Main Article Content

Abstract

Background: Gender-based violence (GBV) adversely affects the physical, sexual, and emotional health of women and girls, potentially directly influencing reproductive health. Systemic inequities, such as gender inequality and poverty that predispose women to GBV are often exacerbated in low- and middle-income countries (LMICs) where resources are limited, especially in informal settlements. Women residing within informal settlements face barriers to resources and must navigate power dynamics that put them in truly vulnerable positions. The COVID-19 pandemic exacerbated many inequities worldwide, including GBV. In this study, we explored the impact of GBV on reproductive health among adolescent girls and women (AGW) residing in informal settlements in Kampala, Uganda during the COVID-19 pandemic. 


Methods: This study utilized data from focus groups among 64 AGW living in informal settlements in Kampala, Uganda to explore experiences of GBV. Thematic analysis of focus group transcripts was conducted via deductive and inductive coding in Dedoose. 


Results: Themes identified were increased participating in sex work due to financial instability, leading to increased risk for sexually transmitted infections, unwanted pregnancy, young pregnancy, unsafe abortion leading to infertility or death, decreased educational attainment, and being pressured into undesired relationships.


Discussion: With women disproportionately experiencing GBV, it is essential to investigate its effects on women’s health. Longterm disparities in women’s health research alongside recent discourse over reproductive health and rights indicates further investigation into contributing factors, especially among those who are disproportionately at risk for facing negative social determinants of health.

Keywords

gender-based violence Intimate partner violence reproductive health sexual health women's health global health

Article Details

Author Biography

Faith Bobholz, Medical College of Wisconsin, United States

Faith Bobholz is a medical student at the Medical College of Wisconsin whose research experience centers on women’s reproductive and sexual health.

How to Cite
Bobholz, F., Oladebo, T., Kiguli, J., Bobholz, M., Nyabigambo, A., Ikonte, C., … Dickson-Gomez, J. (2025). Experiences of gender-based violence and its reproductive health impacts among adolescent girls and women residing in informal settlements in Kampala, Uganda during the COVID-19 pandemic. Pan-African Journal of Health and Environmental Science, 4(2), 116–134. https://doi.org/10.56893/ajhes2025v04i02.08

