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Gender and social norms

Youth health outcomes are affected by the influence of socialisation and cultural attitudes associated with gender and sexual inequality in various societies.

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01. Sex and Gender as two distinct domains

Although sex and gender are often used interchangeably in everyday language, they have distinct meanings. Sex is thought of as a dichotomous concept, with individuals being classified as male and/or female based on their reproductive anatomy (almost always based on the appearance of the external genitalia) and genetic makeup. The determination of sex in the fertilised zygote, fertilised egg cell that results from the union of a female gamete (egg, or ovum) with a male gamete (sperm), determined by the presence of either an X or Y chromosome, with XX resulting in a female and XY resulting in a male. This criterion is used to fill in a birth certificate, though however, it should be noted that there are also individuals who are born with variations in sex development (intersex) and their sex may not be easily classified as male or female. Sex refers to the biological characteristics that define an individual as male, female, or intersex, based on chromosomes, hormones, anatomy reproductive organs, and behaviours, but it is not always binary.

Gender, on the other hand, refers to the social and cultural roles, behaviours, and identities in a society’s expectations that are associated with being male, female, or non-binary. Gender identity is an individual's internal sense of being male, female, or non-binary, and it can align or not align with the sex they were assigned at birth. Gender expression is the external manifestation of one's gender identity, which can include clothing, hairstyles, mannerisms, and other characteristics that are typically associated with a particular gender. Additionally, the concept of gender is specific to humans, since only humans have evident self-awareness that allows them to express gender, and it is not found in other animals, which only have sex.

Sex and gender identities interact in complex and unique ways, creating unique experiences or challenges for different individuals. For example, an intersectional approach to sex and sexuality may recognise that the individuals from different racial and/or ethnic backgrounds may face different social, cultural, or historical factors that influence their experiences of sexuality and sexual health. So, these factors may include racism, discrimination, stereotypes, prejudices, and cultural norms around gender and sexuality. Similarly, an intersectional approach may recognise that individuals with different abilities may face unique challenges and barriers related to sexual health and access to sexual education and resources. It may also recognise that LGBTQIA+ individuals face discrimination and stigma related to their sexual orientation and gender identity, which can have negative impacts on their mental health and well-being. By taking this approach, we can promote more comprehensive, inclusive, and equitable approaches to sexuality and sexual health for all individuals.

02. Gender spectrum and sex physiology

Sex is a biological concept and sex differences in physiology and associated mechanisms can be caused by a combination of three major factors that interact and overlap: sex hormones, genes, and the environment. Sex hormones, such as oestrogen and testosterone, both play a significant role in the development and maintenance of sexual characteristics and behaviours. So, both sexes produce the same hormones but in different amounts, which makes it difficult to define the sex of the individual based only on these sexual molecules. Genetics also plays a role in sex differences since certain genetic variations may be more common in one sex than the other. And finally, the environment also plays a role in sex differences, since the different experiences, expectations, and/or socialisation can affect the development of certain behaviours.

Whereas gender differences on the other hand, reflect a complex interplay of psychological, environmental, cultural, and biological factors. So, it is a complex multifactorial trait that likely results from the interplay of genetic, epigenetic, environmental, and social factors. Thus, the concept of gender identity is not reducible to a single biological or psychological mechanism. It is important to note that gender and sex are not always congruent. While there are associations between gender identity, neuroanatomy, genetics and hormone levels, the exact biological mechanisms underlying gender identity remain to be fully understood. Studies have shown that there are structural and functional differences in certain areas of the brain between cisgender individuals and transgender individuals. However, it is not clear whether these differences are a cause or a result of gender identity.

Sex physiology refers to the biological and physiological characteristics that distinguish males, females, and intersex individuals. These characteristics include chromosomes, hormones, and reproductive organs, and they are typically used to categorise individuals into binary sex categories (male or female). However, biological sex is not always binary, and thus, some individuals may be born with variations in sex characteristics that do not fit the typical binary definitions. While sex often influences gender, it is not possible for gender to influence sex, as sex is a biological characteristic determined by genetic, hormonal, and physiological factors that are not changeable by societal or cultural constructions. Therefore, by acknowledging the diversity of gender identities and gender expressions and recognising the variation that can exist in biological sex, we can create a more inclusive and equitable society that values and respects the experiences and identities of all individuals. This is important since the concepts and definitions related to sexual orientation and gender identity have evolved significantly over the years.

