Scientific Papers

Formal support services and (dis)empowerment of domestic violence victims: perspectives from women survivors in Ghana | BMC Women’s Health

Sociodemographic characteristics of women survivors of domestic violence

A total of 21 women survivors of domestic violence participated in our study. Their ages ranged from 23 to 54 years; with a median age of 42 years. Of these 21, 18 (85.7%) were married, 13 (61.9%) had 3 to 5 children (Table 1). The highest level of formal education among them was senior high school; with 3 (14.3%) attaining this. Majority – 14 (66.7%) engaged in petty retail trading. About half of them 11 (52.4%) depended entirely on their abusers for upkeep (Table 1).

Table 1 Socio-demographic characteristics of women survivors of domestic violence, Weija-Gbawe Municipality, Ghana

Perspectives of women survivors of DV on formal support services

Survivors’ perceptions of legislation and formal support services fell into four categories viz. survivors knowledge of the scope of services and utilization; survivors experiences of accessing formal support services; challenges associated with utilization of formal support service; and (dis)empowerment and agency of survivors accessing formal support services.

Survivors’ knowledge of the scope of support services and utilization

There were three main categories of formal support services that were oversteered by government agencies. These were the criminal justice services, social services and basic material support, counselling, and mediation services from quasi-judicial institutions. These services were complemented by a range of support services rendered by civil society organizations approved by the government.

The criminal justice services

Review of relevant secondary data showed that the criminal justice services comprised arrest and detention of abusers by the police and the adjudications of DV cases by the law courts and family tribunals. DOVVSU of the Ghana Police Service was reconstituted as a gender neutral entity to tackle gender-based violence from the then Women and Juvenile support Unit [WAJU] in 2005 [5]. This unit is the main point of call for survivors when a case of abuse is reported to authorities. It also served as a point of referral to and from other services within the formal support system [32]. Specifically, DOVSSU received and responded to complaints, conducted investigation into cases, provided temporary shelter, referred victims for medical, legal, and counselling services. It also referred dockets to the Justice Department for advice on prosecution [33, 34]. The DV law in Ghana also made provisions for civil protection orders to protect survivors of violence.

The courts handled DV and other violence against women specified by law. In order to swiftly respond to DV, the judiciary service operated human rights, gender-based and sexual offences courts to speed up the adjudication of cases. The justice system in the country also made provision for the family and juvenile courts at the district court level to handle mild cases of DV and other non-violent family disputes bordering on economic neglect and child custody. These courts used alternative dispute resolution (ADR) methods to settle cases. The family courts also had jurisdiction to deal with criminal cases and civil protection orders under the DV Act. Of the 21 survivors, 13 (61.9%) were aware of the role of the police and courts in the provision of formal support for them.

Four (19.1%) of the survivors filed complaints at DOVVSU that led to arrests of their abusers (Table 2). They complained that they experienced difficulties in their attempts to access justice at the law courts for lack of money to file their cases, pay for medical reports, and fund legal representation. Of the 21 DV survivors, 19 (90.1%) were aware of the existence of the DV Act, but none of them knew about the protection and occupation orders it provided as an avenue of seeking protection.

Social services and basic material support

Support services under this category included provision of reception shelters, medical care, skill training, rehabilitation, and reintegration with families. These services were to be provided free of charge under the domestic violence fund. The establishment of the DV fund under the law was equally challenged by low government budgetary allocation to the sector. Of the 21 survivors 5 (23.8%) were aware of the scope of social and material support services, and14 (66.7%) of them sought medical care from health facilities. Of the 14 who sought medical care, 1 (7.1%), had valid health insurance. The remaining had to make out of pocket payments – some with the help of friends and relatives. A medical report costed a minimum of 100 Ghana cedis (20 USD in 2018), provided medical evidence of the abuse in court, these survivors perceived the fee expensive. On different occasions, police officers accompanied three of the survivors to the hospital. On one such occasion, a police officer had to pay the medical bill of one of the survivors. The law requires the police to assist victims to obtain medical care, but is not explicit on the specifics of the assistance such as accompanying victims to hospitals and paying their bills.

