expenses and tuition until the services, with a strong preference for self-
child reached the age of 15. treatment.
The perpetrator could also be detained by “Even if they dare to tell the village leader,
the KNU for up to 1 year or forced to leave they don’t dare to go to the clinic.”
the village by the leaders. One GBV survivor -FGD, married women 25-49 years old
who was interviewed reported that her
parents arranged a marriage to her rapist “I am ashamed to tell the ‘sayarma’ [health
as a measure to protect their daughter’s provider] and I am ashamed that my
reputation in the village. neighbors will find out.”
-FGD, married women 25-49 years old
The perception that sexual assault, within
or outside marriage, is not a health issue Concerns about the long-term safety and
has significant consequences for women’s security of her whole household influenced
health, wellbeing, and opportunity to seek women’s decisions about seeking support in
justice. Among all FGD respondents, there the first place. Respondents described that
was limited knowledge of the importance some women would be too afraid of their
of seeking health care within 3 days from husbands’ response, including continued
skilled providers to access emergency violence, if she were to report him. Other
contraception, post-exposure prophylaxis women were afraid that living without a
(PEP) to prevent HIV infection and receive a husband would expose her to greater risk
forensic exam. from criminals in her community.
BARRIERS TO CARE SEEKING “I wanted to ask for support but my life was
in danger. I was afraid that my family would
Among all FGD groups, there was limited get hurt.”
knowledge of causes and treatments for -Interview, GBV survivor
common gynecological and genitourinary
health issues for women. Women and girls “If the judge does not convict him [the
preferred to treat themselves in private out husband], it [intra-household violence] will
of a sense of “shyness” which stemmed be the same as before. The other issue is
from not knowing what to say about their security. Other people will see that she is
symptoms to the health care provider and living alone. How can she feel safe if she
“shame to have someone touch them” or see has to worry about being hurt by others
their bodies, especially in cases of infection. after he’s gone? She has a family, she has
Instead, women would sometimes purchase children, so she just puts up with it, or else
medications or traditional remedies at local the children will be in trouble and it will be
shops, and trusted female family members difficult for her to get along on her own. You
were the preferred source of medical advice. see a lot of that.”
-FGD, health workers for the WGF program
“I did not go [for treatment of genital itching in Kayin State
and white discharge]. I was ashamed. I did
nothing. I asked my mother for help.” Other women might not report because
-FGD, unmarried women 18-24 years old they would not want their husbands to
Care seeking for GBV mirrors care seeking face any formal consequences, such as
for SRHR, in which internalized shame acts detainment.
as a powerful deterrent against accessing
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Formative Assessment of Access to Sexual and Gender-Based Violence Services in Ethnic Areas in Kayin State
January 2021
Religious beliefs may also play a role in survivor’s decision-making about whether
limiting care seeking behavior. to seek care at all may be influenced by
familiarity and confidence in all potential
“Other women assume that marriage is God- points of care.
given and God does not want a couple to
split up, so they bow their heads and accept More fundamental barriers to access relate
it [GBV].” to women and girl’s relatively restricted
-KII, KDHW leadership mobility. When asked if someone in their
village who had experienced physical
Despite being the most trusted entry points or sexual assault would be likely to seek
for care seeking, a survivor’s parents as services at the OSSC in Kyainseikgyi
well as the Village Heads could also be Township, one respondent replied that
gatekeepers who discouraged women from not only did she not know about the
accessing health, social, or legal services. types of services provided at the OSSC
For example, the parents of a GBV survivor in Kyainseikgyi, she did not know where
who was repeatedly raped by her husband Kyainseikgyi was nor how to get there. The
told her, “Don’t leave the house. You’re a cost and challenges a woman would face
woman. If you run away from your home, it to arrange transportation without someone
won’t be good for you.” Respondents from to accompany her were also reported as
one village reported that the Village Head barriers to seeking care at the OSSC. One
advises any woman who seeks his counsel GBV survivor reflected on the challenge of
to wait three years before deciding whether traveling to the clinic after sustaining severe
or not to separate/divorce, which conveys a injuries.
prioritization of preserving family structures
over ensuring women’s safety. One survivor PRIORITIES FOR IMPROVING GBV
of GBV reported that the Village Head had
discouraged her from reporting the incident
SERVICES
to avoid involving local security forces. Other
Among survivors of GBV interviewed for this
GBV survivors reported that the Village Head
evaluation, multiple women requested that
could give them only vague, unactionable
female service providers be available for
guidance on how to proceed with making a
any examination and treatment of (female)
formal complaint.
