14 Feb : Although there is increasing evidence of risky consensual sex among young people in our society, non-consensual sexual experiences among them have rarely been studied and few interventions have been designed to protect them from the risks of such experiences.
Bill seeks to let 12-yr-olds have non-penetrative sex is certainly not the right choice.
However, what is available suggests that coercion and unwantedness may play a considerable role in the sexual relations of young people â€” girls and young women but also boys and young men.
The implications of non-consensual sexual experiences for young people rights, their health and development and the risks they pose in the transition to adulthood are enormous. At the same time, anecdotal evidence, crime data and my expearence while working with this group on this issue is disturbing picture of coerced or unwanted sex and sexual touch among significant numbers of young people, particularly girls but also boys and young men.
While rape is the most extreme form of non-consensual sex, diverse socio-cultural settings have documented a broad range of experiences that can be identified as sexual coercion, including unwanted touch, coerced sex through threats, and sex in exchange for gifts and money.
Although young people who experience sexual coercion/violence should be able to turn to health care providers, social service agencies and law enforcement agencies for help that their friends and family cannot provide.
They need compassionate sources of counselling, emergency contraception, STI treatment and care for other kinds of health problems. In cases of rape, victims need the services of someone recognised by the courts as qualified to document evidence with legal validity (in many countries a medical doctor is not considered qualified to document legal evidence of rape by the law).
In cases where a young woman or man would like to bring charges against a perpetrator, victims need a competent and sensitised police force and judicial system. Above all, these services need to be delivered in compassionate and non-judgmental ways. Unfortunately, throughout the developing world (and many parts of the developed world), an appropriate institutional response is lacking (if not non-existent).
In many cases, the experience of seeking help from health care providers, much less the police, is traumatising and the same negative attitudes towards victims of violence that permeate the larger society are rampant among the staff of health care institutions, and even more so among the police and judicial systems.
Young people themselves appear to be aware of the lack of institutional support. The majority of rapes are not prosecuted and that more stringent punishment is needed.
Indeed, the response of the health sector, judiciary and law enforcement agencies can exacerbate rather than ameliorate the negative impact of a coercive experience (for example, see Heise, Ellsberg and Gottemoeller 1999 and relevant issues of Human Rights Watch reports such as Human Rights Watch 1999).
While few studies have explicitly explored this issue, studies from India and Nigeria highlight the fact that the police and prosecutors often fail to address victims in a sensitive and professional manner, and few reported rape cases result in convictions (Gangrade, Sooryamoorthy and Renjini 1995; Omorodion and Olusanya 1998).
While working with largely among the unmarried, there is evidence that it is commonplace among married couples as well. It occurs largely among individuals who are acquainted with each other.
It covers a continuum of behaviours ranging from unwanted verbal advances to unwanted touch to assault and forced sex, as well as sex in exchange for money, gifts, food or protection.
The consequences of sexual coercion are formidable: they are short and long-term; and have physical, psychological and social effects.
Sexual health manifestations range from unintended pregnancy, abortion and infection to risk-taking behaviours, including early onset of consensual sex, multiple partner relations and non-use of condoms. Psychological outcomes range from symptoms of anxiety and depression to suicide attempts. School performance can also be affected.
While evidence suggests that sexual coercion may occur at any age, the circumstances of young peopleâ€™s lives and the resources at their disposal are quite different from those of adults, requiring a specific focus on their experiences and needs. Under certain circumstances, and particularly at the time of first sexual experience, young people may be less equipped than adults to avoid non-consensual sex and may have fewer choices available to them when they do experience coercion.
A number of obstacles inhibit adolescents from protecting themselves from non-consensual sexual relations and from taking action against a perpetrator or to withdraw from a coercive relationship. Gender double standards and expectations of women and men in the sexual arena dominate these obstacles.
Communication and negotiation on sexual matters, moreover, tend to be difficult and are often replaced by actions that include force and violence to resolve differences. The lack of a supportive environment and trusted adults and peers to consult on sexual health matters may also enhance young peopleâ€™s (and particularly young womenâ€™s) vulnerability to coercive sexual relations. And finally, perceptions of institutional indifference â€” at the community, school, crime and health sector levels â€” can inhibit help-seeking both among victims as well as others who may wish to seek counselling on how to confront a potentially threatening situation.
