Provider perspectives on barriers to medico-legal service provision for sexual violence survivors in Kenya: a qualitative interview study

BMC Public Health. 2026 Jul 3. doi: 10.1186/s12889-026-28155-w. Online ahead of print.

ABSTRACT

BACKGROUND: Medico-legal services are essential for supporting survivors of sexual violence and facilitating access to justice. Unfortunately, their provision remains a challenge in many low-resource settings. In Kenya, high prevalence of sexual violence contrasts sharply with low rates of case progression and conviction, yet much of the existing evidence is drawn from intervention studies or specific health facilities, limiting understanding of routine medical practice for the general population. This study aimed to explore the perspectives of medico-legal professionals on barriers to delivering effective medico-legal services to sexual violence survivors in both urban and rural Kenya.

METHODS: A qualitative descriptive study was conducted using either semi-structured or small group interviews with 21 medico-legal professionals, including clinicians, lawyers, and police officers. Participants were recruited through professional networks and a non-governmental organisation, known as the Wangu Kanja Foundation (WKF). Interviews were conducted in English either online or in person, audio-recorded, transcribed verbatim, and analysed using the Framework Method with an inductive thematic approach.

RESULTS: Five key themes emerged: professional journey, operating outside of the norm, case details and procedure, limiting factors, and personal reflections. Participants reported inadequate formal training in sexual violence response, reliance on informal or NGO-led training, and significant shortages of forensic and psychosocial resources. Service provision was constrained by weak inter-sectoral collaboration, investigation and prosecution delays within the justice system, and public misconceptions about evidence preservation. Provider bias, including victim-blaming attitudes, and substantial emotional burden among professionals were also evident.

CONCLUSIONS: Medico-legal professionals in Kenya face multiple interrelated barriers, including inadequate training, limited resources, and systemic constraints that hinder effective handling for sexual violence survivors and contribute to case attrition. Integrating sexual violence training into formal professional education, strengthening multisectoral collaboration, and improving resource allocation may enhance survivor-centred handling and improve medico-legal outcomes.

PMID:42399843 | DOI:10.1186/s12889-026-28155-w