Factors shaping responsiveness towards sexual gender-based violence during the COVID-19 Pandemic in Africa: A systematic review

Abstract

:Background: Several studies have been conducted on effects of COVID-19 on health, social and economic situation. However, evidence on the African continet on the responsiveness to sexual gender-based violence during the COVID-19 pandemic has not been adequately documented. This paper systematically reviews evidence from the African context regarding how countries responded to sexual gender-based violence during the height of the COVID-19 pandemic.

Results: Drivers shaping the occurrence of SGBV included social and political responsiveness. The forms of SGBV experienced during the COVID-19 pandemic included; sexual; social- economic; physical emotional and domestic violence. Factors affecting responsiveness towards SGBV includes; limited availability or accessibility to the justice system, challenges accessing health services, inadequate human resources, fear of contracting COVID-19, social and economic barriers, and breakdown of social networks. Strategies for enhancing responsiveness included; training support, status on referral and linkages systems, protection services such as shelters and safety services, helplines and hotlines/communication, and collaboration on SGBV response.

Conclusion: There is need to strengthen broader systems responsiveness through collaboration by creating strategies that promote reduction of SGBV. These strategies should include; community engagement to shift social -cultural norms towards gender and sexuality, creating social development opportunities for empowering and enabling women and girls with self-help and reliant activities, leveraging on community health systems structures to detect, link and monitoring of SGBV cases as well as co-integration of traditional justice system into the mainstream.

Keywords:

• sexual gender-based violence
• COVID-19
• responsiveness
• collaboration
• training
• referral systems and linkages

1. Introduction

According to UN (1993), Sexual gender-based violence (SGBV) is defined as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life” (Rollston et al., 2020). SGBV is a major global public health problem that affects individuals across many settings, cultures, and socioeconomic backgrounds. Prior to the outbreak of the Coronavirus Disease 2019 (COVID-19) pandemic, SGBV was already a pervasive issue, with precariously higher rates reported globally (Rollston et al., 2020). As of 2018, the World Health Organization reported that approximately one in three women worldwide had experienced physical or sexual violence in their lifetime. However, the occurrence of the COVID-19 pandemic has exacerbated this problem, leading to drastic increase in SGBV cases.

Amidst the global declaration of COVID-19 pandemic, governments were under mounting pressure to swiftly implement stringent measures aimed at containing and curbing the spread of the virus. Several studies conducted during the pandemic have consistently reported that the implementation of lockdown measures created a highly conducive environment for the prevalence of SGBV (Mittal & Singh, 2020). The restrictions imposed have left survivors trapped in abusive situations, with limited access to vital support services and resources (Donato, 2020; Kofman & Garfin, 2020b; Piquero et al., 2021). This could be attributed to deep rooted power imbalances and societal norms. Furthermore, disruptions in social and protective networks, along with the closure of schools and safe spaces further heightened the vulnerability of individuals, particularly women and marginalized groups, to SGBV (Donato, 2020; Kofman & Garfin, 2020b; Piquero et al., 2021). The strain on health systems, coupled with the diversion of resources to address the pandemic, impeded the provision of comprehensive support and response mechanisms for survivors (Piquero et al., 2021). Furthermore, the increased stress, uncertainty, and social tensions stemming from the pandemic contributed to a notable rise in intimate partner violence and sexual exploitation (Kofman & Garfin, 2020b; Piquero et al., 2021). These findings underscore the urgent need for comprehensive efforts to address the underlying factors that perpetuate SGBV, while simultaneously bolstering prevention strategies, support services, and legal frameworks (Kofman & Garfin, 2020b; Piquero et al., 2021). Such measures should be sustained during and beyond the pandemic to safeguard the rights and well-being of individuals affected by SGBV.

The impact of COVID-19 has also been evident in society, including the occurrence of SGBV (Mittal & Singh, 2020) perpetrated against a person’s will and based on gender norms and unequal power relationships. SGBV includes threats of violence and coercion, which can be physical, emotional, psychological, or sexual, and can take the form of denial of resources or access to services (Sardinha et al., 2018). Many studies have been conducted on the effects of COVID-19 on health, social and economic situation (Fortier, 2020). Studies that have dealt with factors shaping responsiveness to SGBV in other countries include Domestic Violence During the COVID-19 Pandemic: Evidence from a systematic review and meta-analysis (Piquero et al., 2021); Home is not always a haven: the domestic violence crisis amid the COVID-19 pandemic (Kofman & Garfin, 2020a); Gender-based violence against women in intimate and couple relationships; The case of Spain and Italy during the COVID-19 pandemic lockdown (Donato, 2020). However, evidence on the African continent on the responsiveness to sexual and gender-based violence during the COVID-19 pandemic has not been adequately documented. This paper thereforesystematically reviews evidence from the African context regarding how these countries have responded to SGBV during the COVID-19 pandemic. The paper further unpacks strategies employed in responding to SGBV during the COVID-19 pandemic in Africa.

2. Methodology

Research Question

The research questions that guided this review include:

1. What forms of SGBV were reported in Africa during the COVID-19 pandemic?

2. What strategies were employed in responding to SGBV in Africa during the height of the COVID-19 pandemic?

3. Search strategy

A systematic search of literature was conducted in relevant electronic databases, which included PubMed, Google Scholar, and HINARI from April to August 2021 using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) guidelines. A manual search on Google Scholar was also performed to identify additional relevant studies. Articles were selected based on predetermined eligibility criteria, using the following keyword string to retrieve publications from the databases: policy OR program AND legal OR “access to justice” AND “social and economic support” AND “Social network support” AND “health system” AND “helplines and hotlines OR communication strategies” AND “Coordination OR collaboration OR community engagement AND “strengthen services” AND process. Additionally, manual searches of reference lists and grey literature were performed to identify additional relevant studies.

