Comprehensive Care for Survivors of Sexual Violence in Zambia
This study uses the introduction of emergency contraception (EC) as a catalyst for increasing sexual assault survivors’ access to a broad spectrum of health, forensic, legal, and psychosocial services.
This study, carried out in three districts of Zambia's Copperbelt Province, worked to develop a model of comprehensive care for survivors of sexual assault. The project began in early 2005 as an effort to reduce unwanted pregnancy among survivors of sexual assault through the provision of emergency contraception (EC). In early 2007, the project entered its second phase, expanding its focus to include increasing survivors' access to justice, HIV and AIDS services, and psychosocial counseling. These activities constitute part of the Council's multicountry initiative to develop models of comprehensive care for survivors of sexual violence across Africa.
From 2005 to 2008, Zambia's Ministry of Home Affairs (Police Service), the Ministry of Health (MOH), and the Population Council collaborated on an operations research study designed to improve services for survivors of gender-based violence (GBV). Specifically, the study tested the feasibility of police provision of emergency contraception, a contraceptive method that prevents unwanted pregnancy within 120 hours of unprotected sex. It also hypothesized that the intervention could strengthen GBV services at both police and health facilities through an increased emphasis on multisectoral collaboration.
Under the intervention, Victim Support Unit (VSU) officers were trained to deliver EC to eligible survivors of sexual violence (rape and defilement), and to refer survivors to health facilities for appropriate clinical management and forensic evidence collection. To ensure the quality and safety of such services, VSU officers were trained under the Ministry of Health’s Community-based/Employer-based Family Planning Distributor curriculum, and oversight was provided by a health provider. The study was implemented in five police stations in the Copperbelt's Ndola District and was guided by a multisectoral steering committee.
The study was evaluated through service provision data; a knowledge, attitudes, and practices survey of providers; and focus group discussions. Major findings included:
- Police can safely and effectively provide EC. Over the life of the intervention, VSU officers provided a total of 357 doses of EC to survivors of sexual violence. No adverse events or incidents of misuse were reported. Health sector staff were pleased with the intervention, noting, "We haven't faced any challenges regarding these EC being administered by police officers. If any, it has made our job easy because by the time survivors come to the hospital, they already have received some help so we just pick up from where our friends ended."
- Reporting of sexual violence cases increased by 48 percent in participating police stations from 2006 to 2007, and community members noted, "Now we quickly report to the police because we know we will find assistance like EC."
- Trained VSU officers consistently referred survivors for other health services, including postexposure prophylaxis for HIV, with three of the five intervention sites reporting referral rates of 95 percent or higher.
- The program was perceived by provincial management as successful, sustainable, and cost-effective. According to a one official, "This program is resource-cheap in the sense that it doesn't need a lot of funds to be sustained; keeping in mind that the most expensive part of sustainability of such programs is manpower which we partly have in an already existing system."
The MOH and the Ministry of Home Affairs have now requested that this program be scaled up nationally.
The Copperbelt model of integrated care for survivors of rape and defilement: Testing the feasibility of police provision of emergency contraceptive pills (PDF)
Keesbury,Jill; Zama,Mary; Shreeniwas,Sudha
Publication date: 2009
Sexual and gender-based violence
Duration: 1/2005 - 12/2008
Population Council researchers:
Mary Thole Zama
Zambia Ministry of Health
Zambia Ministry of Home Affairs