References

  1. Acosta, D. F., Gomes, V. L. de O., Oliveira, D. C. de, Gomes, G. C., & Fonseca, A. D. da. (2017). ASPECTOS ÉTICOS E LEGAIS NO CUIDADO DE ENFERMAGEM ÀS VÍTIMAS DE VIOLÊNCIA DOMÉSTICA. Texto & Contexto - Enfermagem, 26, e6770015. https://doi.org/10.1590/0104-07072017006770015
  2. admin. (2024, December 17). Somero-Uganda. https://somero-uganda.info/
  3. Anderson, R. M. (2013). Positive sexuality and its impact on overall well-being. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz, 56(2), 208–214. https://doi.org/10.1007/s00103-012-1607-z
  4. Anguzu, R., Cassidy, L. D., Nakimuli, A. O., Kansiime, J., Babikako, H. M., Beyer, K. M. M., Walker, R. J., Wandira, C., Kizito, F., & Dickson-Gomez, J. (2023). Healthcare provider experiences interacting with survivors of intimate partner violence: A qualitative study to inform survivor-centered approaches. BMC Women’s Health, 23(1), 584. https://doi.org/10.1186/s12905-023-02700-w
  5. Basson, R., & Gilks, T. (2018). Women’s sexual dysfunction associated with psychiatric disorders and their treatment. Women’s Health (London, England), 14, 1745506518762664. https://doi.org/10.1177/1745506518762664
  6. Beroza, A. J., Rine, S., Bikomeye, J. C., Magezi, R. K., Simple, O., Dickson-Gomez, J., Kyomya, M. M., Katende, D., Bojang, M., Twaibu, W., Magololo, F. M., Nyabigambo, A., Musinguzi, G., Mulamira, P., & Beyer, K. (2024). A scoping review of human papillomavirus and cervical cancer knowledge, attitudes, practices, and prevention among female sex workers in Africa. Journal of Global Health Reports, 8, e2024027. https://doi.org/10.29392/001c.124465
  7. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
  8. Bridwell, R. E., Long, B., Montrief, T., & Gottlieb, M. (2022). Post-abortion Complications: A Narrative Review for Emergency Clinicians. The Western Journal of Emergency Medicine, 23(6), 919–925. https://doi.org/10.5811/westjem.2022.8.57929
  9. Bukuluki, P., Kisaakye, P., Bulenzi-Gulere, G., Mulindwa, B., Bazira, D., Letiyo, E., Namirembe, H. N. L., Schmidt, I., Kakande, P. N., & Nissling, S. (2023). Vulnerability to violence against women or girls during COVID-19 in Uganda. BMC Public Health, 23(1), 23. https://doi.org/10.1186/s12889-022-14951-7
  10. Clarke, D., & Mühlrad, H. (2021). Abortion laws and women’s health. Journal of Health Economics, 76, 102413. https://doi.org/10.1016/j.jhealeco.2020.102413
  11. Cleeve, A., Nalwadda, G., Zadik, T., Sterner, K., & Klingberg-Allvin, M. (2019). Morality versus duty—A qualitative study exploring midwives’ perspectives on post-abortion care in Uganda. Midwifery, 77, 71–77. https://doi.org/10.1016/j.midw.2019.06.004
  12. Conroy, A. A., Jain, J. P., Sheira, L., Frongillo, E. A., Neilands, T. B., Cohen, M. H., Wilson, T. E., Chandran, A., Adimora, A. A., Kassaye, S., Sheth, A. N., Fischl, M. A., Adedimeji, A., Turan, J. M., Tien, P. C., & Weiser, S. D. (2022). Mental Health Mediates the Association Between Gender-Based Violence and HIV Treatment Engagement in US Women. Journal of Acquired Immune Deficiency Syndromes (1999), 89(2), 151–158. https://doi.org/10.1097/QAI.0000000000002848
  13. Dickson-Gomez, J., Nyabigambo, A., Rudd, A., Ssentongo, J., Kiconco, A., & Mayega, R. W. (2023). Water, Sanitation, and Hygiene Challenges in Informal Settlements in Kampala, Uganda: A Qualitative Study. International Journal of Environmental Research and Public Health, 20(12), Article 12. https://doi.org/10.3390/ijerph20126181
  14. El Salih, I., Njuguna, F. M., Widjajanto, P. H., Kaspers, G., Bailey, A., & Mostert, S. (2023). Impact of COVID-19 measures on the health and healthcare of children in East-Africa: Scoping review. The International Journal of Health Planning and Management, 38(3), 579–598. https://doi.org/10.1002/hpm.3612
  15. Emina, J., Beguy, D., Zulu, E. M., Ezeh, A. C., Muindi, K., Elung’ata, P., Otsola, J. K., & Yé, Y. (2011). Monitoring of Health and Demographic Outcomes in Poor Urban Settlements: Evidence from the Nairobi Urban Health and Demographic Surveillance System. Journal of Urban Health : Bulletin of the New York Academy of Medicine, 88(Suppl 2), 200–218. https://doi.org/10.1007/s11524-011-9594-1
  16. ESHRE Capri Workshop Group. (2017). Induced abortion. Human Reproduction (Oxford, England), 32(6), 1160–1169. https://doi.org/10.1093/humrep/dex071
