Rape by strangers: punishment and terror.

Rape by strangers, although less common and less likely to be repeated than forced sex by known perpetrators, still often results in unintended pregnancy and sexually transmitted infections, including HIV. Violent forced sex often results in abrasions and cuts that, coupled with non-use of condoms, put a woman at particularly high risk of acquiring HIV if the rapist is infected. Rape-related pregnancy rates vary among settings, depending on such factors as contraceptive prevalence. While the U.S. rape-related pregnancy rate is an estimated 5 percent per rape among victims ages 12 to 45 years, (1) reported post-rape pregnancy rates in developing world settings such as Ethiopia and Mexico range from 15 percent to 17 percent. (2)

These risks of pregnancy and infection are compounded when the rape involves several men. Gang rape by young men has been reported from settings as diverse as South Africa, Peru, and Cambodia. Perpetrators say that, besides bonding with each other in the process, gang rape enables them to punish girlfriends for perceived infidelity. Other typical victims include girls under the effect of alcohol or drugs or thought to be sexually available, sex workers, girls thought to be virgins, and women perceived as challenging men's dominance and thus defying gender norms. (3)

Women are often the victims of domestic and sexual violence following a natural disaster. For example, rape and sexual molestation were reported in Sri Lanka after the December 2004 tsunami. (4) Punishment, humiliation, and terrorizing of women by means of rape have also long been weapons of war. Extensive sexual violence against women has been reported in many conflict situations, including in Algeria, Bangladesh, Bosnia-Herzegovina, China, East Timor, India, Indonesia, Korea, Liberia, the Philippines, Rwanda, Uganda, the former Yugoslavia, and more recently, in the Democratic Republic of Congo (DRC), Sudan, and northern Uganda. Refugees fleeing conflicts are also at risk of rape in their new settings. (5)

In conflict situations, raped women are often traumatized and stigmatized: In many cultures, women can be abandoned, divorced, and declared unmarriageable if they have been raped. Furthermore, many raped women become impregnated, contract sexually transmitted infections, and suffer gynecological injuries that require reconstructive surgery (see article, page 13). Trauma at the time of rape may be greater and childbirth resulting from rape more difficult if women have been circumcised in the most extreme manner, as is the case of 90 percent of all women in the conflict zone of Darfur, Sudan. (6) Work by FHI to train health care providers in Kosovo to address sexual and domestic violence has shown, unfortunately, that providers often do not know how to address the issue of rape with their clients. This can lead to further distress and shame, notes Jane Schueller, an FHI senior technical advisor who both coauthored an FHI training curriculum about prevention of sexual and domestic violence and facilitated the training in Kosovo.

The cruelty of some attacks, as those reported by Doctors Without Borders/Medecins Sans Frontieres (7)--which has been working in the eastern DRC since 1992--underscores the grim consequences of this most extreme form of nonconsensual sex. A large increase in the rate of HIV infection has been associated with the rape of more than 40,000 women and girls there. (8) (Similarly, an estimated two-thirds of women raped during the 1994 genocide in Rwanda were infected with HIV. (9))

Even when victims are spared HIV infection, the harm is often largely irreparable." It was one week after I had given birth to my first baby, in July 2000," recalls one young Congolese woman." I went out to present the baby to my family and accomplish the traditional purification rituals with them." On the way, she ran into Mai Mai (Congolese militia) who "tied me up and six men raped me. The maternity sores were not healed yet; with the rape, my flesh just tore, opening from both sides, even now, I cannot control urination or defecation and both have been coming out from the front."

Subsequently, this woman's baby died. And, she said, "I have no enthusiasm anymore and no self-esteem because of my helplessness in controlling my excrements. I don't even know where my husband is. I haven't seen him again since what has happened to me; but even if I would see him again, what use would it be? I can't even have sexual relations anymore." (10)

References

(1) Holmes MM, Resnick HS, Kilpatrick DG, et al. Rape-related pregnancy: estimates and descriptive characteristics from a national sample of women. Am J Obstet Gynecol 1996;175(2):320-25.

(2) Mulugeta E, Kassaye M, Berhane Y. Prevalence and outcomes of sexual violence among high school students. Ethiop Med J 1998;36(3):167-74; An Evaluation of a Project to Provide Education, Training and Care for Women and Minors Affected by Sexual Violence, January-December 1990. Mexico City, Mexico: Asociacion Mexicana Contra la Violencia a las Mujeres, 1990.

(3) From Non-consensual Sexual Experiences of Young People in Developing Countries: A Consultative Meeting, New Delhi, India, September 22-25, 2003: Jewkes R. Non-consensual sex among South African youth: prevalence of coerced sex and discourses of control and desire; Caceres C. The complexity of young people's experiences of sexual coercion: lessons learned from studies in Peru; and Wilkinson JW, Bearup LS, Soprach T. Youth gang-rape in Phnom Penh.

(4) Jones R. Gender and natural disasters: why we should be focusing on a gender perspective of the tsunami disaster. Interagency Gender Working Group, January 7, 2005. Available only through LISTSERV Mailing List: http://www.igwg.org/listserv.htm; Activists warn of tsunami survivor rapes. Iafrica.com (Cape Town, South Africa). January 4, 2005. Available: http://iafrica.com/news/worldnews/401686.htm.

(5) Krug EG, Dahlberg LL, Mercy JA, et al., eds. World Report on Violence and Health. Geneva, Switzerland: World Health Organization, 2002.

(6) Martin S, Mutchler M. Sudan: For Raped Women in Darfur, Access to Reproductive Health Services Limited. Washington, DC: Refugees International, 2004.

(7) Doctors Without Borders/Medecins Sans Frontieres. Ten Years of Conflict, Violence and Human Suffering, DRC Special Report, December 20, 2002. Available: http://www.doctorswithoutborders.org/publications/ reports/2002/drc1.pdf.

(8) Rape victims 'dying' in DR Congo. BBC News. October 26, 2004.

(9) Lederer E. Security council told that sexual violence against women is taking place 'on a massive scale' during and after conflicts. Associated Press. October 28, 2004.

(10) Doctors Without Borders.