Why Marital for a Topic?

Marital Rape: The  Close friend raped by her husband Line Between  Personal family history of Consent & Coercion  Strong Passion for Women’s Rights Dale Fukura MN, RN,  Scholarly Project – Masters in Nursing Forensic Nurse Examiner 2010

Disclaimer Definitions Used for this Presentation  Rape  forced vaginal, anal or oral sex  Intimate partners  While victims and offenders may be  can include current or former spouses, dates, non- cohabitating intimate partners or cohabitating either male or female, for the partners purposes of this presentation, victims (Bennice & Ressick, 2003) will be referred to as female and  Forced sex can include unwelcome sexual acts offenders will be referred to as male  rough or painful intercourse, threats of violence if sex is refused or beatings which may occur before, during and/or after (Campbell & Soeken, 1999).

Definition (cont) Battering

 Battering is different from physical  Legal definition for most states assault because it is chronic/continuous  refers to rape as a non-consensual sexual behavior, that includes coercion, by the abuser Process where the intimate partner victim (Anderson, Cooper & Okamura, 1997) loses   power  Also referred to as:  control  Spousal rape  becomes psychologically vulnerable  Intimate partner rape (Coker, Smith, McKeown & King, 2000) The offender may use any one of these or a Categories of Marital Rape combination in order to maintain control.

 Force Only The amount of violence may change or increase over  man uses only the amount of force needed to coerce time. wife into having sex Marital rape is a betrayal of trust not just a physical  Battering Rape and sexual violation.  woman is raped and beaten It is an act that may be repeated frequently  beating occurs before, during or after the Results in the victim feeling they deserved what has happened to them.  Sadist/Obsessive Rape (Hidden Hurt: Domestic Information)  man uses torture or perverse sexual acts, often involving pornography

(Bergen, 1999).

Historical / Legal Context What this meant…  Man could rape his wife  Historical definition of rape Without fear of prosecution

 A man having sex with a woman not his wife  Wife had belief she could not refuse sex with husband (Finkelhor & Yllo, 1985)  Without her consent

(Bergen, 1999)  Some (both men and women) who still believe this

Historical Context  1993  All 50 states had one section of sexual  1736 offense codes to cover marital rape  Chief Justice of England stated man could  33 states had conditional exemptions not rape his wife designed to protect a man from rape claim  She had “given” herself in marriage  These exemptions primarily related to (Russell, 1990) degree of violence used  1950s Bennice & Resick, 2003; Kirkwood & Cecil, 2001)  Benjamin Karp stated that rapists were victims of disease  Claimed many suffered more than their  The closer the relation b/t couple, the victims less like assault will be considered rape (Brownmiller, 1975) (Kirkwood & Cecil, 2001) Washington State Statistics What is Coercion?

 2000, 203 cases of non-stranger rape  One definition is the use of force to gain were investigated as DV cases compliance or submission (Oxford English Dictionary).  No information re: victim and offender

 Can mean different things to different  No information re: gender of those involved people

 Offender may/may not be spouse

(Covering Domestic Violence in the Media)

Coercion – why is it important  Coercion and marital rape become more  Date rape & rape by acquaintance often confusing with the addition of cultural involves coercion factors

 Coercion is often involved in marital rape  Some cultures believe marital rape can not occur

 Cultural definition of marriage affords them the right to sexual activities (Heise, Moore & Toubia, 1995)

Most Arab/Islamic countries offer no help for In Kenya it is estimated that more than a wife who is abused. 16,000 occur every year A woman may be granted a divorce only if Only about 8% are reported to health officials there are physical injuries. or law enforcement At a Bahrain Anti Domestic Violence Center Even so, the number of reported cases has in 2008, almost ½ of DV cases reported gone up from 515 in 1990 to over 1600 in involved by a spouse . 2000. (The WIP Contributors: Bahrain offers Women No Protection from Spousal Rape.)