  17. Ganatra, B., Gerdts, C., Rossier, C., Johnson, B. R., Tunçalp, Ö., Assifi, A., Sedgh, G., Singh, S., Bankole, A., Popinchalk, A., Bearak, J., Kang, Z., & Alkema, L. (2017). Global, regional, and subregional classification of abortions by safety, 2010-14: Estimates from a Bayesian hierarchical model. Lancet (London, England), 390(10110), 2372–2381. https://doi.org/10.1016/S0140-6736(17)31794-4
  18. Gruskin, S., Yadav, V., Castellanos-Usigli, A., Khizanishvili, G., & Kismödi, E. (2019). Sexual health, sexual rights and sexual pleasure: Meaningfully engaging the perfect triangle. Sexual and Reproductive Health Matters, 27(1), 1593787. https://doi.org/10.1080/26410397.2019.1593787
  19. Haddad, L. B., & Nour, N. M. (2009). Unsafe Abortion: Unnecessary Maternal Mortality. Reviews in Obstetrics and Gynecology, 2(2), 122–126.
  20. Hegarty, K. L., Andrews, S., & Tarzia, L. (2022). Transforming health settings to address gender-based violence in Australia. Medical Journal of Australia, 217(3), 159–166. https://doi.org/10.5694/mja2.51638
  21. Heidari, S., & Moreno, C. G. (2016). Gender-based violence: A barrier to sexual and reproductive health and rights. Reproductive Health Matters, 24(47), 1–4. https://doi.org/10.1016/j.rhm.2016.07.001
  22. Hufstetler, K., Llata, E., Miele, K., & Quilter, L. A. S. (2024). Clinical Updates in Sexually Transmitted Infections, 2024. Journal of Women’s Health (2002), 33(6), 827–837. https://doi.org/10.1089/jwh.2024.0367
  23. Huq, M. E., Raihan, M. J., Shirin, H., Chowdhury, S., Jahan, Y., Chowdhury, A. S., & Rahman, M. M. (2017). Why Abortion is Illegal? Comparison of Legal and Illegal Abortion: A Critical Review. Mymensingh Medical Journal: MMJ, 26(4), 944–952.
  24. Huschke, S., & Coetzee, J. (2020). Sex work and condom use in Soweto, South Africa: A call for community-based interventions with clients. Culture, Health & Sexuality, 22(1), 1–15. https://doi.org/10.1080/13691058.2019.1568575
  25. Katana, E., Amodan, B. O., Bulage, L., Ario, A. R., Fodjo, J. N. S., Colebunders, R., & Wanyenze, R. K. (2021). Violence and discrimination among Ugandan residents during the COVID-19 lockdown. BMC Public Health, 21(1), 467. https://doi.org/10.1186/s12889-021-10532-2
  26. Katumba, K. R., Haumba, M., Mayanja, Y., Machira, Y. W., Gafos, M., Quaife, M., Seeley, J., & Greco, G. (2024). Understanding the contexts in which female sex workers sell sex in Kampala, Uganda: A qualitative study. BMC Women’s Health, 24(1), 371. https://doi.org/10.1186/s12905-024-03216-7
  27. Kawuma, R., Ssemata, A. S., Bernays, S., & Seeley, J. (2021). Women at high risk of HIV-infection in Kampala, Uganda, and their candidacy for PrEP. SSM - Population Health, 13, 100746. https://doi.org/10.1016/j.ssmph.2021.100746
  28. Khanlou, N., Vazquez, L. M., Pashang, S., Connolly, J. A., Ahmad, F., & Ssawe, A. (2022). 2020 Syndemic: Convergence of COVID-19, Gender-Based Violence, and Racism Pandemics. Journal of Racial and Ethnic Health Disparities, 9(6), 2077–2089. https://doi.org/10.1007/s40615-021-01146-w
  29. Kumar, N., Janmohamed, K., Nyhan, K., Forastiere, L., Zhang, W.-H., Kågesten, A., Uhlich, M., Frimpong, A. S., Velde, S. V. de, Francis, J. M., Erausquin, J. T., Larrson, E., Callander, D., Scott, J., Minichiello, V., & Tucker, J. (2021). Sexual health (excluding reproductive health, intimate partner violence and gender-based violence) and COVID-19: A scoping review. Sexually Transmitted Infections, 97(6), 402–410. https://doi.org/10.1136/sextrans-2020-054896
  30. Maher, M., O’ Keeffe, A., Phelan, N., Behan, L. A., Collier, S., Hevey, D., & Owens, L. (2022). Female Reproductive Health Disturbance Experienced During the COVID-19 Pandemic Correlates With Mental Health Disturbance and Sleep Quality. Frontiers in Endocrinology, 13, 838886. https://doi.org/10.3389/fendo.2022.838886
  31. Mainey, L., O’mullan, C., & Reid-Searl, K. (2023). Working with or against the system: Nurses’ and midwives’ process of providing abortion care in the context of gender-based violence in Australia. Journal of Advanced Nursing, 79(4), 1329–1341. https://doi.org/10.1111/jan.15226
  32. Mannell, J., Ahmad, L., & Ahmad, A. (2018). Narrative storytelling as mental health support for women experiencing gender-based violence in Afghanistan. Social Science & Medicine (1982), 214, 91–98. https://doi.org/10.1016/j.socscimed.2018.08.011
