- Estimates of sexual violence
Surveys of victims of crime have been undertaken in many cities and countries, using a common
methodologyto aid comparability, and have generally included questions on sexual violence. The United Nationshas conducted extensive surveys to determine the level of sexual violence in different societies. According to these studies, the percentage of women reporting having been a victim of sexual assault ranges from less than 2% in places such as La Paz, Bolivia(1.4%), Gaborone, Botswana(0.8%), Beijing, China(1.6%), and Manila, Philippines(0.3%), to 5% or more in Tirana, Albania(6.0%), Buenos Aires, Argentina(5.8%), Rio de Janeiro, Brazil(8.0%), and Bogota, Colombia(5.0%). [The international crime victim survey in countries in transition: national reports. Rome, United Nations Interregional Crime and Justice Research Institute, 1998.] [Victims of crime in the developing world. Rome, United Nations Interregional Crime and Justice Research Institute, 1998]
It is important to note that no distinction has been made in these figures between rape by strangers and that by intimate partners. Surveys that fail to make this distinction or those that only examine rape by strangers usually underestimate substantially the prevalence of sexual violence. [Jewkes R, Abrahams N. The epidemiology of rape and sexual coercion in South Africa: an overview. Social Science and Medicine (in press).]
Apart from crime surveys, there have been a small number of surveys, with representative samples, that have asked women about sexual violence. For instance, in a national survey conducted in the
United States of America, 14.8% of women over 17 years of age reported having been raped in their lifetime (with an additional 2.8% having experienced attempted rape) and 0.3% of the sample reported having been raped in the previous year. [Tjaden P, Thoennes N. Full report of the prevalence, incidence and consequences of violence against women: findings from the National Violence Against Women Survey. Washington, DC, National Instituteof Justice, Office of Justice Programs, United States Department of Justice and Centers for Disease Control and Prevention, 2000 (NCJ 183781).] A survey of a representative sample of women aged 18– 49 years in three provinces of South Africa found that in the previous year 1.3% of women had been forced, physically or by means of verbal threats, to have non-consensual sex. [Jewkes R, Abrahams N. The epidemiology of rape and sexual coercion in South Africa: an overview. Social Science and Medicine (in press).] In a survey of a representative sample of the general population over 15 years of age in the Czech Republic[Weiss P, Zverina J. Experiences with sexual aggression within the general population in the Czech Republic. Archives of Sexual Behavior, 1999,] 28:265–269, 11.6% of women reported forced sexual contact in their lifetime, 3.4% reporting that this had occurred more than once. The most common form of contact was forced vaginal intercourse.
exual violence by intimate partners
Forced sexual initiation
A growing number of studies, particularly from
sub-Saharan Africa, indicate that the first sexual experience of girls is sometimes unwanted and forced. In a case control study, for example, of 191 adolescentgirls (mean age 16.3 years) attending an antenatalclinic in Cape Town, South Africa, and 353 non pregnantadolescents matched for age and neighborhoodor school, 31.9% of the study cases and 18.1% of the controls reported that force was used during their sexual initiation. When asked about the consequences of refusing sex, 77.9% of the study cases and 72.1% of the controls said that they feared being beaten if they refused to have sex [Jewkes R et al. Relationship dynamics and adolescent pregnancy in South Africa. Social Science and Medicine, 2001, 5:733–744.] .
Forced sexual initiation and coercion during adolescence have been reported in many studies of young women and men. Where studies have included both men and women in the sample, the prevalence of reported rape or sexual coercion has been higher among the women than the men [Matasha E et al. Sexual and reproductive health among primary and secondary school pupils in Mwanza, Tanzania: need for intervention. AIDS Care, 1998, 10:571–582.] [Buga GA, Amoko DH, Ncayiyana DJ. Sexual behaviour, contraceptive practice and reproductive health among school adolescents in rural Transkei. South African Medical Journal, 1996, 86:523–527.] [Rwenge M. Sexual risk behaviours among young people in Bamenda, Cameroon. International Family Planning Perspectives, 2000, 118–123.] [Halco´n L, Beuhring T, Blum R. A portrait of adolescent health in the Caribbean, 2000. Minneapolis, MN, University of Minnesota and Pan American Health Organization, 2000.] . For example, nearly half of the sexually active adolescent women in a multi-country study in the
Caribbeanreported that their first sexual intercourse was forced, compared with one-third of the adolescent men [Halco´n L, Beuhring T, Blum R. A portrait of adolescent health in the Caribbean, 2000. Minneapolis,MN, University of Minnesota and Pan American Health Organization, 2000.] . In Lima, Peru, the percentage of young women reporting forced sexual initiation was almost four times that reported by the young men (40% against 11%, respectively) [Caceres CF, Vanoss M, Sid Hudes E. Sexual coercion among youth and young adolescents in Lima, Peru. Journal of Adolescent Health, 2000, 27:361–367.] .