(Rape is Prominent in Kenya Elections) 43% of divorce cases are due to violence, Asian, African-American and Latina women not rape. are more likely to stay with their partners. (Russell, 1990) Rape between a husband and wife does not Immigrant women who are controlled by exist in Islamic law. abusive partners have multiple barriers to leaving: Afghanistan law allows for spousal rape for Shiite couples. fear they might be deported

(The WIP Contributors: Bahrain offers Women No Protection from Spousal Rape.) Possibly being separated from children (Dasgupta, 1998)

Spousal rape affects members of the Lesbian, Gay, Bisexual Transgender population (LGBT) as well. Searched online for examples of student education regarding coercion and SA One small study found 36% of women and 34% of men experienced forced sex with a  Reed College Handbook current or recent partner. (Sexual Coercion in Gay Male and Lesbian Relationships)  Defines consent & coercion  Tells what victim of rape should do In another study of almost 300, 52% reported at least one incident of sexual coercion by partner. (Wisconsin Coalition Against Sexual Assault)

Coercion (cont) Coercion (cont)

 Hampshire College handbook  Mount Holyoke College handbook  Section on sexual  Detailed definition of rape, coercion,  No information about protection from consent sexual assault  Notes that consent is required for sexual  Berkeley University handbook intercourse  Consent is  Section deals with sexual assault & rape  Explicitly communicated  Does not discuss coercion  Reversible  Evergreen State College handbook  Mutual agreement  Primarily deals with after the rape  Fine line between consent & coercion Self - Help Books

 Many use self-help books as a resource  Looking at books dealing with violence in the family  One looked at battered women but little on  Looking at marriage counseling books forced sex (Wilson, 1997)  3 of 4 – no pertinent information (Combs, 2004; Ferguson, 2006; Spring, 1996)  One did cover sexual assault and forced sex (Dugan & Hock, 2006)  One discussed dysfunctional sexual relationships but did not specify coercion or consent (Markman, Stanley & Blumberg, 2001)

Four Types of Coercion Five Types of Acquiescence  Social  Unwanted turns to wanted  Societal expectations that are part of being a wife  Inconvenience of marriage  Interpersonal  Easier not to argue  Sex occurs as the result of aggressive behavior of husband  Doesn’t know what will happen if I don’t  Threatened Physical  Husband specifically implies use of force  Know what will happen if I don’t  Physical  Spouse uses physical violence during sex (Basile, 1999) (Finkelhor & Yllo, 1985)

 Acquiescence due to  Forced sex may occur occasionally for  Fear of what might happen or many  Knowing what will happen  These are severe forms of violence  May occur with other satisfying, consensual sexual acts  Important to look at first three types  This further confuses the issue  Unwanted turns to wanted (Campbell & Soeken, 1999)  Marital duty  Easier not to argue  In cases of forced sex  56% of victims did not refer to this as rape  Will there be an escalation from these forms to the more violent categories?  They did not say “no” (Basile, 1999) (Basile, 1999) Affects on Sexuality & Fertility Popular Attitudes

 Women have 4x greater risk of unwanted or  Study with 469 undergraduate students mistimed pregnancies  Students stated marital rape least likely to be  Due to coercive control considered rape (Kirkwood & Cecil, 2001)  Unclear what came first – abuse or pregnancy (Gazmararian, Adams, Saltzman, Johnson, Bruce, Marks, Zahniser & the Prams Working Group, 1995)  Study of violence between intimate

 Husband takes away her ability and control partners in Cape Town for safe sex  Incidence of sexual violence linked to use of  Loss of control - does/does not want children violence for other problem solving (Abrahams, Jewkes, Hoffman & Laubsher, 2004)  Takes away her power for decision making (Coggins & Bullock, 2003)

Societal Beliefs as to Incidence Acceptance  Approx 80% of general population  Believe husbands use force often or somewhat  often…BUT Rape supportive attitudes  Society does not look at marital rape as real rape  May believe marital rape is less traumatic for victims  The more intimate the relation (Frese, Moya & Megias, 2004)  The more likely forced sex will not be considered rape  Those who believe in more traditional  Believe that it is less likely harm will have occurred marriage beliefs  More likely the victim will be blamed  Place greater responsibility on victim (Basile, 1999; Kirkwood & Cecil, 2001; Monson, Langhinrichsen & Binderup, 2000)  Victim deserved attack (Whatley, 2005)

