Sex­ual vi­o­lence a global pan­demic

One in three women world­wide will ex­pe­ri­ence phys­i­cal or sex­ual vi­o­lence in her life­time, write Va­lerie Do­biesz and Ju­lia Brooks

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THE re­cent ex­po­sure of wide­spread sex­ual pre­da­tion in the Amer­i­can me­dia in­dus­try, from Har­vey We­in­stein to Bill O’Reilly, has elicited shock and sparked de­bate on vi­o­lence against women in the US.

Sex­ual ha­rass­ment isn’t the exclusive do­main of show­biz big shots. It re­mains alarm­ingly preva­lent na­tion­wide, even as other crimes are gen­er­ally de­creas­ing na­tion­wide.

In the US, a 2006 study found that 27% of col­lege women re­ported some form of forced sex­ual con­tact – rang­ing from kiss­ing to anal in­ter­course – af­ter en­rolling in school. This sex­ual vi­o­lence is heav­ily un­der-re­ported, with just 20% of fe­male stu­dent vic­tims re­port­ing the crime to law en­force­ment.

Nor is sex­ual ha­rass­ment lim­ited to the US.

The UN has called gen­der­based vi­o­lence a “global pan­demic.”

As ex­perts in emer­gency medicine and le­gal re­search at the Har­vard Hu­man­i­tar­ian Ini­tia­tive, we be­lieve it’s im­por­tant to ac­knowl­edge that this is­sue tran­scends na­tional bor­ders and class bound­aries to touch the lives of roughly 33% of all women world­wide.

Ac­cord­ing to World Health Or­gan­i­sa­tion es­ti­mates, one in three women world­wide will ex­pe­ri­ence ei­ther phys­i­cal or sex­ual vi­o­lence in her life­time, many of them be­fore the age of 15.

In fact, for many ru­ral women, their first sex­ual en­counter will be a forced one. Some 17% of women in ru­ral Tan­za­nia, 21% in Ghana, 24% in Peru, 30% in Bangladesh and 40% in South Africa re­port that their first sex­ual ex­pe­ri­ence was non-con­sen­sual.

In­ti­mate part­ner vi­o­lence is also per­va­sive glob­ally. In one World Health Or­gan­i­sa­tion study, 22 to 25% of women sur­veyed in cities in Eng­land, Mex­ico, Nicaragua, Peru and Zim­babwe re­ported that a boyfriend or hus­band had com­mit­ted some form of sex­ual vi­o­lence against them. Glob­ally, up to 55% of women mur­dered are killed by their part­ners.

Vi­o­lence against women takes many forms, rang­ing from psy­cho­log­i­cal abuse to the kind of sex­ual pre­da­tion, sex­ual as­sault and rape al­legedly com­mit­ted by Har­vey We­in­stein.

Hon­our killings, phys­i­cal at­tacks, fe­male in­fan­ti­cide, gen­i­tal cut­ting, traf­fick­ing, forced mar­riages and sex­ual ha­rass­ment at work and school are also con­sid­ered gen­der­based vi­o­lence.

Rates range from coun­try to coun­try – from 15% in Ja­pan to 71% in Ethiopia – but vi­o­lence is, in ef­fect, an ubiq­ui­tous fe­male ex­pe­ri­ence.

Sex­ual vi­o­lence is com­mit­ted at par­tic­u­larly high rates in cri­sis set­tings like war zones, refugee camps and dis­as­ter zones.

In th­ese places, even hu­man­i­tar­ian work­ers are not im­mune.

Dyan Mazu­rana and her col­leagues at Tufts Univer­sity found that many fe­male de­vel­op­ment-aid staffers in places such as South Su­dan, Afghanistan and Haiti had ex­pe­ri­enced dis­turb­ing rates of sex­ual as­sault, of­ten per­pe­trated by their own col­leagues.

So what’s driv­ing this per­va­sive phe­nom­e­non?

Re­search re­veals that there are mul­ti­ple causes of sex­ual vi­o­lence, among them gen­der in­equal­ity and power dif­fer­en­tials be­tween men and women.

For ex­am­ple, sex­ual vi­o­lence oc­curs more fre­quently in cul­tures where vi­o­lence is widely ac­cepted and where be­liefs about fam­ily hon­our, sex­ual pu­rity and male sex­ual en­ti­tle­ment are strongly held.

Even in many coun­tries that rank well on gen­der equal­ity, in­clud­ing in the US, weak le­gal sanc­tions against per­pe­tra­tors of sex­ual vi­o­lence can en­cour­age and ef­fec­tively con­done such be­hav­iour.

