Journal of Women's Health Care
Open Access

“Sexual Assaults to Women in Remote Rural Communities”

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Background

Sexual violence (SV) occurs almost in every region all societies and social classes across the world. The prevalence of SV from an intimate partner in their lifetime ranges from 6-59% of women [1]. Sexual assault (SA) is a neglected aspect of public health despite the fact that it reveals the challenges in women's capacity to protect themselves against unwanted sex, pregnancy, and sexually transmitted diseases (STDs). According to the World Health Organization (WHO), SV is a major public health problem and a violation of human rights [2]. McQueen opined that it is a common crime against women all over the world with known negative effects on women’s reproductive and overall health [3]. Murphy-Oikonen reported that one in four women worldwide experienced SA in their entire lifetime, but less than 5% reported it to law enforcement. Furthermore, one out of every five cases reported to the police was considered baseless by the police and was therefore called “unfounded", adding to the agony of the women. SV can lead to various health issues in women, including physical, mental, sexual, and reproductive health problems, and may even increase the risk of getting an HIV infection [4]. Kalra opined that SV against women, in a developing country like India, is often a result of unequal power distribution among men and women. It is also prejudiced by certain societal cultural factors and values [5]. A survey conducted by WHO in 2013 revealed that women who were physically or sexually abused were 1.5 times more likely to have a sexually transmitted infections (STI) including HIV, compared to those who never experienced violence [6]. Furthermore, SV may also lead to an increased incidence of homicide or suicide [2].

Objectives

The present community-based study was conducted to know the burden and consequences of SA suffered by women in remote villages.

Material and Methods

Study design

Observational cross-sectional study.

Study setting and duration

The study was conducted over a period of one year in 140 tribal villages in remote rural, forestry and hilly region.

Inclusion criteria

Randomly, women between ≥20 to ≤49 years of age residing in the villages around the village with health facility (study center) and willing to undergo a personal interview were enrolled as study participants.

Exclusion criteria

Those <20 years or >49 years, not willing to give responses, or not comfortable were excluded.

Sample size

Calculated sample size was 2500 with 95% confidence, and 2% absolute precision. The sample size was calculated using a free online statistical calculator (statulator) [7].

Sampling technique

Participants were selected randomly from each village using a random number table to attain the desired sample size of 2500 participants.

Data Collection

After Institutional ethical committee approval and informed consent from all the participants, various socio-demographic features of all the participants including age, education, occupation, socio-economic status, and parity were recorded on a pre-formed structured data collection sheet. An in-depth face-to-face interview of all the study subjects regarding the SA suffered at home and at the workplaces was conducted using a written semi-structured questionnaire with open and close-ended questions by research assistant, trained nurse midwife. Each interview was conducted for duration of 15-20 minutes, maintaining confidentiality and privacy in an area with mutual understanding.

Results

Of the total of 2500 women interviewed majority (57.7%) belonged to the 20-29 years of age, educated up to primary level (45.3%), laborer by occupation (45.4%), and belonged to lower economic class (48.8%). Most of them had one to two children (57.8%). Of the total of 2500 participants, 1690 (67.7%) women suffered either marital rape by their husbands or were sexually assaulted by their close relatives and/or family friends. Of the 1690 women, who reported SA, 1190 (70.4%) suffered from marital rape by their husbands at night and 500 (29.6%) during the day time. Of the total 1690 women who suffered SV, 1213(48.5%) women in addition to marital rape also suffered rape at the hands of relatives, 1018 by their father-in-law or brother-in-law, 160(13.2%) by other relatives, and 35(2.9%) by non-relatives. The details of relationship of marital rape and rape by relatives and other persons with the socio-demographic features of the participants are shown in [Table 1]. Of the total of 2500 women, 911 (36.4%) reported SV at workplaces. Of these 911women, 336 (36.9%) women suffered SV at the hands of their family members working at the same places, 192 (21.1%) by their friends, 111 (12.2%) by colleagues, 102 (11.2%) workplace superiors, 92 (10.1%) by police and remaining, 141 (15.5%) by others. The relationship of SV at the workplaces with the age, education, occupation, socio-economic status, and parity of the women are depicted in [Table 2]. Of the total 2500 participants who suffered SV at home, 1425 (57.0%) informed about the SV to their family members (58.5%), police officials (32.0%), or some other person (9.4%). Of these 1425 women, 1370(96.1%) had to seek help from healthcare facilities including primary health centers (PHC) (63.1%), sub-district hospitals (SDH) / District hospitals (DH) (28.6%), and other health facilities (8.3%). The socio-demographic features-wise distribution of participants who had to seek healthcare is shown in [Table 3]. Of 911 participants who suffered SV at the workplaces, 100% sought help either from a PHC (43.6%), SDH/DH (14.5%), or from others (16.7%) including family members, neighbors, friends, etc. depicts the correlation of socio-demographic features with the action taken by women against SV at their workplace. It was revealed that of 2500 women interviewed, 1690 (67.7%) suffered SA at home and 911 (36.4%) suffered at their workplaces also. A significant correlation was found between, young age, lower education, being laborer and low economic class of women with SA suffered at home and workplaces (p<0.05). Furthermore, of all the women who suffered SA at home, only 57.0% informed about the incident, and of these, 96.1% sought help from healthcare facilities including PHC, SDH, DH, and other health facilities. On the other hand, 100% of women who suffered from SA at workplaces sought help from health facilities.

