A qualitative study of gender-based violence against women with disabilities in conflict-affected North West Cameroon

Abstract

Background

Women with disabilities face a higher risk of gender-based violence (GBV), yet their experiences remain poorly documented in conflict-affected regions of Cameroon. This study explored how women with disabilities in the Northwest Region experience GBV and the barriers they face in recognizing, reporting, and seeking justice for abuse.

Methods

We conducted a qualitative descriptive study guided by an intersectionality framework to examine how gender, disability, and conflict conditions interact to shape experiences of violence. Eleven women and girls with different forms of disability were purposively recruited through Cameroon Baptist Convention Health Services facilities. Data was collected through in-depth, semi-structured interviews and analyzed using thematic analysis. Coding was conducted manually through an iterative process, and themes were developed through consensus among researchers.

Results

Four major themes emerged. First, participants’ understanding of sexual and domestic violence was shaped by social norms, with many recognizing only forced sexual intercourse as violence, while neglect and abuse within caregiving relationships were often normalized. Second, dependence on family members or caregivers, combined with social isolation and family pressure to protect reputation, limited survivors’ ability to disclose abuse. Third, fear of retaliation, shame, and community stigma discouraged reporting, as survivors often anticipated disbelief or ridicule. Finally, limited knowledge of reporting options and low confidence in police and judicial systems further prevented access to justice. Together, these factors created conditions in which abuse remained hidden and perpetrators faced few consequences.

Conclusion

Women with disabilities in conflict-affected Northwest Cameroon face interconnected social and structural barriers that prevent recognition, reporting, and justice for GBV. Addressing these challenges requires disability-inclusive prevention programs, survivor-centered support services, accessible reporting pathways, and community efforts to challenge stigma and harmful social norms.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-026-04362-w.

Introduction

Gender-based violence (GBV) is a widespread public health and human rights issue for women and girls globally, with disabled women and girls at even higher risk [1]. Studies show they are up to ten times more likely to experience abuse than those without disabilities, with sexual violence and domestic abuse being the most common forms [2]. These factors, among others, including physical, sensory, or psychosocial disabilities, serve to make them even more vulnerable and less able to report their abuse or experience assistance [3]. In most patriarchal communities such as those in the Northwest region of Cameroon, GBV is a cultural phenomenon that reinforces male power over women, and the continued armed conflict has brought about conditions that are even more dangerous for women with disabilities [4–6].

The intersection between gender and disability leads to vanes of discrimination, stigma and dependence on others for daily care [7]. This vulnerability can put women in the way of abuse by caretakers, sexual partners or family members and however fear of retaliation, withdrawal of support or public shame silences them [8]. Perpetrators are often people the victims know and trust, making disclosure even harder. Sexual violence literacy is impeded by poverty, unavailability of reporting systems, and non-existing legal protection. Survivors often have no idea where to go for help, or have limited trust in the justice system, given its corrupt nature, long court process, and expense [9].

Although global documentation shows that GBV is frequent especially in conflict-affected areas, there is limited empirical study evidence on the experiences of women living with disabilities in Cameroon [10]. This data deficiency waters down knowledge around the specific barriers they encounter, which in turn poses a challenge in developing tailored and inclusive interventions [11]. It is essential to record their voices and life experience which is relevant in structuring a comprehensive response to prevent and control both the underlying factors and the long term consequences of abuse [12].

This study utilized the framework of intersectionality which explains how different social identities and structural conditions combine to shape people lived experiences. Rather than viewing factors such as gender, disability, poverty, or conflict exposure separately, intersectionality shows how these factors interact to produce unique forms of vulnerability or disadvantage [13, 14]. Also to examine how compounded identities of being a woman, having a disability and living in a conflict affected setting interact to influence vulnerability to GBV and reporting. Through the analysis of structural, sociocultural and individual barriers to disclosure, we hoped to identify commonalities and the deeper reasons for under-reporting. The aim was to produce evidence that could be used by policymakers, service providers and community advocates to construct stronger protection systems, enhance legal and psychosocial support, and to work to challenge harmful norms. The objective of this study was to explore the barriers to reporting GBV faced by women with disabilities, to document the nature of the violence they experience, and to gain an insight into the impact and influence of socio-cultural interpretations of their world on the lived experiences of women with disabilities in the conflict-affected Northwest Region of Cameroon.

