Awareness and access to support resources among refugee women in Salt Lake City experiencing sexual and gender-based violence

This paper addresses the complex issue of refugee women and their susceptibility to sexual and gender-based violence. Refugees are more susceptible to this violence as a result of their increased vulnerability when they are displaced, as well as changing gender roles and environments as they are forced to resettle. In refugee communities, males typically hold dominance and power in society. Sexual and gender-based violence is perpetuated through its cultural acceptance at the individual, relational, community, and social levels. Survivors are not supported by their communities to seek care and treatment after experiencing this violence. This study seeks to explore the complexity of culture surrounding refugee women living in Salt Lake City, Utah who have survived sexual and gender-based violence by assessing their awareness and access of support resources. This study also seeks to gain an understanding of how to overcome the barriers which survivors face in order to connect them to support resources. Through a qualitative research study, interviews were conducted in order to collect data from practitioners assessing their clients' barriers, awareness, and access of resources. Results found barriers to women receiving treatment in Salt Lake City, and this paper offers recommendations in overcoming these barriers.

AWARENESS AND ACCESS TO SUPPORT RESOURCES AMONG REFUGEE WOMEN IN SALT LAKE CITY EXPERIENCING SEXUAL AND GENDER-BASED VIOLENCE by Katie Rasmussen A Senior Honors Thesis Submitted to the Faculty of The University of Utah In Partial Fulfillment of the Requirements for the Honors Degree in Bachelor of Science In The College of Social Work Approved: ______________________________ Dr. Megan Reynolds Thesis Faculty Supervisor _____________________________ Dr. Jason Castillo Chair, Department of Social Work _______________________________ Dr. Jason Castillo Honors Faculty Advisor _____________________________ Sylvia D. Torti, PhD Dean, Honors College April 2018 Copyright © 2018 All Rights Reserved. ABSTRACT This paper addresses the complex issue of refugee women and their susceptibility to sexual and gender-based violence. Refugees are more susceptible to this violence as a result of their increased vulnerability when they are displaced, as well as changing gender roles and environments as they are forced to resettle. In refugee communities, males typically hold dominance and power in society. Sexual and gender-based violence is perpetuated through its cultural acceptance at the individual, relational, community, and social levels. Survivors are not supported by their communities to seek care and treatment after experiencing this violence. This study seeks to explore the complexity of culture surrounding refugee women living in Salt Lake City, Utah who have survived sexual and gender-based violence by assessing their awareness and access of support resources. This study also seeks to gain an understanding of how to overcome the barriers which survivors face in order to connect them to support resources. Through a qualitative research study, interviews were conducted in order to collect data from practitioners assessing their clients’ barriers, awareness, and access of resources. Results found barriers to women receiving treatment in Salt Lake City, and this paper offers recommendations in overcoming these barriers. ii TABLE OF CONTENTS ABSTRACT ii INTRODUCTION 1 STUDY PURPOSE 11 METHODS 12 RESULTS 14 DISCUSSION 19 CONCLUSION 22 REFERENCES 24 iii 1 INTRODUCTION Violence against women has become one of the most concerning and prevalent public health issues in the world (Rees & Pease, 2007). Throughout the world, one in three women has experienced violence, including beating, coercion into sex, or abuse in her lifetime (Hynes & Cardozo, 2000). A recent survey found that across 81 countries, 30% of women aged 15 years or older experienced intimate partner violence throughout her lifetime (Tol et al., 2017), which is an increase from 25% in a 2013 study (Smith et al., 2013). It is estimated that around the world, 40 to 70% of homicides of women are committed by intimate partners (UNHCR, 2003). Violence against women involves a spectrum of physical, sexual, and psychological acts of abuse, assault, control, threat, and aggression (Guruge, Roche, & Catallo, 2012). This violence can take many forms, including rape, sexual harassment, intimate partner violence, incest, child abuse, female infanticide, and abuse and neglect of older women (Guruge, Roche, & Catallo, 2012). These acts are often perpetrated by male partners, and are a major cause of injury and mental illness among women and children (Rees & Pease, 2007). Defining the Problem Sexual and gender-based violence (SGBV) is considered to be one of the most prevalent violations of human rights, even though it is under-reported everywhere worldwide (Stark et al., 2010). An overwhelming majority of SGBV victims and survivors are women and girls (UNHCR, 2003). This type of violence includes more than acts of sexual assault or rape; sexual and gender-based violence is a consequence of individual attitudes taught by society to reinforce female subordination and perpetuate male power and control. The term “sex” refers to biological characteristics of males and 2 females, while “gender” designates the social characteristics assigned to men and women (UNHCR, 2003). Gender is learned through socialization, and differs between cultures. Society defines roles, responsibilities, power relations, attitudes, and behaviors. These learned behaviors are defined