Prevalence and correlates of sexual violence among adolescent girls and young women: findings from a cross-sectional study in a South African university

Abstract

Background: There is a window of opportunity to address the menace of sexual violence in South Africa, given the formation of the ministerial task team commissioned by the president in 2019 following the brutal rape and murder of a female university student in Cape Town. Epidemiological data on the prevalence and factors associated with sexual violence is critical to understanding the magnitude of the problem and designing interventions towards reversing the trend of sexual violence in the country. Drawing from cross-sectional data from a South Africa university, we examined the prevalence and correlates of sexual violence among adolescent girls and young women (AGYW).

Methods: We analysed data of 451 AGYW selected using stratified sampling. Sexual violence was defined as any sexual acts, and attempt to obtain a sexual act without consent. We used adjusted and unadjusted logistic regression models to examine the factors associated with exposure to sexual violence while controlling for relevant covariates.

Results: The lifetime and past year prevalence of sexual violence was 37.9% and 25.3%, respectively. A higher prevalence of sexual violence was reported by heavy episodic drinkers of alcohol (lifetime 48.4% and past year 34.0%), those who received insufficient financial support (lifetime 58.0% and past year 35.8%) compared to non-users of alcohol and those who received adequate financial support. AGYW who reported heavy episodic use of alcohol were twice more likely to report experiencing sexual violence compared to non-users. However, individuals who received adequate family support were 76% and 65% less likely to report lifetime and past year experience of sexual violence compared to those who received inadequate family support. Also, AGYW who rated themselves as very religious were 80% and 75% less likely to report lifetime and past year experience of sexual violence compared to those who were not religious.

Conclusion: Our study shows that sexual violence affects a large proportion of girls, requiring intervention that not only focuses on increasing social support for survivors, facilitating reporting, and ensuring justice is served, but also target alcohol use reduction and poverty alleviation.

Introduction

Sexual violence is a significant and pervasive public health concern, yet scarcely reported to and investigated by appropriate authorities, especially in sub-Saharan Africa [1, 2]. It has several devastating mental, physical, social and somatic effects such as poor relationships with peers and increased psychological disorders like depression, anxiety, insomnia, post-traumatic stress disorder, self harm, poor academic performance, and physical disability [3–6]. Other adverse consequences of sexual violence include an increased likelihood of engaging in risky sexual behaviours and alcohol abuse as well as increased risk for sexually transmitted infections (STIs), including HIV/AIDS[7–9].

The majority of cases of sexual violence takes place before age 24, and the first year of study is understood to be the most vulnerable year for sexual violence occurrence [4, 10], thus, making college campuses a high-risk environment and a significant and strategic place for interventions aimed at combating sexual violence [11, 12]. Women are particularly at a higher risk, and at least one in five women experience sexual violence or assault during their college years [1, 13]. Various individual-level factors such as multiple sexual partners[14], alcohol or substance abuse [4], prior history of victimisation [4, 15], and socio-economic status [16, 17] further contribute to the increasing burden of sexual violence. Also, institutional-level factors such as lack of effective policies and support for victims [13] foster the growing burden of sexual violence. Likewise, some traditions, such as the patriarchal practices, which portrays women as subordinates, also promote sexual violence and predispose women to higher risk [18, 19].

Although there seems to be an increasing sensitisation to this pressing problem across various countries, there is still a low rate of reporting. The weak justice system, shame, fear of not being believed, and social norms such as the "rape myth" are some of the factors that hinder proper reporting of incidences by victims [20, 21]. Choo and Dunne[22] also implicated a low level of awareness of the various forms of sexual violence activities, especially the non-penetrative acts as another factor contributing to the low reportage of the incidence among the victims. Worryingly, the burden of sexual violence and the associated impacts are not well understood due to poor documentation and under-reporting and this, in turn, affects the development of effective measures and policies for combating the challenge [23, 24]. Unless the silence around sexual violence incidence is broken, the burden might linger for long [25].

