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The Effects of Rape Culture on Health Care Service Delivery 

Rape culture and its effects are a serious issue when it comes to health and mental health policy. According to (Messina-Dysert, 2016), rape culture as a culture “in which “sexual violence is common and widespread, and is encouraged and condoned by prevailing [social] norms and attitudes.” Furthermore, rape culture contributes and accentuates the concept of “victim-blaming”, or blaming the survivor of sexual violence for its occurrence, and minimizes the role that the perpetrator plays in the act of sexual violence (SV).

            Research shows that when a survivor is blamed for their experience, they have less successful recovery outcomes (Greeson, Campbell, & Fehler-Cabral, 2014). But, more importantly in terms of health and mental health, a survivor is less likely to seek help to recover from their experience. Thus, potentially leading to a host of adverse health, and mental health outcomes for a survivor. In light of this fact, this review will discuss the: (1) history of rape culture; (2) socioeconomic and political factors that contribute to its existence; (3) relationship of rape culture with the health-care delivery system; and; (4) recommendations to eradicate rape culture from a social justice perspective.

History

            The term “rape culture” was first introduced in 1975, by the feminist movement in a film titled “Rape Culture” (“A History of Rape Culture”, n.d.). However, the first recorded history of rape cultures originated in 900 B.C. in the Greek culture. Specifically, in the story of Medusa who is a “beautiful young woman” who was targeted and raped by Poseidon, the “God of the Sea”. Subsequently, Medusa was cursed by Athena, and was made to be ugly, in addition to having her hair become a tangle of snakes. With this story, the subjugation of the female gender via rape, and sexual violence was promoted throughout Greek society.

            In Medieval times, abduction and rape, were considered to be crimes worthy of equal punishment under the “raptus law”. This, consequently, led to much confusion about what constitutes “consent” and “rape”.  Additionally, rape culture was promoted through various tales like the story of Lucretia who was forced to have sex without consent by the son of a Roman King, Sextus Tarquinius; and Helen of Troy, whose story has a greater focus on the abduction side of the “raptus law”. Ultimately, however, these two tales created greater acceptance for the idea that a women ought to subjugate herself to men (“A History of Rape Culture”, n.d.).

            Furthermore, in the Victorian Era (late 19th century), the story of King Kong was published. In this story, a gorilla, becomes fascinated with a white woman, abducts her, and in one scene partially disrobes her. At this same time, Darwin published his theory of Evolution, in which over millions of years, man evolved from more primitive ancestors, including gorillas. This served to increase the public’s fascination and horror of the thought that men could find similarities with a savage animal. Consequently, this caused societies at large, to view men as individuals that could take what they want by force with few, if any repercussions (“A History of Rape Culture”, n.d.)

            In the next two sections, socioeconomic and political factors that contribute to the existence, and continuation of rape culture will be discussed. For the purpose of this review, these two sets of factors will be separated from each other. However, it is important to note that because socioeconomic factors directly influence the political arena, and vice versa, a person who wishes to understand a construct as complex, and multifaceted as rape culture, must understand, and respect the intersectionality of these two phenomena.

Socioeconomic Factors

One of the most important factor to consider when discussing rape culture, is the widespread social acceptance of the “Just World Belief” (Lerner, 1965). Lerner, (1965) states that this is the belief that “people [through their actions] get what they deserve, and deserve to get what they get.” Clearly, this belief reflects the American ideals of individualism, self-service, and the belief that “every individual has many choices to choose from”; and is believed to be one of the strongest contributors to rape culture’s existence (Hayes, Lorenz, & Bell, 2013).

In current day, rape culture is widely adhered to, in the fact that the male gender can do what they wish, take what they wish, and are expected to be aggressive and dominant. Further, this is compounded by current gender roles, and their subsequent expectations (Grubb & Turner, 2012). In addition, (Grubb & Turner, 2012) report that these gender roles combined with a patriarchal culture simultaneously create, and perpetuate a variety of myths that surround sexual intercourse, and consent.

Gender roles & rape myths. Men are expected to be dominant, hyper-sexual, and overly aggressive, whereas, females are expected to be submissive, sexually accommodating, and passive. These bipartisan expectations of what male and female “ought to be”; creates a culture in which the term “male” is associated with strength, dominance, and controlling, and “female” is associated with weakness, submissiveness, and subordinate. Because, women are expected to be subordinate, females “ought to” accept the sexual invitations, and initiation without protest; thereby precipitating a hostile, and criticizing environment for women that report non-consenting sexual encounters.