as a “gender identity” (UNHCR, 2003). This inequality and power imbalance between genders often results in violence, and society’s acceptance of this violence perpetuates this continued disparity (UNHCR, 2003). In its “Declaration on the Elimination of Violence Against Women” in 1993 the United Nations defined gender-based violence as, Any act of violence that results in, or is likely to result in, physical, sexual, or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life...and should encompass, but not be limited to, acts of physical, sexual, and psychological violence in the family, community, or perpetrated or condoned by the State, wherever it occurs. (Wirtz et al., 2013) Similarly, intimate partner violence encompasses physical, sexual, psychological, or controlling behaviors, most commonly against women by their current or former male partners (Tol et al., 2017). The UNHCR outlines different forms of violence against women. Under sexual violence, acts may include rape, marital rape, child sexual abuse, defilement, incest, and sexual acts of abuse, exploitation, and harassment. Physical violence may be physical assault, trafficking, or enslavement. Emotional and psychological violence includes abuse, humiliation, and confinement. Socio-economic violence is displayed through discrimination, denial of opportunities or services, social exclusion, ostracism, and 3 obstruct legislative practices. There are also harmful traditional practices including female genital mutilation, early or forced marriage, honor killing, infanticide, and withholding education (UNHCR, 2003). Other acts of violence include spousal battery, non-spousal abuse, intimidation at work and school, and forced prostitution (Wirtz et al., 2013). Causes and Consequences of SGBV SGBV can occur anywhere, including all cultures, races, genders, ages, classes, and religions. There are different levels in which women are victims of violence. The individual level is the degree to which a person is knowledgeable, has personal security, and access to resources, services, and social benefits. These different experiences influence one’s personal history and attitudes towards gender, which dictates whether a person will either be a perpetrator or victim of violence. In relationships, abuse may occur between individuals and families. Communities are influenced by socialization and power dynamics are evident in schools, the workplace, and healthcare. Society stresses cultural and social norms, and establishes expected gender roles. Attitudes and acceptance towards violence is determined by society (UNHCR, 2003). Victims of SGBV experience many consequences which affect all areas of wellness. Consequences of physical health include injuries, chronic pain, sexually transmitted diseases, gastrointestinal disorders, and fibromyalgia. Psychological health consequences may be depression, anxiety, extreme stress reactions, trauma symptoms, and suicide ideation (Guruge, Roche, & Catallo, 2012). Survivors of SGBV have also been linked to a higher risk of drug and alcohol abuse and physical disability. Victims of 4 rape are also at risk of unintended pregnancy, adverse pregnancy outcomes, and HIV (Stark et al., 2010). Refugee Women's Risk for SGBV Refugee women are even more susceptible to SGBV. Today, there are millions of women worldwide who are fleeing their homes in search of freedom, as well as safety from war, persecution, and gender-based violence (Haynes, 2014). There is a complexity of risk factors which causes a refugee woman to be more vulnerable to SGBV. These risk factors include the breakdown of social, family, and government protection, loss of or poor policing, lack of legal resources, and social acceptance of SGBV (Haynes, 2014). A refugee is defined by the United Nations as a person who, Owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it. (Haynes, 2014) A refugee is someone who has left their county of origin because they fear of being persecuted. Similarly, an “internally displaced person” is an individual who has been forced to abandon their home as a result of persecution, war, or conflict, but has remained within the borders of their home country (Hynes & Cardozo, 2000). All displaced persons, especially women, are at an increased risk for SGBV because they may lack the both individual and institutional resources to protect them. 5 The refugee crisis is a major global concern today as its population has remained at alarming rates. In 1994, there were 47 million reported displaced persons (Haynes, 2014). By 2016, the refugee population had increased to 66 million people who were forcibly displaced as a result of persecution, human rights violations, and violence (Fazel & Betancourt, 2017). Human trafficking has also increased worldwide. The International Organization for Migration estimates that annually there are as many as 2 million women being trafficked between countries (UNHCR, 2003). Refugee women are also at an increased risk of SGBV due to the intersection of their identities. Their oppression is linked to the intersection of their cultural, gender, religious, political, and ethnic identities (Haynes, 2014). Perpetrators may use these identities to exert or achieve social control and domination. As a result, more than 55% of the world’s refugees today are women and their dependent children (Robbers, Lazdane, & Sethi, 2016). Culture as a Complex Causal Factor Among the many levels in which a woman experiences SGBV, the societal level is most complex. Members of society together have culture, which is defined as a system of shared beliefs, customs, behaviors, and values in which people are able to make sense of their world and each