Study Selection

Inclusion Criteria:

The study included qualitative, quantitative, and mixed-method peer-reviewed studies conducted in the West (Ghana, Nigeria, Uganda) and East (Kenya, Republic of Congo), North (Ethiopia) and Southern (Namibia, South Africa, and Zimbabwe) African countries.

The population of interest included women in Africa affected by the COVID-19 pandemic. Studies examining the factors influencing responsiveness towards SGBV during the pandemic were also included.

Exclusion Criteria:

Studies not conducted in Africa or not focused on SGBV during the COVID-19 pandemic were excluded.

Studies not published in English languages were also excluded.

Reviews, meta-analyses and other type of publications not reporting original clinical data were excluded, their references were checked for further identification of relevant articles.

4. Data extraction

Data was extracted using a table developed by the research team, which detailed various study characteristics including authors; publication year; study design; study setting; and details regarding the intervention. Two authors were blinded and independently extracted relevant data from each article to ensure rigor.

After the preliminary screening, the full text of the selected articles was checked for eligibility. A total of n = 361 articles were identified through the application of the keyword search strategy. Duplicates (n = 90), articles not relevant (n = 157), articles (30) excluded due to titles and abstracts not addressing SGBV and COVID-19, and articles (n = 82) excluded because they were from outside Africa (Table 1). After screening, 13 articles were considered eligible for inclusion in this study. The detailed study characteristics are provided in Figure 1 below.

Figure 1. PRISMA Flow Diagram.

Table 1. Study characteristics

No	1^st Author/ year/ country [citation]	Study type/design	Study aim	Study participants	Key issues/findings
1	Elliot Mbunge, (2020) South Africa	Qualitative study (explanatory study)	The aim of this study was to review the effects of COVID-19 in the South African health system and society.	Reports, policies and guidelines from WHO, National Institute, South African Department of Health.	Slow progress in restructuring the healthcare system. Poor leadership and management to deal with the problem affecting service delivery.
2	Fawole et al., (2020) Nigeria	Case report	To describes specific scenarios of IPV reported by women during the COVID-19 pandemic in Nigeria to provide insight for policy and programmatic efforts.	case reports from organisations serving women experiencing IPV as well as media coverage of IPV	Adequate emotional and stress management programmes were introduced to help the community deal with economic stress which was associated with increased sexual gender based violence.
3	Rockowitz et al., (2020) kenya	Quatitive study (prospective cross sectional study)	This study examined patterns of sexual violence against adults and children in Kenya during the COVID-19 pandemic to inform sexual violence prevention and protection efforts.	Residents of kenya	Collaborators create safe spaces for survivors to freely complain about their violation of human rights. Very few people or community know of the existence of shelters and those who could not access them because fear contracting COVID19. Safety and protection was questionable during the pandemic. Construction shelters not prioritized and staff operating them were not considered essential workers. Shelters that do exist are also reportedly understaffed, under-resourced, and barely functioning.
4	Magdy et al., (2021) Egypt	Qualitative study	This study aimed at emergency services during COVID-19 through a dose up analysis of the efficacy of state on shelter for survivors of domestic violence.	Documents	Few African countries also introduced gender responsive interventions and policies to address the broader ramifications of COVID-19. many countries did not introduce COVID-19 related policies that addressed sexual gender violence. At the same time selected Islamic settings (Egypt) policies permit minimum force and punishment of women and children for justifiable reason. Gaps in policies and programs on to deal socio-cultural barriers to reporting domestic violence and seeking help. Evidence shows that in many countries have not enhanced legal framework that deal with crimes of SGBV. Barriers to legal enforcement was compounded with shortages of human resources and lack of capacity among law enforcers fully investigated dimensions a SGBV cases A few studies reported an Increase to Justices system responsiveness in some countries, for example normal court matters were suspended to deal with SGBV cases in Egypt. Some studies documented the lack of political will and policy tools to tackle domestic violence. Studies also indicated the lack of rapid responses and interventions that are survivor-centered, and the limited number of shelters and safety
5	Chipare (2020) Namibia	Qualitative study	Aims at discussing violence in the context of COVID-19 and proffer recommendation on how to address this growing burden.	Literature reviews	Policies and programmes were introduced in many African countries to fight against COCID 19.
6	Stark et al., (2020) Republic of Congo	Qualitative study	Exploring the sydemic of COVID-19 and gender based sexual violence in humanitarian setting making use of the leveraging lessons from Ebola	Literature reviews	Policies and programmes were introduced in order to fight COVID 19 Multilateral and localized policies and programming were considered which were essential to address the ever-expanding needs of the communities impacted by the syndemic.
7	Parry et al., (2020) South Africa	Qualitative study	Aimed on the early effects of the COVID‐19 crisis on women, specifically within the South African context.	Literature review	Evidence shows that few countries created and enhanced mechanisms to enable survivors and victims to get support via social support (friends, neighbors or the community) during the pandemic. Deliberate programmes that increase access to social network and sources of social and health support were promoted during COVID-19 lockdowns.
8	Magezi et al., (2020) Zimbabwe	Qualitative study	Exploring the role of the church in a situation of gender based violence from a pastoral care perspective during COVID-19	Literature review	Lack of alternative means of economic support and livelihood for women and girls. Religious and traditional leaders and chiefs received SGBV cases from social networks communities and offer the necessary psycho-social support to victims. Opportunities for churches to engage their congregational members towards changing their practices perpetuating SGBV were missed. Religious and traditional leaders and chiefs hardly involved in identification SGBV cases in their communities and offer help and link survivors to necessary service providers psycho-social support to victims.
9	Katana et al., (2021) Uganda	Mixed method (Cross sectional study|)	To assess adherence to public health measures and their impacts on COVID-19 outbreak in Uganda.	Ugandan residents	Inability to access social or essential health services during the pandemic.
10	Gebremesk et al (2020) Aksum town, northern Ethiopia	Quantitative study	Determining the prevalence of intimate partner violence against reproductive aged women in northern Ethiopia during COVID-19 pandemic.	All reproductive aged women	Awareness of police and judiciary about the increase of violence against women and girls during COVID-19 and provide training on how to respond, protect and refer victims and survivors to appropriate services was promoted. Promotion on training first responders on psychosocial support, including health workers, law enforcement and court officials and emergency shelter and counselling staff still operating during the crisis.
11	Nduna et al., (2020) South Africa	Qualitative study (desktop study)	This study aimed at domestic violence incidence during the COVID-19 lockdowns.	South African women (blacks)	In terms of helping services, community-based domestic violence service were limited as some shifted their services online and over the phone interventions. Persons at risk of violence struggled with public transportation to visit the police, social workers, and local NGOs. Informal sources to help were limited due to the lockdown regulations and social disconnection for people with limited data and airtime to connect with friends and families.
12	Mdluli et al., (2020) South Africa	Qualitative study	Aimed at exploring what positive changes the COVID-19 pandemic has brought for working women.	Secondary data collected.	The findings reveal that technological advancements enable women to work remotely and be present at home consistently. As a result, women spend much time with their aggressive partners at home. Job loss for women poses an economical threat for their families
13	John N et al., (2021) Kenya	Qualitative study	aimed at finding out the impact of the lock down on hard-to-reach women and girls	Women and adolescent girls	Participates felt that the government restrictive policies led to increased exposure of women and girls to different forms of GBV. Lockdown led to increased transactional sex, pregnancies, harmful practices such as drug abuse.

