Going to the hospital in the aftermath of a sexual assault to seek treatment and support is an incredibly traumatic experience — so much so that it can be retraumatizing for some victims, even with advocates and trained sexual assault response team providers guiding them through the process.
The thought that you might arrive at a hospital and not get treated is terrifying, but according to a study conducted by researchers from the Children's Hospital of Philadelphia, that's what's happening to an alarming percentage of teen sexual assault victims. It's not okay, and it needs to stop.
In recent years, America has woken up to the huge backlog of untested rape kits, including some that have been destroyed before the material contents can even be examined. The country has taken on the campus sexual assault crisis. It's even starting to evaluate rape in the prison system. There is a growing interest in addressing sexual assault and violence, and this is an important piece of the puzzle — no one of any age should be assaulted, and anyone who is should receive respectful, detailed, thoughtful treatment.
The researchers gathered information from 38 different pediatric emergency departments, evaluating 12,687 (anonymized) cases to look at how pediatric rape victims were treated when they arrived at the hospital for care. Their findings were troubling in a number of ways.
Distressingly, in 79 percent of the cases, the subjects were under the age of 16 — while the focus of the study was on pediatric emergency departments and thus we would expect the study victims to be, understandably, young, this is rather alarmingly young. 52 percent of the patients identified for the survey had public insurance, reflecting the high rate of child poverty in the United States.
93 percent of the cases involved girls, which likely isn't necessarily an accurate reflection of the gendered breakdown of sexual assault in the real world. Social constraints make it challenging for men and boys to report rape — they may not be believed, they may feel that it's humiliating and emasculating, and in the case of rape and molestation of young boys, complicated power dynamics may suppress willingness to report. (Similar dynamics, of course, are also at play for girls.)
Considerable evidence suggests that male rape is significantly underreported. Overall, 25 percent of American girls and ten percent of boys reported to hospitals for rape treatment, a reminder that sexual assault is a far more widespread problem than commonly believed and stated.
Along racial lines, 34 percent of victims were white and non-Hispanic (62 percent of the general population is white and non-Hispanic), 38 percent were black (13 percent of the population is black), and 21 percent were Hispanic (as opposed to the 17.4 percent of the population that identifies as Hispanic or Latino). These racial disparities, particularly when looking at the disproportionality of sexual assault among black and white teens, are deeply depressing.
One might imagine that when people arrive at a hospital for rape treatment, asking about collecting a rape kit would be a natural first step (you don't want to destroy evidence if possible, so generally you want to hold off on non-life threatening interventions until you have a complete picture of the patient's needs). After that, you might want to provide the victim with testing and prophylaxis, because rapists often don't use condoms and other safer sex supplies.
Shockingly, doctors only tested 44 percent of patients for chlamydia, gonorrhea, and pregnancy, the big three recommended by the American Academy of Pediatrics and the CDC. Just 35 percent received prophylaxis to prevent pregnancy and STIs. The chances of getting adequate treatment increased in facilities with organized sexual assault treatment and counseling, but treatment in other facilities was highly variable. In some hospitals, no teens at all were tested.
That spottiness when it comes to any kind of treatment is unacceptable, but particularly in cases where patients may develop serious illnesses (like HIV) or be faced with difficult choices later down the line (like terminating or continuing an unwanted pregnancy).
The CDC has excellent guidance on the prevention of STIs and pregnancy in rape cases in general, including those involving children and teens. Detailed guidelines articulate patient-specific issues, like whether a patient should receive treatment or vaccination for hepatitis B or HIV, depending on risk factors. The organization also notes specific types of infections of concern in children — those who are not being sexually abused, for example, are unlikely to have chlamydia, so it should be a red flag to care providers even if a child is not in the hospital or at a doctor's office to report sexual assault or molestation. Followup appointments may also be necessary to monitor ongoing health concerns, in addition to counseling and other patient needs.
This study shows simultaneously that sexual assault is a problem for far more children than originally believed, and it's not being treated appropriately in clinical settings. The researchers recommend a streamlined, standardized approach to sexual assault treatment in order to ensure that patients receive the same standard of care no matter where they go, at any pediatric emergency department in the country. Health outcomes in sexual assault cases shouldn't be a case of Russian roulette, depending entirely on where someone sought care, and parents — in cases where parents aren't the ones committing the crimes — shouldn't have to wonder if their children are getting the best possible care.
As researchers explore more and more topics around sexual assault, they overturn an unpleasant and ever-growing series of logs that reveal very unpleasant things beneath. This is one of them, and it's by no means the last. The stranglehold that rape culture has on society means that people rape children and teens and expect to get away with it, and as this study illustrates, the system that's supposed to be caring for victims often enables the people who abuse them.
Whether it's a single sexual assault or ongoing molestation or incest, children need and deserve optimal medical care — unlike adults, they don't have autonomy over where they receive treatment and what kind of care they receive. Even with victim advocates present to help them, they may not understand the scope of treatment options being provided, and they may be unaware of the things that care providers are missing.
When advocates aren't present — as for example at facilities without sexual assault response protocol, i.e. those least likely to provide comprehensive care — only children who have received excellent sexual education and are able to conduct themselves with considerable togetherness in an awful situation will be able to request more testing and treatment. Few 12-year-olds know about the STIs associated with sexual assault, and fewer still would know to ask to be tested for them and provided with prophylaxis to prevent infection. The number who would be able to take control and demand better care after sexual assault approaches zero.
No child should be put in that position, but with only 44 percent of children getting needed care, we're effectively telling child rape victims to fend for themselves.