Methods

This study used a qualitative descriptive design to explore how gender, disability, and living in a conflict-affected setting influence experiences of gender-based violence (GBV) and barriers to reporting among women with disabilities in the Northwest Region of Cameroon. The study was guided by an intersectionality framework, which allowed examination of how gender norms, disability, economic vulnerability, caregiver dependence, and conflict conditions interact to shape exposure to violence and influence reporting and help-seeking decisions [13–15].

Data collection took place between March and April 2021 in facilities supported by the Cameroon Baptist Convention Health Services (CBCHS). Participants were purposively recruited through rehabilitation and health programs serving persons with disabilities in order to capture diverse experiences. Eligibility criteria included being female, aged 15–55 years, living with a physical, sensory, or psychosocial disability, and residing in the conflict-affected Northwest Region. A total of 11 women and girls participated in the study, including individuals with visual, hearing, mobility, and psychosocial impairments. Recruitment continued until interviews no longer generated new information, indicating thematic saturation.

Data was collected through confidential in-depth interviews using a semi-structured interview guide developed following World Health Organization (WHO) recommendations for qualitative health research [16] and informed by Braun and Clarke’s updated thematic analysis framework [17, 18]. The guide also drew on contemporary literature on GBV, disability, and conflict settings. It covered key domains including understanding of sexual violence, experiences of mistreatment or abuse, barriers to reporting, community responses to disclosure, movement restrictions and social isolation, access to justice and support systems, and the impact of conflict on safety and reporting (Supplementary file 1). Interviews began with non-sensitive background questions to build rapport before addressing sensitive topics, ensuring participants felt comfortable and safe throughout discussions.

The interview guide was pre-tested among three participants who were not part of the final study sample to assess clarity, cultural appropriateness, and logical flow. Minor revisions were made to improve comprehension and sequencing of questions. Standardized use of the guide across interviews enhanced consistency, comparability, and methodological rigor, facilitating systematic analysis using Braun and Clarke’s six-phase thematic approach [18].

Interviews were conducted in English or Pidgin English in private and safe locations to protect confidentiality and participant comfort. Seven research assistants conducted interviews after completing a three-day training on qualitative interviewing techniques, confidentiality, ethical handling of sensitive topics, minimizing interviewer bias, and managing emotional distress. Interviewers were trained to recognize participant distress, pause interviews when necessary, and provide referrals to psychosocial or medical services where needed. Interviews went for 30–45 min and were audio-recorded with consent, transcribed verbatim, and translated into English when required. All transcripts were anonymized and securely stored. Participation was voluntary, and participants could withdraw at any time without consequence.

Data analysis followed a manual thematic analysis process conducted iteratively. Researchers first performed open coding to identify important concepts within transcripts (Supplementary File 2- Code Book). Codes were then grouped into 4 broader categories and 12 sub-themes reflecting women’s experiences. A codebook was developed and refined throughout analysis to maintain coding consistency. Two researchers independently coded transcripts, and discrepancies were resolved through discussion and consensus-building. The resulting themes were subsequently reviewed and validated by two additional researchers. Coding was managed manually using notes and spreadsheets, careful documentation of codes and supporting excerpts ensured transparency and traceability of analytic decisions. Although formal inter-coder reliability statistics were not calculated, regular meetings among coders helped improve consistency and agreement. The team also examined how certain ideas co-occurred across interviews through discussions. Intersectionality informed the interpretation of findings by examining how disability status, gender roles, economic dependence, and insecurity linked to armed conflict combine to shape exposure to violence and influence reporting behaviors.

Ethical approval for the study was obtained from the Cameroon Baptist Convention Health Services Institutional Review Board (Reference IRB2021-28). Written informed consent was obtained from all participants before interviews were conducted. Confidentiality was strictly maintained, interviews were conducted in safe environments, and no identifying information was recorded. Participants were provided with information on available psychosocial and protection services to support their safety and wellbeing throughout the study, in accordance with principles outlined in the Declaration of Helsinki.

Results

Interviews show that violence against women with disabilities in Northwest Cameroon is not only an individual experience but a socially produced reality, shaped by family relations, community norms, economic dependence, and weak institutional protection. Participants’ stories reveal how abuse becomes normalized and reporting becomes difficult because social, cultural, and structural forces work together to silence survivors. Four major themes and 12 sub themes describe how women experience violence and why reporting rarely happens. (See Fig. 1)

Fig. 1.