other (Rees & Pease, 2007). It is at this level in which a culture systematically condones or punishes violence on the basis of gender. One factor contributing to an increased risk for SGBV is when males hold dominance over women. Women are more vulnerable than men because they have a lower status than men in many societies. This gender inequality is a result of differing traditional roles between genders and expected behaviors, creating a disparity (Robbers, 6 Lazdane, & Sethi, 2016). Many refugee women’s home cultures accept males exerting dominance over women in violent ways, including abuse. For refugee women, domestic violence is one more experience of violence in addition to the persecution they have experienced prior to immigration (Bhuyan & Senturia, 2005). Many larger communities within certain cultures pressure women to remain with their abusive husbands and to recognize the rights men have over them. Community members may also pressure women to keep their relational problems within the family and community, denying that domestic violence is a problem (Bhuyan & Senturia, 2005). SGBV Perpetration Perpetrators of SGBV in refugee communities may be different than those in nonrefugee settings (Hynes & Cardozo, 2000). SGBV was reported to have occurred to refugee women across many settings, including their home countries, both during times of conflict and peace, as well as camps, the host country, and during transit to the host country (Wirtz et al., 2013). Survivors of SGBV reported that violence occurred during situations of increased vulnerability, as well as conflict and displacement (Wirtz et al., 2013). Refugee women experience SGBV in their communities by perpetrators who are both known and unknown to them (Wirtz et al., 2013). Perpetrators who were known or trusted by the survivor include spouses, intimate partners, family members and relatives, neighbors, other camp residents, and humanitarian staff. Unknown perpetrators include armed actors and strangers in both the country of origin, and the host country (Wirtz et al., 2013). Violence experienced in host countries is because the of increased risk of oppression as a result of the intersection between their racial and gender identities. 7 At the relational level, one study found that psychological abuse most often occurs, followed by physical and sexual abuse (Guruge, Roche, & Catallo, 2012). The most commonly reported types of psychological abuse were insulting, criticizing, intimidation, and controlling behavior. Common physical forms of abuse were slapping, hitting, and shoving, as well as forced sexual intercourse and sexual abuse (Guruge, Roche, & Catallo, 2012). Other forms of abuse include social and financial isolation (Rees & Pease, 2007). SGBV also occurs during times of conflict and war. Rape may be used as a weapon war, and can be an organized strategy to punish or dehumanize women and girls (Haynes, 2014). This strategy has remained effective because it relies on the pervasive cultural norms that put an emphasis on a woman’s virtue and purity (Shanks & Schull, 2000). Rape and other forms of sexual torture are routinely used as strategies to shame and demoralize individuals, creating a divide within a community (Pittaway & Bartolomei, 2001). In camps, refugee women are particularly vulnerable to SGBV from a lack of security and resources for protection. Women often must walk long distances for basic needs such as water and wood, and are vulnerable to abuse (Shanks & Schull, 2000). Economic insecurity and lack of male protection in camps also is an increase for SGBV (Robbers, Lazdane, & Sethi, 2016). In one study, 26% of Burundian refugee women in a Tanzanian camp reported having been victims of SGBV during their time in the camp (Shanks & Schull, 2000). SGBV After Resettlement 8 Resettlement in a host country may contribute to the increased risk of intimate partner violence (Guruge, Roche, & Catallo, 2012). Resettlement stressors include shifts in power dynamics, language barriers, and cultural differences. Another major cause of stress in a resettled home is changes in gender roles (Nilsson, Brown, Russell, & Khamphakdy-Brown, 2008). After resettling in the United States, for example, women may need to work outside of the home for the first time. They could potentially earn more income than their male partners, which results in a change in power dynamics (Nilsson et al., 2008). Male partner’s inability to find employment may result in an increase in family conflict and domestic violence. This is a result of employment being a part of men’s identity and self-worth within their cultures (Rees & Pease, 2007). As women experience gain power and independence, their male partners may begin to feel threatened. One study found that women with a greater proficiency in speaking English were more likely to experience abuse from their partners (Nilsson et al., 2008). SGBV Effects on Refugee Women Refugee women who are survivors of SGBV experience consequences similar to that of women in the mainstream population. Physical and psychological consequences are comparable, however consequences for displaced women may be more severe if they don’t have support systems (Hynes & Cardozo, 2000). For all survivors, it is crucial for SGBV victims to receive clinical care in a timely manner to prevent adverse consequences. This care should be delivered by a competent and compassionate healthcare provider, so as the survivor may begin physical and emotional healing (Smith et al., 2013). Additionally, physical injury may be worsened for some survivors if there is a delay to a physical examination. If examination and care is greater than 72 hours after 9 sexual