How to prevent sexual violence
Psychological care and support
Counseling, therapy and support group initiatives have been found to be helpful following sexual assaults, especially where there may be complicating factors related to the violence itself or the process of recovery. There is some evidence that a brief cognitive-behavioural programme administered shortly after assault can hasten the rate of improvement of psychological damage arising from trauma. As already mentioned, victims of sexual violence sometimes blame themselves for the incident, and addressing this in psychological therapy has also been shown to be important for recovery. Short-term counselling and treatment programmes after acts of sexual violence, though, require considerable further evaluation.
Formal psychological support for those experiencing sexual violence has been provided largely by the nongovernmental sector, particularly rape crisis centres and various women's and men's organizations. Inevitably, the number of victims of sexual violence with access to these services is small. One solution to extend access is through establishing telephone helplines, ideally ones that are free of charge. A Stop Woman Abuse helpline in South Africa, for example, answered 150,000 calls in the first five months of operation.
Programmes for perpetrators
There are few programmes which are targeting perpetrators of sexual violence, they are generally aimed at men convicted of assault because they are the most polular assaulters over females. They are found mainly in industrialized countries. A common response of men who commit sexual violence is to deny both that they are responsible and that what they are doing is violent. To be effective, programmes working with male perpetrators need to make them admit responsibility and to be publicly seen as responsible for their actions. One way of achieving this is for programmes that target male perpetrators of sexual violence to collaborate with support services for victims as well as with campaigns against sexual violence.
Life-skills and other educational programmes
In recent years, several programmes for sexual and reproductive health promotion, particularly those promoting HIV prevention, have begun to introduce gender issues and to address the problem of sexual and physical violence. Two notable examples developed for Africa but used in many parts of the developing world include "Stepping Stones" and "Men As Partners". These programmes have been designed for use in peer groups of men and women and are delivered over several workshop sessions using participatory learning approaches. Their comprehensive approach helps men, who might otherwise be reluctant to attend programmes solely concerned with violence against women, participate and discuss a range of issues concerning violence. Furthermore, even if men are sometimes the perpetrators of sexual violence, the programmes are careful to avoid labelling them as such.
A review of the effect of the Stepping Stones programme in Africa and Asia found that the workshops helped the men participating take greater responsibility for their actions, relate better to others, have greater respect for women and communicate more effectively. As a result of the programme, reductions in violence against women have been reported in communities in Cambodia, the Gambia, South Africa, Uganda and the United Republic of Tanzania. The evaluations to date, though, have generally used qualitative methods and further research is needed to adequately test the effectiveness of this programme.
Developmental approaches
Research has stressed the importance of encouraging nurturing, with better and more gender balanced parenting, to prevent sexual violence. At the same time, Schwartz has developed a prevention model that adopts a developmental approach, with interventions before birth, during childhood and in adolescence and young adulthood. In this model, the prenatal element would include discussions of parenting skills, the stereotyping of gender roles, stress, conflict and violence. In the early years of childhood, health providers would pursue these issues and introduce child sexual abuse and exposure to violence in the media to the list of discussion topics, as well as promoting the use of non-sexist educational materials. In later childhood, health promotion would include modelling behaviours and attitudes that avoid stereotyping, encouraging children to distinguish between good and bad touching, and enhancing their ability and confidence to take control over their own bodies. This intervention would allow room for talking about sexual aggression. During adolescence and young adulthood, discussions would cover myths about rape, how to set boundaries for sexual activity, and breaking the links between sex, violence and coercion. While Schwartz's model was designed for use in industrialized countries, some of the principles involved could be applicable to developing countries.
Medico-legal services
In many countries, when sexual violence is reported the health sector has the duty to collect medical and legal evidence to corroborate the accounts of the victims or to help in identifying the perpetrator. Research in Canada suggests that medico-legal documentation can increase the chance of a perpetrator being arrested, charged, or convicted. For instance, one study found that documented physical injury, particularly of the moderate to severe type, was associated with charges being filed, irrespective of the patient's income level or whether the patient knew the assailant, either as an acquaintance or an intimate partner. However, a study of women attending a hospital in Nairobi, Kenya, following rape, has highlighted the fact that in many countries rape victims are not examined by a gynaecologist or an experienced police examiner and that no standard protocols or guidelines exist on this matter.
The use of standard protocols and guidelines can significantly improve the quality of treatment and psychological support of victims, as well as the evidence that is collected. Comprehensive protocols and guidelines for female victims of assault should include:
- recording a full description of the incident, listing all the assembled evidence;
- listing the gynaecological and contraceptive history of the victim;
- documenting in a standard way the results of a full physical examination;
- assessment of the risk of pregnancy;
- testing for and treating sexually transmitted diseases, including, where appropriate, testing for HIV;
- providing emergency contraception and, where legal, counselling on abortion;
- providing psychological support and referral.