It can be argued, that when a male experiences sexual violence, they are faced with even more hostility and criticism in the event that they choose to disclose their experience. Additionally, because that individual may view his experience as a “failure” to adhere to the male gender role, they often carry an immense amount of shame, guilt, and fear which can serve as significant barriers to disclosure. Because males are expected to be never taken advantage of, and to defend themselves, a male who has been sexually assaulted, is likely to be questioning their masculinity, and may view themselves as “weak”, “less of a man”, or even worse, “feminine”.

In the event that a male discloses their experience, they may be asked questions such as: “why didn’t you fight back”, “are you really sure that happened”, or “are you gay?” Rape culture, is a culture in which any deviation from socially-expected norms, means to be ostracized, minimized, and even ridiculed for an individual’s experience. One must ask themselves, “what does a person’s sexual orientation have to do with being sexually assaulted?”; logically, the answer is “sexual orientation has nothing to do with sexual assault” (Byers, 2016).

Yet, culture is not built solely on logic, but education (or lack thereof), art, music, emotions, belief systems (religious or otherwise), and prevailing social values and expectations. The elements and expectations that characterize a specific culture are then “normalized” through widespread adherence over time. Regrettably, because of this normalization process, logic can be easily discarded to support an individual’s world-view of an individual, despite the existence of contradictory evidence (Denbow, 2014). This reality can have many negative consequences for both male, and female survivors alike; and will be discussed at a later time in this review.

Religion is an important aspect of arguably every culture that has ever existed. Unfortunately, when religion is (mis)used, it can be a strong contributor to “victim-blaming.” For example, conservative Christian ideology places a strong emphasis on the woman’s responsibility to be submissive to men. Although, this is mainly found in the context of marriage, this emphasis on the lesser status of women is dispersed to the broader society in America, as a majority of Americans identify as Christian. Because, women may be viewed as having a “lesser status” it is easier to dismiss, minimize, and therefore blame them for the occurrence of sexual violence (Flood, & Pease, 2009).

Similarly, this carries over into the realm of sexual orientation. Specifically, with males and male-identified individuals who are Gay, Bisexual, or Transgender (GBT). Because, these individuals are viewed as “feminine”, for their sexual attraction to other males, they are given a lesser status by the broader society. Sadly, when a GBT male is sexually assaulted or raped, they are less likely to receive the services necessary for recovery, because of the fear of ridicule, and/or not being believed (Byers, 2016).

Political Factors

            The political factors that contribute to rape culture can be difficult to discern because they are closely enmeshed with the sociocultural aspects in a given culture. Despite this, however, politics, especially conservative political ideology has been shown to further contribute to rape culture (Suarez & Gadalla, 2010). Furthermore, there appears to be a misconstrual of what constitutes rape, and what constitutes reproductive justice. This confusion between women’s reproductive rights, and a woman’s autonomous control of her own body has led to the false belief that rape is solely a sexual act. However, (Harding, 2016) asserts that rape is not a sexual act, but that it is “an act of taking power and control over another individual against their will”. Thus, when a person understands the true nature of rape, the implications of the act take on a much different meaning.

First, every individual has control over their own being, who are we to decide what a woman can, and cannot do? This is important for social workers to consider, as to not value the dignity and worth of a person is to be in direct violation of the NASW Code of Ethics clients” (National Association of Social Workers [NASW], 2008, preamble). Secondly, although research reports that females face a much higher risk of sexual violence, men are affected in different ways as well, including: (1) a social expectation that men be sexually dominant creates an environment in which a male commits an act he would not normally in an attempt to meet this expectation and; (2) according to this societal script, a male who experiences sexual violence has failed to “live up” to what society thinks a male should do, and subsequently experiences demasculinization, and intense shame. Ultimately, both males and females face a hostile recovery environment following sexual violence because of rape culture’s existence.

Rape Culture & Health Care Delivery

            The importance of health care services following sexual violence cannot be emphasized enough. Often, the health care system is the first point of professional contact for a survivor, and a positive or negative experience can have serious implications for the recovery of that individual. A positive interaction with the health care system can significantly improve that individual’s recovery outcome. Conversely, a negative experience can lead to further traumatization, and have a detrimental impact on that individual’s recovery (Campbell, Wasco, Ahrens, Sefl, & Barnes, 2001).

