Childhood sexual abuse is a major societal problem that has long term effects that often carry on into adulthood (Bogar & Hulse-Killacky, 2006, p. 318). Women who have experienced sexual abuse as a child are at greater risk for future rape and attempted rape (Lalor & McElvaney, 2010, p. 163), prostitution (p. 164), and domestic violence (Fuchsel, 2013, p. 380). What follows is a discussion of the effects of sexual abuse on a woman’s adult life with a look at the nature and extent of sexual abuse, the prevalence rates, the consequences, and the socio-cultural, political, and economic factors that affect women’s vulnerability to this type of violence, along with an examination of interventions that might be effective in addressing the problem.
The Nature and Extent of Sexual Abuse
There are a variety of definitions of sexual abuse (Martin & Silverstone, 2013, p.6). Part of the difficulty in studies about sexual abuse surrounds what criteria have been used to define what constitutes sexual abuse. Sexual abuse can be either penetrative or non-penetrative (p. 6). In other situations such as child marriage, which is discussed later, where the child is powerless to refuse sexual advances, often from an older man (United Nations Population Fund, 2012, p.11), it is not labelled as sexual abuse. The World Health Organization (2003) defines child sexual abuse as:
“the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violates the laws or social taboos of society. Child sexual abuse is evidenced by this activity between a child and an adult or another child who by age or development is in a relationship of responsibility, trust or power, the activity being intended to gratify or satisfy the needs of the other person.” (p. 75)
Although sexual abuse occurs in both genders, girls are more likely than boys to be abused and more likely to experience more severe forms of sexual abuse (Martin & Silverstone, 2013, p. 2). “Researchers estimate that the number of women with a history of childhood sexual trauma in the United States and Canada is between 1% and 45%” (Brierre & Runtz, 1991; Geffner, 1992; Valentine & Feinauer, 1993; Vogeltanz et al., 1999; Wyatt & Newcomb, 1990 cited in Bogar & Hulse-Killacky, p. 318).
According to the Canadian Panel (1993) “50 per cent of the female respondents reported that they had experienced at least one incident of sexual molestation before they had reached the age of 16” (cited in Sev’er, 2002, p. 50). Data collection on child sexual abuse is difficult as most is never disclosed to authorities (Martin & Silverstone, 2013, p. 2). Unfortunately, most often the child is raped by someone that they know, a family member or other trusted person which makes reporting difficult as people do not want to report family and friends to authorities (Lalor & McElvaney, 2010, p. 159).
Worldwide statistics about the prevalence of sexual abuse vary greatly. One of the most extensive studies of worldwide rates is from the World Health Organization in which data from “more than 24,000 survey respondents in 10 countries” show a “a high of 21.3% in Namibia “city,” to a low of 1% in Bangladesh “province”” of sexual abuse rates; however the data was only collected from those aged fifteen and under so it is expected that these rates would be higher if ages 16, 17, and 18 were included (Lalor & McElvaney, 2010, p. 162). Furthermore, a study by Finkelhor (1994) “found that research studies in 19 countries produced findings similar to North American research (incidence rates ranging from 7% to 36% for women and 3% to 29% for men), thus undermining the idea that CSA [child sexual abuse] is “peculiarly American.” (p. 160).
Consequences of Sexual Abuse
The consequences of the high prevalence rates of sexual abuse are linked to an increased likelihood of a woman experiencing a future rape (Lalor & McElvaney, 2010, p. 163), prostitution (p. 164), domestic violence (Fuchsel, 2013, p. 380). As well a woman is also at increased risk of mental health problems in adulthood.
In an extensive study by Humphrey and White “victims of childhood assault were significantly more likely to experience either moderate (unwanted or verbal coercion) or severe (attempted or completed rape) adolescent victimization than non-victims” (cited in Lalor & McElvaney, 2010, p. 163). Coles, Lee, Mazza, Taft and Loxton (2015) found that twenty-six percent of women who had been sexually abused also experienced rape as an adult (p. 1932), and a study by Russell (1986) “found that 63% of a sample of women who experienced intrafamilial sexual abuse before age 14, also experienced rape or attempted rape after age 14 (compared to 35% of those who did not report childhood sexual abuse), suggesting that childhood sexual abuse doubled the risk of sexual revictimization” (cited in Lalor & McElvaney, 2010, p. 163). Lalor & McElvaney also state that “[n]umerous studies have noted that child sexual abuse victims are vulnerable to later sexual revictimization, as well as the link between child sexual abuse and later engagement in high-risk sexual behaviour” (p. 163). High-risk sexual behavior puts women at risk of sexually transmitted diseases such as HIV, rape, and unwanted pregnancy (Burn, 2011, p. 69).
