Global estimates suggest that approximately 10 million people worldwide are living without any legal citizenship. Stateless persons face overwhelming obstacles that limit their access to basic entitlements and protections, leaving them vulnerable to discrimination and abuse. Research on health and access to care is generally limited among stateless persons and, currently, there is a dearth of information on statelessness and its relationship to gender based violence (GBV).
The aims of the project were to understand the demographics, experiences, and vulnerabilities of GBV and general health status among stateless populations. This study focused on stateless populations, which is defined as populations who currently live in Cote d’Ivoire who are not citizens of another country nor are migrants because the persons do not have birth certificate from any country or their parents do have national certificate from their country of origin.
Methods: To achieve study aims we utilized a mixed methodology approach, conducted in two phases. The first phase included qualitative research with stateless persons and key informants who serve these populations. Qualitative research enabled us to obtain contextual descriptions of experiences related to documentation, GBV and GBV-related health issues, and access to health care. The second phase included an epidemiologic survey conducted among stateless and national populations, which was informed by qualitative findings. The epidemiologic survey was developed to collect data on a wide array of GBV experiences and GBV-related health indicators as well as to assess availability and access to related GBV services. These two methods were complementary in nature, providing both numeric estimates and contextual support of the topics of interest. This study was conducted by Johns Hopkins University and a local implementing organization, Afrique Secours et Assistance (ASA) and the UNHCR country office in Abidjan, Cote d’Ivoire.
Results: A quantitative cross-sectional survey was conducted throughout Cote d’Ivoire from March 8-May 4, 2017 in rural settings (45 communities) where stateless populations are known to reside and where local leaders and their community were willing to participate in the survey.
A total of 364 women participated, of whom 167 were nationals and 197 were stateless. Compared to national female participants, stateless females were less likely to have ever attended school, less likely to have attended secondary school or college (among those who attended school), and less likely to have a dual parent household during childhood (55.4% vs. 62.9%). In addition, stateless female participants were more likely to have faced challenges with legally marrying someone due to their lack of birth registration and less likely to have enough to meet basic needs for each month (Figure 1).
Figure 1: Demographic differences among surveyed women
A total of 221 men participated, of whom 104 were nationals and 117 were stateless. Similar to stateless female participants, stateless males were less likely to have ever attended school, less likely to have attended secondary school, or college (among those who attended school), less likely to have grown up in a dual parent household less likely to be married, and more likely to have ever faced challenges with legally marrying someone when compared to their national counterparts (Figure 2). In addition, stateless men were less likely to be legally able to open a bank account, and less likely to have health insurance. Stateless men’s partners were less likely than national men’s partners to be able to open a bank account (36.8 vs. 73.4%). Both male and female stateless participants reported the same challenges among their children.
Figure 2: Demographic differences among surveyed men
Approximately one-third of stateless and national women reported physical abuse during childhood (aged 15 years), 7% reported childhood sexual abuse, and 33% reported any childhood physical or sexual abuse. Forty percent reported lifetime physical IPV in adulthood, 27% lifetime sexual IPV, and 40% lifetime physical or sexual IPV, with no difference by nationality status. Among women reporting any IPV victimization, less than one-quarter ever reported IPV victimization to an authority. Sixteen percent of national and stateless women reported physical violence during adulthood by a non-partner. Slightly fewer national than stateless women reported experiencing sexual violence victimization by a non-partner (6.7% vs. 2.2%) and 20% reported any physical or sexual violence by a non-partner with no difference by nationality. In total, approximately 53% of national and stateless women reported any lifetime physical or sexual violence in adulthood or childhood, with no significant difference by nationality status.
Figure 3. Violence victimization among surveyed women
As a child, 47% of men reported experiencing physical abuse, 8% childhood sexual abuse, and 49% any childhood physical or sexual abuse, with no difference by nationality. One in five men (21.3%) reported physical violence during adulthood, 4% sexual violence, and 25% any physical or sexual violence by a partner or non-partner, with no difference by nationality. In total, 25% of national male participants reported any lifetime violence victimization.
Figure 4. Violence victimization among surveyed men
Stateless women were more likely to report difficulty getting money for medical advice or treatment (72.7% vs. 50.0%), and concerns about deportation when accessing healthcare (40.2% vs. 1.3%) relative to national women. Stateless men were also more likely than national participants to report concerns getting money needed for health advice or treatment (73.9% vs. 48.5%), distance to the health facility (37.9% vs. 20.2%) and fear of deportation when accessing healthcare (39.7% vs. 0%) compared to national men.
Conclusions: Gender-based violence is high in Cote d’Ivoire, but does not appear to be different by national or stateless status. However, disparities in basic rights places stateless populations in vulnerable situations. Further, concerns of deportation and worse economic positions prevent stateless persons from accessing healthcare and protection services, potentially including services for GBV.