Peer-reviewed article
Hospital-based services for survivors of sexual violence in Ethiopia: who is missing out? A mixed-methods study.
Woldie SA, Block K, Geremew F, Armstrong G, Diemer K et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined who uses hospital-based sexual violence services in Ethiopia by analyzing 5 years of medical records from 2,283 women and girls, combined with interviews with survivors and service providers. Most hospital clients were under 15 years old and reported assault by strangers, but qualitative interviews revealed that adult women, particularly those experiencing intimate partner sexual violence, avoid these services due to stigma, fear of retaliation, and beliefs that services focus on criminal evidence rather than care. The findings show a significant gap between the survivors seeking hospital help and the actual population of sexual violence survivors in Ethiopia.
Key points
- 43.9% of women and girls using hospital services were under 15 years old
- Over 93.5% sought services for sexual violence, with 71.0% reporting strangers as assailants
- Adult women survivors, especially those experiencing intimate partner sexual violence, avoid hospital services due to stigma and fear of retaliation
- Survivors perceived hospital services as primarily focused on gathering criminal evidence rather than providing comprehensive care
- Marital rape is not illegal in Ethiopia, which discourages women from seeking help for partner violence
Limitations
This study describes who is and is not using existing services, but cannot directly measure the prevalence of sexual violence in the broader population or fully explain all reasons why survivors choose alternative responses. The findings are specific to hospital-based services in Ethiopia and may not reflect the experiences of survivors in other settings or those using non-hospital services.
Abstract
Background Internationally, investment in hospital-based services for sexual violence is increasing. However, service providers, including in low-income countries such as Ethiopia, report discrepancies between the profile of survivors seeking help and those identified in population-based studies. Research on this remains limited. Methods An explanatory mixed-method study design was employed, analysing 5 years' of retrospective records of 2283 women and girls attending hospital-based violence response services in Ethiopia; alongside interviews with 20 survivors of sexual violence and 17 key informants. Quantitative data were analysed using Stata V.18 to produce descriptive statistics. Interview data were analysed thematically. Results Analysis of hospital violence response services' records showed that 43.9% of women and girls seeking services were under 15 years old. Over 93.5% sought services for sexual violence, and 71.0% reported their assailants were strangers. Qualitative interviews revealed that adult women survivors of sexual violence, especially survivors of intimate partner sexual violence, were unlikely to seek help at hospital-based services due to stigma, fear of retaliation, perceptions that services are primarily for gathering criminal evidence rather than providing comprehensive care, and that marital rape is not illegal. Conclusions Analysis of records from hospital-based violence response services revealed a cohort of young clients, largely reporting non-partner sexual violence-in contrast to what might be expected from national prevalence data. Addressing barriers to hospital-based services and ensuring these services provide care for all survivors is essential.