violence, post-exposure prophylaxis for HIV prevention may not be possible (Wirtz et al., 2013). Refugee women who are victims of SGBV are also at an increased risk for unwanted pregnancy, unsafe abortion, and sexually transmitted infections (STIs) (Tanabe et al., 2013). Unfortunately, refugee women do not always have or desire access to care and support after SGBV for a number of reasons. The cultural response to a refugee woman experiencing SGBV is unsupportive of acknowledging, addressing, and caring for the victim. In many third-world countries, rape may result in a woman becoming permanently dishonored (Haynes, 2014). In some cultures and religions, a rape survivor may even become a victim of an honor killing as well (Haynes, 2014). Law enforcement systems treat victims of rape poorly, and justice systems fail to punish perpetrators (Hynes & Cardozo, 2000). One study interviewed refugees from Ethiopia that were resettled in America. Researchers found that despite domestic violence being illegal in the United States, the refugee community in the study rejected this viewpoint and condoned the behavior in traditional Ethiopian ways (Nilsson et al., 2008). Without sufficient community support, a SGBV survivor is also at an increased risk for homelessness when she doesn’t have access to resources (Banga & Gill, 2008). There are other barriers to refugee women receiving care after abuse. In some cultures, women seldom share emotional problems; they may regard psychological problems as a sign of weakness (Nilsson et al., 2008). Another researcher found that many women widely held the belief that if they were to seek assistance after being abused, they would not be believed by others in their community. Many cope alone for 10 fear of cultural shame, isolation, and poverty (Rees & Pease, 2007). Fear of the community’s response is one major barrier for women receiving care after SGBV. Treatment for the Refugee and Broader Population Treatment for victims of SGBV includes conducting a full history and physical examination, ensuring treatment of physical injuries, treating sexual transmitted diseases, and gathering simple forensic evidence. Other forms of treatment include providing psychological support and referring for counseling, as well and offering the option to report the assault to authorities. Emergency contraception and abortion may also be considered for the victim, however this may not be a culturally appropriate option for refugee victims (Shanks & Schull, 2000). Guidelines specific for refugees include private consultations, provision of samegender medical staff, and ensuring gender and cultural sensitive conduct. It is also important that the refugee woman be informed of her rights (Robbers, Lazdane, & Sethi, 2016). Refugee Population in Salt Lake City Refugees constitute of a large population in Salt Lake City, Utah. Today, there are approximately 60,000 refugees living in Utah (Kem C. Gardner Policy Institute, 2017). A majority of the population lives in Salt Lake County. The refugee population in Utah largely represents Somalia, Burma/Myanmar, Iraq, Iran, Democratic Republic of the Congo, and Sudan. In Utah, there are two resettling agencies including the International Rescue Committee (IRC) and Catholic Community Services (CCS). Both of these agencies assist in the resettlement and transition processes. They offer other services including case management, mental health support, language interpretation, and financial 11 assistance. There are 70 refugee-specific programs across Utah that offer services specifically for the refugee population (Utah Nonprofits Association, 2015). In Salt Lake City, major non-resettling agencies that offer refugee-specific services include Asian Association of Utah and Utah Health and Human Rights. Other beneficial resources are Department of Workforce Services and YWCA. Figure 1: Refugees in Salt Lake City by Country of Origin STUDY PURPOSE This study seeks to explore the complexity of culture surrounding refugee women living in Salt Lake City who have survived sexual and gender-based violence by assessing their awareness and access of support resources. Many refugee communities do not encourage seeking support after experiencing SGBV, and as a result many survivors do not access resources already established. By exploring the consequential barriers that survivors face from a lack of community support, it would create understanding of how to overcome these barriers and to connect survivors to resources. This paper will address the following questions: (1) How can refugee women who are survivors of sexual and 12 gender-based violence overcome barriers to be able to address their trauma and receive treatment? (2) How aware are refugee women of available resources in the Salt Lake City area? (3) What resources does a refugee woman need to be able to leave an abusive relationship? METHODS Study Design and Instrument This study used a qualitative approach to research the barriers for treatment, awareness of, and access to resources for SGBV survivors of the refugee community living in Salt Lake City. With the help of the International Rescue Committee of Salt Lake City, a survey was developed to collect data through interviewing practitioners who work closely with refugees. The survey was used as a way to investigate refugee women’s experiences with SGBV through the expertise of their practitioners. The survey questions were: 1. What knowledge and resources do women in an abusive relationship need, especially besides leaving the relationship? 2. What do they need to do to leave the relationship? 3. What resources do they need for coping? 4. What resources do they need when moving toward an improved overall wellness? 