  33. Mbonye, M., Nakamanya, S., Nalukenge, W., King, R., Vandepitte, J., & Seeley, J. (2013). ‘It is like a tomato stall where someone can pick what he likes’: Structure and practices of female sex work in Kampala, Uganda. BMC Public Health, 13(1), 741. https://doi.org/10.1186/1471-2458-13-741
  34. Mbonye, M., Nalukenge, W., Nakamanya, S., Nalusiba, B., King, R., Vandepitte, J., & Seeley, J. (2012). Gender inequity in the lives of women involved in sex work in Kampala, Uganda. Journal of the International AIDS Society, 15 Suppl 1(Suppl 1), 1–9. https://doi.org/10.7448/IAS.15.3.17365
  35. McBride, B., Shannon, K., Pearson, J., Krüsi, A., Braschel, M., & Goldenberg, S. M. (2022). Seeing pre-screened, regular clients associated with lower odds of workplace sexual violence and condom refusal amidst sex work criminalization: Findings of a community-based cohort of sex workers in Metro Vancouver, Canada (2010-2019). BMC Public Health, 22(1), 519. https://doi.org/10.1186/s12889-022-12903-9
  36. Moon, L., Webster, K., Ayre, J., & On, M. L. (2016). Examination of the health outcomes of intimate partner violence against women: State of knowledge paper. In /Mnt/conversions/anrows/files [Report]. ANROWS. https://anrows.intersearch.com.au/anrowsjspui/handle/1/18681
  37. Namagembe, I., Nakimuli, A., Byamugisha, J., Moffett, A., Aiken, A., & Aiken, C. (2022). Preventing death following unsafe abortion: A case series from urban Uganda. AJOG Global Reports, 2(1), 100039. https://doi.org/10.1016/j.xagr.2021.100039
  38. National Survey on Violence in Uganda (2020 Uganda National Qualitative Survey on Violence Against Women and Girls (VAWG)). (2020). https://www.ubos.org/wp-content/uploads/publications/02_2022VAWG_qualitative_report.pdf
  39. Okong, P. (2006). HIV/AIDS and women’s health in Uganda: Lingering gender inequity. Journal of Obstetrics and Gynaecology Canada: JOGC = Journal d’obstetrique et Gynecologie Du Canada: JOGC, 28(11), 980–982. https://doi.org/10.1016/S1701-2163(16)32306-4
  40. Opito, R., Tiyo Ayikobua, E., Akurut, H., Alwedo, S., Ssentongo, S. M., Erabu, W. D., Oucul, L., Kirya, M., Bukenya, L. L., Ekwamu, E., Oluka, A. I., Kabwigu, S., Othieno, E., & Mwaka, A. D. (2025). Factors associated with uptake and acceptability of cervical cancer screening among female sex workers in Northeastern Uganda: A cross-sectional study. PloS One, 20(1), e0312988. https://doi.org/10.1371/journal.pone.0312988
  41. Ostadtaghizadeh, A., Zarei, M., Saniee, N., & Rasouli, M. A. (2023). Gender-based violence against women during the COVID-19 pandemic: Recommendations for future. BMC Women’s Health, 23(1), 219. https://doi.org/10.1186/s12905-023-02372-6
  42. Pallitto, C. C., García-Moreno, C., Jansen, H. A. F. M., Heise, L., Ellsberg, M., & Watts, C. (2013). Intimate partner violence, abortion, and unintended pregnancy: Results from the WHO Multi-country Study on Women’s Health and Domestic Violence. International Journal of Gynecology & Obstetrics, 120(1), 3–9. https://doi.org/10.1016/j.ijgo.2012.07.003
  43. Pinchoff, J., Austrian, K., Rajshekhar, N., Abuya, T., Kangwana, B., Ochako, R., Tidwell, J. B., Mwanga, D., Muluve, E., Mbushi, F., Nzioki, M., & Ngo, T. D. (2021). Gendered economic, social and health effects of the COVID-19 pandemic and mitigation policies in Kenya: Evidence from a prospective cohort survey in Nairobi informal settlements. BMJ Open, 11(3), e042749. https://doi.org/10.1136/bmjopen-2020-042749
  44. Ringwald, B., Taegtmeyer, M., Mwania, V., Muthoki, M., Munyao, F., Digolo, L., Otiso, L., Wangui Ngunjiri, A. S., Karuga, R. N., & Tolhurst, R. (2023). Power and poverty: A participatory study on the complexities of HIV and intimate partner violence in an informal urban settlement in Nairobi, Kenya. Social Science & Medicine, 336, 116247. https://doi.org/10.1016/j.socscimed.2023.116247
  45. Sabri, B., Sellke, R., Smudde, M., Bourey, C., & Murray, S. M. (2023). Gender-Based Violence Interventions in Low- and Middle-Income Countries: A Systematic Review of Interventions at Structural, Community, Interpersonal, Individual, and Multiple Levels. Trauma, Violence & Abuse, 24(5), 3170–3186. https://doi.org/10.1177/15248380221126181
  46. Sánchez, O. R., Vale, D. B., Rodrigues, L., & Surita, F. G. (2020). Violence against women during the COVID-19 pandemic: An integrative review. International Journal of Gynecology & Obstetrics, 151(2), 180–187. https://doi.org/10.1002/ijgo.13365
