HAVE LAST­ING HEALTH REPER­CUS­SIONS

Observer on Saturday - - News - By Bodwa Mbingo

His Majesty King Mswati III this year gave thumbs up to the Sex­ual Of­fences and Do­mes­tic Vi­o­lence (SODV) Act that comes with harsh sen­tences and fines of up to 45 years im­pris­on­ment to ef­fec­tively de­crease the high rate of sex­ual abuse against chil­dren and women.

The Act has come at the right time and as a com­fort to women and chil­dren who have suf­fered in si­lence over the years.

The trauma of sex­ual as­sault or ha­rass­ment is not only hard to for­get; it may also leave last­ing ef­fects on a woman's health.

This find­ing of a study pub­lished Wed­nes­day adds sup­port to a grow­ing body of ev­i­dence sug­gest­ing the link.

In the study of roughly 300 mid­dleaged women, an ex­pe­ri­ence of sex­ual as­sault was as­so­ci­ated with anx­i­ety, de­pres­sion and poor sleep. A his­tory of work­place sex­ual ha­rass­ment was also as­so­ci­ated with poor sleep and with an in­creased risk of de­vel­op­ing high blood pres­sure.

"Th­ese are ex­pe­ri­ences that a woman could have had long ago ... and it can have this long arm of in­flu­ence through­out a woman's life," says Re­becca Thurston, lead au­thor of the study, and a re­search psy­chol­o­gist and di­rec­tor of the Women's Be­hav­ioral Health lab­o­ra­tory at the Univer­sity of Pitts­burgh.

The study data come from a sur­vey of healthy women be­tween ages 40 and 60 who had been re­cruited for a study on menopause and car­dio­vas­cu­lar dis­ease — not sex­ual ha­rass­ment or as­sault. They all had their blood pres­sure checked at study vis­its, as well as height and weight.

Among other ques­tions, the sur­vey asked the women if they had ever ex­pe­ri­enced sex­ual ha­rass­ment at work. Par­tic­i­pants were also asked if they had ever "been made or pres­sured into hav­ing some type of un­wanted sex­ual con­tact." The women were not asked when those events oc­curred.

NPR re­ports that 22 per cent re­ported a his­tory of sex­ual as­sault, and 19 per cent said they had ex­pe­ri­enced work­place sex­ual ha­rass­ment.

Though the sam­ple size was small, the re­sults are sta­tis­ti­cally sig­nif­i­cant. Women who had ex­pe­ri­enced sex­ual as­sault had on av­er­age an al­most three­fold in­creased risk of de­vel­op­ing de­pres­sive symp­toms, com­pared to women who had not. They also had a greater in­ci­dence of clin­i­cally sig­nif­i­cant anx­i­ety.

About one in four women who had been sex­u­ally as­saulted met cri­te­ria for de­pres­sion, while ap­prox­i­mately one in 10 who had not were de­pressed.

Those who ex­pe­ri­enced sex­ual ha­rass­ment at work had a twofold in­creased risk com­pared to women who had not or de­vel­op­ing high blood pres­sure. Poor sleep was more com­mon, too.

"Th­ese [trau­matic ex­pe­ri­ences] are clearly crit­i­cal things that hap­pen to peo­ple early on, that have th­ese re­ally long-last­ing ef­fects," says Su­san Ma­son, an as­sis­tant pro­fes­sor of epi­demi­ol­ogy at the Univer­sity of Min­nesota who stud­ies the ef­fects of trauma.

"Th­ese re­ally shape peo­ple's life tra­jec­to­ries."

Find­ings

Ma­son was not in­volved in this study, but says the find­ings dove­tail with other re­search on the re­la­tion­ship be­tween trauma and phys­i­cal or men­tal health later in life. In­ti­mate part­ner vi­o­lence, for ex­am­ple, has been as­so­ci­ated with the de­vel­op­ment of di­a­betes and high blood pres­sure.

Wed­nes­day's study is par­tic­u­larly note­wor­thy, Ma­son says, be­cause it in­cludes clin­i­cal data — in-of­fice blood pres­sure checks, for ex­am­ple, and val­i­dated di­ag­nos­tic tools for de­pres­sion and anx­i­ety — rather than de­pend­ing ex­clu­sively on self-re­ported di­ag­noses.