5. What knowledge and resources are women already aware of and access for coping or healing after they’ve experienced sexual violence? 6. How does this compare between formal institutions and community help? 7. How does this apply to women who have experienced the sexual violence in the United States in comparison to abroad? 13 8. How are the needs of clients different now than when they first arrived? 9. What types of support do women need to feel that leaving an abusive relationship is possible? 10. Do you think that the sooner a client becomes integrated into their resettled community, the sooner they will feel ready to process their abusive relationship? Study Participants A convenience sample of participants was recruited through key contacts from the International Rescue Committee of Salt Lake City. All of the participants involved in the study work at agencies in the Salt Lake City area, including the International Rescue Committee, Utah Health and Human Rights, and Asian Association of Utah. There were five interviews conducted with eight total participants. All participants work directly with refugee clientele, and have expertise in the complexity of their clients’ experience with SGBV. Data Collection Each interview was either conducted in the participants’ work environments, or received by written form. No identifiable information of the clients was given by the respondents, or collected in the study. When conducted in-person, the researcher verbally asked the interview questions to the participants, and they responded in a conversational manner. The audio portion of the interviews were recorded with the participants’ knowledge, and later transcribed by the researcher. When conducted in written form, the researcher sent the interview questions to the participants by email, who then responded with their answers in the same manner. There were three in-person interviews with six respondents, and two written interviews with two respondents, for a total of eight 14 respondents. All of the interviews were conducted in English. After transcribing the recorded audio there emerged many words, phrases, and ideas that were repeated throughout the participant’s responses. The researcher took note of common words and concepts, marking tallies for each time a word was mentioned. The more frequently a concept was repeated, the higher of importance it was given. Each repeated word was then reviewed in the context in which it was given. Then, the researcher simplified the responses and began to sort them into categories as many common themes were clarified. Most of the repeated words were given in one of a few contexts. These common themes were then sorted and further categorized into three topics described in detail below. RESULTS Demographics A total of eight participants completed the survey. A majority of the participants were female (88%), and all worked in agencies that directly serve the refugee population. Three of the participants are employed at Utah Health and Human Rights, four are employed at Asian Association of Utah, and one is employed at the International Rescue Committee. Understanding SGBV and Identifying Resources Throughout the interviews, the respondents discussed that one significant barrier for their clients receiving treatment is a lack of knowledge of available resources, and a definition of the problem. A refugee SGBV survivor may not understand how SGBV is defined. Similarly, her culture may not define SGBV as an issue that needs to be addressed. As a result, she is not able to identify the trauma and harm that she is experiencing, or seek support. What she has experienced throughout her lifetime may be 15 culturally normative. These differences in cultural norms lead to many refugee women not seeking support for SGBV. “I’ve heard clients say, ‘If my husband is physically abusing me I can’t report it, it’s not allowed’…They don’t recognize that your husband can rape you. They don’t think it’s possible because they’re married…They don’t have the same sense of domestic violence.” In the refugee community within Salt Lake City, SGBV survivors may not access resources because they are not aware that they exist, or there is confusion in how certain procedures or processes occur. They may fear for their children, and be unaware that they could potentially gain custody. Many clients are also unclear of laws, and of the reporting process for SGBV. “I think some of the most important knowledge is understanding the resources available in our community, as well as the laws that protect women in abusive relationships. Many of the women who I work with come from countries where these types of resources and laws are non-existent. They need to know that there are ‘safety nets’ (such as housing and financial help) in place to help them survive.” In addition to being knowledgeable of resources, many also don’t know how to access and utilize these resources. The concept of obtaining institutional support may be new to the survivor, and could require support and guidance. They may not know that there are people willing to help them, or how to reach out to them. 16 “They also need guidance on how to access those resources and utilize them. Women also need to have a clear understanding of what types of behaviors or patterns in behavior are considered abusive, and to begin to recognize the signs of abuse.” Having Support and Not Feeling Isolated Respondents also discussed the importance of survivors being able to identify support at all levels. They need to know that they are not isolated in their experiences and trauma. They are also unaware that there are other women in