South Africa is bedevilled with an exceedingly high rate of sexual violence [26]. The ineffective justicial structures in the country that have failed to deliver justice to many victims of sexual violence, which has, to some extent, worsen the problem [27], resulting in the low level of reporting [28]. Victims are often scared of the corrupt justice system and the possibility of re-traumatisation [28]. Naidoo and Moffat [28] further reiterated that only one out of nine cases of sexual violence gets reported, and there is a resultant promotion of a "rape culture," which leads to a form of acceptance of this odious act. Even though many cases of rape and brutal murder of young girls have received large media coverage, the recent brutal rape and killing of a young university girl in Cape Town shook the conscience of the nation, with the president personally attending her funeral. In response to this incidence, the South African government has organised a ministerial task committee for creating a support system for victims and ensuring justice is established. We are, however, unsure of how far-reaching this effort would be.

With regard to sexual violence across South African academic institutions, there seems to be a lack of adequate campus policies as well as a lack of adequate support systems for the victims [29]. Academic institutions across the country are in the process of enacting and implementing policies centred around awareness creation on sexual violence, ensuring justice for victims, providing support for victims, and ultimately reducing the burden of sexual violence [25], majority of which lacks relevant framework and are poorly implemented [30]. These efforts are better implemented in the presence of adequate data and the identification of contributing or associated factors. Reliable epidemiologic data is required for the formulation of evidence-based and effective policies to combat the menace at both the institution and the population level[7, 31]. This study therefore aimed at determining the prevalence and associated factors of sexual violence among adolescent girls and young women (AGYW) in one of the economically-disadvantaged universities in South Africa. The findings of the study could help ascertain the magnitude of the burden, which in turn could inform better policy formulation and implementation of intervention strategies.

Methods

Results

Discussion

This study was motivated by the recent national attention to addressing sexual violence in South Africa following the brutal rape and murder of a first-year female student at University of Cape Town. Sexual violence often does not receive enough attention given that survivors hardly report the cases, even to friends or close confidants [34]. As such, relying on rape or sexual assault reporting will not provide accurate data on the prevalence of sexual violence among young people. We undertook this secondary analysis to determine the prevalence and associated factors of sexual violence among a cohort of AGYW. Our analysis showed that over a quarter of female students experience sexual violence in the past year and approximately two out five girls did in their lifetime. Overall, this finding highlights the tragic frequency at which young girls are exposed to sexual violence. A pooled analysis of the lifetime prevalence of sexual violence in South Africa academic institutions revealed a similar rate (26.2%) to our study [35]. The observed prevalence in this study is higher than the global prevalence of 7.2% [36] and a prevalence of 17.4% in Southern Africa [36]. Another study conducted in another South African Province reported a 24.9% lifetime prevalence of sexual violence among women aged 18–49 years [37]. Our reported prevalence is also higher than the 16.7% reported prevalence of sexual violence in the past year among Norwegian students [38]. Variations in the definition of sexual violence and the study contexts might explain the contrasting prevalence rates reported in these studies. It is well established that South Africa is confronted with an unacceptably high prevalence of sexual violence [25, 39, 40], and our study further adds to this body of knowledge [34].

Consistent with previous studies [11, 41], our analysis shows that heavy episodic drinking was associated with an increased likelihood of exposure to sexual violence. Scholars have argued that the relationship between alcohol is bi-directional[42–44]. It has also been reported that male students buy alcoholic beverages for female students, pressuring them to drink above their limits and sexually abusing them when intoxicated [45]. The intoxication from alcohol could make individuals lose their agency, thereby subjecting them to rape or inappropriate and unwanted touching of genitals [8, 11]. It also renders the victims powerless and unable to identify or interpret cues, negotiate or take an active decision in the face of such unpleasant incidence [46]. Also, victims of sexual violence may turn to alcohol to cope with the trauma of the incident [44]. Studies have shown that alcohol use and abuse is common among young people in South Africa [47, 48]. Thus, the high prevalence of sexual violence could somewhat be attributed to the abuse of alcohol. As such, there is a need for stricter policies regarding the sales and commercialisation of alcohol and other harmful substances in and around college campuses to curb its consequential adverse effects such as sexual violence.

