Nonconsensual Sex

In this issue

Nonconsensual Sex Undermines Sexual Health

In this article, the myriad ways in which children and adults — male and female alike — are forced to have sex are explored, as are the associations between nonconsensual sex and such adverse reproductive health problems as unintended pregnancy (and its complications) and the acquisition of not only HIV but also other sexually transmitted infections. Rape is one of the most extreme and immediately traumatic forms of coerced sex, as described in Rape by Strangers: Punishment and Terror. But other forms may have a greater health impact. Traditions Can Imprison Women reveals the ways in which cultural customs can lock girls and women into long-term relationships in which continued forced sex is inescapable. Nonconsensual Sex within Marriage, for example, illustrates how commonly women report physically forced sexual intercourse by their husbands. Although it is clear that nonconsensual sex is widespread, the creation of evidence-based policies, programs, and provider practices to prevent and address the problem requires additional research, summarized in More Research Needed, But What Next? A Web Resource directs readers to information about an initiative to promote and disseminate research and build research capacity to reduce and respond to sexual violence in developing countries.

YouthLens: Gender Norms Underlie Sexual Coercion

Nonconsensual sex is an abuse of power commonly rooted in gender norms — societal assumptions and expectations about what it means to be male or female. Various efforts are under way to challenge unhealthy gender norms during young adulthood. Still, evidence that these interventions result in behavioral changes that reduce sexual coercion is needed.

Voices from the Field

These four reports from the field illustrate common forms of sexual coercion. One Boy's Experience: Ashamed and Afraid describes the stigmatizing and health-threatening experience of a young adolescent boy from India who is forced to have sex with an older boy. Marital Sexual Violence Is 'A Terrifying Experience' explores the plight of married women, particularly young married girls, who feel helpless to protect themselves from unwanted sex in their own homes. The dire reproductive health consequences of rape in conflict situations, and attempts to prevent or address the abuse once it has occurred, are described in 'I Was Alive But Not Living...' Finally, the practice of using virginity testing to ascertain girls' sexual purity and discourage them from engaging in sexual activities before marriage is challenged in Virginity Testing Raises Many Questions.

Helping Victims of Sexual Coercion

Reproductive health care providers are often particularly well placed to detect sexual coercion and to care for its predominantly female victims since many women routinely attend family planning or primary health care clinics. These providers, however, rarely have the knowledge, skills, resources, and support necessary to identify cases of sexual coercion; offer medical, counseling, and referral services; or document evidence of sexual assault. This article describes efforts under way to more effectively serve victims of sexual coercion, but emphasizes the need for more rigorous evaluation of such interventions to determine whether they affect clients' health or exposure to further violence. Whether routine screening for physical or sexual abuse by intimate partners is a good strategy, for example, is explored in Advisability of Screening for Violence Debated. Meanwhile, basic measures that providers can adopt to assist clients who have experienced forced sex are outlined in How Providers Can Help. For example, providers may be able to provide postexposure prophylaxis for HIV infection, a medical intervention that continues to be studied in terms of safety, efficacy, and cost-effectiveness, as described in Research on Postexposure Prophylaxis for HIV.

Keys to Preventing Nonconsensual Sex

Few efforts to prevent nonconsensual sex have been rigorously evaluated for effectiveness, but a range of general approaches (summarized in Approaches to Preventing Sexual Violence) and specific prevention interventions have been documented. In general, experts recommend taking a multifaceted approach to prevention and employing interventions that have specific targets and address particular risk factors, Highlighted in this article are prevention interventions that have targeted a group of vulnerable women in Nigeria, primary school children in Tanzania, and eighth- and ninth-grade students in rural North Carolina, USA. Focus on Primary Prevention emphasizes the importance of efforts to intervene before nonconsensual sex can occur and provides a Web Resource directing readers to World Health Organization publications about preventing violence, including nonconsensual sex. Programs for Perpetrators describes the growing interest in rehabilitating perpetrators and features a promising pilot program in Jamaica that sought to do so with the collaboration of the criminal justice system there. Although too young to evaluate, a program in Peru to help men abandon violent behavior against their intimate partners is featured in Men Giving Up Violence. Finally, the rationale for integrating components of nonconsensual sex prevention into HIV programs and vice versa is provided in A Link between Nonconsensual Sex and HIV Prevention