Potential Reasons for Lack of Limitations of Studies Research  Disagreement of definition of rape  Belief that this type of rape is less  Is it rape or acquiescence (Basile, 1999) important than stranger or date rape  Ambiguity regarding the term “coercion”  Marital rape may be considered societal  Personal opinions = different definitions taboo in American culture (Kirkwood & Cecil, 2001) (Whatley, 2005)  Few studies where marital rape is the main topic  Difficult to recruit study participants  Available studies often lack prevalence  Safety issues statistics  Hidden (Kirkwood & Cecil, 2001) Limitations of Studies (Cont) Case Study #1  Many studies use college students as  Lee - middle age Caucasian/Native American participants female  More likely to make sex-role stereotypes  Teen years for  Initially did not recognize emotional/physical (Monson, Langhinrichsen-Rohling & Binderup, 2000) abuse against her  Based on information, she was emotionally abused  Large number of study participants were Caucasian  Can lead to sample bias All names have been change to protect the privacy of the victim (Basile, 1999; Kirkwood & Cecil, 2001; Monson, et al; Whatley, 2005)

Met Bill in her early twenties Emotional abuse began immediately  About that time, met Roy 2 weeks before wedding he hit her in  He picked up the pieces the face  Convinced her to marry him She called wedding off  Took her to California

 Her mother advised her to go back and  Roy was domineering but, initially, sex “deal with it” was consensual

 He began to use coercion  Lee feels she should have seen warning  Her responsibility to give him sex whenever signs he wanted  he had vast pornographic collection  Isolated from family – told her she only had  Most dealt with him

 Lee does not recall other incidences of  Promised to move back near her family rape by Roy  Later told her he had lied to her

 He wanted children – she didn’t  continued until their  He raped her divorce  Lee was never denied  Coercion occurred almost every time, for  Refused to take her to hospital for tubal ligation  Did not visit her sex

 She was forced to perform sexual acts against  She feels in retrospect, she was raped her will frequently

 Roy videotape sex acts with her  Lee has since remarried  Current husband is gentle and understanding  He often pressured her to participate in group  Knows Lee’s past history sex

 Not Lee’s first experience with DV or  Like Lee - About 1/3 of violence identified by victims occurs in current or recent  Paternal grandfather was physically relationship abusive  For a woman - if father  Father was physically abusive until Lee physically/emotionally abused mother was a teenager significantly greater risk to become a victim of  As a child was sexually abused by domestic violence neighbor and family friend She may see violence as normal aspect of intimate relation

 Lee did not have a positive role model (Coker, Smith, McKeown & King, 2000) for stable family

Case Study #2  Julie is a 40-something professional woman  Like Roy – men with increased exposure to pornography are more excepting of use of sexual coercion  She was 16 & Tim was 15 when they met (Anderson, Cooper, Okamura, 1997)  Julies family has no history of DV; Tim’s does

 5 months after started , thought she was pregnant  Initially considered sex consensual  Several months later discovered she was pregnant

 In retrospect, feels he was coercive  This was when the physical violence began  Tim expected sex daily

 He began to hit her  Early in relation, she tried to break up  He became upset  Controlling behaviors increased  Threatened to kill himself  Still demanded sex daily  He talked her into returning  Threatened violence if she did not comply

 Tim was jealous  After becoming pregnant again, he decided they should marry.  He frequently accused her of sleeping with men

 Tim’s dad had wanted her to abort 1 st  After 2 nd child was born, Tim thought Julie had pregnancy slept with his cousin

 Now he didn’t want them to marry  He became angry while driving

 He got angry and threw her against a wall  Threatened to crash car and kill them all

 He finally calmed down

 Tim threatened to kill her  One job she held was as a waitress.