4.1. Quality Assessment

A narrative synthesis approach was used to summarize and analyze the findings from the included studies. Key themes and factors identified across the studies were extracted and organized. These factors were then analyzed and presented in a descriptive manner, highlighting the similarities, differences, and patterns across studies.

5. Data analysis

Data from the selected publications were analysed using a thematic analysis approach aided by NVivo 12 [QSR International UK, 20201], qualitative software (Gebrewahd et al., 2020b). Thematic analysis based on Braun and Clarke (2006) involved familiarization with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes and producing the report. We were able to identify and explore themes and relationships within the coded data. We selected concepts, themes, and patterns by reading and re-reading the included studies. All authors then separately reviewed and came to a final agreement about the themes. All the articles were imported and coded according to the respective themes.

6. Results

6.1. Drivers and forms of GBV experienced during the COVID-19 pandemic

6.1.1. Forms of GBV experienced during the COVID-19 pandemic

Studies reported various forms of GBV, including sexual violence, physical, emotional, domestic, social, and economic abuse, during the COVID-19 pandemic

6.1.2. Sexual violence

Sexual violence, especially against women and children, was one of the most reported cases of SGBV. During the pandemic, African governments like Ethiopia, Nigeria, Tunisia, and Zambia introduced COVID-19 preventive measures and policies that restricted movements, including implementation measures on isolation, “stay-at-home orders”, and the closure of workplaces and schools (Alebel et al., 2018; Fawole et al., 2021a, 2021b; Magdy et al., 2021; Polischuk & Fay, 2020). This encouraged people and families to be together in their homes for a long time, thereby creating a conducive environment for abuse. As a result, cases of gender-based and sexual violence increased. For example, the lockdown in Kenya indirectly forced victims, including women, girls, and children to spend more time at home with perpetrators of SGBV or stay in quarantine with their aggressors (Gebrewahd et al., 2020a). Among Nigerians, couples who previously had busy schedules experienced situations where male partners had enhanced sexual drive that was associated with demand for more sexual encounters than before, with or without the consent of their spouses, as a result of the lockdown (Fawole et al., 2021a; Magdy et al., 2021). Spouses who refused to have sexual encounters were beaten, raped, or physically abused (Fawole et al., 2021a). Additionally, school closures in Kenya created an environment conducive to families arranging for their girls to undergo female genital mutilation (Broekaert et al., 2021).

6.1.3. Social and economic effects of COVID19

Sexual violence was more prevalent in socially and economically disadvantaged populations. The Covid-19 pandemic worsened the economic situation for vulnerable populations, especially women. The general population could not adequately work because of the restrictions. This contributed to the loss of income to help them buy food and pay for utilities. Some women and girls were forced to engage in abusive sexual relationships as a means of survival. Women and girls who refused to engage in sexual relationships experienced withdrawal of financial support for upkeep from male partners and parents (Fawole et al., 2021a). In Kenya, mitigation measures also increased the vulnerability of girls to increased rates of child marriages due to the economic repercussions of COVID-19 (Broekaert et al., 2021).

