A Cycle of Gendered Vulnerability: Understanding Violence, Poverty, and Systemic Failure Among Refugee Women in Malawi.

Gender-based violence (GBV) is an urgent global health and social problem. GBV has implications for women's health outcomes and causes disruption to an individual's ecosystem, including their educational attainment, economic stability, and safety. Refugee women are an underserved subpopulation of women who experience extreme vulnerability related to GBV and poor maternal health outcomes. The primary aim of the study was to gain foundational knowledge about the relationship between gender inequality and GBV in the lives of childbearing-aged refugee women in Malawi, including healthcare utilization. Specifically, we sought to (a) explore women's perspectives on the gendered nature of violence, poverty, and vulnerability in the refugee camp context, (b) understand women's experiences and perceptions of health and social services for GBV survivors, and (c) identify structural factors that facilitate or impede women's access to justice and support. Guided by the Sustainable Development Goals (SDGs), we conducted a qualitative analysis reporting on the qualitative sub-study of a larger mixed-methods project. A total of 50 women were interviewed using focus group discussions from a refugee camp in Malawi on their health, well-being, and experiences with GBV. Data were analyzed using reflexive thematic analysis. The findings revealed a cycle of gendered poverty, vulnerability, and a gendered system response. The following three subthemes were identified: (a) single motherhood and abandonment as drivers of poverty, (b) marriage as a gendered survival strategy, and (c) the constraining effect of children and caregiving. Poverty is gendered, driven by abandonment, enforced through survivalist marriages, and cemented by caregiving constraints. Systemic responses often replicate the very power imbalances that enable GBV, further perpetuating the cycle. These findings underscore the need for culturally appropriate policies and integrated interventions to address the intersecting social and structural factors contributing to gendered violence, poverty, and vulnerability among refugee women.