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Sexual abuse, Rape and Sexual violence
Sexual abuse can be explained as the actual or threatened physical intrusion of a sexual nature, whether by force or under unequal or coercive conditions. [1] Any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic, or otherwise directed, against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting, including but not limited to home and work is termed sexual violence. [2] Rape and sexual assault can be encapsulated under sexual violence.
The World Health Organisation [2] defines rape as physically forced or otherwise coerced penetration – even if slight – of the vulva or anus, using a penis, other body parts, or an object. The attempt to do so is known as attempted rape. The rape of a person by two or more perpetrators is known as gang rape.
Childhood sexual abuse consists of contact abuse ranging from fondling to rape and non-contact abuse, such as modeling inappropriate sexual behavior, forced involvement in child pornography, or exhibitionism. [3]
These crimes are widespread and occur everywhere in the world; the prevalence and effects on women and children have been termed a world public health problem. In the United States, it is reported that one in five women will be raped at a point in their lifetime, and eight out of ten of the victims will know their perpetrator personally. [4] According to Women At Risk International Foundation (WARIF) [5], 24.8% of Nigerian females aged 18 to 24 years experienced sexual abuse prior to age 18 of which 5.0% sought help, with only 3.5% receiving any services. Another study found that twenty-eight percent of women in Nigeria aged 15–49 have experienced some form of physical or sexual violence; almost 45 percent of the women who had experienced violence never sought help or told anyone about the incident. [6]
Although sexual abuse is so prevalent, activists and organizations have cried out that little to no justice is served for its victims in a court.
Consequences of Sexual Violence
Due to its traumatic nature, all forms of sexual violence have ramifications on physical, sexual, and mental health.
Physical effects of sexual assault
The first worry after rape is often the reproductive and sexual health of the victim and whether it will have long term effects. This is why it is advisable to go for routine tests which include pregnancy tests, HIV, syphilis, Hepatitis B, and other sexually transmitted infections. A study found that women survivors reported significantly more medical concerns than did people who have not experienced sexual abuse, the most frequent medical complaint was pelvic pain [7]
Psychological effects
Sexual trauma is associated with both short and long-term psychological consequences. Short-term effects include shock, fear, anxiety, acute stress disorder, confusion, and withdrawal to self. Many survivors experience a reduction in symptoms within a few months, whereas some women experience distress for years.
Long-term outcomes include posttraumatic stress disorder (PTSD), depression, eating disorders, sexual dysfunction, alcohol and illicit drug use, non-fatal suicidal behavior, physical symptoms in the absence of medical conditions, and severe preoccupations with physical appearances; in the most severe cases, women may experience symptoms of a personality disorder. Risks of developing mental health problems are related to assault severity, other negative life experiences, maladaptive beliefs, and perceptions of lack of control. [8]
Childhood sexual abuse has been correlated with higher levels of depression, guilt, shame, self-blame, eating disorders, somatic concerns, anxiety, dissociative patterns, repression, denial, sexual problems, and relationship problems. [3]
Survivors of childhood sexual abuse and adult survivors report feeling self-guilt and blame for the abuse. This is because the perpetrator is usually a known or close person like cousins, uncles/aunts, nephews/nieces, or family friends; the victims often think that they did something wrong or sent the wrong message.
The culture of silence also plays a role here as the accusation of rape is not easily believed, understood, or validated. In our culture where a lady’s morality is often enshrined in her sexual activity, the female victim is usually plagued with questions like “what were you wearing?” or “why were you there?”
All these can lead to negative thoughts and turn to depression. Depression has been found to be the most common long-term symptom among survivors. [3] It is associated with a persistent feeling of sadness and low mood, loss of interest in previously enjoyed activities, self-blame, feelings of helplessness, worthlessness, hopelessness and suicidal ideas.
PTSD can result after experiencing an intensely stressful or debilitating event; either a single secluded event or a series of recurring, distressing events. In a recent study, women who reported childhood sexual abuse were five times more likely to be diagnosed with PTSD compared to non-victims. [9] and they could have symptoms like:
● intrusive and repetitive thoughts,
● dissociative reactions such as flashbacks, upsetting dreams or nightmares,
● avoidance of reminders of the incident,
● self-destructive behavior,
The survivor appears to be always guarded, irritable and aggressive behavior. Immediately after a rape, victims show high levels of distress, which gradually diminish over the following months and years. [10]
Social consequences
Victims of sexual violence are often stigmatized in our society. Nigerians, with their religious and moralistic view, perceive the expression of sexuality outside marriage, including rape, in a negative manner. Often, victims of sexual violence are blamed or accused of bringing it upon themselves either by their seductive mode of dressing, or putting themselves in compromising positions.
Sometimes, survivors' relationships with friends and family becomes impaired; survivors are rejected by their partners or families and considered “spoilt goods.” Survivors might also avoid from performing social/professional activities like school functions, parties etc as a result of the perceived stigma. In new relationships, some survivors prefer to keep an emotional distance in order to avoid the same judgment or stigma; thus creating an aura of isolation or social withdrawal. In some other societies, the entire family may go through ostracization.