6.1.4. Physical and Emotional/domestic abuse

Furthermore, another documented case of GBV was physical abuse because of domestic or intimate partner violence. Some studies that mainly involved women, girls, and children reported having experienced physical abuse from their partners, close family members, or someone else close to them. For example, in Nigeria, some reported having experienced physical violence such as beating, hitting with a stick, and choking (Fawole et al., 2021a; Magdy et al., 2021). Both sexual and physical violence were reported as key drivers of emotional and psychological abuse. A study conducted in Tunisia and Egypt reported survivors of sexually related offenses such as rape and defilement, as well as physical violence, as being psychologically and emotionally abused. This was associated with worsening or treating mental health and well-being problems such as depression, anxiety, and stress (Alebel et al., 2018; Fawole et al., 2021a, 2021b; Magdy et al., 2021; Stark et al., 2020). Furthermore, psychological abuse was also manifested through acts of humiliation, threats, and distress. The psychological effects were observed to be more harmful in populations with reduced means of entertainment, boredom, loss of contact with wider social circles, and economic difficulties (Sediri, Zgueb, et al., 2020). These challenges also contributed to a multitude of poor mental, sexual, and reproductive health outcomes (Sediri et al., 2020).

6.1.5. Drivers shaping occurrence of sexual gender-based violence

In the current systematic review, drivers shaping the occurrence of sexual and gender-based violence were identified and found to be associated with countries’ broader social and economic responsiveness. The policies in some countries created a fertile environment for the escalation of gender-based violence during the pandemic. For example, in Egypt, existing policies permit minimum force and punishment against women and children with justifiable reasons (Magdy et al., 2021). These policies and programs content is usually silent and/or blunt and does not adequately deal with socio-cultural issues, from social norms and patriarchal ideologies to reporting domestic violence and seeking help (Magdy et al., 2021). Gender-based violence in some settings is socially and culturally acceptable. For example, social norms support a husband’s use of violence to discipline his wife and to have sex with her even when she does not want to. It also reflects a norm that associates a man’s use of violence against his wife with illustrating his love for her (Perrin et al., 2019). Prevention of SGBV required a policy environment that dealt with the social and cultural drivers of the problem during the pandemic. This disparity in gender and equity in policy framing missed the opportunity to recognize that women and girls are vulnerable populations (Magdy et al., 2021).

Furthermore, we found that most African governments did not implement strategies to address the consequences of COVID-19. SGBV prevention and response services were deprioritized as governments shifted their resources to COVID-19 response and movement regulations and curfews, which limited the ability of women and girls to access services (Roy et al., 2021). Some African countries, such as Ethiopia, Tunisia, and Egypt, introduced gender-responsive interventions and policies to address the broader ramifications of COVID-19, which nonetheless did not document the root causes of SGBV. Similarly, very few institutions, actors, and interest groups were involved in advocacy for policy reforms on violence against women and girls and for service provision to survivors of violence over the long term (Ndedi & Kem, 2021).

6.1.6. Factors affecting responsiveness towards GBV

6.1.6.1. Limited availability or accessibility to justice system

Access to justice has been a perennial problem, especially in countries that lack a legal framework and criminal justice system that deal with crimes of SGBV (Magdy et al., 2021). Quarantine and lockdown measures resulted in limited and reduced opportunities for victims and survivors to access legal and protection services (Amadasun, 2020; Badu et al., 2020). Survivors needed to travel to a police station and court to report cases; many police stations and one-stop centers were unavailable, especially in rural and peri-urban areas. Rural communities are usually financially vulnerable groups with low economic status (Katana et al., 2021). Thus, logistics-related challenges, including transport fares, the high cost of legal fees and court procedures, and corrupt practices among police officers affect women’s access to judicial services (John et al., 2021; Katana et al., 2021). Moreover, during the pandemic, many victims reduced their reporting of cases to justice centers due to transportation service challenges and restrictions on movement. The situation was worsened in contexts where heavy deployments of law enforcement officers, such as police and military executed COVID-19 control measures and restricted movement, making it difficult for the community to report cases. Furthermore, survivors who managed to travel and report cases were unlikely to receive legal and protection services due to institutional and public office lockdowns that were associated with the suspension of court sessions during the pandemic (Fawole et al., 2021b; Katana et al., 2021; Magdy et al.,), resulting in a lack of monitoring and fast tracking of SGBV cases. Courts need to be able to provide services during such emergencies (Fawole et al., 2021a). However, a lack of innovative court platforms made it problematic to deal with cases. The majority of reported cases were poorly or partially adjudicated, which was mainly attributed to the selective and discriminatory enforcement of anti-intimate gender-based violence-related laws (Magdy et al., 2021).

In addition, the delays in accessing legal protection created a situation where perpetrators interfered with witnesses (Fawole et al., 2021b). As a result, some law enforcers, including the police, did not arrest and prosecute perpetrators because of incomplete evidence (Fawole et al., 2021a, 2021b). Additionally, public offices, such as the courts, were closed during COVID-19. Moreover, there was a strong push for many governments during the pandemic to decongest the prisons (Fawole et al., 2021b). Literature also indicates that there was a lack of rapid responses and interventions that were survivor-centered and a limited number of shelters and safety measures to detect the cases in a timely manner. Poor collaboration between various departments, including the police, justice departments, and social welfare services within the courts created referral gaps between forensic units and other relevant units for psychological support based on the approval of the survivor or victim (Alebel et al., 2018; Stark et al., 2020). The literature indicates the need for the introduction of appropriate strategies to enhance access to and enforcement of legal services during pandemic situations.

6.1.7. Challenges in accessing health services

Additionally, during lockdown, support structures for victims of violence were difficult to access, limiting support and linkages with other sources of help (Fawole et al., 2021a; Sediri et al.,2020). Remote consulting to reduce face-to-face contact and the provision of mental health and gender-based violence services were in most cases unavailable as well (Fawole et al., 2021a).