 Forced her to drive  When she was pregnant with their fourth child, Tim saw a regular customer wave  He became more angry and made her stop

 Tim accused her of sleeping with him  He forced her to climb into the passenger seat

 She finally admitted she had  Wouldn’t let her out; afraid she’d run  He made her feel attractive  Tim drove, beating her as they went  Listened to her  Feels she may have been looking for a  Julie kept her purse over abdomen rescuer  Protect her unborn child  Tore her wedding ring off her finger  This was the first time she realized she was  Threw it out the car raped  Both eyes were puffy

 One eye and lip were bleeding  In retrospect she knows she was raped multiple times both before and after

 At home  Tim’s pattern after violent outbursts was to  pinned her to the bed express remorse, cry and threaten suicide  ripped off clothes  raped her  In the end Julie made the decision to divorce

Getting Away  Tim beat her in front of their 4 kids, ages from a  Julie began planning few months to 5 years

 She hid small amounts of money  Afterwards he expressed remorse

 Family helped her buy plane tickets to fly to her  Wrapped vacuum cord around his neck parents

 Julie tried to stop him  When Tim left for work, Julies family and friends helped her pack up the house – it was her things  Manager didn’t call police  intimidated by Tim  They went to the airport

 Julie and Tim were together for 7 years  Julie was denied birth control measures from the start

 Tim was physically violent 6-8 times a year  Tim said it would kill her

 She was also frequently shoved  Tim isolated her from family and friends

 Tim used to control Julie and for sex  20 Years later she still reacts to his violent legacy

 Tim didn’t use alcohol but did use marijuana during these violent outbursts  Very emotional even today  Tears and anger Conclusion

 When woman is sexually assault by one  Women are frequently screened for that she should expect trust and love from  Shock may be more than that of a victim of  Less likely to be screened for forced sex stranger rape  Considered too intrusive into personal life  Effects more be more long-lasting Dugan & Hock, 2006 (Yllo, 1999)  Healthcare often assumes sexual  This was true especially for Julie intercourse is consensual  In reality it may unwanted, forced or violent (Coggins & Bullock, 2003)

Why Forensic Nurses  Research appears to be lacking in area of  Have the knowledge re: interpersonal  Marital rape crimes  Coercion related to forced sex  Can support clinical staff in issues r/t  Important to identify victim and offender  Victims  As educator  Trends of potential abuser violence  What may/may not be evidence and how to escalation rates handle it  Characteristics of abusers / victims that  As clinician cause abusers to become more violent  Screen for violence  Treat victims/offenders  ID, collect, preserve evidence

References

 Abrahams, N., Jewkes, R., Hoffman, M. & Laubsher, R. (2004). Sexual violence against intimate partners in Cape Town:  Many researchers believe marital rape prevalence and risk factors reported by men. Bulletin of the World Health Organization. 82(5), 330-337. vastly under reported  Anderson, B., Cooper, H. & Okamura, L. (1997). Individual differences and attitudes toward rape: a meta-analytic review. Personal & Social Psychology Bulletin, 1997, 23(3), 295-321.  Potential number of women who have  Basile, K.C. (1999). Rape by Acquiescence: The ways in which been victims/will be victims in lifetime is women “give in” to unwanted sex with their husbands. , 5(9), 1036-1058 staggering  Bennice, J.A. & Resick, P.A. (2003). Marital rape: history, research and practice. Trauma, violence & Abuse, 4(3), 228- 246 References (cont) References (cont)  Bergen, R.K. (1999). Marital rape. Applied Research Forum:  Combs, D. (2004). The Way of Conflict . Novato CA: New World National Electronic Network on Violence Against Women . Library

 Brownmiller, S. (1975). Against our will. New York: Simon &  Covering Domestic Violence in the Media. Retrieved August 30, Schuster. 2005 from http://wscadv.org/projects/FR/Media_Guide.pdf

 Campbell, J.C. & Soeken, K.L. (1999). Forced sex and intimate partner violence. Violence Against Women, 5(9), 1017-1035.  Dasgupta, S.D. (1998). Women’s realities: Defining violence against women by immigration, race, and class. In R. Bergen (Ed.), Issues in intimate violence (pp.209-218). Thousand Oaks, CA:  Coggins, M. & Bullock, L.F.C. (2003). The wavering line in the sand: The effects of domestic violence and sexual coercion. Issues in Sage. Mental Health Nursing, 24, 723-738.  Dugan, M.K. & Hock, R.R. (2006). It's My Life Now: Starting Over  Coker, A.L., Hall Smith, P, McKeown, R.E. & King, M.J. (2000). After an Abusive Relationship or Domestic Violence (2nd Ed). Frequency and correlates of intimate partner violence by type: London: Routledge Physical, sexual and psychological battering. American Journal of Public Health, 90(4), 553-559.  Ferguson, D. (2006). Reptiles in Love : Ending Destructive Fights and Evolving Toward More Loving Relationships. San Francisco: Jossy –Bass