Each year hundreds of thousands of women and girls throughout the world are bought and sold into
prostitutionor sexual slavery. [Migration Information Programme. Trafficking and prostitution: the growing exploitation of migrant women from central and eastern Europe. Geneva, International Organization for Migration, 1995.] [Chauzy JP. Kyrgyz Republic: trafficking. Geneva, International Organization for Migration, 20 January 2001 (Press briefing notes).] [Dinan K. Owed justice: Thai women trafficked into debt bondage in Japan. New York, NY, Human Rights Watch, 2000.] [Richard AO. International trafficking in women to the United States: a contemporary manifestation of slavery and organized crime. Washington, DC,Center for the Study of Intelligence, 1999.] [Brown L. Sex slaves: the trafficking of women in Asia. London, Virago Press, 2001.] Research in Kyrgyzstanhas estimated that around 4,000 people were trafficked from the country in 1999, with the principal destinations being China, Germany, Kazakhstan, the Russian Federation, Turkeyand the United Arab Emirates. Of those trafficked, 62% reported being forced to work without pay, while over 50% reported being physically abused or tortured by their employers. [Chauzy JP. Kyrgyzstan Republic: trafficking. Geneva, International Organization for Migration, 20 January 2001 (Press briefing notes).] A World Organization against Torture (OMCT) report suggested that more than 200,000 Bangladeshi women had been trafficked between 1990 and 1997. [Benninger-Budel C et al. Violence against women: areport. Geneva, World Organization Against Torture, 1999.] Some 50,007,000clarifyme Nepaliwomen and girls are illegally traded to Indiaeach year and trafficking of Thaiwomen to Japanhas also been reported. [Dinan K. Owed justice: Thai women trafficked into debt bondage in Japan. New York, NY, Human Rights Watch, 2000.] Trafficking of women also takes place internally within some countries, often from rural areas to cities. North Americais also an important destination for international trafficking. A study undertaken under the auspices of the United States Central Intelligence Agencyestimated that 45,000 to 50,000 women and children are trafficked annually to the United States. [Richard AO. International trafficking in women to the United States: a contemporary manifestation of slavery and organized crime. Washington, DC, Center for the Study of Intelligence, 1999.] Over 150 cases of trafficking were prosecuted between 1996 and 1999 by the United States Department of Justice. [Richard AO. International trafficking in women to the United States: a contemporary manifestation of slavery and organized crime. Washington, DC, Center for the Study of Intelligence, 1999.] The problem also exists in Europe. A study conducted by the International Organization for Migrationestimated that 10.15% of 2,000 known foreign prostitutesin Belgiumhad been forcibly sold from abroad. [Migration Information Programme. Trafficking and prostitution: the growing exploitation of migrant women from central and eastern Europe. Geneva, International Organization for Migration, 1995.] In Italy, a study of some 19,000 to 25,000 foreign prostitutes estimated that 2,000 of them had been trafficked. [Migration Information Programme. Trafficking and prostitution: the growing exploitation of migrant women from central and eastern Europe. Geneva, International Organization for Migration, 1995.] Most of these women were under 25 years of age; many of them were between 15 and 18 years. [Migration Information Programme. Trafficking andprostitution: the growing exploitation of migrant women from central and eastern Europe. Geneva, International Organization for Migration, 1995.] [Migration Information Programme. Trafficking in women to Italy for sexual exploitation. Geneva, International Organization for Migration, 1996.] Their origin was mainly central and eastern Europe, particularly Albania, as well as Colombia, Nigeriaand Peru. [Migration Information Programme. Trafficking in women to Italy for sexual exploitation. Geneva, International Organization for Migration, 1996.]
exual violence against sex workers
Whether trafficked or not,
sex workersare at high risk for both physical and sexual violence, particularly where sex work is illegal. [Barnard M. Violence and vulnerability: conditions of work for streetworking prostitutes. Sociology of Health and Illness, 1993, 15:683–705.] A survey of female sex workers in Leeds, England, and Glasgowand Edinburgh, Scotland, revealed that 30% had been slapped, punched or kicked by a client while working, 13% had been beaten, 11% had been raped and 22% had experienced an attempted rape. [Church S et al. Violence by clients towards female prostitutes in different work settings: questionnaire survey.British Medical Journal, 2001, 322:524–525.] Only 34% of those who had suffered violence at the hands of a client reported it to police.
