Rapid Gender Analysis TO SUPPORT THE GOVERNMENT OF SIERRA LEONE TO STRENGTHEN ITS HEALTH SYSTEM

This Rapid Gender Analysis (RGA) report presents findings from the gender and power analysis carried out in November and December 2023 in Falaba, Kambia, Bonthe, Tonkolili, Kenema, Karene, Kailahun, and Pujehun districts of Sierra Leone. The purpose of the RGA is to understand how gender and social norms, roles, relationships, and dynamics influence health outcomes and health-seeking behavior in Sierra Leone, especially for vulnerable populations. The report will inform the development of CARE’s future health programming and proposed interventions for health funding opportunities.
The document is structured into four primary chapters – Background, Methodology, Findings: Results and Analysis, and Recommendations—each containing sub-chapters. The background section outlines the study’s purpose, objectives, and underlying rationale. The methodology section describes the research design, applied approaches, data collection methods and participant information. The study’s key findings are categorized into distinct thematic areas aligned with CARE's Good Practices Framework for Gender Analysis and includes the following Core Areas of Inquiry:
• Household decision-making, division of labor and control of productive assets
• Control over one’s body
• Access to public spaces and services
• Claiming rights and meaningful participation in public decision-making
The RGA also applies the above domains related to health outcomes, behaviors, and health-seeking behavior, including gender dynamics within the Sierra Leone health system with recognition that unequal gender dynamics gaps impact health care providers and their ability to deliver quality services. Finally, the recommendations section outlines actions or interventions CARE should consider in future programming.
Key Findings:
* Men have more influence over decisions for the household than women—including the seeking of healthcare—and women lack control over key decisions related to sex, marriage, and children, including if and when to use contraception. Women’s mobility is limited by social norms which require male permission for movement.
• Contraceptive use is low. Despite around 70% of people knowing about contraceptives and where to get them, only 50% are currently using them. Many community members believe modern forms of family planning are haram or unhealthy, with anecdotal evidence suggesting there is perception that it promotes extramarital affairs.
• Front Line Health Workers (FLHW) face major barriers to effective service delivery: almost half of FLHWs interviewed are unpaid, effectively operating as volunteers, struggle with difficult living conditions and lack of supplies, and report inequitable treatment between male and female workers.
• There is a lack of evidence-based health information for pregnant women: only 27% of pregnant women in the study reported having received any information related to sexual and reproductive health or associated risks.
• Despite generally positive health-seeking behavior, both women and men are concerned by lack of availability of medicine. Read More...

Rafah Governorate: Deception, Destruction & Death in the “Safe” Zone Rapid Gender Analysis