However, the delivery of health-care services is significantly impeded for survivors of sexual violence, regardless of their gender. Because rape culture places blame on the survivor for the occurrence of the crime, survivors of sexual violence are far less likely to access the services needed for recovery (Donnelly & Kenyon, 1996). Furthermore, barriers to service access also exhibit themselves across the lines of socioeconomic-status (SES), race, ethnicity, shame, guilt, and self-blame (Amstadter, Mccauley, Ruggiero, Resnick, & Kilpatrick, 2008; Logan, 2005).

            In regard to gender, (Turchik, Mclean, Rafie, Hoyt, Rosen, & Kimerling, 2013) report that the stigma surrounding males and sexual violence, is a serious barrier to the access of medical and mental health services. Compounding this issue, it appears as though the gender of the service provider is also an important aspect of recovery to consider. Specifically, (Turchik, et al., 2013) reports that in their study, 50% of sexual violence survivors preferred service provision from a female, rather than a male. This is not surprising considering that in general, women appear to be more aware of the effects of rape culture, as well as providing the survivor with more compassion and empathy

In a national survey of female survivors regarding the utilization of medical care and/or mental health therapy following SA, (Amstadter et al., 2008) report that 40% of survivors do not seek professional mental health therapy for their emotional problems. Moreover, the authors report that ever seeking help following SA was associated with (1) being white; (2) being married and; (3) having PTSD. The researchers also note the impact that SES and ethnicity had in their study. Such that, women of a low SES and/or ethnic minority were less likely to seek medical and mental health services following SA. In a review of public health centers (Sasso, & Byck, 2010) advocate for an increase in federal funding and further use of a sliding-scale payment plan in order to provide services for those individuals of a low SES.

Another factor that is important for the health care delivery system to consider in service provision, are comorbid disorders that a survivor may experience in the aftermath of sexual violence. In an attempt to cope with symptoms of PTSD, it is not uncommon for a survivor to develop a substance use disorder (SUD) (Darnell, Peterson, Berliner, Stewart, Russo, Whiteside, & Zatick, 2015). Darnell et al., (2015) also report that depression, suicidality, as well as increased risky sexual behavior commonly develop following a sexual assault. Further, the authors report that survivors are more likely to seek health care services if they have a strong social support system, and prior positive interactions with healthcare professionals. Lastly, the researchers report that their findings provide evidence to the fact that additional efforts to improve service linkage are necessary to promote a greater number of successful long-term recovery outcomes.        

Current Policy

            Thankfully, a number of policies that work to prevent sexual violence exist. One of the more important legislative policies that has been ratified in 19 different states, and is in the legislative process in several more, is Erin’s Law. This law asserts that more comprehensive sex education from Kindergarten through 12th grade can serve as a powerful deterrent to the occurrence of sexual abuse. Furthermore, this policy promotes early recognition of S/S of sexual abuse, appropriate boundary setting, informing all ages of the grooming process, as well as ways to: (1) promote the disclosure of sexual abuse to safe authoritative figures; (2) reduce overall levels of self-blame and; educate both adults, and children of available therapeutic services and; (3) educate parents and/or legal guardians of appropriate, and non-shaming ways to react in the event that the occurrence of child sexual abuse is disclosed (National Conference of State Legislation, 2015). This policy is incredibly important in the fact that: (1) multiple studies have shown that proper sex education decreases risk of experiencing sexual violence, and as previously mentioned; (2) education, and therefore awareness are the first steps towards exterminating the existence of rape culture (Byers, 2017).

Eradicating Rape Culture: A Social Justice Perspective

            Social problems at their core, are a conglomeration of social issues that have been minimized, ignored, and/or used as tools of oppression over the course of history. Because of this, social problems are complex, multifaceted, and rendered invisible to the greater society. Thus, attempting to solve a social problem is a difficult, and lengthy process. In order for an intervention to be successful, it must be: (1) broken down; (2) planned out; (3) comprehensive in its scope; (4) cost-effective; (5) easily understood by a large number of individuals regardless of their educational level, and; (6) relatively easy to implement. Lastly, for the purpose of comprehension and clarity, the following sections will break this intervention down into the individual step(s) and address other pertinent aspects vital for an intervention’s success.

