13 Sexual Violence and its Impact on Physical, Mental, and Psychological Health
Sexual abuse is any unwanted sexual contact or activity in which the perpetrator uses force, threats or takes advantage of victims without consent. Sexual violence includes attempted rape, unwanted sexual touch, forcing a victim to perform sexual acts, and rape. Sexual abuse can happen to both men and women of any age and, in most instances, the perpetrator is known to the victim. Sexual abuse has devastating consequences to the victim. These include risk for sexually transmitted infections, injuries, depression, flashback and post-traumatic stress disorders, guilt, blame, and shame. Victims often manifest with low self-esteem, have difficulty forming and sustaining relationships, and struggle with addictions. This chapter focusses on the demographics of the victims of sexual violence in the Canadian context and the adverse health impact of sexual violence. Sexual violence is rooted in a rape culture that encourages male sexual aggression and supports violence against women. Following, to address sexual violence, a multiperspectival approach is needed. This includes bystander education, male involvement in prevention education, and risk reduction approaches.
Key Terms: Sexual, abuse, violence; effects of sexual violence
Sexual violence is defined as, “any sexual act, attempt to obtain a sexual act, unwanted sexual comments, or advances, or acts to traffic, or otherwise directed, against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting, including but not limited to home and work” (Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002, p. 149). Women are seven times likely to be victims of sexual violence compared to men (Statistics Canada, 2017). This chapter is devoted to a discussion related to sexual violence against women, its effects and ways to address it.
Sexual violence manifests as rape within marriage or dating relationships or by strangers, or during armed conflict, homicide, unwanted sexual advances, or sexual harassment. Sexual abuse of mentally or physically disabled people or children; forced marriage or cohabitation; denial of the right to use contraception; or to adopt other measures to protect against sexually transmitted diseases, as well as forced abortion also constitute sexual violence (Krug et al., 2002). Coercion entails the use of physical force and may involve psychological intimidation, blackmail, or other threats (Krahé, 2013). It can also occur when a person is unable to give consent, e.g., while drunk, drugged, asleep, or mentally incapable of understanding the situation (Krug et al., 2002). Online and social media platforms can be used to perpetrate sexual violence, such as threats and harassments and revenge pornography, etc. (Benoit, Shumka, Phillips, Kennedy, & Belle-Isle, 2015).
Sexual violence in Canada is a major problem. The provinces of Manitoba and Saskatchewan have the highest rates of sexual violence reported to the police (Benoit, et al., 2015). According to Conroy and Cotter (2017), 2.2% of Canadians have experienced a form of sexual violence in their lives. In 2012, there were 21,900 incidences of sexual assaults reported to police in Canada. Most of the victims tend to be women, young, Aboriginal, single, homosexual, or bisexual (Conroy & Cotter (2017). Most often, the sexual offender is a friend, acquaintance, or a neighbor (Benoit et al., 2015; Conroy & Cotter, 2017). Women in the sex trade have a higher risk of physical and sexual violence, especially from clients, which compromises their ability to negotiate for safe sex or provide service in a safe environment (Decker, Pearson, Illangasekare, Clark, & Sherman, 2013).
The rates of sexual violence among Aboriginal women are higher than non-Aboriginal women in Canada (Scrim, 2017). Aboriginal women are three times more likely to be victims that non-Aboriginal women (Jodi-Anne, Taylor-Butts, & Johnson, 2006). This violence is rooted in the objectification of Aboriginal women, which is engrained in racism, sexism, and colonialism (Bourassa, McKay-McNabb, & Hampton, 2004). Unresolved trauma, drugs, and alcohol are thought to contribute to high rates of sexual assault in First Nations reserves (Chansonneuve, 2007). Criminogenic factors that are thought to increase Aboriginal women’s risk of victimization include unemployment, low education attainment, being raised in a single family home, alcohol, and drugs (Scrim, 2017).