The ongoing crisis in the Gaza Strip has been described as a “human rights crisis, a human-made humanitarian disaster”1 and a “war on woman.”2 Since October 7th there has been mass scale forced displacement of over a million Palestinians from Northern Gaza to Southern Governorates. The subsequent impacts of this, compounded with pre-existing gender inequalities and multidimensional vulnerabilities, have disproportionately impacted women and girls, as well as other vulnerable groups such as persons with disabilities, children, pregnant and lactating women, elderly populations, those living with chronic and mental health conditions.
Aim and methodology: The aim of this RGA was to hear from women and men currently in Rafah, with a focus on those providing essential services to communities and Internally Displaced People (IDPs) in the Governorate. The aim was to better understand the experiences of women, men, girls and boys at this moment, and to identify how CARE and the local and international humanitarian community, including U.N. Agencies, can best respond - understanding the formidable challenges and barriers to do so.
This RGA was conducted at a time where the population of Rafah were subject to continued and threatened bombardment from land, air and sea. As such it was intentionally designed to be light and small scale in terms of primary data collection; which took place between 7th April to 17th April 2024, and is complemented by secondary data review and analysis.
This RGA is being published in the days surrounding further escalation of violence in Rafah. The Gaza side of the Rafah border crossing with Egypt is blocked 6 and an evacuation order has been issued in the Eastern parts of Rafah; the designated “safe zone” in the Gaza strip. This reinforces the voices of the men and women who told us, with no uncertainty, that nowhere in Gaza is safe.
Key findings related to each area of inquiry and recommendations are summarised below, with more details to be found in the main report.
Key findings:
1. Shifting Gender Roles: Continuous displacement has led to some traditional gender roles adapting and expanding, as well as others being reinforced. Increased and unrealistic pressure has been placed on women to meet the needs and demands of dependents in a highly stressful environment, which has led to an increase in verbal and physical violence against women.
2. Coping Mechanisms: On the verge of starvation, nearly the entire population in Rafah has reported extreme and harmful coping strategies including but not limited to bartering with other essential items, begging, gathering wild foods, scavenging under rubble or in trash or seeking food outside their shelter.8 Reports indicate some women are fasting for several days in a row,9 and boys and girls are forced to work on the street selling or begging. Female heads of household, older women and women with disabilities face security and protection obstacles seeking access to food distributions.10
3. Sustaining through Community Networks of Solidarity: Community solidarity has emerged as a lifeline for survival, such as women supporting children’s education and men distributing food parcels or organising activities for children. Religion and prayer have played a key role in the coping strategies of men, women and children. For youth, social media (when accessible) played a role to maintain connections, articulate fears and share experiences with others. For children, where possible, play and educational outlets within shelters provide a brief respite from the reality of airstrikes.
4. Maternal & Reproductive Health: With an overwhelmed and overstretched health system, people with disabilities, chronic conditions and trauma are left without the most basic care. With estimates of 155,000 women in Gaza pregnant or lactating, and 5,500 expected to deliver in the next month,11 the lack of adequate maternal, sexual and reproductive health services leave mothers, newborns and their children exposed to severe and life-threatening health risks. If women survive pregnancy and childbirth, postpartum recovery, including ability to breastfeed, also present severe challenges.12
5. Mental Health and Psychosocial Support Services (MHPSS): Of extreme concern is the severe emotional, physical and psychological distress among the displaced population, especially among children and youth. As caregivers do their best to survive and manage their own mental health, the impact on children and youth is extensive and holds intergenerational impacts.
6. Education: With formal education effectively stopped since October 7th, children have lost out on a whole academic year of education. While there were reports of some initiatives such as ‘informal learning circles’ and remote learning, these are not easily accessible. Parents, caregivers and children are focused on daily survival; there is the increasing need for adolescents and young girls to support with chores or be confined to their tents due to safety issues; and, particularly for boys, the need to help earn money or seek supplies for the family. Read More...

Rapid Gender Analysis on Power and Participation Shafiullah Khata, Ukhiya, Cox’s Bazar Bangladesh

The current Rohingya refugee crisis is regarded as one of the world's worst humanitarian crises of the twenty-first century. Myanmar's Rohingya Muslims are a stateless Muslim community that have faced systematic discrimination and targeted persecution in Myanmar’s Rakhine State for decades. As the Myanmar government refuses to give Rohingya any citizenship rights, the vast majority of Rohingya have no legal documentation which is effectively making them stateless and trying to escape from the military’s campaign of violence, killing, rape, arson, and other grave abuses.

Bangladesh has taken in the greatest number of refugees thus far. Since 25th August 2017 a large number of Rohingya people has fled into Bangladesh from Myanmar after facing statelessness, targeted violence and discrimination. As of February 2022, there are 923,179 people and 194,091 households in 33 camps in Kutupalong and Nayapara area of Cox’s Bazar District.

There is limited to no participation and/or influence of Rohingya women in decision making or leadership roles within the humanitarian response in Cox’s Bazar Refugee Camp. Societal and religious norms of the Rohingya are patriarchal and tend to favor men’s participation and leadership over that of women; however, there are opportunities identified to support greater participation and leadership of women in public life.
Read More...

Rapid Gender Analysis: Gender, Conflict and Internal Displacement in and from South Lebanon

The overarching objective of this Rapid Gender Analysis (RGA) is to highlight the differential impacts of the growing insecurity at Lebanon’s southern border for men, women and other vulnerable populations such as migrant domestic workers, refugees, and those with diverse sexual identities. The specific objectives are to: (1) Unpack potential shifts in attitudes, behaviours, roles and responsibilities among men and women within the household and community that may enable or prevent more equitable participation in humanitarian program planning and response, especially among internally displaced populations; (2) Identify the gender-based constraints (including gender-based violence and mobility restrictions) that hinder equitable participation or access to humanitarian services/resources/programs; (3) Understand the direct and indirect impacts of the conflict on health, livelihood, shelter, safe access to essential services and resources, including solidarity networks; (4) Generate actionable recommendations for CARE and other humanitarian stakeholders to design and implement more inclusive, equitable and targeted program interventions around key priority areas.

