The International Day for the Elimination of Violence Against Women on 25 November, followed by the global 16 Days of Activism Against Gender-based Violence, is a moment to reflect on, renew, amplify, and strategize to achieve commitments to eliminate violence against women by 2030. Ending violence against women is possible, but only if we act together, now, says the United Ntions.

By Jacqui Stevenson
KUALA LUMPUR, Malaysia, Nov 23 2022 (IPS)

Violence against women is a global crisis, prevalent in every community and society around the world. Globally, estimates published by WHO indicate that about 1 in 3 (30%) of women worldwide have been subjected to either physical and/or sexual intimate partner violence or non-partner sexual violence in their lifetime. Yet, there is limited coordination and insufficient funding to truly address the scale of the issue.

This has catastrophic consequences for the individual women affected, who have their rights violated, bodily integrity and psychological wellbeing undermined and health harmed. It also has ramifications across society, including the costs of providing services to respond to violence and the financial impact of violence itself.

While these costs are borne across sectors, including health, policing, social services and education, among others, often efforts to reduce or prevent violence against women suffer from limited budgets and siloed funding streams. The invisible costs borne by women, and their children, families and communities, are also missing from many responses. While nearly three out of four countries have policy infrastructure in place to support multisectoral action to address violence against women and girls, only 44 percent of countries report having a national budget line item to provide health services to address violence against women.

Recent analysis indicates that foreign donors play a critical role in financing GBV interventions but funding is limited and uncertain, and fails to comply with human rights principles. Bridging the gap between policy and implementation is critical if efforts to reduce violence against women are to meet the urgency and scale required.

Ending violence against women is an urgent legal, moral and ethical imperative. Effective interventions to reduce, prevent and respond to gender-based violence in all its forms must be a priority for all governments.

In addition to ending the violation of women’s human rights and the perpetuation of gender inequality that violence against women represents, interventions to end gender-based violence contribute to achieving the sustainable development goals and more broadly to furthering the development of societies. Effective coordinated investments are a key part of achieving this necessary aim, but it is important to underscore that the case for ending violence does not turn on return for investment.

Recognising the challenges introduced by siloed budgets, UNDP and UNU-IIGH collaborated on a project, with the support of the Republic of Korea, to produce new tools and evidence on “participatory planning and paying models”. These models engage diverse community stakeholders in defining their own solutions and establishing sustainable financing for local GBV action plans.

The approach prioritises the need to engage with diverse policymakers and stakeholders at the local level to generate effective solutions to address violence against women that are both contextually relevant and locally led. The pilots were implemented in Indonesia, Peru and the Republic of Moldova.

Findings from these pilot projects have been published to mark the World Day for Elimination of Violence against Women. Importantly, the models centre the participation and leadership of women and women’s civil society, embedding women’s rights activists in local structures that develop the plans and budgets to address gender-based violence.

The core idea underpinning the participatory planning and paying approach is simple: the benefits of reducing violence are shared by everyone, so the costs can also be shared. Different sectors stand to gain from the financial benefits of reducing violence against women, but are unlikely to adequately fund a comprehensive programme of prevention and response if each acts separately.

Instead, bringing these sectors together along with local communities and other stakeholders, the project facilitated the development of local action plans (LAPs) to address GBV, using participatory methods. Each LAP addressed locally defined priorities to prevent and respond to violence with targeted benefits across a range of health, economic and social sectors and issues.

The LAPs are costed, and, just as the plan itself is participatory, so too is paying for its implementation, with ‘payers’ identified across sectors, and budgets pooled to maximise impact. Rather than siloed budgets funding a mixture of interventions and services with no coherent structure, funding streams are pooled to support a coordinated plan. Through collaboration, shared expertise and decision-making, and local community accountability, the total is greater than the sum of its parts.

Implementing this innovative model is inherently challenging. Particularly in resource-constrained settings such as the settings for these pilots, there are competing demands for limited budgets, and multiple priorities that struggle for attention and funding. Breaking down siloes to achieve shared financing is a political, contested process, and centring the voices, priorities and rights of women, especially those most marginalised, is a challenge.

