TSINAAT NAY IYOB YIHABENA: DIRECT AND INDIRECT VIOLENCE FACED BY ERITREAN WOMEN ASYLUM SEEKERS

Background Female irregular migrants, including those with claims for asylum, experience considerable sexual violence both while migrating and after arrival in their host country. They also often have a high unmet need for sexual and reproductive health services. Researchers originally designed the study to explore the reproductive health needs of Eritrean women asylum seekers who had arrived in Israel since 2007. Participants’ responses prompted researchers to expand the study, to also investigate the sexual violence and exploitation that the women had experienced both en-route to and after arrival in Israel. Methods This is a qualitative methods study. Phase I investigated barriers to the access of contraception from the health systems perspective. Data collection included semi-structured in-depth individual interviews with 25 adult key informants (e.g. health providers, case-workers, government officials, members of international NGOs, activists in the asylum-seeking community, NGO workers and researchers). Phase II of the study investigated the sexual violence and exploitation experienced by female Eritrean asylum seekers in Israel. Phase II consisted of 12 semi-structured in-depth individual interviews (6 men and 6 women) and 8 focus group discussions (4 groups of men and 4 groups of women, N=44) with Eritrean community members living in Israel. Results Participants reported that sexual violence and exploitation had become normalized en-route to Israel. Irregular status and movement hindered access to the institutional support needed to prevent the perpetuation of these practices. Participants indicated that the need for protection from this abuse continued in Israel as a result of political and economic marginalization. In spite of a need for protection, including important reproductive health services such as family planning methods, women reported being unable to access these services due to a number of structural barriers to careseeking for asylum seekers in Israel. Conclusion Interviews and focus group discussions revealed both a considerable risk of sexual violence and exploitation throughout Eritrean women’s migration experiences and a limited access to sexual and reproductive health services. We found that asylum-seeking women migrating irregularly had experienced an increased vulnerability to sexual abuse and limited recourse to support. Our findings suggest that risk and access to care vary by context. Doctoral dissertation committee members Advisor: Pamela Surkan Thesis committee: Drs. Pamela Surkan, Peter Winch, and Wietse Tol Dissertation Defense committee: Drs. Pamela Surkan, Peter Winch, Amy Tsui, and Danielle Germa

A qualitative study exploring barriers related to use of footwear in rural highland Ethiopia: implications for neglected tropical disease control

Background The role of footwear in protection against a range of Neglected Tropical Diseases (NTDs) is gaining increasing attention. Better understanding of the behaviors that influence use of footwear will lead to improved ability to measure shoe use and will be important for those implementing footwear programs. Methodology/Principal Findings Using the PRECEDE-PROCEED model we assessed social, behavioral, environmental, educational and ecological needs influencing whether and when children wear shoes in a rural highland Ethiopian community endemic for podoconiosis. Information was gathered from 242 respondents using focus groups, semi-structured interviews and extended case studies. Shoe-wearing norms were said to be changing, with going barefoot increasingly seen as ‘shameful’. Shoes were thought to confer dignity as well as protection against injury and cold. However, many practical and social barriers prevented the desire to wear shoes from being translated into practice. Limited financial resources meant that people were neither able to purchase more than one pair of shoes to ensure their longevity nor afford shoes of the preferred quality. As a result of this limited access, shoes were typically preserved for special occasions and might not be provided for children until they reached a certain age. While some barriers (for example fit of shoe and fear of labeling through use of a certain type of shoe) may be applicable only to certain diseases, underlying structural level barriers related to poverty (for example price, quality, unsuitability for daily activities and low risk perception) are likely to be relevant to a range of NTDs. Conclusions/Significance Using well established conceptual models of health behavior adoption, we identified several barriers to shoe wearing that are amenable to intervention and which we anticipate will be of benefit to those considering NTD prevention through shoe distribution

Asylum seekers' access to health care in Israel

Gottlieb ND, Ghebrezghiabher H, Gebreyesus T. Asylum seekers' access to health care in Israel. The Lancet. 2015;386(9988): 25

Barriers to contraceptive careseeking: the experience of Eritrean asylum-seeking women in Israel

Gebreyesus T, Gottlieb ND, Sultan Z, et al. Barriers to contraceptive careseeking: the experience of Eritrean asylum-seeking women in Israel. Ethnicity & Health. 2017;25(2):255-272

Additional file 1: of Life on the margins: the experiences of sexual violence and exploitation among Eritrean asylum-seeking women in Israel

Questionnaires: The additional file is comprised of the questionnaires used during the study for the purposes of data collection. These questionnaires were used during all key informant interviews, individual interviews and focus group discussions. (DOCX 121 kb

The association of beliefs about heredity with preventive and interpersonal behaviors in communities affected by podoconiosis in rural Ethiopia

Little is known about how beliefs about heredity as a cause of health conditions might influence preventive and interpersonal behaviors among those individuals with low genetic and health literacy. We explored causal beliefs about podoconiosis, a neglected tropical disease (NTD) endemic in Ethiopia. Podoconiosis clusters in families but can be prevented if individuals at genetically high risk wear shoes consistently. Adults (N = 242) from four rural Ethiopian communities participated in qualitative assessments of beliefs about the causes of podoconiosis. Heredity was commonly mentioned, with heredity being perceived as (1) the sole cause of podoconiosis, (2) not a causal factor, or (3) one of multiple causes. These beliefs influenced the perceived controllability of podoconiosis and in turn, whether individuals endorsed preventive and interpersonal stigmatizing behaviors. Culturally informed education programs that increase the perceived controllability of stigmatized hereditary health conditions like podoconiosis have promise for increasing preventive behaviors and reducing interpersonal stigma