  47. Santos Couto, P. L., Pereira Correia Montalvão, B., Rodrigues Silva Vieira, A., Alves Vilela, A. B., Correia Marques, S., Tosoli Gomes, A. M., Rego Santos, N., & Moraes França, L. C. (2020). Social representations of female sex workers about their sexuality. Investigacion y Educacion En Enfermeria, 38(1), e03. https://doi.org/10.17533/udea.iee.v38n1e03
  48. Schiavon, R., Troncoso, E., & Polo, G. (2012). Analysis of maternal and abortion-related mortality in Mexico over the last two decades, 1990–2008. International Journal of Gynecology & Obstetrics, 118, S78–S86. https://doi.org/10.1016/S0020-7292(12)60004-6
  49. Sikhosana, N., & Mokgatle, M. M. (2021). A qualitative exploration on accounts of condom-use negotiation with clients: Challenges and predicaments related to sex work among street-based female sex workers in Ekurhuleni District, South Africa. The Pan African Medical Journal, 40(54), Article 54. https://doi.org/10.11604/pamj.2021.40.54.29918
  50. Sri, A. S., Das, P., Gnanapragasam, S., & Persaud, A. (2021). COVID-19 and the violence against women and girls: ‘The shadow pandemic.’ International Journal of Social Psychiatry, 67(8), 971–973. https://doi.org/10.1177/0020764021995556
  51. Ssali, A., Nabaggala, G., Mubiru, M. C., Semakula, I., Seeley, J., & King, R. (2023). Contextual, structural, and mental health experiences of children of women engaged in high-risk sexual behaviour in Kampala: A mixed method study. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1185339
  52. Ssekamatte, T., Nalugya, A., Mugambe, R. K., Wagaba, B., Nakalembe, D., Mutebi, A., Bagonza, R. A., Tigaiza, A., Kansiime, W. K., Ssempala, R., Wafula, S. T., Isunju, J. B., & Buregyeya, E. (2023). Prevalence and predictors of sex under the influence of psychoactive substances among young people in informal settlements in Kampala, Uganda. BMC Public Health, 23(1), 801. https://doi.org/10.1186/s12889-023-15679-8
  53. Tsapalas, D., Parker, M., Ferrer, L., & Bernales, M. (2021). Gender-Based Violence, Perspectives in Latin America and the Caribbean. Hispanic Health Care International, 19(1), 23–37. https://doi.org/10.1177/1540415320924768
  54. Uganda records significant reduction in new HIV infections among newborns | WHO | Regional Office for Africa. (2025, April 29). https://www.afro.who.int/photo-story/uganda-records-significant-reduction-new-hiv-infections-among-newborns
  55. Uganda: The Penal Code Act (Cap. 120), 1950. (n.d.). Refworld. Retrieved May 7, 2025, from https://www.refworld.org/legal/legislation/natlegbod/1950/en/118735
  56. Unger, A., & Riley, L. W. (2007). Slum Health: From Understanding to Action. PLOS Medicine, 4(10), e295. https://doi.org/10.1371/journal.pmed.0040295
  57. Vigneshwaran, E., Goruntla, N., Bommireddy, B. R., Mantargi, M. J. S., Mopuri, B., Thammisetty, D. P., Veerabhadrappa, K. V., & Bukke, S. P. N. (2023). Prevalence and predictors of cervical cancer screening among HIV-positive women in rural western Uganda: Insights from the health-belief model. BMC Cancer, 23(1), 1216. https://doi.org/10.1186/s12885-023-11683-8
  58. Violence against women. (2024, March 25). https://www.who.int/news-room/fact-sheets/detail/violence-against-women
  59. Wall, L. L., & Yemane, A. (2022). Infectious Complications of Abortion. Open Forum Infectious Diseases, 9(11), ofac553. https://doi.org/10.1093/ofid/ofac553
  60. Weeks, M. R., Grier, M., Romero-Daza, N., Puglisi-Vasquez, M. J., & Singer, M. (1998). Streets, drugs, and the economy of sex in the age of AIDS. Women & Health, 27(1–2), 205–229. https://doi.org/10.1300/J013v27n01_13
  61. What Are HIV and AIDS? (n.d.). HIV.Gov. Retrieved April 29, 2025, from https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-are-hiv-and-aids
  62. World Health Organization. (2024). Abortion. https://www.who.int/news-room/fact-sheets/detail/abortion
  63. World Health Organization. (2025). Reproductive health. https://www.who.int/westernpacific/health-topics/reproductive-health
  64. Yakubovich, A. R., & Maki, K. (2022). Preventing Gender-Based Homelessness in Canada During the COVID-19 Pandemic and Beyond: The Need to Account for Violence Against Women. Violence Against Women, 28(10), 2587–2599. https://doi.org/10.1177/10778012211034202