03. Gender diverse youth and mental health outcomes

Most gender diverse people position “being transgender” an important part of their identity which is different from their sexual orientation; a trans person might be gay, straight, bisexual, queer, asexual, or nonbinary. Gender affirmation describes the process for a trans person, from their original legal sex to the gender with which they identify, whether binary or non-binary. Transition may involve social, medical and/or surgical, and/or legal steps that affirm a person’s gender. Due to such a complex transition, the trans and/or gender diverse population is more vulnerable to or at risk of experiencing anxiety or depression, or both at some point in their lives, and more likely to experience sexual and gender violence or coercion than the general population, especially for young gender diverse people. Research shows that many gender diverse youth report self-harm or suicide attempts due to experiencing stigma, discrimination, violence that have severe impact on their mental health and well-being.

Overall, family plays an important role in the mental health outcome of young people. A lack of family support makes it difficult for young trans people to access health services, leaving them isolated from mental health care, and thus, their gender identity is not understood nor respected. Whereas young trans people with supportive families do better on many indicators, including less suicidal thoughts and easy access to mental health services which makes a difference in providing them with gender affirming care and safe space. When trans youth receive gender affirming care that is respectful, aware, supportive of their identities and life experiences, they feel supported. Thus, mental health services should promote optimal quality of life for young trans people. Young trans people are more likely to experience positive life outcomes when they receive support that is affirming of their gender identity. 

That is, identifying and addressing institutional barriers for young trans people through youth education; delivering a youth work with the aim of facilitating a sustained understanding of how stigma, prejudice, discrimination and violence affect the mental health and wellbeing of young trans people; and promoting youth health literacy that reduces the negative effects of stigma, prejudices, and discrimination on the mental health. Youth mental health care and support should be tailored to meet the specific needs of trans youth through inclusive, youth-centred care and support. That is, helping young trans people understand that being a trans person is not a mental illness and that a mental health concern may or may not be related to their gender identity; facilitating them to have open conversations about systemic barriers and possible solutions; and ensuring that youth workers reflect and are aware of how their own attitudes about and knowledge of gender identity and gender expression affects the quality of the youth education they provide.

04. Real or perceived gender image and community perceptions

Real or perceived gender image refers to how individuals identify and present themselves in terms of gender, and how they are perceived by others based on societal expectations and norms. Gender identity is an individual’s internal sense of their own gender and one’s gender expression is how an individual outwardly expresses their gender to the outside world, including through their appearance, behaviour, or mannerisms which can be reinforced or discriminated against through society domination of “acceptable” norms for femininity and masculinity. Gender image is shaped by a variety of factors, including societal expectations around gender roles and norms, cultural beliefs and traditions, and personal experiences. It can affect how individuals are treated and valued in and by society and can influence their access to resources, opportunities, and rights.

Society dictates what is considered “acceptable” behaviours, jobs, appearances, and beyond for women and men, and so, these dominant concepts are passed on between generations from birth. Community perceptions regarding sex and gender can vary widely depending on cultural, social, and/or historical factors. Different societies and various communities have different norms, values, and expectations regarding gender roles, expression, and sexuality. It is not easy to change the dominant community’s perceptions that can interfere negatively in shaping gender identity and expression, as individuals often conform to cultural norms and stereotypes to fit in and be accepted. This can lead to pressure to conform to the more traditional gender roles and expectations and can impact an individual's ability to express their gender identity authentically. Community perceptions of gender image can have a significant impact on how individuals are treated and valued in society, namely, because in some cultures, gender is seen as a binary construct.

So often, these communities may view individuals who do not conform to these expectations as deviant or abnormal and so, may subject them to discrimination, harassment and/or violence. While other communities may have more fluid and flexible notions of gender and thus, may celebrate and embrace gender diversity, with greater awareness and acceptance of the LGBTQIA+ identities and experiences. These communities may have more progressive attitudes towards issues such as gender identity, sexual orientation, and non-binary gender identities, and may offer more resources and support for individuals who identify as LGBTQIA+. Negative attitudes and discrimination can lead to marginalisation, social isolation, and/or mental health problems, while supportive and affirming attitudes can promote acceptance, connection, and positive self-esteem. Thus, community perceptions regarding gender image have significant impacts on the experiences and well-being of individuals who do not conform to the traditional gender norms.

