Hospital-based services for survivors of sexual violence in Ethiopia: who is missing out? A mixed-methods study

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.

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.

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.

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.