A survey of sex workers in Bangladesh revealed that 49% of the women had been raped and 59% beaten by police in the previous year; the men reported much lower levels of violence. [Jenkins C. Street sex workers in Dhaka: their clients and enemies. In:The Proceedings of the International Conference on Violence Against Women and Children, Dhaka, Bangladesh, June 1998. Dhaka, 1998.] In
Ethiopia, a study of sex workers also found high rates of physical and sexual violence from clients, especially against the child sex workers. [Ayalew T, Berhane Y. Child prostitution: magnitude and related problems. Ethiopian Medical Journal, 2000, 38:153–163.]
exual violence in schools, health care settings, armed conflicts and refugee settings
For many young women, the most common place where sexual coercion and harassment are experienced is in school. In an extreme case of violence in 1991, 71 teenage girls were raped by their classmates and 19 others were killed at a boarding school in
Meru, Kenya. [Perlez J. For the oppressed sex: brave words to live by. New York Times, 6 June 1990.] While much of the research in this field comes from Africa, it is not clear whether this reflects a particularly high prevalence of the problem or simply the fact that the problem has had a greater visibility there than in other parts of the world.
Harassment of girls by boys is in all likelihood a global problem.Fact|date=July 2008 In Canada, for example, 23% of girls had experienced sexual harassment while attending school. [Bagley C, Bolitho F, Bertrand L. Sexual assault in school, mental health and suicidal behaviors in adolescent women in Canada. Adolescence, 1997, 32:361–366.]
The research done in Africa, however, has highlighted the role of teachers there in facilitating or perpetrating sexual coercion. A report by Africa Rights [Omaar R, de Waal A. Crimes without punishment: sexual harassment and violence against female students in schools and universities in Africa. African Rights, July 1994 (Discussion Paper No. 4).] found cases of schoolteachers attempting to gain sex, in return for good grades or for not failing pupils, in the Democratic
Republic of the Congo, Ghana, Nigeria, Somalia, South Africa, Sudan, Zambiaand Zimbabwe. A recent national survey in South Africathat included questions about experience of rape before the age of 15 years found that schoolteachers were responsible for 32% of disclosed child rapes. [Jewkes R, Abrahams N. The epidemiology of rape and sexual coercion in South Africa: an overview. Social Science and Medicine (in press).] In Zimbabwe, a retrospective study of reported cases of child sexual abuse over an 8-year period (1990 to 1997) found high rates of sexual abuse committed by teachers in rural primary schools. Many of the victims were girls between 11 and 13 years of age and penetrative sex was the most prevalent type of sexual abuse. [Bagley C, Bolitho F, Bertrand L. Sexual assault in school, mental health and suicidal behaviors inadolescent women in Canada. Adolescence, 1997,32:361–366.]
Health care settings
Sexual violence against patients in health facilities has been reported in many places. [Fary T, Fisher N. Sexual contact between doctors and patients: almost always harmful. British Medical Journal, 1992, 304:1519–1520.] [Lamont JA, Woodward C. Patient–physician sexual involvement: a Canadian survey of obstetriciangynecologists. Canadian Medical Association Journal,1994, 150:1433–1439.] [Thomasson GO. Educating physicians to prevent sexrelated contact with patients. Journal of the American Medical Association, 1999, 281:419–420.] [Dehlendorf CE, Wolfe SM. Physicians disciplined for sex-related offenses. Journal of the American Medical Association, 1998, 279:1883–1888.] [McPhedran M. Sexual abuse in the health professions:who’s counting? World Health Statistics Quarterly, 1996, 49:154–157.] [Silencio y complicidad: violencia contra las mujeresen los servicios pu´ blicos en el Peru´ . [Silence and complicity: violence against women in public services in Peru.] Lima, Committee of Latin America and the Caribbean for the Defense of the Rights of the Woman, and Center for Reproductive Law andPolicy, 1998.] A study of physicians disciplined for sexual offences in the
United States, for instance, found that the number of cases had increased from 42 in 1989 to 147 in 1996, with the proportion of all disciplinary action that was sex-related rising from 2.1% to 4.4% over the same period. [Dehlendorf CE, Wolfe SM. Physicians disciplined for sex-related offenses. Journal of the American Medical Association, 1998, 279:1883–1888] This increase, though, could reflect a greater readiness to lodge complaints.
