Table of Contents
Sexual assault is a major health concern that affects millions of Americans. Sexual assault can mean different things to different people but the underlying principle is that, the act was unwanted (Hollier, 2016). The act could be anything ranging from unwanted touching, rape, fondling, attempted rape or making someone perform an unwanted sexual act (Munro-Kramer, Dulin & Gaither, 2017). In the United States (US), it is believed that an individual gets sexually assaulted every ninety-eight seconds, that is one in every five women (Hollier, 2016). Marginalized women are at the highest risk of being sexually assaulted. According to the National Sexual Violence Resource Center (NSVRC), one out of every five women get raped at some point in their life time (NSVRC, 2014). According to Hollier (2016), about 80% of rape victims reports that the first time they were raped was by their 25th birthday, while half of these occurred by their 18th birthday. This paper will focus on women with past sexual assault paying close attention to the state of Maryland, the socio-economic issues the victims face, health disparities in this group, the ethical issues they face as well as come up with a plan on how to address the issues they may be facing.
Background and Significance
According to the NSVRC, the majority of victims of rape and sexual assaults are women and accounting for 91 % of all cases (NSVRC, 2014). Smith et al (2018), in their article reported that yearly about 1.5 million American women suffer from some kind of sexual assault. The victims of sexual assault are women from all ethnic or educational background, works of life or even socio-economic status. In the state of Maryland according to the Maryland Coalition Against Sexual Assault (MCASA), it is estimated that about 19% of adult women in Maryland have experienced rape or attempted rape, while about 44% have experienced some kind of sexual assaults (MCASA, 2020). In 2015, the MCASA reported that a total of 1,758 rape cases were reported in Maryland, which was an increase by 53.3 %. Upon graduation, this writer will provide health services in Maryland and particularly Prince Georges county which according to the MCASA (2015), had the highest number of reported rape cases in the state.
Social Economic Issues of the Problem
Sexual Assault on anyone can be a very humiliating, terrifying and traumatic experience. This experience leaves the individual with a wide variety of problems ranging from emotional, financial, physical, or even psychological issues (Ullman, Lorenz & O, 2018). Sexual assault negatively affects the individual and community as a whole. According to Potter, Howard, Murphey and Moynihan (2018), the financial burden of caring for victims of sexual assault is about $3.1 trillion per year for all victims, or $122,461 per victim in their lifetime. This cost comes from the medical bills, counseling sessions, loss of work, criminal investigation, property damage and so on. The government is responsible for paying about one third of the $3.1 trillion.
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Some of the women feel humiliated and it is estimated that about 60% of sexual assault cases go unreported (Tennessee, Bradham, White & Simpson, 2017). Some victims are so traumatized that, they become unproductive citizens, that is they are not able to keep a job, focus, complete their education, because they are very emotionally unstable. According to Ullman, Lorenz and O (2018), sexual assault has both tangible and intangible cost resulting in the loss of who they are or their purpose in life because some of them live in constant fear.
These victims, tend to feel victimized again when they are blamed for the assault and that is why some of them go unreported (McLean, Crowder & Kemmelmeier, 2018). Another financial burden that some of these victim’s experience is receiving medical bills for the care they sought after the incident. This further traumatizes some of these victims, increasing their financial problems or anxieties
Social Injustice and Health Disparities of Sexually Assaulted Women
Social justice occurs when people are treated fairly but when it comes to sexual assault cases at times the society treat victims with injustice (Hovelson, Scherman & Pearlman, 2016). Health care is a basic human right but people with low socio-economic status for the most part cannot afford basic healthcare not to talk about caring for themselves as sexual assault victims. Women who are marginalized, tend to be afraid to report sexual assault cases for fear that people will not believe them (Potter, Howard, Murphey and Moynihan (2018). When victims don’t report sexual assault cases or seek medical attention, they continue to have other problems that affect their health and continue to put them at a disadvantage. These effects are greatly seen on their physical, mental as well as reproductive health (Hollier, 2016). These problems can sometimes run into families and continue to affect their economic status and thus they will continue to face marginalization. For example, if a single mother who is a victim of sexual assault does not get the help that she needs then she might end up not being able to provide or protect her family because she has inner wounds that have not been heeled.