A key learning from the pilot projects is the need to ensure that senior decision-makers who have budget responsibilities in key sectors and government departments, are engaged early in the process of developing LAPs to gain their support.

Despite the challenges, the benefits of shared budgeting and resource mobilisation are clear. In Peru, UNDP undertook a ground-breaking study to estimate the costs associated with failing to prevent gender based violence. The “Cost of No Prevention” study estimated the annual costs of GBV in the Villa El Salvador community (where the project pilot was implemented) at nearly $72.9 million USD (in 2018 figures), including direct costs such as health care and indirect costs such as absence from work and loss of income, borne by affected women, their children and families, networks and wider communities.

Cost estimates for the participatory planning process to prevent and respond to GBV were estimated at $256,000 USD over 2.8 years (including the costs of project initiation and development of tools and products, so will reduce over subsequent years). This is a clear demonstration of the value for money of participatory approaches to planning and paying models to address gender-based violence.

Failure to adequately prevent and respond to violence places the costs squarely on women’s shoulders. The “Cost of No Prevention” study estimated that 45% of the costs of GBV are absorbed by the affected women themselves, including the costs of increased physical and mental health problems, out of pocket expenses and lower income.

A further 11% is subsidised by households and 44% by the community, including missed school days for children affected by violence in the home, and provision of emotional support, shelter and personal loans by others in the community. Inadequate funding, siloed budgets and limited resources only increase the costs for women, communities, and societies.

Participatory planning and paying models offer a blueprint to fund and provide the services and interventions women need, want and are entitled to. Ultimately, someone must pay the price of violence against women.

Dr Jacqui Stevenson is a research consultant, leading work to generate new evidence on the intersections of gender and health, including GBV and COVID-19, at the UN University International Institute for Global Health.

IPS UN Bureau

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Credit: United Nations

By Jacqui Stevenson and Sagri Singh
KUALA LUMPUR, Malaysia, Apr 20 2022 (IPS)

As a global pandemic, COVID-19 and its continued impacts are unprecedented. Yet many of the challenges that emerged in public health responses to COVID-19 not only had precedence, but were predictable.

As the international community observes World Immunization Week (April 24-30), it is a critical moment to reflect on what lessons have, and have not, been learned, and how we can accelerate progress towards vaccine equity.

The theme of the 2022 World Immunization Week is “Long Life for All”, a framing which underscores the benefits for every individual of access to and uptake of vaccinations. However, this obscures the significant and persistent barriers that ensure that the reality of vaccination is access and uptake for some, not all.

The development of effective and safe vaccines to protect against severe COVID-19 disease is a huge scientific achievement, which placed a spotlight on vaccine development and deployment and highlighted both successes and challenges. Inequity in vaccine access has been evident between high income versus low and middle-income countries, as well as within regions and nations.

As of 14th April 2022, 65% of the total world population has received at least one dose of a COVID-19 vaccine, yet only 15.2% of people in low-income countries have received at least one dose. Even where vaccines are available, access and uptake is impeded by gender-related barriers and inequities, in communities and in health services and settings.

Data on COVID-19 vaccine disaggregated by sex is limited, with the Sex, Gender and COVID-19 Project reporting in its COVID-19 Sex-disaggregated Data Tracker that only 89 countries have ever reported sex-disaggregated data for vaccinations (at least one dose) and 67 countries for fully vaccinated. Only two countries, India and Austria, report on vaccinations for non-binary people.

Senior citizens receive their second dose of the COVID-19 vaccine in Kathmandu in Nepal. Credit: UNICEF/Rabik Upadhayay

Overall, the Data Tracker reports that global data indicates equal numbers of men and women being vaccinated, but that at the country level, there are some significant differences, including Yemen, where 93% of people with one dose are male, and Thailand where 36% are male. In terms of vaccine population coverage, in five countries reporting this data coverage is more than 5% higher in males than females, and in seven countries the reverse is true.

This indicates a critical point in discussions of gender-related barriers – the negative impact of these varies by setting and context, and affect men as well as women and gender diverse people.

