Health, Disability, and Sexual and Gender-Based Violence in Post-Conflict Liberia: Focus group interviews of 120 and surveys of 396 men and women Open Access

Abstract

Background: Liberia, a nation of approximately 3.7 million people, continues to recover from the brutality of 14 years of civil conflict (1989-2003). Chief aims of the research are to provide community-level estimates of mental health conditions and prevalence of post-traumatic stress disorder symptoms; to determine whether there are associations between sexual and gender-based violence and potential risk factors; and to identify statistically significant differences in the perceptions of reporting sexual violence when the victim has a disability (physical, mental, or epilepsy).

Methods: Using data obtained from 396 survey respondents and 120 focus group participants in two urban communities in Monrovia, Liberia, the following mixed-methods study seeks to explore the intersection between sexual violence, mental and reproductive health, and the impact of disabilities on vulnerability to and reportability of SGBV crimes, including rape and physical assault. We asked survey respondents about their experiences during the war, about violence in their homes and their communities, and questions to understand the magnitude of mental and reproductive health issues occurring to the respondent in the 12 months preceding the survey.

Findings: Survey respondents reported several negative mental health outcomes, including high rates of anxiety (32.3%), sadness or depression (30.1%), recurrent nightmares (52.5%), and insomnia (30.3%). Most consequential problems reported by respondents included post-traumatic stress disorder (25.0%), rape (6.5%), domestic violence or beating (27.3%). Additionally, we identified several barriers to health services and facilities and made recommendations to reduce gaps in access.

Conclusions: Rape and domestic violence continue to be extensive problems throughout post-conflict Liberia despite government and non-government organizational attempts to target and prevent SGBV crimes. Recommendations are made herein to improve utility and outreach of services as well as to strengthen community buy-in of services.

Table of Contents

Background/Literature Review 1
Methods 14 Results 20 Discussion 28

Strengths and Weaknesses 36

Future Directions 42 References 45 Tables

Table 1. Descriptive statistics of survey respondents 52

Table 2. Descriptive characteristic statistics for respondents 53

Table 3. Community issues reported in survey 54

Table 4. Community health issues reported in survey 55

Table 5. Barriers to health care and hospital access 56

Table 6. Self-reported physical and mental health issues 57

Table 7. Perceived reportability of SGBV by type of disability 58

Table 8. Perceived vulnerability to SGBV by type of disability 58

Table 9. Reports of rape or physical abuse/"beating" 59

Table 10. Self-reported instances of open mole 60

Figures and Figure Legends

Figure 1. Map of Monrovia, Peace Island and West Point 61

Figure 2. Selection of survey participants for analysis 62

Figure 3. Variables used in quantitative analysis of data 62

Figure 4. Age and sex distribution (by percentage) 63

Figure 5. Qualitative focus group composition, by community 64

Appendices

A. Acronyms 66

B. IRB Approval Letter, Emory University 67

C. IRB Approval Letter, University of Liberia 68

D. Map: West Point Enumeration Zones 69

E. Focus Group Discussion Guide 70

F. Interview Discussion Guide 74

G. Excerpt of Questions from Main Survey Codebook 77

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Mental Health Health Sciences, Epidemiology
Keyword	gender-based violence wartime violence Liberia disability Monrovia post-conflict reproductive health mental health sexual violence health Peace Island sexual and gender-based violence rape domestic violence stigma West Point
Committee Chair / Thesis Advisor	Rochat, Roger, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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