Studies also reported limited access to sexual, reproductive, and health services during the COVID-19 pandemic. The COVID-19 pandemic affected the supply chain for contraceptive (condoms) commodities by disrupting the manufacturing and transportation of contraceptives, commodities, equipment, and the provision of sexual and reproductive health services (Riley et al., 2020). Challenges of access to safe abortions due to restrictions and closures of primary health facilities was also observed (Riley et al., 2020). This creates barriers for survivors of sexual violence to equitable access to healthcare resources to prevent unwanted pregnancies and infections (John et al., 2021). Health education to promote sexual and reproductive health care—including safe abortion and contraceptive services for SGBV survivors—was limited during the COVID-19 pandemic (Riley et al., 2020). In rural areas, accessing services is a challenge because of long distances, issues associated with finding transportation, and associated costs (John et al., 2021). While schools and community-based SRH programs provided girls with a safe space away from their perpetrators and offered opportunities for guidance and counseling on how to avoid risky situations and behaviors. However, the unexpected closure of schools and community-based SRH programs that support marginalized girls and economic insecurity due to the pandemic were seen as one of the major drivers for increased exposure of teenage girls to the risk of pregnancy. This was marked by reduced access to essential services, such as menstrual hygiene products, contraceptive methods, and other SRH services for adolescents and young people.

6.1.8. Inadequate human resources

Shortages of human resources and skilled legal officers to adequately investigate SGBV cases during the COVID-19 pandemic (Gebrewahd et al., 2020a; Magdy et al., 2021) were another problem that affected the delivery of SGBV services. This was associated with less or no training in SGBV law enforcement for police, protection, and court officials (Gebrewahd et al., 2020b). Moreover, the lack of political will to enhance human resources to deal with SGBV during the pandemic affected service delivery responsiveness (Magdy et al., 2021). Consequently, a significant number of cases were discontinued or withdrawn.

6.1.9. The fear of contracting COVID-19

The attitudes of people and the community suggest that certain places, such as police stations and courts, were perceived as hotspots from which they could contract COVID-19. Consequently, fear could have contributed to the unresponsiveness of the police, judiciary, and health care workers to violence against women and girls during the pandemic (Sediri et al., 2020). Few countries had introduced appropriate strategies and policies to increase access to legal services and mitigate SGBV during the COVID-19 pandemic (Roy et al., 2021). Hence, engagement with community leaders, such as chiefs, served as the first line of response to GBV cases. This also limited the identification of high-risk individuals, which is important to strengthen the link between social and national health systems (Gebrewahd et al., 2020b).

6.1.10. Lack of finances to pay for transport

6.1.10.1. Social and economic barriers

Strategies put in place to deal with COVID-19 had profound social and economic protection system consequences. Mass quarantine and travel bans were associated with economic impacts at both business and individual levels by restricting transportation of goods, services, and personal movements. The restrictions and measures limited opportunities for women and young people involved in small-scale businesses and informal employment, resulting in their failure to trade and operate. As a result, most of them lost their revenues and income because of challenges associated with reduced sales and a collapse in business opportunities. Moreover, the rise in unemployment is another challenge that affects especially women and young people. Furthermore, married women also experienced economic hardship, with men using their power and authority to divert household income to alcohol (Fortier, 2020).

There is also reduced public expenditure on social security and community development in some African countries because of inadequate resources that were diverted to fight COVID-19 (Magezi & Manzanga, 2020; Parry & Gordon, 2021). Furthermore, the COVID-19 outbreak was also associated with reduced public investment in social security and protection in many African countries (Fortier, 2020; Hall et al., 2020). This was mainly due to the global economy’s recession, including unequal trade relationships (Hall et al., 2020). The exports and movement of goods and services between countries were exponentially reduced due to travel bans. This was associated with a trade deficit, delayed delivery of services, increased inflation, and weakened the local economy. This affected the fiscal space, where very few resources were allocated to social protection. The literature shows that very few African countries implemented specific empowerment interventions for vulnerable segments of society, including orphans, disabled people, residents of elderly homes, and shelters for street children, during the pandemic (Fawole, 2021a). This contributed to a lack of income due to the unavailability of economic activities for economically disadvantaged women and young people [Parry, 2021]. Consequently, vulnerable population groups were reported to carry a heavier burden of the devastating downstream economic and social consequences of this pandemic (Fortier, 2020; Hall et al., 2020). Negative economic responses were associated with increased reports of girls engaging in transactional sex to obtain basic necessities, such as food and sanitary towels. On the other hand, those who were married were further abused by their male partners, who did not prioritize household expenditure and used household income on beer and alcohol drinking.

Additionally, literature also reported that during COVID-19, there was less involvement of local and international organizations in social protection and empowerment for economically disadvantaged families (Magdy et al., 2021). Lack of deliberate programs to change the unequal burden undertaken by women in household chores in general impacts women’s social well-being (Magdy et al., 2021). The lack of inclusive social security programs that address these economic vulnerabilities, the creation of employment opportunities, and minimum wages is a major gap observed (Parry & Gordon, 2021). Inadequate emotional and stress management programs to help communities deal with economic stress were associated with increased SGBV cases in the community (Fawole et al., 2021b). Reduced income also creates challenges for women and girls, especially victims and survivors, to access healthcare, legal, and health services (Magdy et al., 2021).