their own community who may have similar experiences with SGBV. “Being among other women who have also experienced this normalizes it. It doesn't make it okay, but it helps them to understand that other women have gone through this and have succeeded afterwards.” Respondents also discussed the impact of their client’s negative cultural response to the SGBV they have experienced. At a community level, their clients have learned not to talk about their trauma from fear of social isolation. SGBV is considered a dishonor in many cultures, and survivors may be ostracized or considered unworthy within their community. A survivor may not feel encouraged to seek support, or to leave the relationship if she is fearful of her community’s response. Many participants stressed the importance of building trusting relationships between practitioners and their clients so that they may be a vital support for them. One respondent stated that their client only mentioned that she was being abused after a year and a half of knowing the family. 17 Clients also need to know that there are resources in their community that target SGBV, such as the YWCA. “They need community support. They believe they’re gonna be shunned, when in reality there’s a portion of the community that’s just like them, they just don’t know they exist…There’s a lot of distrust within the community…Many will say they don’t trust anyone from their own community, when in reality I have other clients say the same thing. They should learn that there are other people in their community with the same thoughts.” Oftentimes, a refugee woman may consider a resource to be negative or hurtful, when in reality it could be beneficial to her overall wellness. One example is a refugee woman’s perspective of the police force. In her home country, people in uniform were often perpetrators of SGBV. In her resettled home in America, this trauma may carry over and be a barrier from her trusting the police. “There’s a trauma response to people in uniforms. They can’t trust people in uniforms here because of what they’ve experienced from them back home.” Being Self-Sufficient and Empowered The interviews also showed that in order for a survivor to see herself potentially leaving an abusive relationship, she needs to believe that it is the right decision, both for herself and her children. Alongside knowing what resources are available to her and the legal process of separating herself, she must be able to have a clear understanding of what her options are, and have confidence in her choice. 18 “I strongly believe that women need to clearly see a path forward and have significant support to leave. Our clients are also integrated into tight communities that must be able to show support or be large and diverse enough for women to feel safe in leaving their spouses.” Self-sufficiency is another area in which the respondents considered essential for a survivor to be able to leave an abusive relationship. In her marriage, she may be dependent on her spouse to earn money and to make decisions for their family. She may not be able to idealize herself surviving outside of her spouse. She needs to feel empowered, and to know that she is capable of living a life of safety outside of an abusive relationship. Survivors need to find independence outside of the relationship to be able to meet their basic needs. In the United States, it is important for them to learn English so that they can work or go to school to be able to provide for themselves. If her husband was the primary driver in the family, or the only one to have learned how to drive, she must also learn to drive or use public transportation on her own. “They need self-sufficiency. They need to learn English, and to work. They need the feeling of ‘I can do this!’ because women usually stay home and don’t work.” Another way to feel empowered is to partake in self-care, which may be different for each woman. Activities such as physical exercise, yoga, prayer, meditation, and support from close family members or friends can help a woman to feel more equipped and sufficient to support herself outside of her relationship. To be empowered, she needs to engage in activities that create a sense of accomplishment. 19 “[She needs] mental health support via individual or group therapy, engagement in groups and activities that aid in fulfillment and personal growth (such as book clubs, exercise groups, classes), support for parenting (if they have children), and economic stability.” DISCUSSION Implications This study contributes to the growing body of work surrounding the complexity of refugee women and their trauma related to SGBV. This study provided new insight to the literature surrounding refugee women and the trauma they face from SGBV by highlighting their struggles and barriers in receiving treatment. This study contributes to the knowledge of refugee women specifically living in the Salt Lake City area by interviewing practitioners with considerable expertise and background. Through interviews with respondents, findings collectively suggested that survivors in Salt Lake City must overcome specific barriers in order to receive care after experiencing SGBV. These barriers include a client’s lack of understanding of identifying abuse by differences in cultural norms, having an unsupportive community, knowing what resources are available, how to access these resources, and feeling insufficient. The findings in this study suggest that for women particularly living in Salt Lake City to overcome these barriers, they must identify key supporters, such as agencies, practitioners, and legal authorities, in order to receive care and potentially leave the