Moreover, the implications of non-consensual sexual experiences for young peopleâ€™s rights, their health and development, and the risks they pose in the transition to adulthood are enormous.
The World Report on Violence and Health cautions that sexual violence is complicated by the multiple forms it takes and the contexts in which it occurs, and by the fact that risk factors may vary in importance according to the life stage of the victim (WHO 2002).
The report cites a number of factors that may increase the vulnerability of women in particular to sexual violence, namely young age, alcohol and drug consumption, previous experiences of abuse, multiple partner relations and poverty.
Some research has explored the types of structural and environmental factors that put young people at greater risk of sexual coercion, including poverty, patriarchy, societal norms that support sexual violence and gender inequity, early marriage, inadequate educational and health systems, and ineffective laws and policies.
Most available studies have focused on young womenâ€™s â€” rather than young menâ€™s â€” experiences and suggest that young people who
experience non-consensual sexual experiences are more likely than others to report poor educational attainment, migrant status, residence away from parents, and alcohol and drug use (see for example, Bohmer and Kirumira 1997; Cheng Yimin et al. 2001; WHO 2002), although, in some cases these may be consequences of rather than risk factors for abuse.
Anecdotal evidence points, moreover, to such factors as crowded housing conditions and the lack of adequate or safe housing as additional, yet unexplored, factors. While few studies have directly explored beyond these factors, the context of non-consensual relations described in these largely qualitative studies offers an insight on the kind of risk factors that make for a dangerous environment for young people.
Aside from the structural factors noted earlier, these factors work at the individual, family, community and systemic levels. Prominent among these are gender double standards, power imbalances and
inadequate negotiation skills, lack of awareness of rights and opportunities for recourse, lack of supportive environments and trusted adults on sexual health matters, unfriendly institutional responses (health, crime, legal), and perhaps most important, a failure on the part of social and legal institutions in the community to recognise the problem and punish the perpetrators rather than the victims.
We highlight below what is known in each of these areas.
The objective is to review what is known about non-consensual sexual relations and sexual coercion among young people in developing countries.
What is clear is that studies of non-consensual sexual relations and sexual initiation among young people are sparse. The profile depicted here has relied on a small, pioneering case studies in selected settings drawn from selected sub-populations of youth; consequently, findings may not be representative.
Also clear is that existing studies adopt varying and somewhat ambiguous definitions of non-consensual sexual experiences; and that, as this is one of the most methodologically difficult and sensitive areas of sexual health to research, responses to questions in standard survey instruments may not be entirely reliable.
Notwithstanding these very real limitations, the few available studies provide many common insights and have suggested that although definitions, study populations and study designs may differ, making comparison difficult, non-consensual sex is indeed experienced by disturbing proportions of young people in all settings from which data were drawn. Coercive sex is experienced largely by girls and women, but also by boys and men, as well as those in same sex relationships (although the literature on this is sparse).
While sexual coercion has been studied largely among the unmarried, there is evidence that it is common among married couples as well.
Such incidents occur largely among individuals who are acquainted with each other. Sexual coercion covers a continuum of behaviours ranging from unwanted verbal advances to unwanted touch to assault and forced sex, as well as sex in exchange for money, gifts, food or protection.
The consequences of sexual coercion are formidable: they are short- and long-term, and physical, psychological and social. Sexual health manifestations range from unintended pregnancy, abortion and infection to risk-taking behaviours, including early onset of consensual sex, multiple partner relations and non-use of condoms.
Psychological outcomes range from symptoms of anxiety and depression to suicide attempts. School performance can also be affected.
A number of obstacles inhibit adolescents from protecting themselves from non-consensual sexual relations and from taking action against a perpetrator or to withdraw from a coercive relationship. Gender double standards and expectations of women and men in the sexual arena dominate these obstacles. Communication and negotiation on sexual matters, moreover, tend to be difficult and are often replaced by actions that include force and violence to resolve differences.