Other documented forms of sexual violence against female patients include the involvement of medical staff in the practice of
clitoridectomyin Egypt [Fayad M. Female genital mutilation (female circumcision). Cairo, Star Press, 2000.] , forced gynecologicalexaminations and the threat of forced abortions in China [Human rights are women’s rights. London, AmnestyInternational, 1999.] , and inspections of virginityin Turkey[Frank MW et al. Virginity examinations in Turkey:role for forensic physicians in controlling female sexuality. Journal of the American Medical Association, 1999, 282:485–490.] . Documented forms of sexual violence against male patients include the involvement of medical staff in the practice of male genital mutilationin the United States. Sexual violence is part of the broader problem of violence against women patients perpetrated by health workers that has been reported in a large number of countries and until recently has been much neglected. [Jaffre Y, Prual AM. Midwives in Niger: anuncomfortable position between social behaviours and health care constraints. Social Science and Medicine, 1994, 38:1069–1073.] [Gilson L, Alilio M, Heggenhougen K. Community satisfaction with primary health care services: an evaluation undertaken in the Morogoro region of Tanzania. Social Science and Medicine, 1994, 39:767–780.] [Jewkes R, Abrahams N, Mvo Z. Why do nurses abuse patients? Reflections from South African obstetric services. Social Science and Medicine, 1998, 47:1781–1795.] [Sargent C, Rawlins J. Transformations in maternity services in Jamaica. Social Science and Medicine, 1992, 35:1225–1232.] [d’Oliveira AF, Diniz SG, Schraiber LB. Violence against women in health-care institutions: an emergingproblem. Lancet, 2002, 359:1681–1685.] Sexual harassment of female nurses by male doctors has also been reported. [Shaikh MA. Sexual harassment in medical profession: perspectives from Pakistan. Journal of the Pakistan Medical Association, 2000, 50:130–131.] [Kisa A, Dziegielewski SF. Sexual harassment of female nurses in a hospital in Turkey. HealthServices Management Research, 1996, 9:243–253.]
Armed conflicts and refugee settings
Rape has been used as a strategy in many conflicts, including in
Koreaduring the Second World Warand in Bangladeshduring the war of independence, as well as in a range of armed conflicts such as those in Algeria[Chelala C. Algerian abortion controversy highlights rape of war victims. Lancet, 1998, 351:1413.] , India (Kashmir) [Asia Watch. Rape in Kashmir: a crime of war. New York, NY, Human Rights Watch, 1993.] , Indonesia[Xiau W. Silent consent: Indonesian abuse of women. Harvard International Review, 1999, 21:16–17.] , Liberia[Swiss S et al. Violence against women during the Liberian civil conflict. Journal of the American Medical Association, 1998, 279:625–629.] , Rwandaand Uganda[Swiss S, Giller JE. Rape as a crime of war: a medical perspective. Journal of the American Medical Association, 1993, 270:612–615.] . In some armed conflicts, for example, the ones in Rwanda and the states of the former Yugoslaviarape has been used as a deliberate strategy to subvert community bonds and thus the perceived enemy, and furthermore as a tool of ethnic cleansing.
East Timor, there were reports of extensive sexual violence against women by the Indonesian military [Pacific Women Against Violence. Violence against East Timor women. Pacific Women’s Network Against Violence Against Women, 2000, 5:1–3.] . A study in Monrovia, Liberia, found that women under 25 years were more likely than those aged 25 years and over to report experiencing attempted rape and sexual coercion during the conflict (18% compared with 4%) [Swiss S et al. Violence against women during theLiberian civil conflict. Journal of the American Medical Association, 1998, 279:625–629.] . Women who were forced to cook for a warring faction were at significantly higher risk.
Another inevitable consequence of armed conflicts is the ensuing economic and social disruption which can force large numbers of people into prostitution [Pacific Women Against Violence. Violence against East Timor women. Pacific Women’s Network Against Violence Against Women, 2000, 5:1–3.] , an observation that applies equally to the situation of refugees, whether they are fleeing armed conflicts or natural disasters such as floods, earthquakes or powerful storms.
Refugees fleeing conflicts and other threatening conditions are often at risk of rape in their new setting. Data from the
Office of the United Nations High Commissioner for Refugees, for instance, indicated that among the boat people who fled Vietnamin the late 1970s and early 1980s, 39% of the women were abducted or raped by pirates while at sea, a figure that is likely to be an underestimate. [Mollica RF, Son L. Cultural dimensions in the evaluation and treatment of sexual trauma: an overview. Psychiatric Clinics of North America, 1989, 12:363–379.]