Steps 1-2: Awareness & Education

The first step to eradicating a social problem is to be aware and knowledgeable of its existence. Thus, efforts to bring widespread social awareness and education about rape culture should first be implemented. One potential medium through which awareness can be spread is to have pamphlets, brochures, and/or fliers that discuss the: (1) existence; (2) effects and; (3) factors that contribute to its creation and perpetuation.

Awareness and educational efforts should take place in a variety of professional settings including: (1) hospitals, ER’s and outpatient clinics; (2) court houses, police departments, and jail/prison settings and; (3) high schools, colleges, and universities. In targeting the institutions of health care, criminal justice, and academia the awareness effort is reaching 3 of the most influential institutions in our society, and because of this are vital to spreading awareness to the greater society. As, an educated populace is critical to the success of any attempt in introducing policies that are capable of enacting social change.

Funding

            As with any intervention to bring about social change, funding is a concern that is often brought about in its implementation. Unfortunately, rape culture, and sexual violence are often considered to be socially taboo topics. Consequently, they are stigmatized, and it is likely that receiving large-scale funding from the public sector is not a viable option at this point in time. Therefore, the initial funding would likely take the form of grants from existing organizations, such as “1in6.org”, and “Itsonus.org”, private donations, and/or grassroots contributions.

Staffing         

            Similarly, the staffing needs required for such grassroots efforts can be met in a variety of different ways. First and foremost, the staffing requirements that are necessary to implement an intervention such as this, can partially be met through the use of volunteers, professionals engaging in pro-bono service, as well as potentially salaried individuals.

Policy Change(s)

            Clearly, fighting to change a social problem requires a steady flow of income. Because, private donations are not always guaranteed, and grant money will run out, it may become necessary to push for policy change that will address this issue. Two examples of potential changes include: (1) an additional tax on alcohol due to its strong correlation with crimes related to sexual violence; and (2) re-distributing a percentage of bail/bond monies associated with sexual violence to fund prevention programs.

Step 3: Continuity & Implementation

            In order for an intervention to be successful, it must be a continuous and on-going effort. Giving rise to the question, “How do we ensure that future generations receive the education necessary to minimize the impact of rape culture?”  One possibility is to create, and implement universal education programs that inform the wider population of: (1) factors contributing to rape culture’s existence; (2) the harmful effects that may occur from lack of education when a survivor seeks services in the Health Care or Criminal Justice System and; (3) appropriate ways to respond to survivors (Collin-Vézina, Daigneault, & Hébert, 2015).

            Collin-Vézina et al., (2015) promote the use of universal education programs and report that they are:(1) cost-effective; (2) easy to implement and; (3) accessible to a wide audience. More importantly, if these programs were to be implemented, they would reduce the stigmatization of rape culture, and increase the possibility of large-scale funding from the public sector. This, in turn, will help to create a more informed, and accepting population; creating a less hostile environment for survivors to receive services necessary for recovery. Lastly, universal education programs should be used in conjunction with the informative approach via pamphlets, brochures, etc. that was previously mentioned in this review. With a two-pronged approach to providing education, the potential for individual’s to not receive this education (due to a lack of awareness that it exists, lacking time, and other factors) is greatly reduced.

Conclusion:

            Rape culture is a widespread social phenomenon with a long and extensive history throughout societies around the world. It is created by a variety of socioeconomic and political factors, including gender roles, and social expectations. Because it places blame on a survivor, and not the perpetrator for the occurrence of the crime, it has many negative implications for a survivor’s recovery. This review explores the effects of rape culture on the access, and service delivery within the health care system. Many studies have shown that negative reactions from health care professionals, and the failure to recognize and treat comorbid disorders make a survivor less likely to report to other agencies, and to adhere to follow-up treatment plans.

            Although, there are currently policies in place that seek to inform people of rape culture’s harmful effects, additional policies are still necessary. This review provides an outline and argument for one such policy option. Despite the many issues such as, funding, implementation, staffing, research, and garnering support that should be considered in the creation, and implementation of policy, the benefits greatly outweigh the costs of such a task. Lastly, this review highlights the necessity of a comprehensive, educational, and unified approach to dismantling a complex, and multi-faceted social problem such as, rape culture. 

 

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