Researching Gender-Based Violence and Access: Lessons from the Field in Ethiopia

Guest post written by student researchers Megan Churchill, Inaara Ali, and Barrett Liebermann

Researching Gender-Based Violence and Access: Lessons from the Field in Ethiopia

A Chance for Real World Research

We’re Megan, Inaara, and Barrett, recent Masters graduates from George Washington University. Every year, GW gives students in our program the chance to work in partnership with a client organization and take on a real research project. For the three of us, coming straight from undergrad into grad school, this was an exciting opportunity to contribute research for an organization doing work that matters. This felt like our first real opportunity to put the research skills we’d been building to use for something beyond the classroom. 

With all of us concentrating in Global Gender Policy — Inaara and Megan in International Affairs, Barrett in Global Communication — our shared interest in gender is what pulled us together as a group in the summer of 2025. From there, the brainstorming started almost immediately. Each of us had studied Gender-Based Violence (GBV) in our coursework, and we knew right away that we wanted our research to center on how GBV impacts a community. 

The idea for our client organization came from Barrett, whose mom, Erica Liebermann, sits on the board of Grounds for Health (GfH), a nonprofit that provides healthcare to women in rural Kenya and Ethiopia. The more we read about their work, the more it felt like the right fit, so we reached out to Kyle Engelman, GfH’s director. Kyle was eager to support our research and told us that Grounds for Health could benefit from a study on the impact of GBV on women’s access to healthcare. Her enthusiasm for the topic was contagious, and by October 2025 we were deep into desk research on GBV and women’s access to healthcare in rural Ethiopia.

Our Research Question 

Soon we developed our official research question: How does GBV impact women’s access to cervical cancer healthcare in rural Ethiopia? The study of the intersection of GBV and global health is important because GBV is a threat women face worldwide, with nearly one in three women experiencing physical or sexual violence in their lifetime. When women face GBV it affects them physically and psychologically and may restrict their access to essential healthcare services. At the same time, cervical cancer is the fourth most common cancer among women worldwide. Cervical cancer is highly preventable through early screening and treatment, so GfH’s work to provide women with HPV testing is critical. We believe that in Ethiopia, where access to cervical cancer prevention remains limited, it is necessary to study how gender norms and stigma impacts women’s abilities to seek healthcare. 

In researching GBV we didn’t just ask how physical violence prevents women from accessing care. We also asked, what roles are women expected to perform in their daily lives? Might those expectations mean they don’t have time to access healthcare? We asked if women have the right to make their own decisions and if they need to ask their husbands for permission or transportation support to reach a health post. 

Experience Conducting Research

One of the biggest appeals of working with GfH was the ability to have strong community centered research. Working with GfH allowed us to interview 8 community health extension workers and 7 healthcare providers. By interviewing healthcare workers who are not only members of the community but also trusted intermediaries, we were able to gain significant insight on the needs of the community. In addition to those interviews and focus group we also interviewed 4 GfH staff members including Kyle, Grounds for Health’s director, Ashenafi Argata, the Country Director in Ethiopia, Demis Berhan, the Program Quality Specialist in Ethiopia, and Mesfin Wana, the HPV Program Specialist at Grounds for Health. 

The hospitality of the GfH staff in Ethiopia is something we will never forget. Mesfin not only served as our translator throughout our time in Hawassa but he also arranged all interviews for us and drove us out to health posts. The generous amount of support given to us by the entire GfH team is what made this research possible. 

While we were in Ethiopia we had the opportunity to join the “10k for HER” a fundraiser walk that took place on International Women’s Day on rolling dirt roads near Hawassa. Participating in this walk made us keenly aware of the importance of proximity to healthcare clinics. 10k was chosen as the distance for this fundraiser because women sometimes have to walk this distance in their journey to and from the nearest health clinic. Throughout the walk we had food and water and we stopped to rest in the shade. We were also buoyed by the GfH staff and healthcare workers participating in the walk who chanted and skipped and kept spirits up. This made us think of the women who take this walk alone, who do not have snacks to bring or who must walk faster in order to return to their children. For those who must walk miles to access healthcare, maybe they have the opportunity to access care, but it is a challenge and a struggle to do so.

Research Findings

From interviewing healthcare extension workers, we learned that “access to care” is not limited to the care provided in a health post or clinic. Access to care extends well beyond that, through the efforts of health extension workers and their work in awareness raising within communities. We realized that access to care starts at a more fundamental level — with knowledge and awareness about care itself and the home visits that healthcare workers provide.

We also learned that being prevented from access to care isn’t just about being physically prevented from seeking care. The people we talked with told us that resources, stigma, the right to make decisions, and misconceptions about the need for healthcare, all influence women’s abilities to gain access to care. 

Our preliminary findings noted that self-testing implemented by GfH in 2022 increased screening uptake. Self testing – proven to be reliable – allows for women to swab themselves and then receive a result without having to receive a speculum exam. While this eliminates the stigma around a speculum exam, unmarried women often still avoid seeking care due to stigma surrounding premarital sex and the societal perceptions around why they are visiting a health post. Additionally, 75% of health extension workers reported that women must obtain their husband’s permission to seek care and providers sometimes communicated test results to husbands rather than patients. 

We found that although self-testing improved access to screenings, it does not address underlying social norms, leaving many women, particularly unmarried women and those requiring spousal permission, excluded from essential healthcare services.

What Struck Us Most

What most struck us about GfH’s power is their connection to the community. Whether it’s labeled, “community organizing,” or not, the way GfH operates is rooted in the community. Before traveling to Hawassa Ethiopia, we knew that GfH was partnered with Ethiopian healthcare workers, but we didn’t know just how well the organization uses community centered approaches in its work. In Ethiopia, coffee is not only a source of income, but also something that brings people together through traditions like the coffee ceremony. After the “10K for Her”, we watched Ashenafi, the Ethiopia in Country Director, speak with village elders about cervical cancer prevention during a traditional coffee ceremony. This experience of direct community engagement showed how deeply Grounds for Health is connected to the community, and how coffee can help bring people together around women’s health.

Much of life in Hawassa felt community centered; the ritual of coffee ceremonies and shared time, family style meals, the willingness of healthcare extension workers to be on call at all hours of the day for the many hundreds of women they serve. Grounds for Health has partnered with this community, and is using their community centered approaches in working to increase women’s access to healthcare. We think that this embrace of community and partnership with local healthcare workers has contributed to Grounds for Health’s success and high follow up rates; From mid-2022 to today, over 92% of all women who tested positive and needed follow up care, returned to the health center for care. 

Reflecting on our time in Ethiopia conducting research, we’re missing it. We’re missing the energy of life: people crossing the street freely, cars giving space and gently honking their approach, donkeys and carts on rural roads near Hawassa. We’re missing the food: injera with lentils and vegetables, fish and meat cooked in delicious spices. Most of all we’re missing the Grounds for Health staff and the kindness and support they showed us in our research process. 

Read the full policy paper here.