Trauma-informed care for abortion providers treating sexual violence survivors in humanitarian settings
An orientation and resources for frontline abortion trainers and health workers
Introduction to trauma-informed care for abortion providers treating sexual violence survivors in humanitarian settings
The world is facing multiple concurrent humanitarian emergencies that stem from conflict, natural disasters or pandemics. In such crises, women and girls may encounter disruptions in their social and family structures or livelihoods and, in turn, experience greater gender and reproductive health disparities. Increases in the risk of gender-based violence (GBV) and barriers to accessing contraceptive methods, safe abortion or other sexual and reproductive health (SRH) services make it challenging for women and girls to manage their lives during humanitarian crises.
Gender-based violence is “an umbrella term for any harmful act that is perpetrated against a person’s will and that is based on socially ascribed (i.e., gender) differences between men and women. It includes acts that inflict physical, sexual or mental harm or suffering, threats of such acts, coercion and other deprivations of liberty.”
How prevalent is sexual violence during crises? And what impact does it have on women and girls? One in five refugee and displaced women experience sexual violence in humanitarian settings. Common perpetrators of this violence are intimate partners, acquaintances, aid workers in positions of power or militant groups using rape as a weapon of war. The health impact of GBV on the reproductive lives of women and girls includes—but is not limited to—unwanted pregnancy, unsafe abortion, pregnancy complications, STIs and HIV/AIDs. In the absence of prevention, mitigation or treatment, these outcomes can lead to maternal morbidity or mortality. Each of these issues are addressed in the Minimum Initial Service Package (MISP) with the goal of reducing maternal mortality through improved access to life-saving reproductive health care. This includes provision of comprehensive abortion care to the full extent of the law.
Survivors of crises and sexual violence typically experience multiple forms of trauma during and following the acute event. The standard of care for clinical management of rape survivors is provided in the Clinical Management of Rape and Intimate Partner Violence Survivors: Developing protocols for use in humanitarian services document—created by the World Health Organization (WHO), the United Nations Population Fund (UNFPA), the United Nations High Commissioner for Refugees (UNHCR) and the Inter-Agency Field Manual on Reproductive Health for Humanitarian Settings (IAFM)., However, non-GBV specialists and other SRH frontline providers can enhance their service delivery by providing trauma-informed care throughout their interaction with a client.
Why do abortion and SRH frontline providers need this approach? Reproductive health services that require pelvic exams may re-traumatize clients, which may hinder women accessing care. There is a high likelihood that clients in emergency or conflict settings are experiencing trauma, even if they do not disclose sexual or other forms of violence at the time of treatment. Trauma-informed care should be an existing standard for non-specialized GBV health-care workers. This approach is survivor-centered and strengthens the GBV and SRH response and prevention activities in complex humanitarian settings.
This trauma-informed care toolkit aims to improve care for survivors by increasing providers’ capacity to respond to the complex problem of sexual violence and GBV in humanitarian settings. The toolkit provides essential information on the principles of trauma-informed service—guidance on trauma-informed counseling and how to create an environment that is receptive to providing trauma-informed reproductive health care and steps for strengthening the linkages between the SRH and protection sectors—to ensure every client feels reassured, respected and protected.
This toolkit is designed for abortion providers who might not have access to the fuller courses, may be at the receiving end of referrals for abortion care, may be receiving abortion care training or will find application of the content helpful to their ongoing abortion services.
The toolkit is designed to complement other key training resources focused on care of sexual violence survivors, such as the Clinical Management of Sexual Violence Survivors in Crisis Settings created by the Inter-Agency Working Group on Reproductive Health in Crises (iawg.net) and the WHO curriculum, Caring for women subjected to violence: A WHO curriculum for training health-care providers. The toolkit builds on previously published materials with a unique focus on the intersection of trauma-informed care and abortion care.
Instructional PowerPoint presentation: Trauma-informed services for abortion providers treating sexual violence survivors in humanitarian settings
The PowerPoint slides include content about sexual violence and trauma-informed care and their intersections with abortion, for frontline providers treating sexual violence survivors in humanitarian settings. They provide a definition of trauma-informed care and contextualize it within the broader GBV movement for sexual and reproductive health and rights. This content will strengthen participants’ understanding of service delivery considerations for sexual assault survivors seeking abortion services. This PowerPoint can be adapted to align with any abortion training in humanitarian settings and can also be adapted for training in development settings. The modular style is meant to conform to a variety of training needs and contexts with roughly 6.5 hours of content for a full day with breaks.
Trauma-informed care case studies and facilitator’s guide for skills practice and service integration
Includes six case studies—three clinical and three on service integration and referrals—that reflect the needs of survivors seeking abortion services and referrals in humanitarian settings.
Direct observation feedback form
The direct observation feedback form integrates the “LIVES” method and trauma-informed care into the suggested flow of an abortion service delivery encounter. It is designed to be used in role-play with three trainees rotating through the roles of patient, provider and observer. It can be used with the toolkit case studies that are focused on clinical care to allow trainees to practice their skills.
Referral and informed consent form
The referral form, which includes provider and client copies, allows both the client and provider to remain informed of the type of referral(s), the contact information of the provider and the client and details of the referral service(s). This form also includes informed consent procedures to ensure the client is in control of her care and actively chooses the selected services and referrals she prefers to be provided by the health worker.
Pre- and post- training survey
The pre- and post- training survey assess changes in participants’ knowledge and attitudes regarding sexual violence, abortion and trauma-informed care before and after the training.
Resources and handouts for participants
Several resources have been included in this package to provide additional reference and reinforcement of key issues for participants. They can be included as handouts, if necessary and relevant to your context. These include:
- Caring for women subjected to violence: A WHO curriculum for training health-care providers Handout 6a: Communication skills and pathway (WHO Job Aid on the LIVES Method)
- WHO Job Aid: Pathway for care for IPV (p. 38)
- WHO Job Aid: Pathway for initial care after assault (p. 65)
- UN Women: The shadow pandemic—violence against women and girls and COVID-19
- IAWG MISP Quick Reference Guide
- IAWG Safe Abortion Care in the MISP Brief