05. Gender and sex against social and culture norms

Sex does not exist outside social, cultural meanings and how we understand sex shapes how we understand gender. That is, our physical body never exist outside cultural and social meanings, which reinforces our understanding of gender as a social construct. That is, many claims about sex traits (like females are physically weaker than males) actually carry implications about how women and men are expected to behave or act in their own culture and set the social norms to adhere to. So, claims about sex are not identical to claims about gender; rather, they imply claims about gender roles and norms. Gender roles and norms support the views that a person is not born a man or a woman; but rather becomes a woman or a man through gender socialisation: females become women through a process whereby they acquire feminine traits and learn feminine behaviour. Thus, social, and cultural forces either have a causal role in bringing gendered individual into existence or shape the way we are as women and men, and the mechanism of this construction is social learning. 

Gender is a total of culture notions of what is appropriate to each gender by way of temperament, character, interests, status, worth, gesture, and expression. Feminine and masculine gender-norms, however, are problematic in that gendered behaviour conveniently fits with and reinforces women and gender minority groups’ subordination: from early age, society teaches women to be passive, docile, and emotional helpmates for men. However, since these roles are simply learned, we can create more equal societies by unlearning them. For instance, parents often unconsciously treat their female and male children differently using a gender-stereotypic language: boys are described as strong, alert, and coordinated while girls are described as tiny, soft, and delicate. So, at an early age in one’s life, the agents of socialisation starting with family members, should aim at diminishing the influence of gender socialisation.

Parents intentionally tend to reinforce certain behaviours: girls are discouraged from playing sports like football or from playing rough and tumble games and are more likely than boys to be given dolls or cooking toys to play with, whereas boys are told not to cry like a baby and are more likely to be given masculine toys like trucks and guns. As a result, children are influenced by what they observe in around them, and it would shape who they become as adults. This makes countering gender socialisation difficult. But this does not end here, children's books have portrayed males and females in blatantly stereotypical ways: males are portrayed as adventurers and leaders, while females are portrayed as helpers and followers. Even though alternative approaches are being used such as making characters gender-neutral or genderless imaginary creatures, the readers label the majority of gender-neutral characters masculine, while the characters that fit feminine gender stereotypes, for instance, by being helpful and caring are labelled feminine.

06. Oppression and gender-based discrimination

By distinguishing sex and gender, it has been established that many differences between women and men are socially produced, and therefore, changeable, and at the same time, distinguishing sex and gender, enables the two to come apart: they are separable in the way that a person can be of male sex and yet be gendered a woman or vice versa or neither as a woman nor a man, to indicate that there are persons who do not fall within binary gender norms. That is, although biological differences are fixed, gender differences are not as they are the results of cultural practices and social expectations, and thereby, gender differences are oppressive results of social interventions that dictate how women and men should behave. 

Women are oppressed as women and by having to be women, further, a person of male sex, gendered a woman, or vice versa, or neither or falls under the LGBTIQA+ is oppressed as an LGBTIQA+ person and for belonging in the LGBTIQA+ community. As result of this oppression, girls, and women in majority and LGBTIQA+ persons are exposed to unequal treatments compared to men, and do not have equal rights and opportunity as men, which brings about gender discrimination. Since gender is a social construct, it is mutable and alterable by the political and social reforms that ultimately would bring an end to women and LGBTIQA+ persons’ subordination. That is, society needs political and social reforms aim at creating a genderless, but not a sexless society, in which a person’s sexual anatomy is irrelevant to who a person is, what a person does, and with whom a person is in love or have sex with. But which reforms and which social practices construct gender are the major controversies in the field of gender discrimination prevention. 

There is no consensus on these issues. But the issue is not that male dominance is a result of social learning; rather, socialisation is an expression of power. That is, socialised gender differences in masculine and feminine traits, behaviours, and roles are not responsible for power inequalities. Females and males are socialised differently because there are underlying power inequalities. Thus, dominance/oppression (power relations) is prior to differences (traits, behaviour, and roles). For example: society portrays females with sex traits claiming females to be physically and/or mentally weaker than males, as result, a female gendered woman with same academic qualifications as a male gendered a man, experiences discrimination during the hiring processes when she is passed over for the man even though she has equal skill, academic credential, underlying ability, experience or other attributes that imply equivalent expected productivity for a same job. Hence, gender discrimination is conceptualised as the differential treatment of a person or group on the basis of gender. By this definition, gender discrimination is about power relations, rather than traits, behaviour, and roles.