Another injustice that some of these victims’ face is the fact that people tend to treat them not as victims but as someone who invited such an assault. For fear of being victimized again by the society or loved ones, some remain silent and not seek medical care (McLean, Crowder & Kemmelmeier, 2018). In addition, because of health inequality and lack of insurance, some victims after seeking medical care receive huge amount of medical bill from the treating facilities. These bills for example just open the wounds of the trauma that they endured. From the way the society treats the victims with no respect in some cases has made some victims to live in constant fear that people close to them will not trust them if they find out they were victims of sexual assault.
Ethical Issues as it Relates to Sexually Assaulted Women
As health care providers when it comes to ethical principles, we must respect all four aspects of ethics on the provision of safe and efficient care. These ethical principles that guides our profession are autonomy, justice, beneficence and non-maleficence (Tayade, 2015). In the U.S, sexual assault cases must be reported to the authorities in most states. As providers, we are faced with this dilemma when providing care to victims who come in after they have been sexually assaulted and tells the provider that they just want to seek medical care and not get the authorities involved. In these situations, the provider is faced with a dilemma to treat and not report, or treat and report which is what the provider will eventually do because they have to follow the law. This reporting is what make some of the victims not to seek care especially those that are marginalized for example people of low economic status, underemployed or immigrants who are undocumented. The sharing of information with other professionals is unethical because the victims for the most part have not given a formal consent to that sharing
Another dilemma that occurs is the fact that, some of these sexual assault cases ends up with pregnancy. According to Perry, Murphy, Rankin, Cowett and Harwood (2016) about 5% of these victims request to have their pregnancy terminated. Some providers find this challenging because based on their personal believe, they cannot do it. These providers should do what is right for them and are not be obligated to do what they consider unethical or is against their moral principle, but refer these patients out to other healthcare professionals where they can get the medical care that they are seeking.
The information that the victims discloses to the health professional might be frightening to the healthcare professional but they must remain supportive and non-judgmental and document in detail every finding for legal purposes.
Plants of Action
It is important that any discussion about sexual violence be done in an environment where privacy is guaranteed and no judgement passed. Providers must make their patient comfortable and normalize the topic of sexual assault to be able to gain the victims trust, that will encourage them to open up. The first plan I will like to implement is the use of screening tools. The American College of Obstetricians and Gynecologist (ACOG), encourage healthcare providers to screen all patients for sexual assaults at annual visits and routinely if there is a suspicion (ACOG, 2019). Patients that screen positive should be assessed and referred to where they can obtain the needed help. Follow up should be done quarterly as well to see the progress that they are making and provide more encouragements if need be.
It is important that if victims are identified they should be given all the support they need. This will be my second plan of action, to make sure these victims are provided with all the support that they need and deserves. This will be accomplished by collaborating with other community partners where they can get referrals, professional in-services, specialized services, trainings, workshops to help cope with any problems they may have (NSVRC, 2014). Follow up will be done quarterly to see what progress are being made.
A third plan that will be implemented will be to educate sexual assault victims of available resources in their community. Some victims have financial problems stemming from medical bills, important to educate them about the Maryland crime victim resource center, where they can get a variety of health. This program provides a variety of recourses to victim’s for example financial assistance to help cover the medical cost and other cost that the victim might have incurred because of the assault (Maryland crime victims, 2020).
Conclusion
Sexual assault is a problem in our society and it’s a burden on the individual, their families, community and the society as a whole. It is the responsibility of everyone to make sure that victims be treated with dignity and respect and not be victimize again by our actions. This must start with member of the healthcare community educating the public and providing a save haven where people who have been victims can come and get the help they need and to help empower others. People should come out and speak up about their situation so these perpetrators can be held responsible for their actions and not subject other people to the same fate. Talking and getting help is the first step in the healing process because interventions may be lifelong. Providers must screen women for sexual abuse and provide them with the needed care.
