"Sexual violence against minors is a global health issue and must be addressed in a developing context," argued Michal Avni, gender advisor for the U.S. Agency for International Development at a Global Health Initiative and Environmental Change and Security Program event on October 20, 2009. Affecting one of the most disenfranchised populations--youth—such sexual violence is often accompanied by stigma and shame, while ethics and methodology issues make conducting research on this disturbing problem difficult.
Scope and Consequences of Sexual Violence Against Minors
"The concept of rape is widely understood, but most sexual violence does not fit this definition," maintained Kiersten Stewart, public policy director of the Family Violence Prevention Fund. Methodological and definitional differences make sexual violence difficult to research. However, most studies show that violence against youth includes some level of coercion. To fully address the underlying causes of sexual violence against minors, Stewart emphasized that policymakers must understand the power relationship between perpetrator and victim.
The perpetrator is often known to the victim; prevalence studies show that the highest rates occur in intimate relationships. In Uganda, 36 percent of all 15-19 year-old married women report having been sexually abused; and in the United States, 20 percent of teens are sexually abused by an intimate partner.
Sexual violence against youth has significant health consequences and is linked to poor reproductive health choices later in life. Violence against adolescent girls leads to higher rates of HIV/AIDS, unwanted pregnancy, unsafe abortions, and maternal deaths, said Stewart. Research demonstrates that adolescent girls in abusive relationships are 4-6 times more likely to become pregnant and three times as likely to become infected with a sexually transmitted disease. Coercive sex increases risky reproductive behavior, such as lower use of condoms and other forms of birth control.
Stewart encouraged researchers to ask their questions in multiple ways and settings to help ease the victims' concerns about being identified by their community and abuser. She advocated for more research to better understand perpetrators' behavior and the scalability of intervention programs.
Lessons From Swaziland
"We can't let the data sit on the shelf," argued Jim Mercy, special adviser for strategic directions at the Centers for Disease Control and Prevention. His research in Swaziland found that female victims who reported sexual abuse in their adolescence have higher rates of depression and other mental health problems such as suicide, post-traumatic stress disorder, panic disorders, and substance abuse. Survey respondents who disclosed a close relationship with their mothers were less at risk for abuse than those who did not. Additional risk factors for abuse include lack of education, exposure to emotional abuse, and witnessing sexual assault.
Mercy found that girls who experience child sexual abuse are at greater risk for sexually transmitted diseases, unwanted pregnancies, and complications from pregnancy. "Imagine what the cost to society is of these type of exposures," said Mercy, who urged program managers and policymakers to use the data to break through the embedded relationships that make this problem so difficult to address.
Translating Research Into Practice in Swaziland
"There is a lot of data," said Jama Gulaid, country representative, UNICEF Swaziland, which is a tremendous asset for us." He described how Swaziland is using Mercy's data to inform policy and take actions to prevent sexual violence against youth through 14 short, medium, and long-term steps.
Gulaid said the first and most critical action was to disseminate the results and recommendations locally. Talking about sexuality is not easy, he said, "but when you bring in violence it is even more difficult, so you have to do two things: you have to share information and you have to present it in certain ways." Research findings must be presented by a local community member because, he says, "Who says it, how you say it, and when you say it matters."
Through public information campaigns and improved legal systems, child sexual abuse can be deterred. Gulaid explained that a significant amount of information and capacity building is taking place in Swaziland's education sector. These school-based interventions include trained community-child protection groups, toll-free telephone lines, case investigation services, and personal counseling.
Lessons from Swaziland's efforts have helped open global discourse on this silent problem. However, more research is needed to fully understand this sensitive global health topic.
Following the public event, panelists convened with members from the Interagency Gender Working Group to discuss additional research on gender based violence against youth including a presentation by Deborah Bourne, Hope Enterprises Ltd, and Ian Askew, director of reproductive health services and research at the Population Council.
Drafted by Calyn Ostrowski and edited by Meaghan Parker.
- Senior Gender Adviser, U.S. Agency for International Development
- Public Policy Director, Family Violence Prevention Fund
- Special Adviser for Strategic Directions, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC)
- Country Representative, UNICEF Swaziland