6.1.11. Breakdown of social networks

Quarantine and restrictions in movement resulted in limited social interaction, for example, many women and girls could not have access to their regular social networks and sources of social support, or to health and other support services (Magdy et al., 2021). The lack of access services was also associated with limited opportunities to seek immediate assistance, and limited health, legal, and social services beyond hotline calls (Fawole, 2021a). COVID-19 further hampered access to social support and recreational services for children, women and girls, contributing to making them more vulnerable to violence (Magdy et al., 2021). The restriction of movements during COVID-19 decreased informal mechanisms of social support through family and close friends, where survivors could receive encouragement and emotional support during the pandemic (Fawole et al., 2021b). Local support groups and system were also paralyzed as a result of inadequate funds to sustain the programmes that promote social and psychological wellbeing (Fawole et al., 2021b). Social network is an essential step in the clinical pathway that generally aims at enhancing access to services and coping mechanism during an outbreak. A Nigerian study reported that there was inadequate enhancement mechanism that enable survivors and victims’ get support via social support from friends, neighbors, or community during the pandemic (John et al., 2020; Magdy et al., 2021). The same study also reported that there were inadequate deliberate programmes that increase access to social networks and sources of social and health support for women in vulnerable positions during the lockdown. Social networks help survivors to get required support from relevant stakeholders such as religious, and traditional leaders and health care workers who can link them to services including psycho-social support.

6.1.12. Limited prioritizing of GBV services

Ways of improving timely access to healthcare during the pandemic are crucial. This study identified that healthcare systems in Africa were already stretched, resulting in limited access to medical services, psychological screening, and rehabilitative services among survivors (Fawole et al., 2021a). We found that very few countries, such as Egypt, strengthened their emergency service capabilities during the pandemic by using innovative measures to combat domestic violence (Magdy et al., 2021). The delays in accessibility and delivery of health services were associated with critical shortages of human resources as healthcare providers and police were overwhelmed dealing with COVID-19 cases, enforcing restrictions such as isolation and quarantine, and managing emergencies in critical care (Magdy et al., 2021). The lack of prioritization of SGBV in preference to dealing with COVID-19 worsened the health conditions, such as biological, social, and mental, among survivors of SGBV (Magdy et al., 2021).

In terms of service delivery, with poor access to emergency diagnostic and testing services for survivors of rape and defilement, they had to be aware if they were exposed to infections and take immediate treatment (Magdy et al., 2021). Timely access to screening services helps the survivors obtain medical reports and the immediate initiation of preventative treatment such as post-exposure prophylaxis to prevent HIV and emergency contraceptives to prevent unwanted pregnancies. Furthermore, there was a lack of access to health services resulting in negative mental outcomes and wellbeing, such as anxiety, stress, and suicidal attempts. This is because clinical and psychological support for survivors of rape and mental health, including related traumas and emotional well-being, remained a challenge during the pandemic (Magdy et al., 2021). Another challenge included the lack of mobile SGBV services targeting survivors, especially women, girls, and the disabled. The absence of medical services further prevented survivors from obtaining medical reports required for legal procedures to begin.

6.2. Strategies for enhancing responsiveness

6.2.1. Training support

It is important to ensure the maintenance of human resources to respond to violence against women and children. The health system was stretched with shortages of human resources during the pandemic, so training and capacity building for community-based volunteers to enhance responsive care are essential. However, the evidence shows that many countries in Africa did not put in place deliberate programs to train additional actors to respond to SGBV issues during the pandemic. This created a gap in service delivery where healthcare services such as screening and multisector response were needed to care for SGBV victims. Collaboration between the victim support unit, social welfare, and health care providers in providing training on SGBV for health care providers to screen and give holistic care to violence victims was needed (Ndedi & Kem, 2021). Moreover, other additional actors require technical expertise to understand the importance of working together as sectors in enforcement and the delivery of services to survivors. Training and capacity-building opportunities for human resources to respond to SGBV issues, though neglected, are critical, as evidence suggests that countries which had organized training was associated with strengthened enforcement of anti-GBV laws which contributed to decreased violence against women (Magdy et al., 2021).

6.2.2. Status on referral and linkages systems

Literature highlighted how poor referral and linkage systems could deepen gender inequality in access to services. Strengthening monitoring of SGBV cases facilitated the early identification of survivors. The detected survivors are referred to appropriate authorities, such as one-stop centers, to enable them to access legal, medical, and psychological assistance (Riley et al., 2020). This also enabled survivors to access a safe space protected by the state. However, a lack of monitoring and strengthened referral systems resulted in limited access to SGBV services at one-stop centers. For example, a Zimbabwean study found that very few survivors accessed services at one center, including screening and legal services. Moreover, it was also observed that protection shelters continued to remain unoccupied because of poor referral system (Adhena et al., 2020).

Furthermore, studies also reported reduced outreach and health education on SGBV services; as such, many survivors and the public also lacked information on where to report SGBV issues. Few community actors are involved in conducting outreach service campaigns to make women aware of the national resources that are available to women victims of domestic violence (Magdy et al., 20212021). In Egypt, as a result of the fear of contracting COVID-19, community actors, including religious and traditional leaders and community members, were not actively involved in monitoring and linking survivors to necessary service providers (Magdy et al., 2021).

6.2.3. Protection services including shelters and safety services

Protection services, including shelters and safety services for survivors whose abusers may be family or friends or neighbors, are essential during the pandemic. The construction of shelters to accommodate survivors, which was not prioritized during the pandemic, was key (Rockowitz et al., 2020). Moreover, the state of existing shelters is extremely bad and uninhabitable (Rockowitz et al., 2020). Shelters that do exist are also reportedly understaffed, under-resourced, and barely functioning (Rockowitz et al., 2020). In Egypt, most of the shelters lacked safety protocols to ensure that survivors were protected from perpetrators (Rockowitz et al., 2020). Consequently, some survivors refused to be accommodated because of their concerns regarding the safety of the housing facilities. While some members of the community knew of the existence of shelters, there were those who could not access them out of fear of contracting COVID-19 due to a lack of PPEs (Rockowitz et al., 2020). Additionally, the limited number of shelters that exist were reported to be inaccessible to the public. More people used the church facilities as safe spaces (for shelter) and for other necessary services.

