In Swaziland, young women have an elevated likelihood of having experienced sexual violence before age 18 if they lack a strong relationship with their mother or are not currently attending school, according to a national household survey.¹ Such young women are about twice as likely as those who are very close to their mother or are still attending school, respectively, to have been a victim of sexual violence (odds ratios, 2.0–2.3). In addition, the odds of having experienced sexual violence are elevated among young women who, by age 13, knew of a sexual relationship between a teacher and student (1.7) or knew of a child who had been sexually assaulted (1.5). Emotional abuse during childhood is also associated with having been a victim of sexual violence (2.2), but physical abuse is not.

While childhood sexual violence is an issue throughout the world, it may be of particular concern in Swaziland, where victims are not only at risk for such consequences as depression and unwanted pregnancy, but also face a high risk of becoming infected with HIV: In 2007, one in four 15–49-year-olds were HIV-positive. To assess risk factors for sexual victimization, the researchers analyzed data from a nationally representative 2007 survey of young women aged 13–24. Households were randomly selected via a two-stage cluster approach, and one young woman was randomly picked from each household. The response rate was 96%.

In face-to-face interviews conducted in private locations away from their homes, the 1,244 respondents provided information about their social and demographic characteristics, and answered questions about their home life, schooling and quality of relationships with their parents. They were also asked whether, by age 13, they had experienced physical or emotional abuse, had been told about or witnessed the sexual assault of a child, or had known of a student who had had sex with a teacher; and whether they themselves had ever been a victim of childhood sexual violence, defined as either undesired sex resulting from physical force or verbal pressure, attempted coerced sex or unwanted sexual contact (i.e., being forced to touch someone else or being touched against one's will) that occurred before age 18. The researchers used logistic regression to identify factors associated with sexual violence.

Slightly more than half of respondents were 18 or older; 36% were 16 or younger. The vast majority (84%) lived in rural areas, and slightly more than a third had lost at least one biological parent before age 18. Nearly all respondents had attended school, and 10% were married. Overall, 33% of the young women had experienced some form of sexual violence by age 18, and 5% had been forced to have sex. These proportions likely would have been higher, the authors noted, if all of the respondents had reached age 18.

In logistic regression analyses that adjusted for young women's age, socioeconomic status and residence, respondents had elevated odds of having been a victim of sexual violence as a child if, by age 13, they had experienced emotional abuse (odds ratio, 2.2), had known of a student who had had sex with a teacher (1.7) or had known about or seen the sexual assault of a child (1.5). Respondents who were not going to school at the time of the interview also had elevated odds of having been a victim of sexual violence (2.3), and those who had a "somewhat" or "not very" close relationship with their mother (2.0), or whose mother was dead or missing (2.3), were more likely than those who were "very" close to their mother to have been abused. Childhood physical abuse was not related to sexual victimization in the final model.

The investigators acknowledge several limitations of the study, particularly its cross-?sectional design and the potential impact of recall bias, but also note its high response rate and nationally representative sample. They emphasize that some of the factors associated with sexual victimization, such as having a poor relationship with one's mother and not attending school, suggest that a lack of "adequate supervision and guidance" puts young women at risk of suffering sexual violence. To address this issue, the researchers advise providing young women with "greater educational opportunities," mentoring programs (because orphanhood is common in southern Africa) and initiatives that foster communication between young women and their parents.—S. Ramashwar

REFERENCE

1. Breiding MJ et al., Risk factors associated with sexual violence towards girls in Swaziland, Bulletin of the World Health Organization, 89(3):203–210.