Thematic Tree

Participants’ conceptualization of sexual and domestic violence

Participants’ understanding of violence reflects the social environments in which they live. Community beliefs and everyday experiences influence what behaviors are recognized as abuse, which in turn shapes whether violence is reported or tolerated.

Sexual violence is mainly understood as forced intercourse

Most participants described sexual violence as forced sexual intercourse. Other unwanted sexual acts were rarely identified as violence, suggesting that community definitions strongly influence how abuse is recognized. P4 explained: “Sexual violence is when a man forces you to have sex with him.” Similarly, P9 said: “You cannot say someone touching your breast is sexual violence because there was no penetration.”

Because many behaviors are not labeled as violence, survivors may not see themselves as victims or may feel reporting is unnecessary or unjustified. As a result, some abusive behaviors continue without challenge.

Sexual attention is sometimes interpreted as acceptance

For some women, attention from men was sometimes interpreted positively, especially in contexts where women with disabilities often experience rejection or invisibility. P2 reflected: “Sometimes I feel happy when a man talks to me about sex. It makes me feel accepted.”

This shows how experiences of exclusion influence how sexual behavior is interpreted. In some situations, attention that later becomes abusive initially appears as social recognition, making it harder to identify harm early.

Domestic abuse seen as part of everyday life

Domestic abuse, neglect, and movement restrictions were often described as familiar experiences within households, particularly when disability was involved. P6 explained: “Domestic violence is when people beat us because we are disabled.” P1 described neglect at home: “Sometimes they leave me in the house without food and don’t allow me to go outside. It makes me feel like I am not important.”

These experiences suggest that abuse becomes embedded within caregiving relationships. Over time, mistreatment may appear normal, reducing the likelihood that survivors seek help.

Dependence, isolation, and control within families and communities

Participants’ stories show that dependence on others for care and financial survival often places women in situations where abuse can continue without resistance. Isolation and control further limit opportunities to seek help.

Economic and caregiving dependence limit reporting options

Many participants depended on family members or partners for food, shelter, or mobility assistance. Reporting abuse could risk losing essential support. P11 explained: “Because we depend on them for food and money, many women are afraid to talk. If you complain, they may stop helping you.” As a result, survivors often choose silence to protect their basic survival needs.

Movement restrictions and social isolation increase vulnerability

Several women described being confined to their homes or restricted from interacting with others, limiting access to help. P8 said: “They don’t allow me to go outside or meet people. Everything is brought to me in the house.” P11 added: “Because we stay inside and depend on them, many women are afraid to talk about what happens.” Isolation reduces access to social support and increases dependence on perpetrators, allowing abuse to continue unnoticed.

Family pressure to protect reputation reinforces silence

Family members sometimes discouraged reporting violence to protect the family’s image, especially when perpetrators were relatives. P5 explained: “If the person who abused you is a family member, they say it should stay inside the family.” P3 similarly shared: “My mother and sisters tell me not to talk about problems because people will laugh at our family.”

Fear, shame, and community reactions shape silence

Participants described fear and shame as major forces shaping decisions not to report abuse. Community reactions often reinforce silence.

Fear of retaliation from perpetrators

Some participants feared physical harm or abandonment if they reported violence. P7 said: “He told me that if I tell anyone, he will kill me. So I kept quiet.” Fear makes reporting appear more dangerous than remaining silent.

Fear of disbelief and public ridicule

Past experiences where survivors were mocked or accused of lying discouraged others from reporting. P9 explained: “A woman reported rape and people laughed at her and said she was lying. After that, many of us stopped talking.”

Shame and self-blame discourage disclosure

Some women felt embarrassed discussing abuse, even with health workers, while others blamed themselves. P2 said: “I did not know how to explain it to the doctor. I just stayed quiet.” P1 reflected: “I blamed myself because I went to his house, so I felt it was my fault.” Community gossip also discouraged disclosure. P6 noted: “If people hear about it, they use it later to insult you.”

Limited trust in reporting and justice systems

Even when survivors considered reporting abuse, many felt formal systems would not protect them.

Lack of knowledge about reporting options

Some participants did not know where to seek help. P8 explained: “My husband beats me, but I don’t know who to report to.”

Distrust in police and legal services

Participants often described police and legal services as unreliable. P4 said: “Police will ask for money before helping you.”