GBV survivors. Given the importance of
confidentiality to survivors, they advocated
Both health care workers and villagers
for more privacy in clinical care settings,
expressed concern about how opaque
noting that rooms with audio privacy were
referral pathways for GBV-related services
especially difficult to access.
would be from the perspective of a GBV
survivor. While INGOs/LNGOs, local
Mental health and psychosocial support
ECBHOs, and CSOs may coordinate at the
services as part of GBV case management
State and Township levels to prevent gaps
were reported to be inadequate. For one
and overlaps in service delivery and outline
survivor, emotional and psychological abuse
referral pathways, there remains confusion
by her husband continued throughout her
at the community level about which
medical treatment, and the mental health
organizations are providing different GBV-
support from health care providers was
related services and where. While some
noticeably lacking. Beyond the immediate
clinic staff and village leaders may be aware
GBV case management response, women
of (full or partial) referral pathways, the
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Formative Assessment of Access to Sexual and Gender-Based Violence Services in Ethnic Areas in Kayin State
January 2021
reported that safe housing for their worker of trying to break up marriages
children and themselves was a long-term in their community. Health workers were
requirement. especially concerned when, due to the
distance between remote villages and the
SUPPORTING HEALTH WORKERS clinic, they would have to sleep overnight
in the village following GBV outreach and
Both KDHW leadership and health workers awareness raising activities. In some cases,
emphasized the importance of advocating the health workers had to seek protection
to local authorities (e.g., KNU, DKBA, BGF, and stay overnight in the home of the village
and other forces) to gain their support leader.
of community engagement on GBV and
SRHR. After these central meetings, Another challenge raised by health workers
advocacy could take place at (KNU) was related to the format and content of
district and township level meetings to awareness raising materials for SRHR and
disseminate information and get feedback GBV. The posters and flipcharts used by
from local stakeholders, including Village health workers conveyed most information
Health Committees, on safe and effective by text in Burmese language in Karen
approaches for outreach. According to one settings with high levels of illiteracy, and
health worker, their illustrations of women with severe
injuries may unintentionally reinforce
“The main thing for improving GBV services patterns of low care seeking except in life-
will be to mobilize the village leaders, threatening emergencies.
because whatever you want to do at the
village level, it is up to the village head.” Health workers emphasized the importance
-FGD, health workers for the WGF program of keeping awareness raising sessions as
in Kayin State short as possible, using awareness raising
materials in local languages, and diversifying
Building and maintaining positive the messages at each session to keep
relationship with village leaders was community members’ attention.
considered important because health
workers recognized that they had no “The longer the session, the less people will
authority on their own to mobilize and listen.”
speak to villagers. Health workers also -FGD, health workers for the WGF program
recognized the importance of building trust in Kayin State
with villagers over the course of multiple
outreach visits to lose their status as It is important to note that some SRHR
“strangers” to the community. messaging related to STIs or family planning
(e.g., demonstrations of putting a condom
Health workers expressed concerns for on a banana) can be highly embarrassing
their personal safety when they reached both for health workers to deliver and for
out to women who had been identified by community members to observe in the
the Village Head as having experienced standard mixed group format of community
GBV, as well as when they conducted awareness raising sessions.
house-to-house visits for awareness raising
about GBV, especially if husbands or male “Some communities do not like the
household heads were present at the time awareness raising campaigns. The villagers
of the visit who would accuse the health are also embarrassed. They say that there
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Formative Assessment of Access to Sexual and Gender-Based Violence Services in Ethnic Areas in Kayin State
January 2021
is no such thing [GBV] happening in our SUMMARY
village.”