07. Origin and perpetuation of gender-based violence

Gender-based violence refers to violations of fundamental human rights by act, omission, or by advocacy of hatred which perpetuate sex-stereotyped norms and roles which deny human dignity and self-determination of an individual and hamper human development. Such human right violations refer to the physical, sexual, and psychological harm that reinforce women and LGBTIQA+ persons subordination and perpetuate male power and control. So, gender-based violence is the violence that is directed at a person or a group on the basis of gender and/or sex. It includes acts that inflict physical, mental, or sexual violence and suffering, threat of such acts, coercion, or other deprivations of liberty, whether occurring in private and/or public.

The distinction made between public and private spheres should not serve as an excuse for not addressing domestic violence as a form of gender-based violence. Hence, the exclusion of women and girls from the public arena only increases their vulnerability to violence within the family. Moreover, acknowledging that LGBTIQA+ persons encounter combined gender and sex discrimination implies that the boundaries of gender-based violence should not be defined respectively by girls or women experiences. That is, a lesbian, gay, bisexual, transgender, intersex, or a queer person should not be protected only to the extent that their experiences coincide with those of a binary person, either as a man or a woman. Even though the majority of the victims or the survivors of gender-based violence are girls and women, by making gender-based violence experienced by women the standard gender-based violence form to address, this standard appear to be another perpetuation of gender-based violence against non-binary, the entire LGBTIQ community, as gender-based violence prevention laws and polices do not protect them by assuming that they cannot and should have pure claims of gender-based violence.

This contradiction is another manifestation of origin and perpetuation of gender-based violence and these are conceptual limitations of the binary-issue analyses that intersectionality challenges. The point is that a human female can experience gender-based violence in any number of ways and that the contradiction arises from society’s assumptions that only claims that fall within the margins of gender binary are pure, valid, therefore, legitimate. Such exclusive assumptions that deny LGBTIQA+ persons equal rights and opportunities as those given to girls and women should be challenged in the same way that laws and policies that deny girls and women equal rights and opportunities to those of men are being challenged today. For instance, a lesbian woman can experience gender-based violence in ways that are both similar to and different from those experienced by women, and often a non-binary person experiences double-discrimination: the combined effects of practices that discriminate on the basis of sex, and gender.

08. A look at a gender-based violence context

Gender-based violence is a pervasive and a life-threatening health, human rights, democracy, and protection problem in all societies across the world. Deeply social constructed and rooted in gender inequality and social and cultural norms that disempower and discriminate, gender-based violence is present at all levels of society from family in one's childhood, private and governmental institutions to community offerings where the most marginalised women and LGBTIQA+ persons are exposed to violence. Yet the family, community leaders, and the policy makers have normalised social and cultural norms, attitudes, and behaviours which in the one way or the other, tolerate and deny protection to women as well as sexual and gender minorities groups targeted and discriminated purely on the basis of their sex, sexuality, and sexual orientation, or their gender, gender expression, and gender identity.

Patriarchy emphasises that our society is somehow organised by placing the male gender as a controlling, as a strong figure that represents everyone else. The woman is regarded as the helper of the man or one of the dominated. By looking at patriarchy as a system that oppresses and dominates women, and all other non-binary persons, this subordination has always to be maintained by violence. Violence is the most important way which is used to enforce the patriarchal structure of power that is present in society. It forces women and all other non-binary persons to feel ashamed. It makes women to feel pain and also to demonise their feeling out of that sense of shame that they experienced for being beaten, without support, without resort, without the ability to stop violence that is perpetuated against them in society. So, patriarchy is supported by blind obedience, on the basis of fear, and the destruction of individual willpower. Hence, an environment conducive to violence on the basis of gender and sex has been normalised in our society, and this is gender-based violence.

Such an environment creates norms, policies, and institutions that contribute to the significant vulnerability and victimisation of women, and of sex and gender minority groups more than men. Hence, Gender-based violence affects sex and gender minority groups as much as it affects women. Girls and women are often the victims and survivors of violence, sexual assault, and rape which significantly affects their psychological and future life. Even though these are not clearly understood and recognised as important areas of human rights concern. Gender- based violence affects the family as a whole. It affects the male who perpetrates it. It turns them into perpetrators, instead of reasonable human beings. And also, it affects the lives of children and their future life in terms of understanding how the world works. Gender-based inequality is also expressed in the way women go out to work, which puts in jeopardy the projection and realisation of their human rights.