6.2.4. Helplines and hotlines/communication

Multiple barriers to delivering SGBV services via communication platforms during COVID-19 were reported in the literature. Some countries’ toll-free hotlines for survivors to report SGBV were unavailable, while communication services through officers such as police were cited in many cases as a major impediment to service delivery for SGBV survivors. Thus affecting the reporting of cases and linkage to first-line care, including psychosocial and other services (Rockowitz et al., 2020). The lack of sufficient demand creation and sensitization via social media platforms and other platforms to encourage the public to use hotline services was a common delivery barrier reported, thereby limiting coverage. Reported barriers to accessing SGBV interventions included services such as multi-sectoral services clinics, legal services, and protection within 48 hours. Limited personal resources for victims, such as the use of mobile facilities to communicate or report their situation, was another reported barrier, increasing the direct and indirect financial costs of accessing services. In some settings, communication systems that address technological issues and are gender sensitive to ensure effective services for women and girls to freely report were barriers (Rockowitz et al., 2020). Additionally, in some cases, women and girls may not feel free to communicate with male officers because it is socially unacceptable. Digital prosecution and judicial services were also missing due to underinvestment in online services and making sure that judicial systems continue to prosecute abusers amidst the pandemic (John et al., 2021).

6.2.5. Collaboration on SGBV response

Collaboration in the delivery of integrated services, including justice and treatment for survivors of SGBV, is a salient but neglected aspect. Evidence suggests that very few countries had various stakeholders such as local councils, women’s groups, mother’s unions, leadership committees, health extension workers, churches, and NGOs conducting awareness campaigns in the community to break the culture of silence on SGBV. SGBV requires a careful combination of legal measures such as arresting perpetrators, prosecution by the judiciary, and safety orders, as well as provisional societal responses including community responses, advocacy, and the provision of shelters (Fawole et al., 2021b). Moreover, heightened awareness and service delivery by community actors, including frontline workers, social workers, and the police, where victims can present with physical or psychological trauma, sexual and reproductive health complications, neglect, or other signs of abuse, including mental health services, are also important (Rockowitz et al., 2020). Evidence suggests that actors in Africa were found collaborating in delivering SGBV services at one-stop centers in terms of provision of counseling, collection of evidence, and providing medical services to survivors (Kruk et al., 2015; Parry & Gordon, 2021; Polischuk & Fay, 2020). Collaborating actors also created safe spaces for survivors to freely complain about their violations of human rights (Adhena et al., 2020).

Differing approaches to conducting sensitization and engaging broad-based stakeholders with new messages on the management and prevention of SGBV against women and girls during COVID-19 were found (Magezi & Manzanga, 2020). While many countries had limited actors’ involvement, some women-led organizations mounted pressure on their governments to pay attention to SGBV rates and ensure the availability of comprehensive SGBV services during the pandemic (Magezi & Manzanga, 2020). In some cases, some countries used religious organizations, though passively, to engage public issues such as SGBV, including Intimate Partner Violence cases during and after COVID-19 (Ndedi & Kem, 2021). Opportunities for churches to engage their congregational members in changing their practices that perpetuate SGBV were, however, missed (Ndedi & Kem, 2021). Since the churches are spread across the country, they can easily work closely with communities, including chiefs, to reduce the surge of SGBV across countries (Ndedi & Kem, 2021). These weak involvement and collaboration weaken the responsiveness to challenges associated with gender stereotypes and harmful masculinities, accentuated under COVID-19 circumstances such as increased household care work for women and financial insecurity or unemployment (Ndedi & Kem, 2021). The media discourse shifted to only reporting COVID-19 cases, whereby very little awareness against violence against women and girls was discussed during COVID-19 (Ndedi & Kem, 2021). This reduced the provision of information to the public on how survivors of SGBV can access services through referrals, obtain them safely, and get empowerment opportunities (John et al., 2021). Moreover, local and regional authorities had not made public spaces safe for women and girls throughout different stages of the pandemic (Magezi & Manzanga, 2020).

7. Discussion

This paper systematically reviewed evidence from the African context regarding countries’ responses to sexual and gender-based violence during the COVID-19 pandemic. Previous research has illustrated that public health crises exacerbate gender inequalities and place women and girls at increased risk of gender-based violence and sexual exploitation and abuse in different communities (Magezi & Manzanga, 2020). Through a systematic review of the literature, a number of strategies employed in responding to sexual and gender-based violence during the COVID-19 pandemic in Africa have been identified.

Sexual and gender-based violence has been a growing phenomenon during the COVID-19 pandemic, especially in LMICs and particularly in Africa, where health systems have been more overwhelmed (Kruk et al., 2015). In general, the pandemic has had a gender-related impact on African societies, mostly affecting women and female children, in addition to worsening the social and economic well-being of income earners. Evidence collected in over 80 countries suggests that 1 in 3 women who have been in a relationship have experienced physical and/or sexual violence by an intimate partner at some point in their lives (John et al., 2020). This was associated with inadequate inclusion of gender issues across sectors that support women and vulnerable populations to access justice (Stark et al., 2020). The slackening of police investigations may have also increased violence against women (Gebrewahd et al., 2020b).