So can cul­tural ac­cep­tance. We­in­stein’s sex­u­ally preda­tory be­hav­iour was long­stand­ing and well-known within the film in­dus­try, yet he was al­lowed to con­tinue his abuse with im­punity – un­til women be­gan speak­ing up.

Like­wise, Fox News re­newed Bill O’Reilly’s con­tract even af­ter he and the com­pany had made at least six multi-mil­lion-dol­lar set­tle­ments with women who filed sex­ual ha­rass­ment claims against him. Aware­ness of a prob­lem is one thing; tak­ing ac­tion is quite another.

Men with lower ed­u­ca­tion lev­els, or who have been ex­posed to mal­treat­ment or fam­ily vi­o­lence as chil­dren, are more likely to com­mit sex­ual vi­o­lence them­selves.

That’s be­cause vi­o­lence begets vi­o­lence, a re­la­tion­ship that’s abun­dantly clear in the kind of con­flict zones where we work. Mass rape has long been used as a weapon of war, and has been well-doc­u­mented dur­ing con­flicts in the Demo­cratic Repub­lic of the Congo, Colom­bia and South Su­dan.

Among the most salient cases are the Rwan­dan and Bos­nian geno­cides. Ac­cord­ing to the UN’s High Com­mis­sioner for Refugees, up to 500000 Rwan­dan women were sys­tem­at­i­cally raped in 1994 as part of an eth­nic cleans­ing strat­egy, while tens of thou­sands of Bos­nian women and girls were sys­tem­at­i­cally raped be­tween 1992 and 1995.

Wher­ever and how­ever it hap­pens, vi­o­lence against women and girls poses a ma­jor pub­lic health prob­lem for women and for their com­mu­ni­ties.

Some 42% of women who ex­pe­ri­ence in­ti­mate part­ner vi­o­lence re­ported an in­jury – in­clud­ing bruises, abra­sions, cuts, punc­tures, bro­ken bones and in­juries to the ears and eyes – as a con­se­quence of that abuse. Women who suf­fer vi­o­lence are also 1.5 times more likely to have sex­u­ally trans­mit­ted dis­eases like HIV, syphilis, chlamy­dia and gon­or­rhea, twice as likely to ex­pe­ri­ence de­pres­sion and drink­ing prob­lems and twice as likely to have an abor­tion.

Vi­o­lence against women is also closely as­so­ci­ated with sui­cide and self-harm.

If there’s any sil­ver lin­ing to the We­in­stein and O’Reilly scan­dals, it’s that in com­ing out against th­ese high-pro­file men, dozens of women have helped to high­light not just the preva­lence of sex­ual vi­o­lence in the US but also the so­ci­etal norms that si­lence women and al­low abusers to go unchecked.

Hu­man­i­tar­ian or­gan­i­sa­tions from the World Health Or­gan­i­sa­tion to the UN to the US Agency for In­ter­na­tional De­vel­op­ment have recog­nised that gen­der-based vi­o­lence is not just a women’s is­sue. Ad­dress­ing it re­quires work­ing with men and boys, too, to counter the cul­tures of toxic mas­culin­ity that en­cour­age or tol­er­ate sex­ual vi­o­lence.

Af­ter all, women’s rights are hu­man rights, so sex­ual vi­o­lence is ev­ery­one’s prob­lem to solve.

The fact is, so­ci­eties with high rates of sex­ual vi­o­lence are also more likely to be vi­o­lent and un­sta­ble. Re­search shows that the best pre­dic­tor of a state’s peace­ful­ness is how well its women are treated. – The Con­ver­sa­tion

Do­biesz is Emer­gency Physi­cian at Brigham and Women’s Hospi­tal, Direc­tor of Ex­ter­nal Pro­grammes STRATUS Cen­tre for Med­i­cal Sim­u­la­tion, Core Fac­ulty Har­vard Hu­man­i­tar­ian Ini­tia­tive, Har­vard Univer­sity.

Brooks is re­searcher in in­ter­na­tional law and hu­man­i­tar­ian re­sponse, Har­vard Hu­man­i­tar­ian Ini­tia­tive (HHI), Har­vard Univer­sity

Woman at the Saartjie Baart­man Cen­tre for Abused woman and chil­dren in Cape Town. It’s not just al­le­ga­tions of sex­ual abuse by in­flu­en­tial Amer­i­cans such Har­vey We­in­stein and Bill O’Reilly that are shock­ing: sex­ual vi­o­lence is a global pan­demic says the World Health Or­gan­i­sa­tion.

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