All the DV survivors and subject experts agreed that paying for medical care and medical reports before a case can be booked in the law courts is a disincentive for the pursuance of DV cases. The medical report is a mandatory requirement particularly for physical assault including sexual abuse without which the police cannot prosecute the case. There was no form of specialized or priority services for survivors of DV who reported at the health facilities.

The Department of Social Welfare (DSW) is a government agency mandated to provide psychosocial counselling and shelters for abused women. Of the 21 survivors, 5 (23.8%) had knowledge of the range of services provided by this agency and 10 (47%) utilized psychosocial counselling services. Nevertheless, the provision of shelters remains non-existence due to inadequate funding to operate them. Some survivors indicated that the threat of homelessness delayed their decision to seek help from formal support services. A survivor who got separated from her husband after reporting him to the police and is now lodging with her sister shared her frustration:

If my sister did not take me in, I don’t know what would have happened to me. However if government provides a place where people in my situation can lodge for the meantime whilst they reorganize their lives, it will help. (Survivor 1, Interview, May 3, 2018)

In the absence of shelters for battered women, the DSW provided psychosocial counselling, conduct physical and medical needs assessment and refer survivors to other support services including the services of partner civil society or non-governmental organizations. The DWS also provided counseling and mediation services particularly within the family tribunals. Specifically, the DSW mediated DV incidents that were considered civil cases, as against criminal. These case bordered on economic abuse including child maintenance and paternity disputes among couples.

Mediation and counseling services from quasi-judiciary agencies.

The Commission on Human Right and Administrative Justice (CHRAJ) also provided mediation and counseling services. Of the 21 survivors, 1 (4.7%) reported knowledge of the role of CHRAJ in supporting abused persons, and none utilized any services from this agency. CHRAJ is a quasi-judicial institution created under the 1992 Constitution to help promote transparency and public accountability in the area of human rights protection.

The DV Act (Sect. 24) made provisions for the court in a criminal trial of DV cases to promote reconciliation by referring some cases to mediation under certain circumstances. These circumstances included when the violence is not aggravated or does not require a prison sentence more than two years, the victim offers to have the case settled out of court, and when the court had the opinion that the case can be resolved peacefully through alternative disputes resolution (ADR). Following a complaint of human rights abuses, officials of CHRAJ invited both the complainant and respondent to talk out their issues. As a neutral facilitator, the officials helped the parties to negotiate a mutually beneficial agreement for an amicable settlement. Though these settlements or agreements are not legally binding and a party can violate it without any consequences, CHRAJ was still a point of call for some DV victims. When parties do not reach an agreement, they are referred to the judicial system for redress.

Government approved support services provided by civil society organizations

Our study found that civil society organizations including non-governmental women’s rights organizations also played an important role in the provision of services to DV survivors. The services provided by these entities were supplementary to the formal support services. The range of services rendered included training and advocacy on DV prevention, psychosocial and legal counselling, education on gender-based violence, skills training, and provision of temporal shelter for survivors of DV.

The International Federation for Women Lawyers (FIDA-Ghana) provided free legal aid to women survivors, initiated research into socio-legal issues affecting the status of women and children, trained and sensitized stakeholders and the public on gender-based violence, served as referral centers for DV survivors from the police, CHRAJ, and DWS for legal assistance. Of the 21 survivors, 2 (9.5%) sought assistance for redress from FIDA. All the 21 survivors indicated that at one point, they had contact with these women’s rights organizations and were knowledgeable of the services they provided. At the time of this study, FIDA-Ghana also operated a flagship legal literacy and capacity building program that trained community members to serve as paralegals to DV survivors and other vulnerable groups at the community level. The project also offered legal training on handling gender-based violence with police officers in some selected police stations.

Survivors experiences of accessing formal support services

Severity of abuse, social, and economic obstacles informed preference for specific services.

Of the 21 survivors – 16 (76.2%) experienced physical violence (Table 2). Four of these 16 survivors (25%) of physical violence experienced sexual violence in addition. Severe physical violence was a major trigger to seek formal support services. Other forms of violence included verbal/psychological abuse, and economic abuse in the form of financial neglect. Nearly all 20 (95.2%) were abused by their intimate partners. The remaining survivor was abused by her in-laws. Counselling was offered to 10 (47.6%) of the survivors (Table 2).

