CHAPTER 6 Sexual violence CHAPTER 6. SEXUAL VIOLENCE . 149 Background How is sexual violence defined? Sexual violence occurs throughout the world. Sexual violence is defined as: Although in most countries there has been little any sexual act, attempt to obtain a sexual act, research conducted on the problem, available data unwanted sexual comments or advances, or acts to suggest that in some countries nearly one in four traffic, or otherwise directed, against a person’s women may experience sexual violence by an sexuality using coercion, by any person regardless intimate partner (1–3), and up to one-third of of their relationship to the victim, in any setting, adolescent girls report their first sexual experience including but not limited to home and work. as being forced (4–6). Coercion can cover a whole spectrum of degrees Sexual violence has a profound impact on of force. Apart from physical force, it may involve physical and mental health. As well as causing psychological intimidation, blackmail or other physical injury, it is associated with an increased threats – for instance, the threat of physical harm, risk of a range of sexual and reproductive health of being dismissed from a job or of not obtaining a problems, with both immediate and long-term job that is sought. It may also occur when the consequences (4, 7–16). Its impact on mental person aggressed is unable to give consent – for health can be as serious as its physical impact, and instance, while drunk, drugged, asleep or mentally may be equally long lasting (17–24). Deaths incapable of understanding the situation. following sexual violence may be as a result of Sexual violence includes rape, defined as suicide, HIV infection (25) or murder – the latter physically forced or otherwise coerced penetration occurring either during a sexual assault or subse- – even if slight – of the vulva or anus, using a penis, quently, as a murder of ‘‘honour’’ (26). Sexual other body parts or an object. The attempt to do so violence can also profoundly affect the social well- is known as attempted rape. Rape of a person by being of victims; individuals may be stigmatized two or more perpetrators is known as gang rape. and ostracized by their families and others as a Sexual violence can include other forms of assault consequence (27, 28). involving a sexual organ, including coerced contact Coerced sex may result in sexual gratification on between the mouth and penis, vulva or anus. the part of the perpetrator, though its underlying purpose is frequently the expression of power and Forms and contexts of sexual violence dominance over the person assaulted. Often, men A wide range of sexually violent acts can take who coerce a spouse into a sexual act believe their place in different circumstances and settings. These actions are legitimate because they are married to include, for example: the woman. — rape within marriage or dating relationships; Rape of women and of men is often used as a — rape by strangers; weapon of war, as a form of attack on the enemy, — systematic rape during armed conflict; typifying the conquest and degradation of its — unwanted sexual advances or sexual harass- women or captured male fighters (29). It may also ment, including demanding sex in return for be used to punish women for transgressing social favours; or moral codes, for instance, those prohibiting — sexual abuse of mentally or physically adultery or drunkenness in public. Women and disabled people; men may also be raped when in police custody or in — sexual abuse of children; prison. — forced marriage or cohabitation, including While sexual violence can be directed against the marriage of children; both men and women, the main focus of this — denial of the right to use contraception or to chapter will be on the various forms of sexual adopt other measures to protect against violence against women, as well as those directed sexually transmitted diseases; against young girls by people other than caregivers. — forced abortion; 150 . WORLD REPORT ON VIOLENCE AND HEALTH — violent acts against the sexual integrity of larger section may be elucidated through survey women, including female genital mutilation research and the work of nongovernmental organiza- and obligatory inspections for virginity; tions. But beneath the surface remains a substantial — forced prostitution and trafficking of people although unquantified component of the problem. for the purpose of sexual exploitation. In general, sexual violence has been a neglected There is no universally accepted definition of area of research. The available data are scanty and trafficking for sexual exploitation. The term fragmented. Police data, for instance, are often encompasses the organized movement of people, incomplete and limited. Many women do not report usually women, between countries and within sexual violence to police because they are