CHAPTER 6 Sexual violence

1 CHAPTER 6 Sexual violenceBackgroundSexual violence occurs throughout the in most countries there has been littleresearch conducted on the problem, available datasuggest that in some countries nearly one in fourwomen may experience Sexual violence by anintimate partner (1 3), and up to one-third ofadolescent girls report their first Sexual experienceas being forced (4 6). Sexual violence has a profound impact onphysical and mental health. As well as causingphysical injury, it is associated with an increasedrisk of a range of Sexual and reproductive healthproblems, with both immediate and long-termconsequences (4, 7 16). Its impact on mentalhealth can be as serious as its physical impact, andmay be equally long lasting (17 24). Deathsfollowing Sexual violence may be as a result ofsuicide, HIV infection (25) or murder the latteroccurring either during a Sexual assault or subse-quently, as a murder of honour (26). Sexualviolence can also profoundly affect the social well-being of victims; individuals may be stigmatizedand ostracized by their families and others as aconsequence (27, 28).

2 Coerced sex may result in Sexual gratification onthe part of the perpetrator, though its underlyingpurpose is frequently the expression of power anddominance over the person assaulted. Often, menwho coerce a spouse into a Sexual act believe theiractions are legitimate because they are married tothe of women and of men is often used as aweapon of war, as a form of attack on the enemy,typifying the conquest and degradation of itswomen or captured male fighters (29). It may alsobe used to punish women for transgressing socialor moral codes, for instance, those prohibitingadultery or drunkenness in public. Women andmen may also be raped when in police custody or Sexual violence can be directed againstboth men and women, the main focus of thischapter will be on the various forms of sexualviolence against women, as well as those directedagainst young girls by people other than is Sexual violence defined? Sexual violence is defined as:any Sexual act, attempt to obtain a Sexual act,unwanted Sexual comments or advances, or acts totraffic, or otherwise directed, against a person ssexuality using coercion, by any person regardlessof their relationship to the victim, in any setting,including but not limited to home and can cover a whole spectrum of degreesof force.

3 Apart from physical force, it may involvepsychological intimidation, blackmail or otherthreats for instance, the threat of physical harm,of being dismissed from a job or of not obtaining ajob that is sought. It may also occur when theperson aggressed is unable to give consent forinstance, while drunk, drugged, asleep or mentallyincapable of understanding the violence includesrape, defined asphysically forced or otherwise coerced penetration even if slight of the vulva or anus, using a penis,other body parts or an object. The attempt to do sois known asattempted rape. Rape of a person bytwo or more perpetrators is known asgang can include other forms ofassaultinvolving a Sexual organ, including coerced contactbetween the mouth and penis, vulva or and contexts of Sexual violenceA wide range of sexually violent acts can takeplace in different circumstances and settings. Theseinclude, for example: rape within marriage or dating relationships; rape by strangers; systematic rape during armed conflict; unwanted Sexual advances or Sexual harass-ment, including demanding sex in return forfavours; Sexual abuse of mentally or physicallydisabled people; Sexual abuse of children; forced marriage or cohabitation, includingthe marriage of children; denial of the right to use contraception or toadopt other measures to protect againstsexually transmitted diseases; forced abortion; CHAPTER 6.

4 Sexual violent acts against the Sexual integrity ofwomen, including female genital mutilationand obligatory inspections for virginity; forced prostitution and trafficking of peoplefor the purpose of Sexual is no universally accepted definition oftrafficking for Sexual exploitation. The termencompasses the organized movement of people,usually women, between countries and withincountries for sex work. Such trafficking alsoincludes coercing a migrant into a Sexual act as acondition of allowing or arranging the trafficking uses physical coercion, decep-tion and bondage incurred through forced women and children, for instance, areoften promised work in the domestic or serviceindustry, but instead are usually taken to brothelswhere their passports and other identificationpapers are confiscated. They may be beaten orlocked up and promised their freedom only afterearning through prostitution their purchaseprice, as well as their travel and visa costs (30 33).

5 The extent of the problemSources of dataData on Sexual violence typically come from police,clinical settings, nongovernmental organizations andsurvey research. The relationship between thesesources and the global magnitude of the problem ofsexualviolencemaybeviewedascorrespondi ngtoaniceberg floating in water (34) (see Figure ). Thesmall visible tip represents cases reported to police. Alarger section may be elucidated through surveyresearch andthe workofnongovernmental organiza-tions. But beneath the surface remains a substantialalthough unquantified component of the general, Sexual violence has been a neglectedarea of research. The available data are scanty andfragmented. Police data, for instance, are oftenincomplete and limited. Many women donot reportsexual violence to police because they are ashamed,or fear being blamed, not believed or otherwisemistreated. Data from medico-legal clinics, on theother hand, may be biased towards the more violentincidentsof Sexual abuse.

