Elsevier

The Lancet

Volume 383, Issue 9929, 10–16 May 2014, Pages 1648-1654
The Lancet

Articles
Worldwide prevalence of non-partner sexual violence: a systematic review

https://doi.org/10.1016/S0140-6736(13)62243-6Get rights and content

Summary

Background

Several highly publicised rapes and murders of young women in India and South Africa have focused international attention on sexual violence. These cases are extremes of the wider phenomenon of sexual violence against women, but the true extent is poorly quantified. We did a systematic review to estimate prevalence.

Methods

We searched for articles published from Jan 1, 1998, to Dec 31, 2011, and manually search reference lists and contacted experts to identify population-based data on the prevalence of women's reported experiences of sexual violence from age 15 years onwards, by anyone except intimate partners. We used random effects meta-regression to calculate adjusted and unadjusted prevalence for regions, which we weighted by population size to calculate the worldwide estimate.

Findings

We identified 7231 studies from which we obtained 412 estimates covering 56 countries. In 2010 7·2% (95% CI 5·2–9·1) of women worldwide had ever experienced non-partner sexual violence. The highest estimates were in sub-Saharan Africa, central (21%, 95% CI 4·5–37·5) and sub-Saharan Africa, southern (17·4%, 11·4–23·3). The lowest prevalence was for Asia, south (3·3%, 0–8·3). Limited data were available from sub-Saharan Africa, central, North Africa/Middle East, Europe, eastern, and Asia Pacific, high income.

Interpretation

Sexual violence against women is common worldwide, with endemic levels seen in some areas, although large variations between settings need to be interpreted with caution because of differences in data availability and levels of disclosure. Nevertheless, our findings indicate a pressing health and human rights concern.

Funding

South African Medical Research Council, Sigrid Rausing Trust, WHO.

Introduction

Reports of rapes and murders of young women in India and South Africa have focused international attention on the horror of sexual violence. Although it is tempting to view these events as isolated, they should be seen as part of a larger, daily reality of sexual violence against women.

The terms rape, sexual violence, and sexual abuse encompass many forms of violence, including sexual harassment and sexual trafficking.1 An important issue in sexual violence is the relationship between the victim and perpetrator. Historically and in the popular media, sexual assault has commonly been viewed as an act between strangers and, therefore, a crime, as supported by sexual-assault laws.2 Research into intimate-partner violence in the past decade, however, has shown that a substantial proportion of sexual violence occurs within marriage and other intimate partnerships.3, 4 Sexual violence perpetrated by people, such as strangers, acquaintances, friends, colleagues, peers, teachers, neighbours, and family members is referred to as non-partner sexual violence. Irrespective of whether sexual violence is perpetrated by partners or non-partners, it is generally traumatic for the victim, although the pattern, degree, and effect of violence might differ dependent on the perpetrator.5, 6, 7, 8 Intimate-partner sexual violence frequently occurs over long periods of time and is accompanied by controlling behaviour, whereas such a pattern might not be present in non-partner sexual violence.4

Despite the focus on violence within intimate partnerships,3, 9 research on non-partner sexual violence has increased less,1, 4 and the development of common definitions and measuring tools have not received the same attention. Where comparisons have been done, non-partner sexual violence has shown similarities with intimate-partner violence in terms of risk factors and the broad range of effects on health.5, 6 Nevertheless, there are also some important differences, including in prevalence, as reported in the WHO Multi-country Study on Women's Health and Domestic Violence against Women (WHO-MCS)9 and studies of population-based rape in South Africa and Asia.10, 11 Findings indicated that rapes by strangers are more violent and have higher risk of involvement of weapons and injury than those by known perpetrators, but with the latter the betrayal of trust might greatly affect post-assault outcomes, including psychological functioning.5, 6, 12

A fundamental first step in the development of effective responses to non-partner sexual violence is improved understanding of prevalence in the general populations of different countries and regions. We did a systematic review of data on the prevalence of non-partner sexual violence worldwide in women aged 15 years and older. This study was done as part of the work for the Global Burden of Disease 2010 study13 to contribute to the quantification of the burden of disease and injury attributed to interpersonal violence.

Section snippets

Literature search

We did a review of population-based prevalence estimates of non-partner sexual violence worldwide that involved peer-reviewed and grey literature. We searched for articles published from Jan 1, 1998, to Dec 31, 2011. We also manually searched for citations in reference lists of retrieved articles and made contact with experts. We included studies published in languages other than English, and obtained full-text translation as required. The databases and search terms used are presented in the

Results

We identified 7231 abstracts or records for screening. The main reasons for exclusion were incorrect study design (non-population-based studies), focus on intimate-partner violence, and analysis of combined perpetrators or types of violence (figure 1). We identified 44 potential records in the additional search that were not included because none was a journal article, and seemed instead to be commentaries, letters, or web-based information that was no longer available. 145 records or abstracts

Discussion

We estimated that worldwide in 2010, 7·2% of women older than 15 years had reported ever having experienced non-partner sexual violence. Thus, non-partner sexual violence is widespread and in some regions is endemic, reaching more than 15% in four regions. Generally, prevalence was highest in regions with the most datapoints. The regional variations were wide. Thus, although they might reflect true variations, differences could be linked to levels of disclosure. Sexual violence is highly

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