Healthcare systems’ readiness to address gender-based violence during COVID-19 and beyond in Pakistan: a mixed methods study

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BACKGROUND: The COVID-19 pandemic has exacerbated gender-based physical, financial, sexual, and psychological harm on a global scale, resulting in a surge of gender-based violence incidents. Consequently, there has been an increased demand for Sexual Reproductive Health Services (SRHS) in response to the pandemic. This study aims to comprehend the impact of COVID-19 on contraception, comprehensive abortion care, sexually transmitted infections (STIs) prevention and treatment, and Gender-based violence (GBV) support at both sub-national and facility levels. METHODOLOGY: An explanatory sequential mixed-methods study was conducted from October 2021 to September 2022 across 9 public and private healthcare facilities in Sindh, Pakistan. Quantitative data were collected from 250 participants (156 women and 94 partners), and facility readiness assessments were conducted using WHO-adapted Service Availability and Readiness Assessment tools. Qualitative in-depth interviews were subsequently conducted with purposively selected women, partners, and 33 healthcare providers until thematic saturation was achieved. Quantitative and qualitative findings were integrated during analysis and interpretation. RESULTS: Only 33.3% (3/9) of facilities routinely screened for domestic violence, 11.1% (1/9) provided referral linkages to external GBV support services, and 11.1% (1/9) had healthcare providers trained in GBV response within the preceding six months. Health Management Information Systems documented GBV cases in only 11.1% (1/9) of facilities. Qualitative findings indicated increased violence during the pandemic, driven by economic stress, unemployment, and restricted mobility, while sociocultural stigma, lack of trained personnel, and weak referral systems limited service utilization. CONCLUSION: The study identified notable deficiencies in healthcare facilities' preparedness to address instances of violence against women. These deficiencies encompassed the absence of national guidelines, limited resources, inadequate identification methods, scarce referral services, and insufficient privacy measures. Moreover, a lack of training for healthcare practitioners jeopardizes their capacity to provide adequate care and support to GBV victims and survivors.

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