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Disclosure of rape or sexual assault

Intimate partner perpetrated sexual violence is a neglected aspect of DVA and yet it is one of the most damaging.
© Coventry University. CC BY-NC 4.0 Images by Getty Images
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Intimate partner perpetrated sexual violence is a neglected aspect of DVA (Tarzia, 2020) and yet it is one of the most damaging.
A study based on a secondary analysis of data from the WHO multi-country women’s study on violence and health (García-Moreno et al., 2015) reported that sexual violence in combination with any other form of abuse (physical or psychological) led to the worst mental health outcomes – attempted suicide, suicidal thoughts and memory loss – relative to any other type alone, or in combination (Potter et al., 2020).
The study also demonstrated that sexual abuse combined with another abuse type was the most common category, affecting 15.6% of those surveyed internationally (total n=21,221). It is therefore important that providers in antenatal care are prepared to ask about sexual violence and abuse, and for the possibility that rape may be disclosed in response to an enquiry about abuse.
Many people do not identify their experiences as ‘forced sex’, instead framing the issue as part of normal relationship negotiations (Basile, 2002; Logan et al., 2007). Being pregnant compounds the complexity of the situation faced by the person. Depending on the nature of the attack and the person’s perceptions, they may have significant concerns for their baby’s health and wellbeing as well as for themselves.
Offering reassurances based on objective indicators (scans, health checks and so on), together with the ‘LIVES’ and other approaches outlined in earlier sections of the course, will be useful in supporting the person.
If rape or sexual assault is disclosed, health providers need to explain what the reporting requirements are. In some countries, there is mandatory reporting for rape/sexual assault. You will need to explain that you are required to report, what you will report and to whom. In other parts of the world, the decision to report resides with the individual themselves (exception: reporting is universally mandated where there is concern for the welfare of a child or vulnerable adult).
Irrespective of a decision to report to the police or not, it is vital that the woman or birthing person is made aware of the options available to meet medical (eg injuries), sexual health (STI testing), mental health and forensic care needs, eg forensic medical examination.
These options will, to some extent, depend on when the attack occurred. In any case, it is appropriate to explain the role of a medico-legal service or Sexual Assault Referral Centre (UK) and sensitively explore next steps with her. Documentation of the history of the rape or sexual assault is important; the reasons for documenting should be explained (to provide the best care).
Gain explicit consent before contacting external services on the person’s behalf and prior to sharing information.
Where a safeguarding concern is identified (for example, a child or vulnerable adult is at risk of harm), this needs to be reported. However, it is good practice to discuss these intentions and the reasons behind them with the person before taking action. If they agree, this step could help to preserve trust in the longer-term and empower the person to take steps towards increased safety. If they disagree with the reporting, at least you have done your best to be transparent and honest. It is advisable to avoid language such as ‘escalating’ as this is likely to create unnecessary anxiety.
Where an adolescent/young person under 18 years discloses rape or sexual assault, the implications of the report for health and safety need to be given consideration; the limits of confidentiality and requirement to report to the police explained; and confidentiality preserved where possible.
Health providers/professionals are advised to act in accordance with their own hospital practices and policies.
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References

Basile, K. C. (2002). Prevalence of wife rape and other intimate partner sexual coercion in a national representative sample of women. Violence & Victims, 17(5), 511-24. Web link
García-Moreno, C., Hegarty, K., d’Oliveira, A. F. L., Koziol-McLain, J., Colombini, M., & Feder, G. (2015). The health-systems response to violence against women. The Lancet, 385(9977), 1567-1579. DOI link.
García-Moreno, C., Jansen, H. A. F. M., Ellsberg, M., Heise, L., & Watts, C. (2005). WHO multi-country study on women’s health and domestic violence against women. World Health Organization. Web link
Logan, T. K., Cole, J., & Shannon, L. (2007). A mixed-methods examination of sexual coercion and degradation among women in violence relationships who do and do not report forced sex. Violence & Victims, 22(1), 71-94. Web link
Potter, L. C., Morris, R., Hegarty, K., García-Moreno, C., & Feder, G. (2020). Categories and health impacts of intimate partner violence in the World Health Organization multi-country study on women’s health and domestic violence. International Journal of Epidemiology, dyaa220. DOI link
Tarzia, L. (2020). “It went to the very heart of who I was as a woman”: The invisible impacts of intimate partner sexual violence. Qualitative Health Research, 31(2), 287-297. DOI link
World Health Organization. (2014). Health care for women subjected to intimate partner violence or sexual violence: A clinical handbook. Web link
World Health Organization. (2019). Caring for women subjected to violence: A WHO curriculum for training health-care providers. Web link
© Coventry University. CC BY-NC 4.0 Images by Getty Images
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Identifying and Responding to Domestic Violence and Abuse (DVA) in Pregnancy

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