FHI - Forced Sex, Reproductive Health Problems Linked -- June 10, 2005

Research Triangle Park, NC, USA — Many adults — particularly women — adolescents, and even children are at risk of serious health problems because they are unable to refuse unwanted sex, experts warn. Nonconsensual sex resulting from physical force or social and psychological pressure may be a major contributing factor to such reproductive health problems as unintended pregnancy and its complications, HIV/AIDS, and other sexually transmitted infections (STIs). HIV is a life-threatening infection, but other STIs can also be serious, causing cervical cancer and infertility. Transmission of these infections will persist — despite common STI/HIV prevention approaches of emphasizing sexual abstinence, faithfulness in relationships, and condom use — as long as nonconsensual sex remains widespread.

Trends Are Clear

More research is needed to create evidence-based policies, programs, and provider practices to prevent and address the problem of nonconsensual sex. But considerable data about forced sex exist and certain trends are clear:

Settings that would appear to provide the greatest protection against abuse, such as homes, schools, and even health care facilities, often present considerable risk.
Most victims know their abusers.
A substantial proportion of victims are young.
Most victims are women or girls.
Forced sex is commonly accompanied by physical violence or emotional abuse.
Such forms of sexual coercion as child or marital sexual abuse are ongoing and may grow worse over time.

The current issue of Network, the reproductive health journal of Family Health International (FHI), describes the variety of means by which adults — men and women alike — adolescents, and children are pressured to have sexual relations that they do not want. For example, reports from the field describe sexual violence against women in the Democratic Republic of Congo, sexual abuse of male youth and sexual coercion of women within marriage in India, and virginity testing in Zimbabwe. In these and other cases, the behavior of perpetrators may be condoned or supported by gender norms (attitudes about gender) or by long-standing traditions and customs. Meanwhile, victims often suffer such shame and stigma that they do not report or object to the abuse or receive treatment.

Reproductive health providers are often particularly well placed to detect sexual coercion and to care for its predominantly female victims. The appropriate level of services to offer in a given setting depends on the resources available. However, ways in which providers can help clients cope with the effects of sexual coercion and prevent further abuse include recognizing warning signs of forced sex, assessing a victim's continuing safety, confronting myths that condone nonconsensual sex, counseling abused clients about contraception and STI prevention, learning about local regulations governing sexual abuse, and building and maintaining a referral network.

Experts have called for more rigorous evaluation of health provider interventions to determine how they affect clients' health or exposure to further violence. Some have also called for financially supporting and rigorously evaluating initiatives that address the root causes of nonconsensual sex. Some prevention programs, for example, aim to reverse gender norms that fuel sexual violence. To date, most prevention initiatives have been implemented in the United States and other industrialized countries. "It would seem that there are also many programs aimed at the prevention of nonconsensual sex in developing countries, but most of these programs are not documented, making it difficult to describe the current range of interventions they deliver and the risk factors and target groups they aim to influence," says Dr. Alexander Butchart, coordinator of violence prevention at the World Health Organization (WHO). "Since so few of these programs have been evaluated, saying how successful they are is also difficult."

Nevertheless, reviews of evaluated programs worldwide and discussions among prevention experts have identified some characteristics that seem to help prevention efforts succeed. These include implementing multifaceted strategies that target subgroups of people at highest risk. For example, in many countries, one high-risk group is married women, since nonconsensual sex within marriage is often reinforced by social norms, laws, and policies. Youth are another general but important target. Working with youth also provides an opportunity to reverse social and gender norms by teaching more egalitarian ways for young men and women to interact.

Family Health International is dedicated to improving lives, knowledge, and understanding worldwide through a highly diversified program of research, education, and services in family health and HIV/AIDS prevention and care. Since its inception in 1971, FHI has formed partnerships with national governments and local communities in countries throughout the developing world to support lasting improvements in the health of individuals and the effectiveness of entire health systems.