As well as vaccination coverage, there are also differences in hesitancy and intention to take up the vaccine when offered or available. A systematic review of gender differences in intention to take up vaccination found that men were “on average 41% more likely to report that they intended to receive a vaccine (rather than being unwilling or undecided) compared with women”.

Gender-related barriers to vaccination exacerbated by COVID-19 have been identified by GAVI as including: limited access to health services, increasing unpaid care responsibilities disproportionately borne by women, increases in gender-based violence, and inequitable access to health information including digital platforms.

Limited ability to travel to attend health facilities, discrimination and harassment in health services, and limited decision-making power, are also significant barriers. Vaccine hesitancy among healthcare workers has also been identified as a challenge, requiring targeted messaging and efforts to work with and learn from their experiences.

Recognising the substantial gender barriers to equitable vaccine access and uptake, the SDG3 Global Action Plan for Healthy Lives and Well-Being for All: Gender Equality Working Group and the Gender and Health Hub, United Nations University International Institute for Global Health have developed a Guidance Note and Checklist for Tackling Gender-Related Barriers to Equitable Covid-19 Vaccine Deployment.

The aim of the checklist is to support efforts to ensure that as many people as possible, regardless of their gender identity and the gender norms that prevail in their communities, have equitable access to COVID-19 vaccines. Drawing on evidence of gender-related barriers and what works to address them, it offers practical actions for countries to implement to ensure that COVID-19 vaccine deployment upholds gender equality and equity, contributing to the aim of ‘long life for all’ through leaving no one behind in vaccine access.

If action is not taken to address gender barriers in COVID-19 vaccine access and uptake, we risk significant gaps in vaccination coverage, undermining the achievement of population-level immunity which is essential in curbing the pandemic.

At the individual level, many more people will become sick and die if we fail to realise the full potential of COVID-19 vaccination programmes by failing to ensure equitable access. In turn, these outcomes will lead to delayed economic recovery, exacerbating existing inequities and further marginalising those already marginalised.

The spotlight shone by the COVID-19 pandemic has also created opportunities to do things differently. Progress has been made in some key areas, which can and should now be implemented and accelerated more widely. The importance of sex and gender disaggregated data at all stages of research and development through to delivery has been more widely recognised and must now be adopted across the board.

While some countries are collecting and reporting such data, significant gaps remain, as well as the opportunity for COVID-19 to be a catalyst to act to fill these gaps. Progress has also been made in developing and delivering interventions that engage women and girls and/or marginalised people as co-designers of solutions, rather than simply recipients of interventions.

The checklist provides practical steps for actors involved in vaccine deployment to integrate attention to sex and gender in their core business and approach, to mitigate barriers at each step in COVID-19 National Deployment and Vaccination Plans (NDVPs), ensuring that gender-related barriers are prioritised not an afterthought.

The costs of failure are immeasurably high, yet the gender-related barriers that have emerged in COVID-19 vaccine deployment were anticipated and can be mitigated. The checklist outlines clear, actionable steps to effectively tackle gender-related barriers at each step of vaccine deployment, from making sex and age disaggregated data on pre- and post-market vaccine trials an essential requirement for expedited approval and emergency regulatory approval procedures, to using differentiated vaccine delivery strategies to effectively reach women, men and gender-diverse people.

By implementing the actions in this checklist, identifying and acting on known and context-specific gender-related barriers, prioritizing targeted outreach to vulnerable and disadvantaged groups and partnering with women’s organizations and other community-based groups, it is possible to address and mitigate these barriers.

It further supports integration of gender as part of the core business of governments and partnerships engaged in COVID-19 vaccine deployment and delivery, rather than an add-on or afterthought, which is often the case yet seriously undermines potential impact.

The gender-related barriers to equitable vaccine deployment are persistent but not immutable, predictable but not inevitable. We have the vaccines, we have the knowledge to deploy them equitably, what is needed now is the will to get it right.

Dr Jacqui Stevenson is a Research Consultant at the United Nations University International Institute for Global Health (UNU-IIGH). Dr Sagri Singh is the Chief of Gender and Health at UNU-IIGH. They lead the work to generate new evidence on the intersections of gender and health, including COVID-19.

IPS UN Bureau

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