Key Findings
• For domestic migrant workers, refugee and IDP and those identifying as LGBTQI+ mutual aid groups and seeking local solidarity networks are essential in securing essential services, creating advocacy channels and build social safety nets.
• Women in urban regions hold more influencing power over household decisions than those in rural areas.
•Female refugees/IDPs, domestic migrant workers and LGBTQI+ individuals reported barriers to accessing sexual and reproductive health services as well as other essential health services.
•The psychological toll of the current violence is triggering overwhelming levels of stress, anxiety, and fear across the community, especially affecting children and those with memories of migration and conflict.
• Overcrowded shelters lack gender-sensitive considerations and amplify risks of GBV, particularly exploitation and harassment.
• Economic coping strategies from the long-standing economic crisis is taking a toll on livelihoods and the ability of households to save, leading women and other vulnerable groups to be exposed to disproportionate safety and protection risks. Read More...

Rapid Gender Analysis Ukraine October 2023

This Rapid Gender Analysis (RGA) has been carried out to shed light on the gender dynamics, needs, experiences and challenges of women, men, adolescent girls and boys and people with diverse gender identities, from different groups and backgrounds, as they cope with the humanitarian crisis after more than one and a half years of full-scale war. The analysis explores how pre-existing and reinforced power relations affect people’s experiences of conflict, and how they cope with the ensuing humanitarian emergency. This report draws on primary data collected in four oblasts (Kharkivska, Dnipropetrovska, Odeska, and Mykolaivska), as well as secondary data from before and during the crisis. A mix of quantitative and qualitative research methods was used, including 45 key informant interviews (KIIs), 611 individual surveys, 12 focus group discussions (FGDs), 12 community mapping exercises and eight individual stories. Data was collected from a total of 735 individuals, of which 43% female adults, 28% male adults, 18% adolescent girls, and 11% adolescent boys, including 9.5% individuals living with some form of disability, and 3.9% identifying as LGBTQI+. Additionally, the role of women-led organizations and women’s rights organizations (WLOs/WROs) was highlighted, with a particular interest in understanding barriers and opportunities around leadership and participation in the humanitarian response.
The war in Ukraine is not gender neutral. Since the beginning of the full-scale invasion, women and men have been playing distinct and specific roles. As the humanitarian crisis ensues, a general trend has emerged: women are often providing alone for their families while facing loss of income, family separation, and massive disruptions in the provision of essential services; whilst many men are engaged in the more direct war efforts on the frontlines, exposing themselves to potential death, severe injuries and mental health distress. Although Ukraine has not yet adopted full
conscription, men between ages 18-60 may be called into military service unless they have legal grounds for deferment or exclusion. Many Ukrainian women have also voluntarily enrolled in the military and territorial defense forces.1 Yet, the mobilization of men is deeply rooted in beliefs around masculinity related to self-sacrifice on the battlefield and the defense of their country and family, which reinforces notions of feminine roles rooted in reproductive care. The implications of amplified and more polarized beliefs around gender roles will continue with the ongoing war and its aftermath, particularly for those who may not fit those social norms and expectations, such as people with disabilities and LGBTQI+ individuals. Read More...

Gaza Strip Rapid Gender Analysis: Brief

There is an increasing recognition that conflict is not gender neutral; in fact, protracted conflicts such as in Gaza create a landscape of multidimensional and intersectional vulnerabilities for diverse groups compounding over time (specifically around access to food, mobility, poverty, education, protection and employment) and disproportionately affect women and girls across all categories. The escalation of violence in Gaza and the surrounding region has led to an unfathomable level of death, deprivation and destruction for the most vulnerable populations and further compromises their ability to respond, adapt and build resilience to continued shock. Thus, the humanitarian response must account for these pre-existing vulnerabilities while integrating and adapting to the complexity of this unprecedented crisis through a gender and inclusive programming lens. This Rapid Gender Analysis (RGA) aims to highlight existing gender, age and disability data and provide operational recommendations for the humanitarian response in Gaza, while centering ‘Do No Harm’ principles. Given the rapidly evolving context of this crisis, this RGA brief draws from secondary data to inform immediate programming and will be updated as more information becomes available and more in-depth information is needed to support the humanitarian response. Read More...