09. Common causes of gender-based violence

In every community across the world there are people who are affected by acts of gender-based violence that are often publicised, whereas abuses committed behind closed doors in the confines of one’s own home often remain completely hidden. LGBTIQ persons who do not enjoy the protection of their governments within many countries, are among those most vulnerable to acts of gender-based violence. Gender-based violence is most prevalent in environments where there is a general lack of respect for human rights, and gender-based violence is itself a violation of fundamental human rights that perpetuate sex-stereotyped roles on the basis of power inequalities. The common causes of gender-based violence are largely rooted in unequal power relations between male and female that perpetuate and condone various type of violence within the family, the community, and the State. 

Gender-based violence is further embedded and rooted in gender inequality and strengthened by women disempowerment which makes it one of the primary obstacles to achieving gender equality. Gender inequalities perpetuate attitudes, norms, and policies which promote gender-based violence. As a result, many actors involved in the field of youth education and training do not understand the inherent link between gender inequalities, power relations, and gender-based violence and its relevance to their youth work. Thus, capacity and accountability become issues; in many countries, there are no policies or systems for gender-based violence prevention and response. Lack of state accountability to protect and promote the realisation of human rights for all, significantly constrains capacity development of agents of change; and thus, hinders effective and timely response. 

This is the most dominant and persistent prejudice in gender-based violence prevention as specialised considerations for gender-based violence against children and LGBTIQ persons are not consistently integrated into gender-based violence response programmes or child protection programmes. Hence, with the absence of accountability, policies, and guidelines related to protection from gender-based violence and assigned responsibilities, tend to be discriminatory against some persons and to focus less on their lived experiences. Engaging equally with women, children and LGBTIQ person is critical for a successful gender-based violence prevention work, especially in youth work and youth initiatives as these interventions may challenge prevailing cultural and social norms in collaboration with young people, including women’s groups and LGBTIQ communities as essential partners. The equal Inclusion of both women and LGBTIQ persons in community-based intervention is too often ignored but their capabilities should be brought to the forefront from the earliest stages of planning, designing, and implementing gender-based violence interventions.

 

10. Gender-based violence’s victim, survivor, and perpetrator

A victim of gender-based violence is a person affected by violence which targets that person on the basis of sex and/or gender under different forms: (a). Physical, sexual, and psychological violence occurring in the family, including battering, sexual exploitation, sexual abuse of children in the household, dowry-related violence, marital rape, female genital mutilation, or other traditional harmful practices or exploitation. (b). Physical, sexual, and psychological violence occurring within the general community, including rape, sexual abuse, sexual harassment, and intimidation at public spaces, human trafficking, or forced prostitution. (c). Physical, sexual, and psychological violence perpetrated or condoned by the State and institutions, wherever it occurs. 

We have three faces of victims: (1). Direct victims: those who have suffered direct effects of gender-based violence. Those who are assaulted or raped, or physically and psychologically abused, sexually exploited, tortured, detained, or discriminated against, on the basis of their sex and/or gender. (2). Indirect victims: those who are linked to direct victims in such a way that they too suffer because of that connection. The relatives of a direct victim might be punished because of their connection to that person through socio-economic deprivation, denial of opportunities, or family break-down. Children of a direct victim have to bear the consequences of what happened to their parents and may behave like victim. Trauma can be handed down; children tend to absorb and retain pain and grief, consciously or unconsciously which they carry into adulthood: a problematic heritage that can lead to them become perpetrators. (3). Individual and collective victims: brutal conflicts inflict severe harm on individual person when sexual and gender-based violence is used a weapon of civil wars or genocides. In such cases, individuals are targeted because of their connection to an identifiable collectiveness.

Herein, a survivor of gender-based violence is defined as the victim of gender-based violence who implicitly or explicitly recognises and reacts to acts of sexual and gender-based violence. Those who are assaulted or raped, physically and/or psychologically abused, sexually exploited, tortured, detained, or discriminated against on the basis of their sex and/or gender and choose to live and take on the fight one day at time are survivors. Whereas the perpetrators of gender-based violence are sometimes the very people upon whom the victims or survivors depend on to assist and/or protect them. Most cases of gender-based violence involve a female victim or survivor and a male perpetrator. Most acts of gender-based violence against boys and men are also committed by female and male perpetrators. Perpetrators include: (a). Intimate partners; (b). Family members, close relatives, and friends; (c). Influential community members (teachers, leaders, politicians); (d). Security forces and (e). Institutions.