Women who have experienced child sexual abuse are also more likely to be involved in prostitution. Widom and Kuhns noted that “childhood sexual abuse to be a significant predictor of prostitution in female subjects” (cited in Lalor & McElvaney, 2010, p. 164). They found over 10.73% of their subjects were involved in prostitution (p. 164). Lalor and McElvaney (2010) report that “70% of the subjects in the study by Silbert and Pines (1982) in the United States and 62% of those in a study by Bagley and Young (1987) in Canada reported that childhood sexual abuse affected their decision to become involved in prostitution” (p. 165).
As well as a connection between prostitution and sexual abuse there is a connection between domestic violence and sexual abuse. Fuchsel (2013) reported that “of the participants [who had] experienced some type of DV [domestic violence] incident in present or past relationships . . . 78% of the participants had [also] experienced some type of CSA [child sexual abuse]” supporting similar findings from “Daigneault et al., 2009; Hattery, 2009; Karin Bø Vatnar & Bjørkly, 2008; Krebs et al., 2011; Watson & Halford, 2010” (p. 380).
Women who have been sexually abused also have a higher rate of mental health problems which include “psychotic symptoms, depression, anxiety, PTSD, dissociation, eating disorders, somatization, personality disorders, low self-esteem, suicide and self-injury, substance abuse, sexual dysfunction, risk behaviors, and interpersonal problems” (Maniglio cited in Coles, Lee, Mazza, Taft & Loxton, 2015, p. 1932). Added to the mental health problems women “with histories of CSA [child sexual abuse] who also experienced IPV [intimate partner violence] in adulthood have significantly elevated levels of posttraumatic stress disorder (PTSD) and depression compared to those with a history of only one form of violence” (Astin, OglandHand, Coleman, & Foy, 1995; J. C. Campbell & Soeken, 1999; Messman-Moore et al., 2000 cited in Campbell, Greeson, Bybee, & Raja, 2008, p. 195). Many women feel their health and physical well being has been affected by their sexual abuse, with those who have experienced more severe or more frequent sexual abuse reporting more difficulties (Bogar & Hulse-Killacky, 2006, p. 318).
Socio-cultural, Political, and Economic Factors
Child marriage is not generally referred to as sexual abuse because it occurs under socially accepted norms (Wondie, Zemene, Reschke & Schroder, 2011, p. 315), the marriage is often to an older man and the girls are “powerless to refuse sex” (United Nations Population Fund, 2012, p.11). Child marriage is often accepted as part of a culture as the girls know that this is what their mothers and those mothers before them did (Wondie, Zemene, Reschke & Schroder, 2011, p. 315). The women are not usually given a choice who they marry, and do not want to enter into marriage, a violation of their basic human rights (United Nations Population Fund, 2012, p.6).
Early marriage subjects women to pregnancies before her pelvis is physically large enough to deliver a baby (Burn, 2011, p. 44). This can result in obstetric fistula where the “tissues between the vaginal wall and the bladder or rectum are torn during childbirth, resulting in incontinence, infections, and ulcerations” (Burn, 2011, p. 44). Women who experience obstetric fistula are “ostracized and abandoned because fistula makes personal hygiene difficult” (Burns, 2011, p. 45) and it increases the likelihood of her experiencing poverty as she is uneducated and unemployable. According to the United Nations Population Fund (2012) “[o]ver 67 million women 20-24 years old in 2010 had been married as girls. Half were in Asia, one-fifth in Africa. In the next decade 14.2 million girls under 18 will be married every year; this translates into 39,000 girls married each day” (p.6).
Although economics is at the root of the cause of prostitution (Burn, 2011, p. 166), a history of sexual abuse makes a woman more susceptible to choosing prostitution if she is already grappling with low self esteem and substance abuse problems. “It has been frequently reported that victims of rape and sexual abuse develop sexually promiscuous lifestyles in an effort to “conquer” the situation and bring it under their control” (Bogorad, 1998; Parson & Bannon, 2004, cited in Wondie, Zemene, Reschke & Schroder, 2011, p. 306). Burn (2011) states that “[r]ape, sexual abuse, and sex work arising from economic hardship also put millions of girls and women at risk of HIV infection because women and girls in these situations do not usually have the power to negotiate the terms of sex” (p. 69). Women make up close to seventy percent of the world’s poor (Monzini, 2005, p. 59).
Effective Interventions for Prevention of Sexual Abuse
It would seem that the answer to protecting women from the potentially harmful fallout on her adult life of experiencing sexual abuse as a child, would be to stop sexual abuse from happening in the first place.
A response to stopping it has been to start school programs that are targeted at educating children about sexual abuse, however a “critical review of 22 studies of school-based prevention programs found that while most showed gains in children’s knowledge and skills, there was little evidence of the use or effectiveness of prevention skills, nor of changes in disclosure” (Weatherley, Siti Hajar, Noralina, Preusser & Yong, 2012, p. 120). Unfortunately, school-based prevention programs put the onus of stopping sexual abuse on the child. There needs to be societal changes where children are protected by the community rather than turning a blind eye to child maltreatment (p. 125).