Sudan – Khartoum, Al Gezira, East Darfur, South Darfur Rapid Gender Analysis

On April 15, 2023, heavy clashes erupted between the Sudanese Armed Forces (SAF) and Rapid Support Forces (RSF) in Khartoum. The conflict has since expanded and involves more non-state armed actors. There has been a near total collapse of services in the most conflict-affected states, including the closure of markets, shops, healthcare centers, schools, and the outages of water, electricity, banking, and telecommunications infrastructures. The complexity of the situation sets the tone for rippling consequences that have been seen across the entire population, especially affecting already marginalized groups and those with pre-existing vulnerabilities (such as female-headed households and those with chronic health conditions). The purpose of the Rapid Gender Analysis (RGA) is to provide information about the different needs, capacities and coping strategies of women and men focusing on four states: Al Gezira, Khartoum, East Darfur, and South Darfur. The RGA gathered primary data from 121 participants in August 2023, and triangulated the findings against 90 secondary data sources.
Data from the RGA shows that despite women taking on more income-generating responsibilities, they continue to have unequal decision-making rights within the household. One of the biggest changes in gender roles has been the emergence of more women in the labor force. Men and women alike reported feeling that the only job opportunities currently available are for women. As such, women are increasingly working outside of the household to financially provide for their families. Despite this change, the division of household unpaid care work has not shifted; in most cases, the burden of caretaking for the family is shouldered by women and has only expanded since schools have closed. Therefore, while most women feel they have gained marginally more decision-making power within the household, it has been primarily related to caregiving tasks and making choices around pursuing different types of income-generating opportunities.
Similarly, women are playing important roles in the humanitarian response, but they remain sidelined from humanitarian decision-making. Many of the patriarchal norms that have been long-present in Sudanese culture that restrict women’s agency and participation in the public sphere have continued. Read More...

CARE Rapid Gender Analysis Ghana- Upper East, Ashanti, Western North, Central and Bono COVID-19

Between March 2020 and May 2020 Ghana was ranked second amongst countries in the West and Central Africa region most impacted by the COVID-19. In the number of cumulative cases in the WHO Africa region, Ghana is number three. Three regions have maintained their position as having the highest number of COVID-19 cases in Ghana – Greater Accra, Ashanti and Western Regions. On March 12th 2020, Ghana recorded its first two cases. Because of the spread of the virus, the government has taken proactive deterrent measures to prevent its spread. Some of the measures range from the closure of land, sea and air borders (except for the transport of goods) to partial lockdown, closure of schools, enforcement of social distancing, mandatory wearing of face mask, quarantining of suspected cases, partial closure of markets and ban on all social gatherings. Despite these restrictions, the virus seems to be making rapid spread in the country. Ghana’s total confirmed cases as at Wednesday, April 15, 2020 is as follows: Confirmed cases 268, Recoveries 83, Well/responding to treatment 175, Critically/moderately ill 2, Deaths 8. The novelty of the virus will impact women, men, girls and boys in different aspect across the sixteen regions of Ghana.
The management of the pandemic has led to an increase in the workload of women in households. Men continue to predominantly retain the role of heads of household, in some cases dedicating more time to family discussions. However, women are taking full responsibility for household chores and caring for dependents, such as children, vulnerable elderly, and the sick, as well as children who have dropped out of school due to the temporary closure of schools. This significant increase in work for women has significant effects on their physical and psychological health.
Men also face mental health problems as they are under stress from the loss of paid work and have difficulty managing the confinement measures that prevent them from working.
Women's economic empowerment continues to be conditioned by social norms that limit women's control over economic resources and decision-making over financial resources in the household. The response to the crisis can easily increase the already existing gender gaps in livelihoods given the preventive measures adopted by the authorities, even though some of them have already been lifted.
Read More...

Gender Analysis in Sudan: Exploring Gender Dimensions of Humanitarian Action and Women’s Voice and Leadership in East Darfur, Gadarif, Kassala, South Darfur, and South Kordofan