These are some of the many reasons cases of sexual assault are under-reported in this society. Although societal stigma is gradually reducing as a result of increased enlightenment and awareness, more advocacy work needs to be done, especially in rural areas.
Healing from sexual assault
Healing from sexual assault is often a long hard road; it is not easy and does not work the same way for everyone. The best way to start the healing process after getting physical examinations done is to go for mental health care. This will help deal with the aftermath and provide good and healthy coping strategies for the survivors.
Healing from sexual trauma does not mean that the survivor will forget the experience or never again experience any symptoms. Rather, successful recovery is subjective and measured by whether the survivor increases his or her involvement in the present, acquires skills and attitudes to regain control of his or her life, forgive him or herself for guilt, shame and other negative cognitions, and gain stress reduction skills for overall better functioning. [11]
Maximizing efforts to reduce sexual violence requires combining resources and coordinating activities across different settings (e.g., research, healthcare and criminal justice). We need in-depth research into the prevalence and its perpetrators, more sensitization of the public, legislation on appropriate punishment of sexual offenders, training of law enforcement officers and ensuring perpetrators of such act are brought to book. [10]
It is important to continue educating and enlightening the general public on physical, psychological and social sequelae of sexual violence. This education is critical to improving reactions to disclosure, reducing stigma, and raising awareness of available services and resources for survivors.
Help/Referral Centres
If you suffer from Domestic or Sexual Violence/Abuse or know someone who is in that situation, please reach out to the following organisations for help:-
Cece Yara Foundation for Child Sexual Abuse
Lagos State Domestic and Sexual Violence Response Team (DSVRT) - https://www.dsvrtlagos.org/
Women At Risk International Foundation (WARIF) -
Or call them on:
CECE YARA Child Helpline - +234 800 800 8001
DSVRT- 08000333333 (Toll Free), +234 8137960048
WARIF 24 Hour confidential helpline +2348092100009
References
1. Glossary on Sexual exploitation or abuse [Internet]. 2nd ed. United Nations; 2017 [cited 24 August 2020]. Available from: https://hr.un.org/sites/hr.un.org/files/SEA%20Glossary%20%20%5BSecond%20Edition%20-%202017%5D%20-%20English_0.pdf
2. World report on violence and health [Internet]. 1st ed. World Health Organisation; 2002 [cited 24 August 2020]. Available from: https://www.who.int/violence_injury_prevention/violence/global_campaign/en/chap6.pdf?ua=1
3. Hall M, Hall J. The Long-Term Effects of Childhood Sexual Abuse: Counseling Implications [Internet]. American Counseling association; 2011 [cited 24 August 2020]. Available from: https://www.counseling.org/docs/disaster-and-trauma_sexual-abuse/long-term-effects-of-childhood-sexual-abuse.pdf?sfvrsn=2
4. Statistics about sexual violence [Internet]. National Sexual Violence Resource Center; 2015 [cited 24 August 2020]. Available from: https://www.nsvrc.org/sites/default/files/publications_nsvrc_factsheet_media-packet_statistics-about-sexual-violence_0.pdf
5. Nigeria Demographic and Health Survey [Internet]. Abuja: National Population Commission; 2018 [cited 24 August 2020]. Available from: https://www.dhsprogram.com/pubs/pdf/FR359/FR359.pdf
6. Rape stats in Nigeria – WARIF [Internet]. Warifng.org. 2020 [cited 24 August 2020]. Available from: https://warifng.org/rape-stats-in-nigeria/
7. Jean C, Thomas P, Patti P. APA PsycNet [Internet]. Psycnet.apa.org. 1988 [cited 24 August 2020]. Available from: https://psycnet.apa.org/record/1989-15829-001
8. Yuan N, Koss M, Stone M. The Psychological Consequences of Sexual Trauma [Internet]. VAWnet.org. 2006 [cited 24 August 2020]. Available from: https://vawnet.org/material/psychological-consequences-sexual-trauma
9. Coid, J., Petruckevitch, A., Chung, W-S., Richardson, J., Moorey, S., & Feder, G. Abusive experiences and psychiatric morbidity in women primary care attenders. British Journal of Psychiatry; (2003) [cited 24 August 2020] Available from: https://pubmed.ncbi.nlm.nih.gov/14519611/
10. Yuan N, Koss M, Stone M. The psychological consequences of sexual trauma [Internet]. VAWnet.org National online resource center on violence against women; 2006 [cited 24 August 2020]. Available from: https://vawnet.org/sites/default/files/materials/files/2016-09/AR_PsychConsequences.pdf
11. Chivers-Wilson K. Sexual assault and posttraumatic stress disorder: A review of the biological, psychological, and sociological factors and treatments [Internet]. PubMed Central (PMC). 2006 [cited 24 August 2020]. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2323517/