relationship, if necessary. The study findings also highlight areas of importance for a survivor’s recovery, including feelings of empowerment through self-care and gaining independence. In the context of 20 Salt Lake City, independence may encompass the survivor learning how to drive or take public transportation, becoming proficient in English, and being economically secure. The research findings also suggest that while a woman may be aware of resources, she may not access them in fear of her community’s response. Study Limitations One limitation of this study was the small sample size. With a limited number of participants, the study did not include a diverse sample set of practitioners’ expertise and opinions towards refugee women in Salt Lake City experiencing SGBV and the complexity of receiving care. The study findings may have been different if there was a larger sample size of participants. Another limitation in the data was the lack of specifying countries of origin. This study explored the general refugee population in Salt Lake City and gauged the practitioners’ knowledge without regard to the specific countries in which their clients originate. The results from this study would have made a greater contribution to the existing body of literature if it explored specific characteristics and habits of clients per their country of origin in order to compare trends. In a future study, it would be beneficial to specify data per country of origin in order to explore emerging patterns. Recommendations This study found that as a result of their negative cultural response, SGBV survivors often feel isolated and alone. Many respondents stated in the interviews that women need to know that they are not the only ones in their communities experiencing this violence. As a result, women often do not access established resources. 21 One recommendation to address this issue is the Peer Education Model proposed by the Women’s Refugee Commission (WRC, 2017). Peer education follows a community-based approach to increase empowerment (WRC, 2017). Their model was specific to addressing individuals involved with sex work, however this model can be implemented to empower survivors of SGBV as well. The WRC ran a pilot program of the model in 2016. The pilot trained 50 refugee women who had been engaged in sex work to be peer educators. The training included a variety of activities and media to teach the curriculum, including focus groups, peer and expert discussions, and slideshows (WRC, 2017). The trainings were holistic, and covered a range of topics including human rights, life planning skills, relevant local laws, peer counseling, gender-based violence prevention and response, community outreach, and mobilization. As peer educators, the women committed to being focal points to other refugees in their community. They organize information, safety, and know-your-rights sessions for their peers, conduct oneon-one mentoring, and provide referrals for legal aid and other services in response to SGBV. Additionally, they act as outreach coordinators, and take on capacity-building activities and share information (WRC, 2017). The Peer Education Model is especially beneficial to refugee women as they can receive help from someone in their own community who speaks their language. Another benefit of the model is that the educator is also familiar with struggles related to specific cultural restrictions from within that community. It would be advantageous to the SGBV survivor for agencies supporting refugees to implement the Peer Education Model so as to further increase access to established resources. 22 Another recommendation is the Neighborhood Method, which is based on systematically gathering information on refugee women who have experienced SGBV through a social network of respondents (Stark et al., 2010). This method is based on the assumption that respondents are likely to share valid information about others’ experiences with SGBV, such as their neighbors or sisters (Stark et al., 2010). This method is particularly effective when the respondent has a long-term, established relationship with the practitioner. In this pilot study, the interviewers were all local, female social workers who addressed the community members conversationally. By acknowledging the significant role of culture in the construction and understanding of violence, the social workers used local language and definitions with respect to relevant terms. A benefit of this method is that it increases the number of SGBV reportings as the respondents feel more comfortable disclosing sensitive information such as SGBV about their loved ones when they have a close relationship with the correspondent (Stark et al., 2010). Therefore, the respondent may be able to overcome the barrier of social stigma when they are reporting their neighbor’s or sister’s experience with SGBV to a trusted correspondent. CONCLUSION This study explored the cultural complexity surrounding refugee women living in Salt Lake City who have survived sexual and gender-based violence by assessing their awareness and access of support resources. Through qualitative measures, data was collected from practitioners in Salt Lake City who work closely with refugees, and could use their expertise to speak on behalf of their clients’ experiences. The data found that barriers to women in Salt Lake City receiving treatment after experiencing SGBV include 23 the negative, cultural perspective from their community, a lack of understanding of available resources and how to access them, a lack of understanding in identifying SGBV, and feelings of insufficiency. 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