Table 2 Experiences of women survivors with formal support services, Weija-Gbawe Municipality, Ghana

Survivors who received counselling service indicated that they felt better afterwards even though counselling alone did not stop the abuse. Survivor 3 who reported her ex-partner to the department of social welfare for economic abuse and the refusal to pay child maintenance shared her experience:

At the social welfare department, I was advised to avoid situations that will lead to fights resulting in my child’s father not giving money. The officer also told me to engage in some economic activity to reduce financial pressure on him (ex-partner). My ex was also advised to take up his responsibility until our child becomes 18 years. He agreed but did not change his behaviour thereafter. (Survivor 3, Interview, May 3, 2018)

Four of the 21 survivors (19%) confirmed that the perpetrators of violence against them were arrested and detained by the DOVVSU of the Ghana Police Service. In cases of severe physical and emotional abuses, survivors in our study obtained support from their friends or relatives and advice on decision to report the abuse to the police. Survivor 4 who had endured physical and sexual violence from her husband for many years had the support from family members when she decided to report him. Her decision to report her abuser led to a separation, and the case was pending adjudication at the time of our study. She recounted that:

Reporting the case has led to our separation. I am living with a friend for the meantime. I thank God that my children are now adults. (Survivor 4, Interview, May 3, 2018)

Aside fear of loss of life, severe and prolong violence was also a driver of the decision to report the abuse to authorities. In such cases, the informal networks of survivors (e.g., friends, family members, and pastors) supported them to report abuses to the police. The support from these agencies ended the violence for seven (33.3%) of our study participants (Table 2). Survivor 8 who had relief from her abuser after reporting him to the police narrated that:

when the police arrested and asked him to report to the police station every two days, he stopped abusing me. So far, I am satisfied because he has stopped beating me. (Survivor 8, Interview, May 3, 2018)

Challenges associated with utilization of formal support services

Delays and need for frequent follow-ups

Survivors in our study mentioned delays especially with in the criminal justice system as the reason why they dropped their cases. Survivor 6 suspected that her abuser might have induced the police to dismiss the case following his arrest and cautioning. According to her, on his release, he abandoned her and the family. She shared her experience:

The police made me go to the hospital and they arrested him. After he was released later, he packed his clothes and left without telling me anything. Subsequent follow up with the case officer was futile, as his whereabouts was not known. Maybe he paid money to have the case dismissed. (Survivor 6, Interview, May 3, 2018)

Delay in getting services was reported as a common cause of dissatisfaction with formal support services. Whereas six (28.65%) were satisfied with the support offered by service providers, 14(66.7%) were not satisfied with the services. Narrating her dissatisfaction with the formal support services, Survivor 7 recounted as follows:

When I reported the case at DOVVSU, there were delays and this necessitated frequent follow-ups. I did not have money to continue the case to the court, so I stopped pursing the issue. My marriage is unstable now, the abuse has not stopped, and he is angry that I reported him to the police. (Survivor 7, Interview, 3 May 3, 2018)

A women’s right advocate lamented on the delays in the adjudication of DV cases in the courts:

The slow pace of obtaining justice on DV cases is frustrating. When you report a case, it takes a long time to be adjudicated…if you don’t follow up repeatedly, the case will come to naught. (Women’s rights advocate 1, Interview, June 12, 2018)

Survivors’ lack of economic empowerment

Most DV survivors in the study were not economically empowered. This countered their efforts at seeking medical care, and medical reports. Section 8 of the Act makes provision for free medical care for DV survivors, but this is not provided for and hence, not complied with at the point of services. In adequate funds for this sector has not created an enabling environment for implementation of this provision. Consequently, survivors express the view that the free treatment and medical reports need to be urgently implemented or at worse medical bills to be charged on abusers. Survivor 9 also made this proposal to government as a way of deterring abusers in the following statement:

The government should educate the men and let them know that there is a law protecting women from domestic violence. If they do not comply with it…they would be arrested, pay medical bills, and punished severely. (Survivor 9, Interview, May 3, 2018)

DV survivors perceived hospitals as one places where they have temporary shelter devoid of the risk of encountering the perpetrators. They were of the conviction that, attending public hospitals in their time of distress is important and should not attract fees, whether for treatment or medical reports.

