Sexual Abuse & Young Adult Reproductive Health
Most young adult reproductive health programs generally operate on the premise that young people are engaging in consensual sex. Yet sexual abuse is unfortunately common among youth, though data on its prevalence is limited. Program managers and service providers should be aware that young people who have been sexually abused have different reproductive and sexual health needs those who are not victims, and develop their educational programs and services accordingly.
What is Sexual Abuse?
Sexual abuse is a violation perpetrated by a person who holds, or is perceived to hold, power over someone who is vulnerable. The abuse may have physical, verbal and emotional components. It includes such sexual violations as rape, sexual assault, sexual harassment, incest, and sexual molestation. The victim experiences sexual activity that is neither wanted nor agreed to. Some non-governmental organizations (NGOs) also consider very early age at marriage to be a form of sexual abuse.,
Sexual abuse crosses cultural and socio-economic lines. It occurs in homes, schools, the workplace and other public places. The perpetrators are usuallybut not alwaysmale. They can be family members, neighbors, teachers, supervisors, schoolmates and, on occasion, strangers.
How Prevalent Is Sexual Abuse among Young Adults?
Because it is an exploitation of power, young people are more vulnerable to sexual abuse than are adults. Emerging data indicate sexual abuse is a major problem worldwide:
How Does Sexual Abuse Affect Young Adult Reproductive Health?
The acute consequences of sexual abuse for both male and female victims include physical injury, sexually transmitted infections (STIs), and psychological trauma. For female victims, there is the added danger of unwanted pregnancy, injury, and the chronic complications of STI-related vaginal discharge, dysmenorrhea and pelvic pain.,
As data emerge, it is clear that sexual abuse has long-term effects on the sexual and reproductive health of young adults. There is some evidence that adolescents who were sexually-abused as children are more likely than non-abused children to engage in high-risk sexual activity. They are more likely to engage in consensual sex earlier as well as to have unprotected sex and sex with multiple partners. 10,, , Victims of sexual abuse are often incapable of undertaking self-protective behavior, because the personal skills needed to prevent STIs and unintended pregnancy are exactly those life skills stunted by sexual abuse.11,13 They may be unable or unwilling to make and follow through on decisions that will reduce abuse or remove them from harmful situations.10,11 Sexual abuse can also result in low self-esteem, causing victims to seek acceptance through sex. ,
Adolescent girls who have been abused often have difficulty differentiating between sexual and affectionate behaviors, and have a higher incidence of teenage pregnancy and STI/HIV infection than in their non-abused peers.,
How Can the Needs of Victims of Sexual Abuse Be Met?
Sexual abuse is being addressed in varying degrees across cultures and within communities. Program strategies range from raising awareness of the issue to implementing training workshops and developing counseling and referral networks. The impact of sexual abuse programs on young adult reproductive health is not fully understood, because most programs operate on a small scale and have little or no evaluation data.
There is, however, broad consensus that education and services are important tools for addressing sexual abuse among youth. The following recommendations are based on existing efforts, which demonstrate their programmatic feasibility in diverse settings.
Prevent Sexual Abuse: Include training skills for refusing sex, improving communication, and resolving conflict in all young adult reproductive health education efforts, as well as in other appropriate forums.
Raise Awareness and Advocate for Legal Sanctions: Create societal awareness by bringing the issue of sexual abuse into the public domain. Target policymakers, parents, teachers, community leaders, police and the media with educational campaigns.21 Create systems for data collection to monitor the incidences and prevalence of abuse and publicize the results.24 Advocate for the review, revision and enforcement of laws to protect victims and punish abusers.
Screen for Sexual Abuse: Train health providers, teachers and peer educators to
identify individuals who have been victims of sexual abuse by including questions about
abuse in health assessments. Health care providers, in particular, need to be aware that
not all clients are having consensual sex, pregnancy may result from incest or rape, and
introducing condom use may put young women at risk of reprisal.11,13
Respond with Services: Create a protocol for responding to clients who have been
sexually abused and, when necessary, develop a referral system to health, legal and other
The Brazilian Family Planning Association, BEMFAM, demonstrates how all four recommendations can be incorporated within the work of a single organization. It trains staff to identify victims of sexual abuse and has developed health care and counseling guidelines for young women who report violence. It distributes materials promoting the availability of clinic staff to work with victims of violence, and works with schools to raise awareness about sexual abuse and help teachers respond to young people facing abuse. It also has established a referral system to special courts that handle youth issues and agencies that provide therapy for victims of violence.26
The In FOCUS series summarizes for professionals working in developing countries some of the program experience and limited research available on young adult reproductive health concerns. This issue was prepared by Stephanie Shanler based on presentations prepared by Lori Heise, Lindsay Stewart and Ellen Weiss, and reviewed by outside experts and the staff of the FOCUS program. The In FOCUS series and other publications can be downloaded from the FOCUS website <www.pathfind.org/focus.htm>.
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