Humanitarian Health Work and the Silences around Incontinence among Sexual Violence Survivors
Sirén, Elina (2023)
Sirén, Elina
2023
Master's Programme in Public and Global Health
Yhteiskuntatieteiden tiedekunta - Faculty of Social Sciences
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Hyväksymispäivämäärä
2023-10-13
Julkaisun pysyvä osoite on
https://urn.fi/URN:NBN:fi:tuni-202309108078
https://urn.fi/URN:NBN:fi:tuni-202309108078
Tiivistelmä
Sexual violence, one form of gender-based violence, is assessed to be commonplace, yet underreported, across complex humanitarian emergency settings. Consequently, the long term impacts of sexual violence on survivors remain poorly recognised, and related health care needs grossly neglected. Incontinence is one of the known consequences related to experiences of sexual violence. Nevertheless, sexual violence, incontinence and continence care are all multiple silenced and stigmatised topics; combined, and in spaces lacking security and continuity of care, even more so.
Though prevalence of both sexual violence and incontinence problems among survivors remain missing pieces of a puzzle, humanitarian health workers should be competent to deal with all health conditions which potentially follow acts of sexual violence. Worryingly, however, we seem to know very little about humanitarian health professionals’ preparedness to address incontinence among survivors of sexual violence and to care for the affected individuals. In addition, proficiency alone is not enough if resources (including continence management aids) remain scarce and contexts non-supportive of care.
For its part, this explorative thesis aims to map humanitarian health workers’ preparedness to identify continence care needs among survivors of sexual violence and provide care for these individuals in complex emergencies. This aim is approached through three research questions exploring how incontinence and continence care are addressed in humanitarian health contexts; what the barriers to adequate care of these individuals are; and how sexual violence disclosures are encouraged or discouraged in these settings.
Through qualitative analysis of three distinct data sets; (1) carefully chosen humanitarian work guidelines, (2) an online questionnaire aimed at humanitarian health workers and (3) humanitarian health worker key informant interviews, the findings of this study suggest sexual violence survivors with incontinence face many types of barriers to adequate care. These are often intertwined and embedded in the wider continuum of indirect violence and range from individual level to system level barriers to hearing, understanding and caring sufficiently. Moreover, according to the key informants, shame (stigma) is strongly associated with non-disclosure (silences) of experiences of sexual violence and incontinence among survivors.
The study has highlighted the challenges of caring for sexual violence survivors with incontinence in humanitarian health contexts and suggests that silences surround both incontinence related to experiences of sexual violence and the health care needs assessment of these survivors. In conclusion, significantly more effort is required across humanitarian health care contexts to identify sexual violence survivors with incontinence and sufficiently care for these individuals.
Though prevalence of both sexual violence and incontinence problems among survivors remain missing pieces of a puzzle, humanitarian health workers should be competent to deal with all health conditions which potentially follow acts of sexual violence. Worryingly, however, we seem to know very little about humanitarian health professionals’ preparedness to address incontinence among survivors of sexual violence and to care for the affected individuals. In addition, proficiency alone is not enough if resources (including continence management aids) remain scarce and contexts non-supportive of care.
For its part, this explorative thesis aims to map humanitarian health workers’ preparedness to identify continence care needs among survivors of sexual violence and provide care for these individuals in complex emergencies. This aim is approached through three research questions exploring how incontinence and continence care are addressed in humanitarian health contexts; what the barriers to adequate care of these individuals are; and how sexual violence disclosures are encouraged or discouraged in these settings.
Through qualitative analysis of three distinct data sets; (1) carefully chosen humanitarian work guidelines, (2) an online questionnaire aimed at humanitarian health workers and (3) humanitarian health worker key informant interviews, the findings of this study suggest sexual violence survivors with incontinence face many types of barriers to adequate care. These are often intertwined and embedded in the wider continuum of indirect violence and range from individual level to system level barriers to hearing, understanding and caring sufficiently. Moreover, according to the key informants, shame (stigma) is strongly associated with non-disclosure (silences) of experiences of sexual violence and incontinence among survivors.
The study has highlighted the challenges of caring for sexual violence survivors with incontinence in humanitarian health contexts and suggests that silences surround both incontinence related to experiences of sexual violence and the health care needs assessment of these survivors. In conclusion, significantly more effort is required across humanitarian health care contexts to identify sexual violence survivors with incontinence and sufficiently care for these individuals.