The stay-home COVID-19 prevention measures may have contributed to an increase in gender-based violence, and for this reason, the home environment may have become an unsafe space for women during COVID-19 (Gebrewahd et al., 2020b). In fact, these mitigation efforts to protect the public from contracting coronavirus disease have been reported to cause vulnerabilities and risks to sexual gender-based violence, especially among women and girls (Sánchez et al., 2020). In this manner, movement restrictions or quarantine measures to mitigate the COVID-19 pandemic in community settings may increased the incidence of intimate partner violence (Polischuk & Fay, 2020). Meanwhile, UN women reported that these mandates resulted in the “Shadow Pandemic,” a surge in GBV worldwide that exposed pre-existing gender inequalities (Fuhrman et al., 2020). Most organizations where women and girls could seek protection were unavailable during the height of the pandemic (Sri et al., 2021), and some were forced to stay at home with their abusers and with no one to report this to. Findings from the review highlight how measures to curb the COVID-19 pandemic were particularly hard on women and young girls, as others have observed.

Globally, the COVID-19 pandemic negatively affected household economic situations. As the cases of COVID-19 persisted and the lockdown measures changed their dynamics, put economies under stress and exacerbated poverty levels. Several factors were responsible for this increase, including the loss of household income and the loss of economic stability, which resulted in men staying at home and not going to work due to lockdown orders. The worsening economic situation brought on by the COVID-19 pandemic negatively impacted individual and household economic situations, leading to abuse of women and girls, as perceived in several contexts.

Setting up an effective health information system for SGBV is critical. Though the existing health information system is sex-disaggregated, showing the association of COVID-19 with violence against women and girls and informing the response, this is still a major barrier in Africa. Studies found that many countries had not established clear national and community monitoring and reporting systems to enable tracking of the SGBV situation in Africa (Chavula et al., 2021). Very few countries publish health information regarding SGBV on digital platforms such as official Facebook and websites (Zulu et al., 2022). However, reported data on SGBV was rarely accurate because of instances of underreporting of domestic violence. This might be due to a lack of utilization of real-time data collection methodologies. Consequently, limiting the planning mechanism for how to respond to the needs of women and girls in the context of COVID-19. This also hampers service delivery, including shelters for safety and access to medical services during the pandemic (Schneider et al., 2022). There is a need for collaboration with key community health system actors, including community health workers, teachers, and community leaders, to ensure SGBV interventions are responsive and acceptable in different community settings (Magdy et al., 2021; Tetu et al., 2021; Zulu et al., 2021). This is also critical in ensuring that survivors can easily access SGBV-related services, including SRH (contraceptives) and HIV services of their choice, within the community setting (Chavula et al., 2021).

8. Limitation and strengths of the study

The main limitation of the study was the limited available research for many countries conducted in Africa that may hinder the generalizability of the findings to the entire continent. However, one of the main strengths of the study is the extensive literature search conducted, which included articles utilizing different methodological approaches such as qualitative, quantitative, and mixed-method peer-reviewed studies conducted enriched the comprehensive analysis of the topic. Furthermore, efforts were made to mitigate the limitation of missing publications by conducting multiple searches and examining reference lists, enhancing the validity and robustness of the study. Another strength of the study is the representation of studies from various regions in Africa, including Western, Eastern, Northern, and Southern African contexts. This regional diversity enhances the credibility and comprehensiveness of the findings across different contexts in Africa.

9. Conclusion

This systematic review on factors shaping responsiveness towards sexual gender-based violence during the COVID-19 pandemic in African contexts documents valuable lessons for countries to enhance their response strategies to SGBV. Community education about various forms of SGBV issues affecting women and girls especially during pandemic situations is one of the essential services in addressing inequalities and vulnerability. The study highlighted that strengthening the health system's responsiveness is essential for preventing and managing SGBV cases. These strategies should include community engagement to shift social-cultural norms surrounding gender and sexuality, creating community development opportunities that empower women and girls through self-help income generating initiatives. In addition, integrating traditional justice systems and community health systems into the mainstream approaches strengthen detection and management of cases is crucial to identify, link and monitor the cases across sectors. The study also shows the importance of social accountability mechanisms in the enhancement of community voices that provides checks and balances to authorities to improve community friendly SGBV service delivery to all. Therefore, future studies should focus on unlocking the socio-cultural dynamics, documenting the efficiency and effectiveness of empowerment initiatives in relation to how they contribute to the prevention of SGBV. Additionally, studies should be conducted to evaluate the role of comprehensive integration of traditional and community health systems response into the mainstream mechanisms to further advance knowledge on the significance of collaboration in dealing with SGBV.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

MPC and JMZ: were involved in the conception and design, analysis and interpretation of the data; the drafting of the paper, revising it critically for intellectual content. HH, CH, DJ, NS, and TM: were involved in the design, analysis and interpretation of the data; the drafting of the paper, revising it critically for intellectual content. All authors approved the final version to be published.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Not funded

Notes on contributors

Malizgani Paul Chavula

Malizgani Paul Chavula Research Officer, School of Public Health, University of Zambia

Tulani Francis L. Matenga

Tulani Francis L. Matenga Researcher- School of Public Health, University of Zambia

Hikabasa Halwiindi

Hikabasa Halwiindi Dean and Researcher – School of Public Health, University of Zambia

Caroline Hamooya

Caroline Hamooya Research Assistant- School of Public Health, University of Zambia

Noah Sichula

Noah Sichula Lecturer Community Education, University of Zambia

Deborah L Jones

Deborah L Jones Professor in Behavioral Science, University of Miami Miller School of Medicine

Joseph Mumba Zulu

Joseph Mumba Zulu Professor and Lecturer – Community Health, School of Public Health, University of Zambia