CARE Sudan is working to ensure that gender dynamics in Sudan are well understood, and that gender is fully integrated into all programmes and operations. This gender analysis covers each of the sectors to which CARE Sudan responds, highlighting key similarities and differences within the five operational states in which CARE Sudan operates. In all sectors, the analysis assesses differences in barriers and opportunities for different populations, especially women and girls.
Study Findings
Livelihoods. Unlike most of the other sectors of focus in this analysis, livelihoods present the most diverse experiences of women across states, localities, and villages. Generally, however, women the Darfur states experience similar challenges and opportunities, whereas the women in the other three states each have different types of experiences based on the context and norms in these regions. Core challenges experienced by women include the lack of available job opportunities, women’s responsibility over the household which doubles their burdens, lack of ownership and
control over productive assets, and exposure to gender-based violence. These issues are driven by some harmful and unequal official and customary laws, paternalistic gender norms, insecurity and conflict, illiteracy and poor education, and limited education.
Governance and Peacebuilding. Governance systems have been in turmoil since the 2019 Revolution. Despite this period of well-documented crisis at the national level, few issues were described by study respondents at the local level. This indicates a severe separation between national and local issues on the ground. However, women are consistently excluded in all governance and peacebuilding spaces across all states. The most common issues raised included hierarchical traditional mechanisms and powerholders, domination of men over decision-making, deliberate exclusionary practices, and the artificial fulfilment of women’s quota. These issues persist due to women’s illiteracy and poor education, social norms and traditional practices, harmful beliefs about women, low access to information for women, withdrawal of civil society, heavily centralized governance systems, and gaps in gender equality laws.
Gender-Based Violence. The types of GBV identified in Sudan include domestic / family violence (e.g., hard beating, psychological abuse), community social violence (e.g., exclusion, humiliation), harmful traditions and customs (e.g., early marriage, FGM/C), and violence during war (e.g., rape, killing). Women experience several challenges related to GBV – beyond the act of violence itself – such as stigmatization of reporting and the normalization of domestic violence. GBV is so prevalent due to unequal laws the enable it, patriarchal gender norms, economic hardship, insecurity and conflict, and the absence of law enforcement. It is driven internally by the family by the deep need
to protect family honor.
Water, Sanitation, and Hygiene (WASH). Issues around water are well-understood and agreed upon by community members, with little differences in opinions be gender. The core issues relate to water include unreliable water accessibility, unequal responsibilities for water fetching and management that fall almost exclusively to women and girls and cause harmful health impacts, and the contamination of water sources. Similarly, related to sanitation, there is inadequate availability of latrines and poor cleanliness and waste accumulation in available latrines. Women specifically face the core hygiene issue of unavailability of dignity kits and no soap for washing. Such issues are primarily caused by poor governance and insufficient budgets alongside decentralized and male dominated water decision-making that does not account for women’s needs and discriminatory social norms and practices.
Health. The main health challenges identified in the states related to pregnancy and reproductive health, with little attention given to infectious or chronic diseases. Core to all health issues is the deficit of available and/or adequate reproductive and general health care centres. Health care may be the only sector in which men and women feel there is more equitable treatment between the genders; in fact, pregnant women tend to get preferential treatment in health centers when they are seen. However, significant issues remain for women including a lack of trained (female) medical staff and unaffordable medications and services. Like other sectors, poor governance and insufficient budget are primary drivers of weak health systems despite the INGO community playing a major role in building and delivering care at health centers. A significant emerging issue in the sector is the increasing mental health needs for women, particularly refugees.
Food Security and Nutrition. Families in all states report insufficient food availability driven by the rapidly collapsing economic situation and price hikes due to inflation. Food scarcity challenges are compounded by the deterioration of the agricultural season as a result of climate change in as most families are constrained to eat just what they can grow or procure very easily and cheaply locally. Even when food is available, it is very limited in variety causing low nutritional intake.
Women experience malnutrition because social norms dictate that they eat last and least even though overcoming food shortages is primarily the burden of women. Read More...

CARE Rapid Gender Analysis Democratic Republic of Congo (DRC) – Mudja, Munigi and Kanyaruchinya IDP camps in North Kivu province

In the Democratic Republic of Congo (DRC), the province of North Kivu, has recently been affected by insecurity resulting from conflict between armed combatants (militia) and the government forces (FARDC). This has had a negative impact on the territories of Rutshuru, Nyiragongo and Masisi. The fighting which began in Rutshuru and Nyiragongo, spread to the eastern part of Masisi territory, depriving the rest of the adjacent area, including Goma, of a supply route. The National Road 2 connecting Goma to Rutshuru, is controlled by the combatants since the October-November 2022 offensives. By December 2022, at least 530,190 persons have been displaced since the fighting began, including at least 318,114 women and girls. More than 88% of internally displaced persons (IDPs) live in collective centres (churches, schools, stadiums) and makeshift sites (camps), while the rest are hosted by host families. More than 137,000 IDPs were forced to return to their places of origin in Rutshuru and Rwanguba health zones when fighting intensified in October 2022. Population movements remain dynamic and evolve according to the security context. To have a response that considers the different needs, capacities and coping strategies of women, girls, boys, and men affected by displacement, CARE International in DRC conducted a Rapid Gender Analysis (RGA) in the displacement camps of Nyiragongo Health Zone, Kanyaruchinya, Munigi and Mudja camps from December 2022 to January 2023. Focus group discussions, Individual and Key Informant Interviews were held with the affected population. Read More...

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