References (cont) References (cont)  Finkelhor, D. & Yllo, K. (1985). License to rape: Sexual abuse  Kirkwood, M.K. & Cecil, D.K. (2001). Marital rape; a student of wives. New York: Holt, Reinhart & Winston. assessment of rape laws and marital exemption. Violence Against Women, 7(11), 1234-1253.  Frese, B., Moya, M. & Megias, J.L. (2004). Social perception of rape: How rape myth acceptance modulates the influence of  Markman, H.J., Stanley, S.M. & Blumberg, S.L. (2001). Fighting for situational factors. Journal of Interpersonal Violence, 19(2), 143- Your Marriage: Positive Steps for Preventing Divorce and 161 Preserving a Lasting Love, New and Revised. Jossey-Bass: San Francisco  Gazmararian, J.A., Adams, M.M., Saltzman, L.E., Johnson, C.H., Bruce, F.C., Marks, J.S., Zahniser & The Prams  Monson, C.M., Langhinrichsen-Rohling, J. & Binderup, T. (2000). Working Group (1995). The relationship between pregnancy Does “no” really mean “no” after you say “yes? Attributions about intendedness and physical violence in mothers of newborns. date and marital rape. Journal of Interpersonal Violence, 15(11), Obstetrics & Gynecology, 85(6), 1031-1038 . 1156-1174

 Oxford English Dictionary, Retrieved April 19, 2006 from  Heise, L., Moore, K. & Toubia, N. ( 1995). Defining “coercion” and “consent” cross-culturally. SIECUS Report, 24(2). http://dictionary.oed.com.offcampus.lib.washington.edu/entrance.dtl

 Rape is Prominent Issue in Kenya Elections: Women eNews.  Hidden Hunt: Domestic Abuse Information. Retrieved January Retrieved January 31, 2010 from 31, 2010 from http://womensenews.org/story/rape/020401 http://www.hiddenhurt.co.uk/Articles/maritalrape.htm .

References (cont) References (cont)

 Russell, D.E.H. (1990). Rape in Marriage (expanded and rev. ed.).  Whatley, M.A. (2005). The effects of participant sex, victim dress Bloomington: Indiana University Press. and traditional attitudes on causal judgments for marital rape victims. Journal of Family Violence, 20(3), 191-200.  Spring, J.A. (1996). After the Affair: Healing the Pain and Rebuilding Trust When a Partner Has Been Unfaithful. New  Wilson, K.J. (1997). When Violence Begins at Home: A York: Harper Collins Publishers, Inc Comprehensive Guide to Understanding and Ending Domestic Abuse. Hunter House Inc: Alameda Ca.  Washington State Legislature Retrieved December 11, 2004 from http://www.leg.wa.gov/RCW/index.cfm?section=10.99.020&fuseacti  The WIP Contributors: Bahrain Offers Women no Protection from on=section Spousal Rape. Retrieved February 26, 2010 from http://www.thewip.net/contributors/2009/06  Waterman, C.K., Dawson, L.J., Bologna, M.J. (1989). Sexual coercion in gay male and lesbian relationships: Predictors and  Wisconsin Coalition Against Sexual Assault: Lesbian, Gay, Bisexual, Implications for support services. The Journal of Sex Research, Transgendered (LGBT) Populations and Sexual Assault. (2003) 26(1), 118-124.

 Yllo, K. (1999). Wife rape: A social problem for the 21st century. Violence Against Women, 5(9), 1059-1063. Questions???

Contact information: Dale Fukura, MN, RN, APFNS Forensic Nurse Examiner [email protected]