11. Gender-based violence from a perpetrator’s perspective

If society aims to effectively tackle gender-based violence, then our youth work should take into consideration the development of a plan for working with the perpetrators. This is not any way to justify or excuse the actions of perpetrators, this is to highlight that gender-based violence preventive and response measures should also look at how the preparate come to be. A lot of what we know about gender-based violence comes from victims, survivors, and witnesses. Not many have turned to the perpetrators to understand how gender-based violence is used in their particular setting and the circumstances that shaped their attitudes and behaviours over their lifetime. Working with perpetrators of gender-based violence is difficult but necessary. Perpetrators' human rights, including their own safety and fair trials must be respected. 

If the perpetrator is also a previous victim and a survivor of gender-based violence, the person has protection and rights as guaranteed by international human rights law to have access to health support and psychological help. It has been established that children of direct victims of gender-based violence have to bear the consequences of what happened to their parents as trauma can be handed down where the children absorb or retain pain and grief, consciously or unconsciously which is a problematic heritage that create the perpetrators. That is, in many cases, the perpetrators are created by society, and excluding them in the process of gender-based violence prevention is in itself a human right violation, because inclusion and participation are human rights in themselves regardless on a person’s social, legal, or criminal status. So, it is important to not only consult preparators, but also to consult with national authorities on what actions are taken locally to work with preparators of gender-based violence to ensure their rehabilitation. 

And when rehabilitation has not been completed to ensure an extended and a monitored period, ensuring that the perpetrator not return to the community or do not have access to their victims. This is relevant as many acts of gender-based violence are also related to other key global health issues such as substance abuse, trauma, depression, etc. Childhood trauma and witnessing of gender-based violence are also proven to be influential factors, which supports the idea that those exposed to gender-based violence during youthhood should be prioritised for interventions. So, sustainable gender-based violence preventive and response measures require transformation of cultural and social norms and changes in attitudes and behaviours on how society view perpetrators. This requires looking beyond the surface by establishing a conversation and get to know the perpetrators to see and view gender-based violence in their particular setting and the circumstances that shaped their attitudes and behaviours over their lifetime.

12. Challenges to gender-based violence response

Partnerships and networks across multiple sectors, including the legal system, the medical and psychosocial services, police, and other support services, are the cornerstone of an effective gender-based violence response. However, gender-based violence survivors do not always have easy and unhindered access to all these services or to the necessary information, support, and guidance as to how they should expose and report incidents of gender-based violence. One of the risks of seeking support is the possibility that the survivor’s friends, family, or the community will find out, which can lead to them being stigmatised, kicked out of their home or community, or exposed to a more severe violence as a form of punishment or with the intent to humiliate them. 

These often occur in societies where being a victim of gender-based violence is perceived as shameful, with women being considered guilty of attracting sexual assaults against themselves based on their lifestyle, or where being a LGBTIQ persons in considered a taboo, a curse, and mental health problem. In some community, it is very likely that service providers are exposed to threats, hostility, and violence by the perpetrator or they community if they are seen as helping a survivor. And while most forms of gender-based violence are criminalised in many countries, the practices of law enforcement in many cases favour the perpetrators, which helps to account for low levels of trust in public authorities, the main reason why most cases of gender-based violence incidents go unreported. In many countries, there is no or limited access to medical care, healthcare services or psychosocial support for gender-based violence survivors. Whereas the support for LGBTIQ survivors does not exist at all.

In addition, gender-based survivors have often no access to advocacy and legal support, including free legal assistance, help, advice, advocacy, and court support services; the family and community do not take the lead in providing safe spaces and security for victims or survivors. Gender-based violence survivors face quite often difficulties in finding information about their rights and entitlements, including free access to qualified and impartial interpreters, translation of legal documents, if necessary. Further, lack of support for professional and social reintegration of victims or survivors partly accounts for enduring low levels of reporting and documentation of gender-based violence incident with legally required evidence. Moreover, the lack of education or economic resources generally makes victims or survivors, vulnerable to more violence; in the cases of child marriage, gender-based violence creates a pattern of violence and poverty that is self-perpetuating making it extremely difficult for the victims to extricate themselves. Thus, it is imperative that multi-sectorial services are strengthened and enhanced so that the effects of gender-based violence are tackled and further harm is avoided.

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