In some countries, the protocol forms part of the procedure of a sexual assault evidence kit that includes instructions and containers for collecting evidence, appropriate legal forms and documents for recording histories. Examinations of rape victims are by their nature extremely stressful. The use of a video to explain the procedure before an examination has been shown significantly to reduce the stress involved
Training for health care professionals
Issues concerning sexual violence need to be addressed in the training of all health service staff, including psychiatrists and counsellors, in basic training as well as in specialized postgraduate courses. Such training should, in the first place, give health care workers greater knowledge and awareness of sexual violence and make them more able to detect and handle cases of abuse in a sensitive but effective way. It should also help reduce instances of sexual abuse within the health sector, something that can be a significant, though generally unacknowledged, problem.
In the Philippines, the Task Force on Social Science and Reproductive Health, a body that includes doctors, nurses and social scientists and is supported by the Department of Health, has produced training modules for nursing and medical students on gender-based violence. The aims of this programme are:
- To understand the roots of violence in the context of culture, gender and other social aspects.
- To identify situations, within families or homes that are at a high risk for violence, where it would be appropriate to undertake:
- primary interventions, in particular in collaboration with other professionals;
- secondary interventions, including identifying victims of violence, understanding basic legal procedures and how to present evidence, referring and following up patients, and helping victims reintegrate into society.
These training modules are built into the curricula for both nursing and medical students. For the nursing curriculum, the eleven modules are spread over the 4 years of formal instruction, and for medical students over their final 3 years of practical training.
Centres providing comprehensive care to victims of sexual assault
Because of the shortage of doctors in many countries, specially trained nurses have been used in some places to assist victims of sexual assault. In Canada, nurses, known as sexual assault nurse examiners, are trained to provide comprehensive care to victims of sexual violence. These nurses refer clients to a physician when medical intervention is needed. In the province of Ontario, Canada, the first sexual assault care centre opened in 1984 and since then 26 others have been established. These centres provide or coordinate a wide range of services, including emergency medical care and medical follow-up, counselling, collecting forensic evidence of assault, legal support, and community consultation and education.
Centres that provide a range of services for victims of sexual assault, often located in places such as a hospital or police station, are being developed in many countries. For example the One-Stop Crisis Centreis a unit in the Kuala Lumpur Hospital that provides coordinated interagency response to violence against women. Specialized centres such as these have the advantage of providing appropriately trained and experienced staff. In some places, on the other hand, integrated centres exist providing services for victims of different forms of violence.
Prevention campaigns
Attempts to change public attitudes towards sexual violence using the media have included advertising on billboards and in public transport, and on radio and television. Television has been used effectively in South Africa and Zimbabwe. In Zimbabwe, the nongovernmental organization Musasa has produced awareness-raising initiatives using theatre, public meetings and debates, as well as a television series where survivors of violence described their experiences.
Other initiatives, besides media campaigns, have been used in many countries. The Sisterhood Is Global Institute in Montreal, Canada, for instance, has developed a manual suitable for Muslim communities aimed at raising awareness and stimulating debate on issues related to gender equality and violence against women and girls. The manual has been pilot-tested in Egypt, Jordan and Lebanon and (in an adaptation for non-Muslim settings) used in Zimbabwe. A United Nations interagency initiative to combat violence against women is being conducted in 16 countries of Latin America and the Caribbean.
The campaign is designed:
- to raise awareness about the human, social and economic costs of violence against women and girls;
- to build capacity at the governmental level to develop and implement legislation against gender violence;
- to strengthen networks of public and private organizations and carry out programmes to prevent violence against women and girls.
International treaties
International treaties are important as they set standards for national legislation and provide a lever for local groups to campaign for legal reforms. Among the relevant treaties that relate to sexual violence and its prevention include:
- the Convention on the Elimination of All Forms of Discrimination Against Women (1979);
- the Convention on the Rights of the Child (1989) and its Optional Protocol on the Sale of Children, Child Prostitution and Child Pornography (2000);
- the Convention Against Transnational Organized Crime (2000) and its supplemental Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children (2000);
- the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (1984).
A huge number of international agreements set norms and limits of behaviour, including behaviour in conflicts, that necessitate provisions in national legislation. The Rome Statute of the International Criminal Court (1998), for instance, covers a broad spectrum of gender-specific crimes, including rape, sexual slavery, enforced prostitution, forced pregnancy and forced sterilization. It also includes certain forms of sexual violence that constitute a breach or serious violation of the 1949 Geneva Conventions, as well as other forms of sexual violence that are comparable in gravity to crimes against humanity. The inclusion of gender crimes in the definitions of the statute is an important historical development in international law.
Reporting and handling cases of sexual violence
Many countries have a system to encourage people to report incidents of sexual violence to the police and to improve the speed and sensitivity of the processing of cases by the courts. The specific mechanisms include dedicated domestic violence units, sexual crime units, gender training for the police and court officials, women-only police stations and courts for rape offences.
Problems are sometimes created by the unwillingness of medical experts to attend court. The reason for this is frequently that the court schedules are unpredictable, with cases often postponed at short notice and long waits for witnesses who are to give short testimonies. In South Africa, to counter this, the Directorate of Public Prosecutions has been training magistrates to interrupt proceedings in sexual violence cases when the medical expert arrives so that testimonies can be taken and witnesses cross-examined without delay.