Government agencies need to acknowledge not only the extent of the problem, but also the long-term effects of sexual abuse that carry on into adulthood (Weatherley, Siti Hajar, Noralina, Preusser & Yong, 2012, p. 125). A comprehensive program includes “cooperation between the educational, health, social, child protection, police, and judicial sectors and target not only children at risk but also the potential offender” (Save the Children Norway cited in Lalor & McElvaney, 2010, p. 168). It will take a lot more research and education before there is any significant change in our laws and belief systems that allow perpetrators to continue to violate children. As well there needs to be education of medical and health personnel so that there can be “early identification and intervention for victims of violence before physical health problems can develop” (Campbell, Greeson, Bybee & Raja, 2008, p.203).
There is no causal relationship between being sexually abused as a child and the future violence a woman may suffer, as not all women who have been sexually abused experience further violence as an adult; however, a history of sexual abuse can increase the risk that a woman will experience domestic violence, prostitution, and rape in adulthood. The experience a women receives as a child may change her beliefs about herself when she is objectified for the purposes of sex. When a woman’s basic human right to choose her sexual partners is not respected from an early age, it teaches her that she is powerless and voiceless to stop future violence against herself and even normalizes it in a society that seems to passively accept it. Given the prevalence rates of sexual abuse there are a considerable number of women who are affected as adults by what happened to them in childhood. Mental health issues, unwanted pregnancy, early pregnancy, poverty, HIV, obstetric fistula are just a few of the problems that women may experience that often have roots in childhood sexual abuse.
Bogar, C. B., & Hulse-Killacky, D. (2006). Resiliency determinants and resiliency processes among female adult survivors of childhood sexual abuse. Journal of Counseling and Development : JCD, 84(3), 318-327. Retrieved from http://search.proquest.com/docview/219018779?accountid=1343
Burn, S. (2011). Women across cultures: A global perspective (3rd ed.). New York: McGraw-Hill.
Campbell, R., Greeson, M. R., Bybee, D., & Raja, S. (2008). The co-occurrence of childhood sexual abuse, adult sexual assault, intimate partner violence, and sexual harassment: A mediational model of posttraumatic stress disorder and physical health outcomes. Journal of Consulting and Clinical Psychology, 76(2), 194-207. doi:10.1037/0022-006X.76.2.194
Coles, J., Lee, A., Mazza, D., Taft, A., & Loxton, D. (2015). Childhood sexual abuse and its association with adult physical and mental health: Results from a national cohort of young Australian women. Journal Of Interpersonal Violence, 30(11), 1929-1944. doi:10.1177/0886260514555270
Fuchsel, C. L. M. (2013). Familism, sexual abuse, and domestic violence among immigrant Mexican women. Affilia, 28(4), 379-390. doi:10.1177/0886109913503265
Lalor, K., & McElvaney, R. (2010). Child sexual abuse, links to later sexual exploitation/high-risk sexual behavior, and prevention/treatment programs. Trauma, Violence, & Abuse, 11(4), 159-177. doi:10.1177/1524838010378299
Martin, E., & Silverstone, P. (2013). How much child sexual abuse is “below the surface,” and can we help adults identify it early? Frontiers in Psychiatry, 4(7). doi:10.3389/fpsyt.2013.00058
Monzini, P. (2005). Sex traffic: Prostitution, crime, and exploitation. London & New York: Zed Books.
Sev’er, A. (2002). Fleeing the house of horrors women who have left abusive partners. Toronto: University of Toronto Press.
United Nations Population Fund, 2012. Marrying too young. End child marriage. http://www.unfpa.org/sites/default/files/pub-pdf/MarryingTooYoung.pdf
Weatherley, R., Siti Hajar, A. B., Noralina, O., John, M., Preusser, N., & Yong, M. (2012). Evaluation of a school-based sexual abuse prevention curriculum in Malaysia. Children and Youth Services Review, 34(1), 119-125. doi:10.1016/j.childyouth.2011.09.009
Wondie, Y., Zemene, W., Reschke, K., & Schroder, H. (2011). Early marriage, rape, child prostitution, and related factors determining the psychosocial effects severity of child sexual abuse in Ethiopia. Journal Of Child Sexual Abuse, 20(3), 305-321 17p. doi:10.1080/10538712.2011.573458
World Health Organization, 2003. Guidelines for medico-legal care for victims of sexual violence. Gender and Women’s Health, Family and Community Health Injuries and violence prevention, noncommunicable diseases and mental health. http://whqlibdoc.who.int/publications/2004/924154628X.pdf