Notably, this study indicates that adequate family support is associated with a lower likelihood of exposure to sexual violence. As such, one could infer that adequate family support is protective against exposure to sexual violence. The pathway through which adequate family support reduces the odds of exposure to sexual violence could be understood through the vulnerability lens. The main needs of adolescents and young adults are material in nature, and money is required to meet these needs. Not getting enough money from home makes young people rate the level of support from their family as inadequate. Adequate family support means young people are not at the mercy of influential men who often lure vulnerable girls with material and monetary gifts, which increases the risk of exposure to sexual violence[16, 17]. Our finding and explanation is consistent with previous studies that have established the link between poverty and sexual violence[49–51]. For example, the National Crime Victimisation Survey in the United States established that the poorest Americans are 12 times as likely as the wealthiest Americans to be exposed to sexual violence[49]. Given our finding on insufficient family support and exposure to sexual violence, it is paramount that any intervention being considered to tackle the menace of sexual violence must focus on addressing family and income vulnerabilities that predispose young people to sexual violence.

We also found a significant relationship between religiosity and lifetime and past year experience of sexual violence. In this study, religiosity was found to be protective against the experience of sexual violence. There are differing opinions on the impact of religion on sexual or intimate partner violence. While some scholars consider religion to be associated with positive health behaviours, including avoidance of alcohol or substance misuse and consequentially, reduction of sexual violence [52, 53], others have a contrary opinion. Religion, with or without cultural norms, is sometimes a guise under which victims and perpetrators hide or are hidden [54, 55]. The findings in our study could be associated with the protective effect of religion on substance misuse and other positive health behaviours.

Our study established that close acquaintances were culprits of two-thirds of cases of sexual violence, and two-fifth of survivors did not mention the incidence to any one. These findings are important, especially in the era of "Me Too movement", where survivors are dismissed for not mentioning the incidence to no one. In fact, one of the greatest challenges of dealing with the burden of sexual violence is the silence around it[25]. Many victims find it difficult to report, and this has, in turn, led to less attention being paid to the matter. Several factors are responsible for this, and this includes the fact that many of the perpetrators are close acquaintances, which makes reporting difficult[56]. Living nearby and trust in the perpetrator, despite potentially being in danger, may play a role in higher victimisation [7]. Also, the fear of stigmatisation, shame, not being believed, and the gender-inequitable societal norms as well as the poor justice system, further reinforce this high rate of under-reporting of sexual violence cases [28]. This challenge could be more serious in academic institutions as students could find it difficult to report cases of sexual violence due to the fear of unknown consequences, both on their academic performances and generally in terms of risk of re-traumatisation and bullying. There is a need for an improved justice system and for the establishment of an effective support system that encourages victims to voice out without the fear of being penalised, stigmatised or ostracised, and that protects the victims. Also, universities need to put measures in place to control such acts on college campuses and even at the hall of residences to reduce this challenge.

Conclusion

Our study shows that sexual violence occurs at a tragic frequency, requiring intervention that not only focuses on increasing social support for survivors, facilitating reporting, ensuring justice is served. Also, alcohol use and inadequate family support were associated with exposure to sexual violence. As such, alcohol use reduction and conditional cash transfer programmes for indigent AGYW are potentially relevant interventions.

Declarations

Competing interests- AIA is an associate editor with BMC Women's Health. Other authors have no conflict of interest to report.

Funding- We received no funding towards the completion of this work.

Availability of data- Data will be made available by the corresponding author upon request.

Acknowledgements- Researchers acknowledge all study participants and research assistants, who provided their time to ensuring the collection of quality data. The authors also wish to acknowledge both the University of Fort Hare and the African Population and Health Research Centre for providing an enabling environment for the completion of this work.

Authors contributions- AIA conceptualised the study and performed the statistical analysis. AIA, EOO and EM contributed to results interpretation and drafting of the manuscript. All authors revised the manuscript and approved the final version.

Consent to publish- No applicable

Ethical consideration- Ethical clearance was granted by the University of Fort Hare ethical review body. Furthermore, researchers upheld all ethical research considerations that include confidentiality of provided information, informed consent and anonymity of participants. Lastly, this study followed all the prescribed IRB guidelines for research when using human subjects.

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