Survivors lack of comprehensive knowledge on the scope of support services

Survivors were not able to seek all the range of services available to them under the DV Act because of their limited awareness of these services. Hence, in expressing their expectations, some survivors called for the police in cases of arrests and subsequently release to secure a bond of non-violent behaviours (protection order) from their abusers, even though this service is stipulated in the Act. Those who suffered financial neglect expected a bond on their partners to assume their financial responsibilities to the family.

Institutional constraints

The efforts of survivors to access justice were thwarted by institutional constraints. This often result in delays attributed to several factor such as lack of central government budgetary allocation for service provision, lack of logistics by officials to carry out their mandate and inadequate trained official specialized in handling gender-based violence. A women’s Right advocate at FIDA-Ghana stressing on these constraints have this to say:

They (police) will help but the speed with which they do that is not fast. We partner with some police stations and offer training on the handling of DV cases. But we do this on piecemeal basis …I wish this could be done on a larger scale, but it is not feasible because of limited funds at the disposal of NGOs. Ideally, government should offer these training in larger scale to help the police to be more responsive in handling these cases. (Women’s right advocate 2, Interview, 14 June 2018)

This state of affairs negatively impacted on survivors desire to see the police arrest and prosecute abusers (for severe cases of physical and sexual abuse), fine, and caution where necessary. However, prosecution in severe cases was hindered among survivors who sort for this service. This was partly due to ineffective law enforcement in some cases, the unprofessional conduct of officials in the forms of trivializing domestic violence cases, accepting inducements from abusers and acting cold and unsupportive of survivors’ case. Similarly, an officer from the DSW stated that inadequate funding hinders the provision and maintenance of government-run shelters (Officer, Department of Social Welfare, Interview, June19, 2018). Our records review also found that the government budgetary allocation for the Ministry of Gender, Children and Social Protection for its expanded role was under 1% of the total national budget as of 2015 [35].

One of the three women’s rights advocates indicated that police trivialization of DV and the cold and sometimes harsh reception of victims at the police stations instantly discouraged women reporting DV. Oftentimes, this discouraged survivors from pursuing the case even if they succeeded registering it. She shared some experiences of survivors who reported at the police station to file a complaint and some of the responses they got were:

“What did you do before he beat you… go home if he beats you again then you come” and.

“You are reporting your husband to the police? He will leave (divorce) you”. (Women’s rights advocate 3, Interview, June 20, 2018)

Survivor (dis)empowerment and agency in seeking formal support services

Survivors in our study find that positive attitude from officials and support from their informal networks to their decision to seek formal support services empowering. Survivors also appeared to have internalized local and national campaigns against violence with emphasis on abuser accountability. This is reflected in the majority 19 (90.5%) of our participants indicating knowledge of the existence of the DV to punish abusers if victims reported the abuse, even though they were not conversant with the specificities of the provisions of the law itself.

An officer of the department of social welfare weighed in on DV survivor’s awareness of formal support services stating that:

Previously, fewer DV survivors reported abuse, but now more of them are reporting. This is because of education on radio, TV, and community outreaches by women’s right organizations. Even with this education, family and friends discourage some women from reporting abuse to us. It is only on few extreme cases of violence that survivors’ informal network supports their decision to report the perpetrator. (Social welfare officer, Interview, June 19, 2018)

This awareness notwithstanding, all survivors indicated that their initial point of call to end the abuse was to their informal social network. Also, they all indicated that their first decision to access formal support services was informed by their contact with media and community outreaches of DV activists and backed by some form of support from at least one family member or friend.

