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Monday Jul 31, 2017

FPs Can Influence Rape Culture by Talking About Consent

Every 98 seconds, someone in the United States is sexually assaulted(www.rainn.org). One in five American women will be raped at some point in their lives.

[Word cloud highlighting terms such as violence, rape and victim]

And our rape culture -- social attitudes that normalize or trivialize such assault and abuse -- makes it all too easy for perpetrators to commit these acts.

In North Carolina, for example, women cannot revoke consent after sex has begun. According to that state's law, no doesn't mean no if you first said yes(www.usatoday.com). Eight states have spousal exemptions that make rape within a marriage legal. In Ohio, for example, if a husband drugs his wife and then rapes her, it is considered "marital privilege(www.daytondailynews.com)." 

Even when an assailant is not protected by such antiquated laws, the odds are not on the side of justice. Only six out of a thousand perpetrators of rape will serve time in prison(www.rainn.org) for the crime. This statistic becomes less surprising with the knowledge that hundreds of thousands of backlogged rape kits(www.endthebacklog.org) -- DNA evidence -- may be sitting unopened all across this country.

Instead of prosecuting criminals, it is common for our society to blame victims, who -- 90 percent of the time -- are women.

"She shouldn't have been wearing that."

"She shouldn't have been out that late."

"She shouldn't have had so much to drink."

"She asked for it."

We even hear assault downplayed or legitimized.

"Boys will be boys."

These views are even perpetuated by those who are supposed to represent us in government. In 2005, Donald Trump stated, "I don't even wait," in reference to whether or not he had to ask before kissing a woman. Weeks after a recording of that infamous video(www.washingtonpost.com) was leaked to the media, Trump was elected as the 45th president of the United States.

Our patients live in this culture. Victim blaming, lack of criminality in all circumstances of rape, normalizing of sexual assault in conversations with professionals, as well as in casual conversation -- all this trivializes the importance of consent. As family physicians, we have an opportunity to change this culture.

In family medicine, we provide medical care to children and young adults who may one day commit rape or, more likely, become a victim of rape. We provide care for people who have been sexually assaulted and those who commit sexual assault. As continuity caregivers, we intersect with our patients at multiple stages of life. We know them as children, we counsel them as teenagers, and we care for them as adults. As doctors of both victims and perpetrators, we are uniquely positioned to influence rape culture.

How? Talk about consent.

The first patient I treated after a sexual assault was Sarah (not her real name). When she told me of the rape, she spoke without obvious emotion, her affect flat. I told her I was sorry this had happened to her and that it should never happen to anyone.

Her response was a simple. She shrugged her shoulders and said, "It's OK." 

The assailant was known to the patient, as is common. She did not want to report the assault, which is also common. What upset me most about Sarah was her acceptance of what had happened. She didn't seem angry at all.

The U.S. Preventive Services Task Force gives a grade B recommendation to screening women of childbearing age for domestic violence(www.uspreventiveservicestaskforce.org), including sexual assault. No recommendation exists for discussing domestic violence with male patients. Men can be victims of sexual assault and are overwhelmingly the most common perpetrators of sexual assault, so why aren't we talking to them about domestic violence and rape?

Like HPV vaccine -- which is recommended before sexual activity to prevent the spread of HPV -- we should talk to our young patients about consent before they become sexually active.

Programs in Kenya aimed at reducing incidence of rape have found the most important place to start was with the attitude of young boys(www.upworthy.com). A study of these programs(www.ncbi.nlm.nih.gov) found that by empowering young men to speak openly about rape among their peers -- helping them to speak up and stop perpetuating language and actions that lead to sexual violence, and to recognize that rape is never justifiable -- the incidence of rape was reduced. Not surprisingly, researchers found that teaching women self-defense and safety was shown to not be nearly as effective as teaching boys not to rape.

We need to talk with our young patients about consent. Just as we address condoms and contraception, we can talk with our patients about consent and communication.

Encouraging communication between our patients and their partners creates a space where barrier protection, contraception (if relevant), and personal boundaries can and should be talked about.

By encouraging our patients to prioritize consent and open communication with their sex partners, perhaps we can begin to create a culture where we all know sexual assault is never OK.

Natalie Hinchcliffe, D.O., loves teaching residents, advocating for her patients and addressing stigmas in medicine. She is passionate about providing care for lesbian, gay, bisexual, transgender and queer patients, HIV primary care, and reproductive health and family planning services where access to such care is limited. She practices in Ohio.

Posted at 03:51PM Jul 31, 2017 by Natalie Hinchcliffe, D.O.

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