Inclusive Research & Design for Enhanced SRH and GBV Support Services

39% of Pakistani women face abuse; holistic SRH and GBV care needed for comprehensive support.

The Challenge

Last year, research by Pakistan’s Demographic and Health Survey and the UNFPA showed that 39% of women in Pakistan, between 15 and 49 years, faced abuse, and 80% of married females endure domestic violence. At the same time Sexual and reproductive health is a fundamental human right; central to reducing poverty and improving long-term health. It is intrinsic to our right to life, freedom, health, choice, privacy, education and the prohibition of discrimination. SRH  and GBV cases are often interconnected where one issue could lead to the other or women may need support for both at the same time.

When women have to access these services in silos, it fails to acknowledge the interconnected nature of their issues. This results in incomplete care for individuals, missed opportunities for early intervention, a lack of holistic support, duplication of efforts and resources, and potential re-victimization and stigmatization. A holistic and integrated approach is essential to address the complex interplay between SRH and GBV, ensuring individuals receive comprehensive and coordinated care. We worked with the International Rescue Committee (an international NGO) to draw from the experiences and preferences of individuals, in order to inform the guidance for what user-centered, integrated SRH and GBV service delivery should look like in Pakistan. The research and prototype testing for this future service was done in Swat, Pakistan and Juba, South Sudan. Ideate Innovation design, carried and compiled the report for the research in Swat and trained the research team in South Sudan for similar research work.

Sara was incredibly collaborative and was able to work efficiently with different stakeholders and project members across sometimes competing priorities. She is also very adaptable to the changing needs of the project and adjusting approaches to align with client needs.

Senior Innovation and Design Officer, IRC

The Work

Discovery and Assessment
When women are abused, they just bear it and get mentally ill and eventually commit suicide. Sometimes they get a divorce. Rizwana, Married, Matta
I see 4 patients at the same time. I cannot see patients one by one because of the load so I think there are many issues which patients do not discuss with me because the are not alone and the door isn’t shut. Dr. Maha, Chuprial

Our findings in Swat indicate that participants find it almost impossible to talk about GBV incidents even with their families never mind health care providers. Current health services are not designed and delivered in a way that allows for doctors to build rapport with their patients and provide enough privacy that the patient feels comfortable enough to share confidential matters such as abuse.

Designing an ideal integrated service for SRH and GBV entails having difficult conversations with women particularly women from more conservative and religious regions. Given this the research took place over three rounds. Most conversations took place in the form of a focus group in spaces where women felt comfortable and safe enough to talk about such private topics.

Design and Development

We took a storytelling approach to our research where we explored different topics related to SRH and GBV by telling a story, sharing drawings regarding that story and then discussing the story’s characters, actions and motivations. This allowed the participants to be able to maintain a certain level of privacy, confidentiality and distance from their own traumatic experiences while also being able to discuss sensitive issues openly and comfortably. Additionally storytelling as a research tool allows us to enhance empathy, understand collective experiences and communicate complex problems.

In order to ensure that the research was inclusive we interviewed cis and trans women in our research. Additionally service providers such as doctors, nurses, psychologists etc were also interviewed in order to ensure that both demand and supply side factors are considered.

In the earlier part of the research the aim was to understand their current experience, preferences and barriers surrounding accessing care for SRH and GBV which would include healthcare as well as legal care, psycho social support and overall safety. We then co-designed solutions for their barriers and collated all of our learnings to come up with a prototype of an integrated service which was then tested in the field. The prototype was also tested through storytelling. This approach takes the burden of imagination away from the participant, by reducing this mental load they can more easily share what they like, dislike etc. about the prototype.

The Outcome

The main output from our research was a report covering insights on:

  1. Drivers of Seeking SRH and GBV Support
  2. Current Experiences of SRH and GBV Support
  3. Overcoming Barriers
  4. Key Features of Service Provision

These insights were then converted into Key Recommendations for service providers. In order for the recommendations to be more digestible and make sense they are provided across the journey that a woman or a girl might go through while trying to access the integrated service.