Stop treating sexual health as women’s responsibility

Public health authorities have been asking a lot of women this past week.

Last Tuesday, the U.S. Centers for Disease Control and Prevention released an infographic that explained that any woman who drinks too much is at risk of violence, sexually transmitted infections and unwanted pregnancy. The solution: women should not drink too much and their doctors should tell them so.

Last Wednesday, a report published by the Chief Public Health Officer of Canada stated in its key messages: “risky drinking can increase the risk for . . . rape.” Again, all of the report’s solutions are aimed squarely at reducing the amount people drink.

These reports also mention brain damage, traffic accidents and cancer in the same breath as violence and rape, as though each of these dangers arises solely from the alcohol use itself, with no other factors being necessary.

Meanwhile, Zika virus has been in the global spotlight as a suspected cause of birth defects. The World Health Organization recently declared it a Public Health Emergency of International Concern. In several Central and South American countries where the virus has been spreading, health officials have advised women to avoid getting pregnant for the foreseeable future.

These advisories take pains to detail all of the dangers that might be faced by women and their potential offspring, but as a multitude of online commentators quickly pointed out, in other respects their perspectives are worryingly narrow.

Queer and transgender women are never mentioned, as though they do not exist. Such erasure can only reinforce their marginalization. The availability of family planning services, such as birth control and safe abortion, is also ignored. These services would be a lot more helpful than just dispensing advice.

Perhaps the most conspicuous blind spot, though, is the exclusive focus on women themselves. Who is getting women pregnant? Who is transmitting infections? Who is raping intoxicated women? In most cases, it’s men.

We know that sexual violence is extremely common: The CDC estimates that at least one in five women is sexually assaulted in her lifetime. Estimates are closer to one in two for bisexual women and transgender people.

The assailant is typically an opportunistic acquaintance who’s found a way to exploit his social power, not an unknown brute in a dark alley.

And our standard response as a society involves providing plenty of salt to rub into the wound: We instruct women to be afraid and to protect themselves, and we leave it at that.

Many people think this is reasonable advice, but it assigns all of the responsibility for sexual assault prevention to the potential victim. None is assigned to the rapist, perhaps because we falsely imagine him to be a force of nature, unpredictable and unresponsive to social cues.

Whatever our rationale, the result is that when sexual assault does occur, survivors know they can expect skepticism and blame if they dare to reveal their stories. Many internalize this blame, and feel ashamed at having “failed” to prevent their own sexual assault. So they stay silent. Far from being unresponsive, the abuser knows he can use their fear to his advantage.

So instead of just addressing women, our public health organizations could exhort men to avoid getting anyone pregnant. We could instruct men not to rape. Such messages are currently so rare that they might be read as satire.

But when we address the drinker and not the abuser, and when we say that women but not men can prevent pregnancy, men learn that they can demand sex and they will not be held accountable. Such wellmeaning but misguided advice is a self-fulfilling prophecy and a hazard to public health.