ashamed, countries for sex work. Such trafficking also or fear being blamed, not believed or otherwise includes coercing a migrant into a sexual act as a mistreated. Data from medico-legal clinics, on the condition of allowing or arranging the migration. other hand, may be biased towards the more violent Sexual trafficking uses physical coercion, decep- incidents of sexual abuse. The proportion of women tion and bondage incurred through forced debt. who seek medical services for immediate problems Trafficked women and children, for instance, are related to sexual violence is also relatively small. often promised work in the domestic or service Although there have been considerable advances industry, but instead are usually taken to brothels over the past decade in measuring the phenomenon where their passports and other identification through survey research, the definitions used have papers are confiscated. They may be beaten or varied considerably across studies. There are also locked up and promised their freedom only after significant differences across cultures in the will- earning – through prostitution – their purchase ingness to disclose sexual violence to researchers. price, as well as their travel and visa costs (30–33). Caution is therefore needed when making global comparisons of the prevalence of sexual violence. The extent of the problem Sources of data Estimates of sexual violence Data on sexual violence typically come from police, Surveys of victims of crime have been undertaken in clinical settings, nongovernmental organizations and many cities and countries, using a common survey research. The relationship between these methodology to aid comparability, and have sources and the global magnitude of the problem of generally included questions on sexual violence. sexual violence may be viewed as corresponding to an Table 6.1 summarizes data from some of these iceberg floating in water (34) (see Figure 6.1). The surveys on the prevalence of sexual assault over the small visible tip represents cases reported to police. A preceding 5 years (35, 36). According to these FIGURE 6.1 Magnitude of the problem of sexual violence CHAPTER 6. SEXUAL VIOLENCE . 151 TABLE 6.1 violence. For instance, in a Percentage of women aged 16 years and older who report having been national survey conducted in sexually assaulted in the previous 5 years, selected cities, 1992--1997 the United States of America, Country Study Year Sample Percentage of women population size (aged 16 years and older) 14.8%ofwomenover17years sexually assaulted in the of age reported having been previous 5 years raped in their lifetime (with an (%) additional 2.8% having experi- Africa Botswana Gaborone 1997 644 0.8 enced attempted rape) and 0.3% Egypt Cairo 1992 1000 3.1 of the sample reported having South Africa Johannesburg 1996 1006 2.3 been raped in the previous year Tunisia Grand-Tunis 1993 1087 1.9 Uganda Kampala 1996 1197 4.5 (37).Asurveyofarepresenta- Zimbabwe Harare 1996 1006 2.2 tive sample of women aged 18– Latin America 49 years in three provinces of Argentina Buenos Aires 1996 1000 5.8 Bolivia La Paz 1996 999 1.4 South Africa found that in the Brazil Rio de Janiero 1996 1000 8.0 previous year 1.3% of women Colombia Bogota´ 1997 1000 5.0 had been forced, physically or Costa Rica San Jose´ 1996 1000 4.3 by means of verbal threats, to Paraguay Asuncio´ n 1996 587 2.7 Asia have non-consensual sex (34). China Beijing 1994 2000 1.6 In a survey of a representative India Bombay 1996 1200 1.9 sample of the general population Indonesia Jakarta and Surabaya 1996 1400 2.7 Philippines Manila 1996 1500 0.3 over 15 years of age in the Czech Eastern Europe Republic (38), 11.6% of women Albania Tirana 1996 1200 6.0 reported forced sexual contact in Hungary Budapest 1996 756 2.0 their lifetime, 3.4% reporting Lithuania Ðiauliai, 1997 1000 4.8 Kaunas, Klaipe˚ da, that this had occurred more than Paneve˚ zys,ˇ Vilnius once. The most common form of Mongolia Ulaanbaatar, 1996 1201 3.1 contact was forced vaginal inter- Zuunmod Source: references 35 and 36. course. studies, the percentage of women reporting having Sexual violence by intimate partners been a victim of sexual assault ranges from less than In many countries a substantial proportion of 2% in places such as La Paz, Bolivia (1.4%), women experiencing physical violence also experi- Gaborone, Botswana (0.8%), Beijing, China ence sexual abuse. In Mexico and the United States, (1.6%), and Manila, Philippines (0.3%), to 5% or studies estimate that 40–52% of women experien- more in Tirana, Albania (6.0%), Buenos Aires, cing physical violence by an intimate partner have Argentina (5.8%), Rio de Janeiro, Brazil (8.0%), also been sexually coerced by that partner (39, 40). and Bogota´, Colombia (5.0%). It is important to Sometimes, sexual violence occurs without physical note that no distinction has been made in these violence (1).