Legal processes seen as slow and costly

Court procedures were described as long and expensive, discouraging survivors from seeking justice. P11 explained: “People go to court and nothing happens, so it feels like a waste of time.”

Discussion

Participants’ conceptualization of sexual and domestic violence

Limited information regarding sexual violence among women with disabilities was a significant barrier to acknowledging abuse, discussing or seeking help for it. Participants recognised ‘forced sexual intercourse’ as sexual violence, but did not consider other acts like unwanted touch, sexual comments, and exposure to pornography as abuse. This narrow perspective is similar to what has been observed in other disenfranchised groups: exposure to constant discrimination and inflexible social norms renders certain behaviors normal and erodes individuals’ sense of corporal self-possession [19, 20]. Some respondents went so far as to think that men showing emotions like that were “normal,” a belief based in patriarchy that justifies a man’s sexual entitlement. This parallels evidence from South Africa, which found gender-role attitudes to attenuate the negative effect of coercive practices [21]. From a health-system standpoint, this lack of acknowledgment hinders both survivors’ recognitions of transgressions and the likelihood that they will seek help, demonstrating the importance of an active, routine inquiry which includes the full range of sexual violence [22]. Addressing this issue calls for sexuality education, grounded in a rights-based approach, that is specifically geared towards women with disabilities in formats that are accessible, and complemented by culturally sensitive community outreach and the training of service providers. These strategies must locally and globally challenge harmful norms and beliefs, broaden the understanding of what constitutes sexual violence beyond penetration, and assert women’s rights to safety, self-determination and dignity.

Dependence, isolation, and control within families and communities

They also described domestic abuse that was a toxic mix of discrimination, neglect and violence, much of it at the hands of the very people they relied on for daily care. These narratives reflect global evidence that women with disabilities put themselves at heightened risk for abuse through dependence on carers that may lock them into patriarchal relations [23]. There are parallels in trans and gender-diverse populations, where reliance on partners or families for shelter likely contributes to the duration of exposure to violence [19], and among healthcare students, where structural power differentials contribute to the silencing of victims, despite differing dynamics of dependency [24]. Dealing with this type of violation needs more than laws, as Kumari et al. (2025), it requires coordinated strategies that make protective services and economic and social empowerment integral, as well as staff training for health and social workers on identifying the less obvious harms, such as neglect and isolation [25].

Fear, shame, and community reactions shape silence

Fear and shame emerged as powerful forces silencing women with disabilities who experienced sexual or domestic abuse, shaping both their emotional responses and decisions not to disclose. Many feared direct retaliations from perpetrators, as one woman with mobility impairment recounted being threatened with death if she spoke out. Others feared the reactions of family members, knowing disclosure could lead to punishment, confinement, or further abuse. Past community experiences also discouraged reporting. Shame compounded these fears, particularly in healthcare settings where survivors struggled to explain their experiences to providers, anticipating skepticism or judgement echoing global evidence that stigma and victim-blaming are key deterrents to disclosure [19, 20]. These fears were intensified by social isolation and physical restrictions imposed by abusers, which not only cut off victims from supportive networks but also created conditions where violence could escalate unchecked. Similar patterns have been documented in other marginalised groups, where controlling movement and access to resources deepens dependence and silences victims [23, 25]. To break this cycle, trauma-informed, survivor-centred interventions addressing the psychological blockades of fear and shame as well as the structural facilitators of isolation are needed, along with community trust in protection and justice systems.

Limited trust in reporting and justice systems

Limited legal protection was a recurring theme, with participants highlighting the absence of clear policies and disability-inclusive referral pathways for addressing GBV. Many did not know where to report abuse, and for those aware of formal channels, protracted judicial processes characterised by frequent adjournments and multiple court appearances were both financially and emotionally draining. The associated costs placed justice out of reach for most, a reality compounded by perceptions of bias and inefficacy. Trust in the police was similarly low, with some participants citing corruption and demands for payment before cases could be heard. These experiences is parallel with global research showing that survivors in marginalised groups including women with disabilities and transgender individuals often perceive justice systems as inaccessible, costly, and unresponsive [19, 20]. This justice gap does nothing to encourage reporting, and It perpetuates a culture of impunity. Tackling the problem involves disability-informed GBV legislation, reasonable and accessible reporting mechanisms, police and courts that are more accountable and human-rights compliant, and community-level legal literacy programmes to foster trust by survivors in the formal protection mechanisms [22, 25].