In many refugee camps as well, including those in Kenya and the United Republic of Tanzania, rape has been found to be a major problem. [Morrell R, ed. Changing men in Southern Africa. Pietermaritzburg, University of Natal Press, 2001.] [Nduna S, Goodyear L. Pain too deep for tears: assessing the prevalence of sexual and gender violence among Burundian refugees in Tanzania. Kibondo, International Rescue Committee, 1997.]
Customary forms of sexual violence
Marriage is often used to legitimize a range of forms of sexual violence against women. The custom of marrying off young children, particularly girls, is found in many parts of the world. This practice is legal in many countries and is a form of sexual violence, since the children involved are unable to give or withhold their consent. The majority of them know little or nothing about sexbefore they are married. They therefore frequently fear it [George A. Sexual behavior and sexual negotiation among poor women and men in Mumbai: an exploratory study. Baroda, Sahaj Society for Health Alternatives, 1997.] and their first sexual encounters areoften forced. [Sharma V, Sujay R, Sharma A. Can married women say no to sex? Repercussions of the denial of the sexual act.Journal of Family Welfare, 1998, 44:1–8.]
Early marriage is most common in Africa and South Asia, though it also occurs in the Middle East and parts of Latin America and Eastern Europe. [Early marriage: whose right to choose? London, Forum on Marriage and the Rights of Women and Girls, 2000.] [UNICEF Innocenti Research Center. Early marriage: child spouses. Innocenti Digest, 2001, No. 7.] In
Ethiopiaand parts of West Africa, for instance, marriage at the age of 7 or 8 years is not uncommon. In Nigeria, the mean age at firstmarriage is 17 years, but in the Kebbi Stateof northern Nigeria, the average age at first marriage is just over 11 years. [UNICEF Innocenti Research Center. Early marriage: child spouses. Innocenti Digest, 2001, No. 7.] High rates of childmarriage have also been reported in the Democratic Republic of the Congo, Mali, Nigerand Uganda. [Early marriage: whose right to choose? London, Forum on Marriage and the Rights of Women and Girls, 2000.] [100. UNICEF Innocenti Research Center. Early marriage: child spouses. Innocenti Digest, 2001, No. 7.]
In South Asia, child marriage is especially common in rural areas, but exists also in urban areas. [Ahmed EM. Violence against women: the legal system and institutional responses. Lahore, AGHS Legal Aid Cell, 1998.] [Kumari R, Singh R, Dubey A. Growing up in rural India: problems and needs of adolescent girls. New Delhi, Radiant Publishers, 1990.] [UNICEF Innocenti Research Center. Early marriage: child spouses. Innocenti Digest, 2001, No. 7.] In
Nepal, the average age at first marriage is 19 years. Seven per cent of girls, though, are married before the age of 10 years, and 40% by the age of 15 years. [UNICEF Innocenti Research Center. Early marriage: child spouses. Innocenti Digest, 2001, No. 7.] In India, the median age at first marriage for women is 16.4 years. A survey of 5000 women in the Indian state of Rajasthanfound that 56% of the women hadmarried before the age of 15 years, and of these, 17% were married before they were 10 years old. Another survey, conducted in the state of Madhya Pradesh, found that 14% of girls were married between the ages of 10 and 14 years. [UNICEF Innocenti Research Center. Early marriage: child spouses. Innocenti Digest, 2001, No. 7.]
Elsewhere, in Latin America for instance, early age at first marriage has been reported in Cuba,
Guatemala, Honduras, Mexicoand Paraguay. [UNICEF Innocenti Research Center. Early marriage: child spouses. Innocenti Digest, 2001, No. 7.] [Early marriage: whose right to choose? London, Forum on Marriage and the Rights of Women and Girls, 2000.] In North America and Western Europe, less than 5% of marriages involve girls younger than 19 years of age (for example, 1% in Canada, Switzerlandand the United Kingdom, 2% in Belgiumand Germany, 3% in Spain, and 4% in the United States. [Indicators on marriage and marital status. In: 1997 Demographic yearbook, 49th ed. New York, NY,United Nations Statistics Division, 1999.]
Other customs leading to violence
In many places, there are customs other than child marriage that result in sexual violence towards women. In
Zimbabwe, for instance, there is the custom of ngozi, whereby a girl can be given to a family as compensation for a death of a man caused by a member of the girl's family. On reaching puberty the girl is expected to have sexual intercourse with the brother or father of the deceased person, so as to produce a son to replace the one who died. Another custom is chimutsa mapfiwawife inheritance, according to which, when a married woman dies, her sister is obliged to replace her in the matrimonial home.
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