The lack of a supportive environment and trusted adults and peers to consult on sexual health matters may also enhance young peopleâ€™s (and particularly young womenâ€™s) vulnerability to coercive sexual relations. Perceptions of institutional indifference â€” at the community, school, legal and health sector levels â€” can inhibit help-seeking both among victims as well as others who may wish to seek counselling on how to confront a potentially threatening situation.
Sexual and reproductive health programmes for young people are largely premised on consensual sex: they often aim to increase young peopleâ€™s knowledge of safe sex, advocate abstinence or condom use, and provide sexual health services in youth-friendly ways. They are not necessarily equipped to deal with the needs of young people who experience non-consensual sex, whose needs go far beyond receiving more information on safe sex. At the same time, programmes that deal explicitly with non-consensual sex are often narrowly defined.
Their focus has tended towards improving the management of the few rape cases that are actually reported to the police, on the assumption that increasing the chances of apprehending and sentencing perpetrators will act as a deterrent. While this is a necessary step, it is not sufficient.
There is a paucity of published literature on programmes that address non-consensual sex among young people, and the absence of a discussion of these in this review is a reflection of this sparse information. We acknowledge that this limitation makes it difficult to draw programme recommendations from this review. However, the evidence presented in this review underscores a number of factors that appear to compound young peopleâ€™s vulnerability to sexual coercion, and a perusal of these suggest a number of programmatic actions:
â€¢ Education, counselling and service activities that address non-consensual sex among young people must be integrated into existing programmes and extended to reach places where young people congregate
Non-consensual sexual experiences have major implications for STIs and HIV, for young peopleâ€™s health and development, and for their rights. Yet, neither school activities, nor STI/AIDS prevention programmes nor reproductive health and family planning services typically address these concerns. Steps must be taken to fold appropriate prevention and care activities into existing programmes and facilities, and to reach young people outside of schools and health facilities â€” at youth centres, in programmes for the out-of-school and wherever else they may gather.
â€¢ Sexuality education activities must counter traditional gender stereotypes and equip young people with the awareness and skills necessary to protect themselves from coercive encounters and to seek appropriate care in case of such incidents
Evidence suggests that young people may accept sexual coercion as inevitable in their lives and may not perceive options in practice that enable them to prevent or seek help for such incidents. Sexuality education must dispel these misperceptions, reverse ingrained norms of gender double standards, power imbalances and male entitlement to sex, and reinforce life and negotiation skills activities that strengthen young peopleâ€™s ability to protect themselves from unwanted sexual advances and to take appropriate action should such incidents occur.
â€¢ Sensitise parents, teachers and other trusted adults with whom young people interact to the importance of communicating about sexual matters with youth and of providing a supportive and non-judgemental environment more generally
The importance of a supportive environment â€” and in particular a close relationship with parents â€” has been stressed in available studies as a protective influence. Findings have also suggested that known adult males are frequently perpetrators of sexual coercion among young people and that fears of censure from trusted adults inhibit young victims from disclosing a coercive experience.
Programmes are needed therefore that apprise adults, particularly parents, of the reality of sexual coercion and the need to communicate with their children on sexual matters, and to provide their children a supportive environment where they can raise sexual health concerns.
Train providers to identify adolescent victims, to understand the links between sexual violence and health and rights, and to provide them sensitive counselling, appropriate services and safe options
Case studies suggest that many health providers have negative attitudes towards those who experience sexual coercion/violence (for example, see Guedes et al. 2002).
These findings suggest the need to train health providers to recognise and enquire sensitively about sexual abuse. Ideally, health providers should be able to Non-consensual sexual experiences of young people:
A review of the evidence from developing countries provide appropriate counselling and services that enable young victims to deal with the incident, and assist others who may not have experienced the â€œtip of the icebergâ€� in protecting themselves from further and even more severe forms of coercion.
They also need to know how to provide emergency contraception and basic referrals to available competent and compassionate community services (including the police) to help young people who have experienced sexual violence.