Limitations

This study has several limitations that should be considered when interpreting the findings. First, the research was conducted with a relatively small sample of women with disabilities in one conflict-affected region of Cameroon. While the in-depth qualitative design provided rich narratives, the findings may not fully represent the diversity of experiences among women with disabilities in other parts of the country or in different cultural and political contexts. Second, participants were recruited through health facilities, which may have excluded women with disabilities who are not connected to services and who might face even greater barriers. Third, the sensitive nature of gender-based violence may have led some participants to withhold details due to fear, shame, or safety concerns, which could have limited the depth of disclosure. Fourth, although we took steps to reduce bias, such as training research assistants and using standardized guides, interviewer characteristics and power dynamics may still have influenced how participants responded. Finally, because this was a qualitative study, the results are not generalizable but are meant to provide contextual insights that can inform policy and program development.

Recommendations

Governments and humanitarian actors should strengthen policies to ensure that gender-based violence (GBV) prevention and response programs fully include women with disabilities. Reporting and referral systems must be accessible to women with different types of impairments, including mobility, hearing, visual, and psychosocial disabilities. Social protection and economic empowerment programs are also needed to reduce survivors’ dependence on abusive caregivers or partners. In addition, police and judicial services should receive training to provide respectful and survivor-centered support, while legal processes should be made more affordable and accessible so survivors can safely seek justice.

Health, social, and community services should improve early identification and support for survivors by training service providers to recognize both visible and hidden forms of abuse, including neglect and movement restriction. Disability-inclusive sexuality and rights education should be promoted to help women and communities better understand different forms of violence. Community outreach programs are needed to reach women who are isolated at home, while accessible safe spaces and shelters should be created for survivors needing protection. Community awareness campaigns and survivor peer-support networks can help reduce stigma and encourage safe reporting.

Further research is needed in other regions and settings to better understand how women with disabilities experience violence and access support services. Studies should also evaluate which prevention and response interventions are most effective in protecting women with disabilities, especially in conflict-affected areas. Future research should include women not connected to services and examine caregiving dynamics and long-term recovery pathways to inform programs that support survivors’ independence and wellbeing.

Conclusion

Women with disabilities in the Northwest Region of Cameroon face many connected barriers when it comes to recognizing, reporting, and seeking justice for gender-based violence. Low awareness of what counts as sexual violence, abuse linked to dependence on caregivers, fear and shame, stigma from families and communities, forced social isolation, and weak legal protection all combine to make abuse seem normal and keep survivors silent. Addressing these issues calls for a survivor-centred approach that provides rights-based sexual education tailored to women with disabilities, builds supportive family and peer networks, and strengthens inclusive GBV policies and referral systems. Just as important are affordable and accessible legal pathways, along with community programs that challenge harmful gender and disability norms. Without such targeted action, women with disabilities will continue to face high risks of violence with little access to protection, justice, or recovery.

Abbreviations

CBCHS

Cameroon Baptist Convention Health Services

GBV

Gender–Based Violence

IRB

Institutional Review Board

Authors’ contributions

J.C.A., S.A.N., and N.J.N. conceived and designed the study. C.J.G., N.A.A and M.O.M. coordinated data collection. S.A.N. and J.C.A. conducted the data analysis and drafted the initial manuscript. N.J.N. and C.J.G. contributed to data interpretation and manuscript revisions. P.T.M., S.A.N, and M.O.M provided overall supervision, critical input on methodology, and reviewed the manuscript for important intellectual content. All authors reviewed, edited, and approved the final version of the manuscript.

Funding

Cameroon Baptist Convention Health Services.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

The study received ethical approval from the Cameroon Baptist Convention Health Services Institutional Review Board (CBCHS IRB) (Reference: IRB2021-28). All participants gave written informed consent before taking part. They agreed to participate in the interviews, to have the conversations audio-recorded, and for anonymized quotes to be used in publications. The study followed the principles of the Declaration of Helsinki, respecting participants’ rights to autonomy, confidentiality, and their freedom to withdraw at any time without any consequence.

Consent for publication

All participants gave written informed consent before taking part. They agreed to participate in the interviews, to have the conversations audio-recorded, and for anonymized quotes to be used in publications.

Competing interests

The authors declare no competing interests.