-FGD, health workers for the WGF program The findings from the assessment
in Kayin State demonstrated that women and girls
face risks including rape, sexual assault,
Developing educational videos using Karen intimate partner violence, forced marriage,
languages was recommended as a way to and emotional and psychological abuse.
relieve this embarrassment as well as to However, definitions of GBV in the
keep community members engaged during community were more likely to reflect
awareness raising sessions. transgressions of social and gender norms,
such as premarital sex and adultery. Intra-
In addition to providing feedback on the marital rape and other forms of violence
content of SRHR and GBV messaging, were often considered a “fact of marriage.”
health workers also advised on the timing of
awareness raising activities. Opportunities Typically, the only kind of support that would
for one-on-one and group education be sought for GBV would be mediation by
at the clinic are limited, because health the village leader(s) between husbands
workers may have to attend to other and wives, or negotiation of a financial
patients or patients themselves may prefer settlement and/or marriage between a rape
to return to their own work and household survivor and the perpetrator. Parents and
responsibilities as soon as possible. village leaders, who were considered to be
Conducting awareness raising sessions at the first or only source of support for GBV
local religious celebrations was considered survivors, often acted as gatekeepers who
inappropriate and ineffective. Health workers would either facilitate or prevent women
recommended that all community-based from seeking specialized care and support.
awareness sessions be timed according to Internalized shame was a powerful deterrent
harvest schedules and the time of day when for women when it came to seek both
members would be most willing to take time general SRH services as well as GBV service
to participate in the sessions. needs.
Health workers also emphasized the Women reported that a survivor of GBV
importance of improving both the would avoid seeking health care unless her
consistency and appropriateness of care for life were threatened, for fear of bringing
all SRHR services to increase uptake. Health shame on herself or her family. For women
workers reported that patients stopped who did seek health care services for GBV,
coming to EHO clinics that experienced reported service gaps included mental
stock outs of medicines and family planning health and psychosocial support, and
supplies. Women in KDHW’s catchment survivors emphasized the importance of
areas were also starting to seek care at the availability of a female service provider
public facilities that offered their preferred and consultation rooms that ensure audio
(longer-term) family planning methods, and visual privacy. The safety and security
because at the time of the assessment of women and their children remained an
few EHO clinics could provide long-term ongoing concern beyond the immediate
methods. GBV programmatic response, with fear of
retribution and continued abuse by the
perpetrator if he remained or returned to the
village.
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Formative Assessment of Access to Sexual and Gender-Based Violence Services in Ethnic Areas in Kayin State
January 2021
LIMITATIONS their personal stories, perspectives, and
recommendations.
This study was conducted as a formative
assessment with a limited sample size
to inform program design and was not
designed to be comprehensive. The study’s
definition of “GBV,” the way respondents
were selected, and the way questions
were asked led to dialogues about GBV
that focused on men as perpetrators and
women as survivors. While women and girls
are at higher risk of experiencing GBV, this
study did not capture the experiences of
men, boys, and persons of diverse sexual
orientations and gender identities (SOGI).
While there was no purposive sampling
of GBV survivors based on age, the
experiences of younger survivors were not
captured by this assessment.
The FGDs of women of reproductive age
were conducted in Burmese with the
assistance of a translator who spoke local
Karen languages, but future assessments
should emphasize collecting data in the
respondents’ native language. Finally, the
data were collected in 2018 as part of a
programmatic assessment, and the reported
findings do not reflect the adaptations to
programming in the catchment areas of
the 13 clinics and OSSC to better meet the
needs of the communities within the project
area since the study was conducted.
ACKNOWLEDGMENTS
CPI would like to express its gratitude to
KWO for their commitment to supporting
women and girls in their community, and
for supporting the data collection for this
assessment. CPI would like to thank KDHW
leadership, program staff, and health
providers for sharing their time and insights
on case management of GBV in their
communities. Most importantly, CPI would
like to thank all of the women who shared
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