Sexual violence is often grossly underreported to police (Scrim, 2017). Often, the victims do not perceive sexual violence to be severe enough to warrant reporting. Others do not know what constitutes sexual violence. Fear, shame, the embarrassment of being judged, blamed, and not believed, and fear of the perpetrator may keep some victims from reporting to police (Benoit et al., 2015; Lindsay, 2015). Among Aboriginal peoples, the proximity of First Nations people living on reserves makes the victims of sexual violence reluctant to report sexual assault or child sexual assault to the police (Sexualassault.ca. n.d). Moreover, a lack of confidence in police makes Aboriginal women less likely to report incidences of violence against them compared to non-Aboriginal women (Boyce, 2016).
Addressing sexual violence
Sexual violence has devastating physical, mental, emotional, and psychological consequences to the victims. Victims of sexual violence are three times more likely to experience a disruption in life and seven times more likely to fear for their lives (Sinha, 2013). Victims of sexual violence may have a diminished sense of self and self-esteem; may experience dissociation and powerlessness; show signs and symptoms of post-traumatic stress disorders, such as nightmares and flashbacks; and may relive the traumatic experience long after the event happened (Jina & Thomas, 2013). Depression and suicidal ideation are common mental health consequences of sexual violence. Victims may attempt to regain control of life by abusing drugs and alcohol. (Jina & Thomas, 2013). The physical consequences of sexual violence include pain, fatigue, muscle problems and gynecological problems (Jina & Thomas, 2013; Sinha, 2013; Lonsway & Archambault, 2017).
Feminist scholars have articulated sexual violence within the context of rape culture and as a form of social controls that is motivated by violence, power, or control (Lee, Guy, Perry, Sniffen & Mixson, 2007; McPhail, 2016). Therefore, to confront this culture, community-focused solutions are required (Banyard, Moynihan, & Plante, 2007). Prevention of sexual violence must, therefore, comprise of confronting rape culture through bystander intervention, male involvement in prevention education, and risk reduction approaches (American college health association (n.d).
First, bystander education, based on a community of responsibility model, teaches men and women to safely and effectively intervene in situations involving sexual violence is often regarded as a primary prevention intervention (Banyard, Moynihan, & Plante, 2007). Such an intervention increases the likelihood of community receptivity to prevention messages and may increase the possibility of community members taking an active role in prevention and intervention (Banyard, Plante, & Moynihan, 2004).
Second, involving men in sexual violence prevention does not frame them as potential perpetuators; rather, this approach acknowledges that those sexual violence behaviors are related to norms of masculinity (American College Health Association, n.d.). Men can thus be involved in this endeavor by intentionally taking responsibility for playing a role in ending sexual and relationship violence as a men’s issue, intentionally modeling respect for women and refusing to participate in events that denigrate women (American college health association (n.d).
Finally, risk reduction approaches entail the development of skills to reduce an individual’s risk of experiencing sexual violence. These include recognizing signs of unhealthy relationships, situational awareness, communication skills, and self-defense (American college health association, n.d.). Involving men in addressing sexual violence against women can help a community find long-term solution to this issue (Lamontagne, 2011).
In addition, developing organization-specific initiatives to address sexual violence is paramount to mitigating the effects of violence, and to champion proactive and prevention initiatives. In Canada, several Indigenous organizations and initiatives are responding to violence especially against women. These include, National Native Women’s Association in Canada (NWAC), Sisters in Spirit campaign, Ontario Federation of Indian Friendship Centres, Strategic Framework to End Violence Against Aboriginal women, National Strategy for Abuse Prevention in Inuit Communities, Ontario Native Women’s Association, and Mothers of the Red Nation, Manitoba (Lamontagne, 2011).
Health care providers have a significant role to play in supporting victims of sexual violence. As the first professionals to encounter clients facing sexual and other forms of violence, health care providers are best positioned to respond to and assist these victims as they seek healthcare (World Health Organization, 2013). Women who are victims of sexual violence are likely to seek care more than non-abused women (World Health Organization, 2013). By diagnosing sexual violence promptly, they can offer treatment, counseling, document injuries and refer clients to receive legal and social assistance.
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