6 The proportion ofwomenwho seek medical services for immediate problemsrelated to Sexual violence is also relatively there have been considerable advancesover the past decade in measuring the phenomenonthrough survey research, the definitions used havevaried considerably across studies. There are alsosignificant differences across cultures in the will-ingness to disclose Sexual violence to is therefore needed when making globalcomparisons of the prevalence of Sexual of Sexual violenceSurveys of victims of crime have been undertaken inmany cities and countries, using a commonmethodology to aid comparability, and havegenerally included questions on Sexual summarizes data from some of thesesurveys on the prevalence of Sexual assault over thepreceding 5 years (35, 36). According to theseFIGURE of the problem of Sexual REPORT ON violence AND HEALTH studies, the percentage of women reporting havingbeen a victim of Sexual assault ranges from less than2% in places such as La Paz, Bolivia ( ),Gaborone, Botswana ( ), Beijing, China( ), and Manila, Philippines ( ), to 5% ormore in Tirana, Albania ( ), Buenos Aires,Argentina ( ), Rio de Janeiro, Brazil ( ),and Bogota , Colombia ( ).

7 It is important tonote that no distinction has been made in thesefigures between rape by strangers and that byintimate partners. Surveys that fail to make thisdistinction or those that only examine rape bystrangers usually underestimate substantially theprevalence of Sexual violence (34).Apart from crime surveys, there have been asmall number of surveys, with representativesamples, that have asked women about sexualviolence. For instance, in anational survey conducted inthe United States of America, age reported having beenraped in their lifetime (with anadditional having experi-enced attempted rape) and the sample reported havingbeen raped in the previous year(37).Asurveyofarepresenta-tive sample of women aged 18 49 years in three provinces ofSouth Africa found that in theprevious year of womenhad been forced, physically orby means of verbal threats, tohave non-consensual sex (34).In a survey of a representativesample of the general populationover 15 years of age in the CzechRepublic (38), of womenreported forced Sexual contact intheir lifetime, reportingthat this had occurred more thanonce.

8 The most common form ofcontact was forced vaginal violence by intimate partnersIn many countries a substantial proportion ofwomen experiencing physical violence also experi-ence Sexual abuse. In Mexico and the United States,studies estimate that 40 52% of women experien-cing physical violence by an intimate partner havealso been sexually coerced by that partner (39, 40).Sometimes, Sexual violence occurs without physicalviolence (1). In the Indian state of Uttar Pradesh, ina representative sample of over 6000 men, 7%reported having sexually and physically abusedtheir wives, 22% reported using Sexual violencewithout physical violence and 17% reported thatthey had used physical violence alone (41).Table summarizes some of the available dataon the prevalence of Sexual coercion by intimatepartners (1 3, 37, 42 53). Findings from theseTABLE of women aged 16 years and older who report having beensexually assaulted in the previous 5 years, selected cities, 1992--1997 CountryStudypopulationYear SamplesizePercentage of women(aged 16years and older)sexually assaulted in theprevious 5years(%) AmericaArgentinaBuenos de RicaSan Jose and Surabaya iauliai,Kaunas, Klaipe da,Paneve zys, , : 6.

9 Sexual neither rare nor unique to any particular region ofthe world. For instance, 23% of women in NorthLondon, England, reported having been the victim ofeither an attempted or completed rape by a partner intheir lifetime. Similar figures have been reported forGuadalajara, Mexico ( ), Leo n, Nicaragua( ), Lima, Peru ( ), and for the MidlandsProvince in Zimbabwe ( ). The prevalence ofwomen sexually assaulted by an intimate partner intheir lifetime (including attempted assaults) has alsobeen estimated in a few national surveys (forexample, Canada , England, Wales and Scotland(combined) , Finland , and the United States ).Forced Sexual initiationA growing number of studies, particularly fromsub-Saharan Africa, indicate that the first of adultwomenreportingsexual victimizationby anintimate partner,selectedpopulation-based surveys,1989--2000 CountryStudypopulationYearSamplesizePerc entageassaulted inpast 12 monthsPercentageever assaultedAttemptedor completedforced sex(%)Attemptedor completedforced sex(%)Completedforcedsex(%)BrazilaSao RicoNational1993--19967 , Umea and KingdomEngland, Scotlandand Wales19891 London, StatesNational1995--19968 Bank andGaza StripPalestinians19952 Province : references1--3, 37, results from theWHO multi-country study on women s health and domestic violence .

10 Geneva, World Health Organization, 2000(unpublished). Sample size reported is the denominator for the prevalence rate and not the total sample size of the group included women who had never been in a relationship and therefore were not at risk of being assaulted by an intimate reported to be husbands, boyfriends and estimate; unweighted prevalence rate was REPORT ON violence AND HEALTH case control study, for example, of 191 adolescentgirls (mean age years) attending an antenatalclinic in Cape Town, South Africa, and 353 non-pregnant adolescents matched for age and neigh-bourhood or school, of the study cases of the controls reported that force was usedduring their Sexual initiation. When asked about theconsequences of refusing sex, of the studycases and of the controls said that they fearedbeing beaten if they refused to have sex (4).Forced Sexual initiation and coercion duringadolescence have been reported in many studies ofyoung women and men (see Table andBox ).