Though some survivors in the study still faced resistance from their informal networks in reporting abuses, majority of them 12 (57.1%) reported some instances that they were \ supported financially and psychologically by relatives and even law enforcers to report their abuse. In all these instances, the abuse was severe and habitual. For instance, a survivor’s sister encouraged her to report the abuse, and later supported her accommodation needs. Another Survivor also reported that she was motivated to continue the filing of a complaint against her partner after she received encouragement and support from a police officer. She narrated that:

When we got to the hospital, I did not have enough money to pay for the services. Had it not been the police officer who paid the bills, I would not have been attended to and as such couldn’t have filed the case. (Survivor 2, Interview, May 3, 2018)

A significant finding is that psychosocial and financial supports from victims’ informal networks as well as law enforcers were drivers for decision to report the abuse to the criminal justice system. Nevertheless, some survivors of the study still reported revictimization and pressures from their families to some extent. Of the 21 survivors 6 (28.5%) felt disempowered by discouragements from their informal networks and negative attitude of officials. These survivors reported exercising their agency by defying these setbacks and reported their abuse. Whilst others 3 (14.2%) issued threats to the abuser. Threats of reporting alone did not stop the abuse even though they sent a signal to the abusers that survivors were aware of the avenues for redress. Defiance and issuance of threats were ways that some of the survivors negotiated setbacks that were disempowering to them in seeking state support services.

Insights and perspectives from experts

The expert interviews revealed that the implementation of the DV Act had been problematic. This had to do with a disconnection between the DV law and its actual implementation. For instance, Sect. 29 of the DV Act makes provision for the establishment of victims of domestic violence support fund intended to provide basic material needs and support for victims. This fund was not operational. Some of the identified impediments that created this disconnect included lack of awareness of the Act and its provisions, inadequate funds for the implementing agencies, and inadequate personnel with appropriate specialized skills to handle domestic violence cases. A women’s right activist who bemoaned the lack of knowledge of the protection and occupation order had this to say:

Even professionals including police officers and social workers are not conversant with the protection and occupation order and procedure for their application as protection strategies for survivors of DV. (Women’s rights advocate 2, Interview, June 14, 2018)

A police officer at DOVVSU stated that, inadequate logistics hinders the effectiveness of their services to the public. In explaining the challenges of DOVVSU further, the officer stated that:

Lack of financial resources to run the office negatively affect service delivery to the public. Other challenges we face include inadequate training of personnel on effective prosecution of domestic violence and sexual and gender-based violence cases, and also heavy workload. (Police officer, Interview, May 30, 2018)

A women’s right advocate pointed out that getting a medical report at the right time is challenging to most women; and delay in getting the report because of financial difficulty tempers evidence (women’s rights advocate 2, Interview, June14, 2018).

The medical report fee commits a medical officer to the case and is meant to defray costs of transportation should the officer have to appear in court in person to give testimony during hearing of the case. A medical officer interviewed on the rationale of the fee charged explained that:

The issue is that, if the government takes up the costs incurred in terms of transportation and other related costs for medical officers to appear in court to testify, then the medical fee would be waived for DV survivors. (Medical officer, Interview, June 4, 2018).

All the women survivors in the study and experts agreed that paying for medical care and medical reports before a case can be booked is a disincentive for the pursuance of DV cases.

The interview with CHRAJ official explained that mediation and counselling by psychologists are often used to resolve milder cases of abuse, with an aim of promoting reconciliation. However, in cases of extreme physical violence the law was applied (CHRAJ official, Interview, June, 12 2018). The process and conditions for the referral of mild cases is well prescribed at Sect. 24 of the DV Act.

In the case of providing protective services to complement formal support services, The Ark Foundation – a Christian based non-governmental organization had a shelter for battered women. However due to financial constraints, the organization could no longer run the shelter at the time of this study. Hence, the organization resorted to shelter provision with support from other partners who sponsor the upkeep for persons they refer there (Women’s rights advocate 1, Interview, June 12, 2018).

According to a women’s rights advocate, some external family members of the survivors mostly prefer counselling or verbal cautioning of the abuser compared to prosecution in less severe instances of abuse. The advocate explained that the family members prefer this option because:

Arresting and prosecuting often lead to separation and divorce, which is detrimental to the family if they have children and especially if the abuser is the sole bread winner. (Women’s right advocate 3, Interview, June 20, 2018)

These pressures often led to complainants withdrawing the case before adjudication even began. For example, Survivor 5 from our sample was pressurized by family members to drop a complaint filed at DOVVSU. She revealed that:

Our family members advised me not to pursue the case because of our young children. I had to drop the case because I would have been tagged disrespectful to them if I did not. (Survivor 5, Interview, May 3, 2018)

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