Clin­i­cians do not have the abil­ity to cor­rob­o­rate women's mem­o­ries of sex­ual as­sault or ha­rass­ment, how­ever. Thurston points to lit­er­a­ture on the way trau­matic mem­o­ries are pro­cessed that demon­strates that dis­crete events like a sex­ual as­sault of­ten re­mains vivid in a way other mem­o­ries don't. This is why, she says, she trusts the study par­tic­i­pants who say they've been through th­ese ex­pe­ri­ences.

"If the pa­tient thinks it's im­por­tant, it's im­por­tant," says Dr. Va­lerie Gilchrist, chair of the de­part­ment of fam­ily medicine at the Univer­sity of Wis­con­sin who has writ­ten about screen­ing for sex­ual vi­o­lence in pri­mary care.

She rec­om­mends that clin­i­cians ask pa­tients if they have ex­pe­ri­enced sex­ual as­sault, par­tic­u­larly pa­tients who are ex­pe­ri­enc­ing sig­nif­i­cant stress or have dif­fi­culty with pelvic ex­ams. Au­thors note that sex­ual as­sault and ha­rass­ment seemed to be less com­mon in this group of women than in na­tional es­ti­mates.

The preva­lence in their co­hort was sig­nif­i­cantly lower than a 2014 es­ti­mate from the Cen­ters for Dis­ease Con­trol and Preven­tion, which found that 19 per cent of Amer­i­can women had been raped, and al­most 44 per cent had ex­pe­ri­enced an­other form of sex­ual vi­o­lence. Thurston thinks this is be­cause the study ex­cluded a fair num­ber of women for rea­sons re­lated to its orig­i­nal in­tent of re­search­ing menopause and car­dio­vas­cu­lar dis­ease. Women tak­ing med­i­ca­tions for de­pres­sion were not in­cluded, for ex­am­ple, as well as those with se­ri­ous med­i­cal prob­lems.

"Sex­ual as­sault and sex­ual abuse are much more com­mon than peo­ple think," Thurston says. Th­ese are "key toxic stres­sors for women." While re­searchers were not sur­prised that sex­ual as­sault and ha­rass­ment seemed to be re­lated to the de­vel­op­ment of mood dis­or­ders and poor sleep, they were im­pressed by the strength of the as­so­ci­a­tion.

"Th­ese should be ur­gent pub­lic health pri­or­i­ties," Ma­son says.

"How do we ad­dress the fun­da­men­tal ways that our so­cial struc­ture af­fects health?"

Mean­while, Eswatini fol­low­ing a 10 years of dif­fer­ing views be­tween stake­hold­ers and leg­is­la­tors can now boast of a le­gal in­stru­ment that is ex­pected to strongly deal with the wide­spread oc­cur­rence of sex­ual and gen­der-based vi­o­lence. For many years, it looked like the leg­is­la­tion would never see the light of day fol­low­ing dif­fer­ing views on some of its clauses.

This was due to al­leged per­cep­tions that some of the clauses would in­fringe on the Eswatini law and cus­tom. While the plan to en­act the leg­is­la­tion was in­tro­duced in 2006, it was a case of so near yet so far in 2011 when the House of As­sem­bly passed the Bill of 2009, but it was never en­acted into law. The same hap­pened in June 2013 when or­gan­i­sa­tions cel­e­brated af­ter the 2009 Bill was passed and awaited royal as­sent by His Majesty King Mswati III for full en­act­ment into law which how­ever, did not hap­pen. To­wards the end of last year, the Bill of 2015 was in the spot­light when the then Chair­per­son of the Deputy Prime Min­is­ter’s Of­fice (DPM) Port­fo­lio Com­mit­tee, for­mer San­dleni MP James Sime­lane, tabled a re­port on it with the four clauses hav­ing been re­moved.

The four clauses that were re­moved were Clauses 4, 10, 42 and 47 and the com­mit­tee stated that some of them were against Eswatini cul­ture.

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