Sexual Violence as a Public Health Issue

Illustrated by Victoria Xu

Given the explosion of movements against sexual violence such as Me Too, Time’s Up and #That’s Harassment, the issue of sexual violence is now at the forefront of the national consciousness. With more and more survivors coming forward and renewed dialogue in public forums, it has become apparent that sexual violence is a serious and widespread issue. In addition to causing both short-term and long-term physical harm such as bruising, genital injuries, increased risk of sexually transmitted diseases and gastrointestinal issues, survivors of sexual violence may face psychological harms such as depression, anxiety, suicidal ideation and post-traumatic stress disorder. Sexual violence is also linked with unhealthy coping mechanisms behaviors such as alcohol and substance abuse. Survivors may need to take time off school and may experience difficulties with their personal relationships and regaining a sense of normalcy (1)

Sexual violence impacts people of all ages, genders and sexual orientations: anyone can experience or perpetrate sexual violence. The Injury Control and Risk Survey from 2001-2003 reports that 10.6% of women and 2.1% of men experienced forced sex in their lifetime, which translates to 11.7 million women and 2.1 million men in the United States. In addition, studies have found that the lifetime prevalence of marital rape, or rape perpetrated by a spouse or intimate partner ranges from 10% to 14% depending on the definition of “intimate partner” used by the study (2).

Recent studies have also shown that college-age women and individuals who identify as transgender or gender non-conforming are especially at risk of experiencing some form of sexual violence. The Campus Climate Survey on Sexual Assault and Misconduct conducted by the Association of American Universities found that the overall rate of sexual contact by force or inability to consent was 13% among students enrolled in college. The highest rates of nonconsensual sexual contact were reported by undergraduate women (25.9%) and undergraduates who identified as transgender women, transgender men, genderqueer, gender questioning or gender not listed (22.8%) (3).

Given its massive negative impact and prevalence, the issue of sexual violence cannot be solved solely by responding to the assault after it has occurred. While the criminal justice system may provide deterrence, incarceration, rehabilitation and restitution, these efforts come after the crime has been committed, and the burden of reporting the crime and preventing future abuse is placed on the survivor. The criminal justice approach is only part of the puzzle when it comes to addressing the issue of sexual violence. After-the-fact interventions must be complemented by efforts to prevent sexual violence from being perpetrated in the first place (4)

Public health initiatives aim to maximize the health, safety and well-being of the maximum number of people. To this end, it prioritizes primary prevention—preventing violence before it is perpetrated—and emphasizes reducing the rate of sexual violence at a population level, rather than focusing solely on individuals. Such an approach is suitable for an issue such as sexual violence which impacts not only individual victims and offenders but also the communities around them.

The Centers for Disease Control and Prevention (CDC) is the primary national public health organization in the United States, and utilizes a four level social-ecological model to better understand the factors that influence sexual violence to inform its strategies (5). The model considers the complex interplay of individual, relationship, community and societal influences, and helps identify “risk factors” and “protective factors.” While risk factors are characteristics that increase the likelihood of a person becoming a perpetrator or victim of sexual violence, protective factors act as a buffer against risks and reduce the likelihood of a person becoming a victim or perpetrator of sexual violence. 

The goal of public health interventions is to minimize risk factors and enhance protective factors at all four levels of the social-ecological model and ultimately reduce the rate of sexual violence in the population. For instance, interventions that aim to reduce risk factors at the individual, relationship, community and social levels may include addressing individual skill deficits, negative peer influences, adverse community living conditions and inappropriate social messages respectively. Similarly, interventions that seek to enhance protective factors may involve skill-building workshops for young men, bystander training, mass campaigns that educate communities about the importance of consent and policy reforms (4).

Public health draws on a wide range of scientific disciplines including medicine, epidemiology, sociology, psychology, criminology and economics. It involves collaboration with multiple stakeholders such as parents, caregivers, educators, institutions, nonprofit organizations and the media to develop, implement and evaluate interventions that reduce risk factors and enhance protective factors that impact sexual violence across multiple levels of influence. Thus, the public health approach is a promising framework for reaching comprehensive and wide-ranging solutions to preventing the sexual violence “epidemic.”

Edited by: Julia Bulova
Illustrated by: Victoria Xu

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