Table 1: Correlation of socio-demographic features with the sexual violence at home

Table 2: Correlation of socio-demographic features with the sexual violence at workplaces

Table 3: Correlation of socio-demographic features with the action taken after sexual violence at home

Discussion

SA can lead to a lot of negative health impacts including physical, reproductive, and psychological effects [8]. It is a complex and pressing social issue that needs urgent solutions. SV, especially in women, has extremely negative and long-term health impacts including vaginal discomfort, recurrent urinary tract infections, chronic pain, chronic backache, fibromyalgia, insomnia, chronic fatigue, eating disorders, social anxiety, and depression. These disorders are due to the trauma to the body, mind, and soul of women suffering from SV [9].

The present community-based study was conducted to know the burden and action taken by women after suffering SA in rural remote communities with extreme poverty. It was revealed that more of young women between 20-29 years, with less education, agricultural laborers, and those belonging to the low economic class suffered SV at home by their husbands, relatives, and others and also at the workplaces by their employers and co-workers. Furthermore, it was found that only 57.0% of women who suffered SA at home informed about the incident and sought help compared to 100% of women who suffered SV at the workplaces. Actual figures around the world are not well known due to various reasons. Ba et al., reported that the studies from six countries, five in Africa (18 studies), especially in the Democratic Republic of Congo (DRC) (12 studies), the numbers and quality of studies published did not match the significance of the problem. The findings highlighted the need for care of the survivors and also raised concerns about how they and their children get affected in the long term [10]. Jina et al., reported that women who were sexually assaulted had the highest burden of post-traumatic stress disorders. Implementing screening and intervention programs in dealing with women’s health may be valuable, as reproductive health consequences are common [8]. Kohli et al., reported that many survivors of genderbased violence (GBV) in the Democratic Republic of Congo (DRC) reported barriers to access to health services like distance, cost, lack of trained providers, and fear of stigma. They also reported that in 2004 a mobile health program was started in rural South Kivu province of Eastern DRC for vulnerable women and men to know the barriers to access identified by GBV survivors and their families. The mobile health program treated 772 women of which 85% were survivors of SV. Around 45% reported that they never received health services after the last SA and the majority of the survivors reported symptoms of STI following SA. The program identified three important areas that needed further development including the provision of health services to women to reduce the possibility of future stigma, engaging male partners in health education and clinical care, and strengthening linkages for referral of survivors and their partners for psychosocial support and mental health services [11]. In the present study also, 67.7% reported SA at home and of these 911 further suffered SA at their workplaces also. Furthermore, only 57% of women who suffered from SA at home informed to their family members, relatives, friends, and police, but of these 96.1% of women sought help from various health facilities regarding SA-related injuries and 100% of women who suffered SA at workplaces sought help from health facilities. A study by Dartnall et al., revealed that the prevalence of rape ranged between 6 and 59% among women who experienced sexual abuse from their husbands or boyfriends in their lifetime. They reported that two population-based studies from South Africa revealed 28% and 37% of men, perpetrated rape and it was found that rape perpetration reported in high-income countries was significantly lower than those from low- and middle-income countries. They also reported that women and girls were more at risk of being victims and men the perpetrators and, in the majority of the cases, the perpetrator was someone known to the victim [1]. Freedman et al., reported that the research highlighted the ways in which limited understanding of sexual and GBV led to interventions with unintended and sometimes negative consequences for gender relations in the DRC.12 Research suggested that policymakers, and practitioners needed to rethink about approaches to tackling SV and GBV and to incorporate them into a more coherent approach for gender equality [12]. Garcia et al., after having multi countries studies reported that the lifetime prevalence of physical or SV, or both, varied from 15% to 71%, with two sites having a prevalence of less than 25%, seven between 25% and 50%, and six between 50% and 75%. Men who were more controlling were more likely to be violent against their partners. In all but one setting women were at far greater risk of physical or SV by a partner than by other people [13].

