Beyond initial care: a mixed-methods study of hospital-based health services for women and girls who have experienced sexual violence in Ethiopia

Objective To assess services provided by, and barriers to, hospital-based one-stop centre (OSC) services for women survivors of sexual violence in Ethiopia.Design A mixed-methods study integrating quantitative service data with that from qualitative interviews.Setting Hospital-based OSCs in Addis Ababa, Ethiopia.Participants Hospital records of 2283 female survivors, in-depth interviews with 20 survivors and 17 key informants.Results Quantitative analysis of hospital records showed the majority (61.9%) of survivors seeking OSC care did so within 72 hours of experiencing sexual violence. Most received diagnostic sexually transmitted infection (STI) testing, emergency contraception and postexposure prophylaxis for HIV. Legal and psychosocial referrals were made for 93.5% and 68.4% of survivors, respectively, with 11.8% referred for antiretroviral therapy. The majority of survivors (79%) did not return for follow-up care, including for repeat STI and pregnancy testing. Qualitative findings highlighted women’s experiences of gaps in psychological support, mistrust in legal systems and structural barriers to ongoing care such as work constraints, safety concerns and transport challenges.Conclusions While initial diagnostic services are largely implemented, significant gaps remain in preventive, therapeutic and follow-up care for survivors of sexual violence. This underscores the need to strengthen hospital-based OSCs in Ethiopia to provide comprehensive, survivor-centred care.