A recent study conducted in Turkey to detect the factors affecting SV against women revealed that the women’s exposure to SV was affected by a number of factors, including region, age, educational level, employment, marital status, health condition, parity as well as exposure to physical, economic, and verbal abuse. Furthermore, it was found that education, employment, drug abuse, infidelity, and other variables related to the husband/partner also affected the women’s exposure to SV. The researchers concluded that young women residing in rural and less developed regions, and with low levels of education were more likely to experience SV [14]. Another similar study conducted to assess the magnitude and nature of SV against married women in urban and rural Bangladesh by their partners and factors associated with physically forceful sex by partners revealed a significantly higher prevalence of SV against rural women (50%) compared to urban women (37%). Furthermore, a significant number of women suffered from SA by their husbands. The factors that were found to be positively associated with forced sex by husbands included a similar history of physical abuse of the mother of the husband by his father, dominating behavior of the husband, and forced first sex [15]. A National Intimate Partner and SV survey conducted on 22,590 women and 18,584 men, to know the prevalence of different types of SV at the work places by authoritative or non-authoritative employees and its impacts including safety issues, psychological effects, and missing days of work revealed that 5.6% of women (almost 7 million) and 2.5% of men (nearly 3 million) experience some kind of SV at the workplaces. Around 4% of women reported SV by non-authority figures and 2.1% by authority figures. The most commonly reported SV by the majority of the women was unwanted sexual contact. Furthermore, around 1 million women (0.8%) reported rape by a workplace-related culprit. The most common impact of SV in the workplaces was an environment of fear for both men and women [16].

Another recent study conducted to know the prevalence and predictors of help-seeking behaviors among these women on 19,125 married, separated, divorced, or widowed women in India who had experienced physical or SV by their husbands revealed that less than 1/4th (23.7%) of married, separated, divorced, or widowed women sought help after suffering physical and or SV by their partners, and only 1% sought help from formal institutions. It was observed that help-seeking was most common in women who experienced a combination of physical, sexual, and emotional abuse (48.8%) and least likely in those who suffered only SV (1.5%). Other factors associated with the help-seeking behavior of women included were age, religion, and region [17]. A recent study conducted in Ethiopia to know the help-seeking behavior and associated factors among women who experienced physical and SV reported that only 22.5% of the women sought help after physical and SV. The factors that significantly increased the help-seeking behavior of women included age ≥30 years, employed, economically sound, and experiencing severe violence [18]. A similar recent survey conducted on 1,504 Taiwanese women revealed that 5.76% of women suffered from SV, but the majority of these victims were hesitant to seek help from formal support systems [19].

Conclusion

In the present study, it was revealed that the rural, young women, with low levels of education, laborers and those belonging to lower socio-economic status were more at risk of suffering SV at the hands of their husbands, close and distant relatives, and at workplaces. Of all the 2500 women interviewed, 67.7% reported SA at home and of these 911 faced SA at their workplaces also. Furthermore, only 57% of women suffering from SA at home informed about the incident to their family members, relatives, friends, and police, but of these 96.1% of women sought help from various health centers regarding SA-related injuries and 100% of women suffering from SA at workplaces sought help from healthcare facilities after the incident.

Funding

There was only honorarium for research assistant

Conflicts of Interest

Authors have no conflicts of interest to disclose

Ethics Approval

The present study was conducted after Institutional Ethical Committee approval

Consent to Participate

The study was conducted after informed consent from the participants

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