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Published in Monograph No 41: Violence Against Women in Metropolitan South Africa, September 1999

Summary Emotional distress and difficulties with relationships are the primary outcomes of abuse. Many of the past effects were still occurring at the time of the interview, emphasising the need for ongoing support to victims of abuse. The majority of victims (73%) said the emotional impact of abuse was the most significant for them personally. 95% of the women had experienced some symptom of psychological distress after the worst incident of abuse: over two-thirds experienced feelings of anger, depression, irritability, and changes in sleeping and eating patterns. A quarter (24%) had attempted suicide and half (49%) thought about taking their own lives. Of the 111 women for whom sexual abuse was the most serious incident, 39% feared contracting a sexually transmitted disease (STD) and 30% were worried about contracting the human immunodeficiency virus (HIV). 36% were worried about becoming pregnant and 33% about having a child. Seventeen women said they contracted an STD and six contracted HIV after being sexually abused; sixteen survivors became pregnant, eight had an abortion, seven had a child and four said the incident left them infertile.

Women were asked how the abuse affected them in the past and in the present. A qualitative overview indicates that abuse generally impacted negatively on the emotional and psychological functioning of survivors. Abuse also had a detrimental impact on women’s relationships and daily functioning. Some physical effects were reported, as well as personality changes and/or changes in behaviour patterns.

Past and present effects of abuse

In terms of the past effects of abuse, women were most likely to describe emotional and psychological problems. They also said their self-image had been negatively affected and that they had suffered from fear or stress (Table 14). At the time of the interview, women were still faced with many of these problems: emotional and psychological difficulties were the most commonly described current effects of abuse, followed by difficulties with general relationships (Figure 11). Of the 66 women who suffered from emotional or psychological problems in the past, 33% still experienced these problems at the time of the interview. Of the 27 women whose general relationships had been affected in the past, half said their relationships continue to be negatively affected. This highlights the need for ongoing support, whether in the form of counselling, familial and community support or legal assistance to survivors of violence and abuse. This supports the suggestion that “... besides physical injury and socio-economic neglect, abuse kills a person’s spirit, his/her ability to freely and deeply make emotional contact with others.”18

Table 14: Past effects of abuse

Women were also asked to identify the two most significant effects the abuse had had on them personally. The majority (73%) described the emotional impact of the incident as most important. This applied to women who were abused both by intimate partners and other people known to them, as well as by strangers. After the emotional impact, the second most important effects of abuse were described as being physical (40%) and sexual (28%) in nature.

Figure 11: How women are currently affected by abuse (only responses > 5%)

Symptoms of psychological distress

The symptoms of psychological distress experienced after abuse provide some indication of the impact of the incident. Nearly all the women (95%) had experienced some symptom of psychological or emotional disarray after the event (Figure 12).

The data indicates that survivors of abuse experienced a high degree of emotional distress. The most common feeling among women was anger at themselves or at the abuser (Figure 12). Depression was also widespread – as many as 87% of women had suffered from depression at some time as a result of the incident of abuse they considered the most serious. Many of these symptoms – depression, nightmares, suicidal ideation and attempted suicide, panic attacks and flashbacks – are clear indicators of distress. It is of concern that a quarter of the women had attempted suicide and half had thought about taking their own lives. This reflects the degree of suffering experienced by this group of women.
Certain types of abuse may lead to particular symptoms of psychological distress. Key symptoms of Post-traumatic Stress Disorder (flashbacks and nightmares) or possibly Rape Trauma Syndrome were more often reported by women who said sexual abuse was the worst type of abuse they had experienced (Table 15). Half of all the women who had experienced nightmares, flashbacks, had thought about suicide and had attempted suicide, had experienced sexual and sexual/emotional assault. Depression was the only symptom that was reported more frequently by victims of physical and emotional/physical abuse.

Table 15: Symptoms experienced as a result of the worst incident of abuse

Worst abuse type	Depression	Nightmares	Suicidal ideation	Suicide attempt	Panic attacks	Flashbacks
Emotional	11.2	8.1	10.6	9.4	9.7	9.2
Physical	16.3	13.4	12.1	7.8	14.9	16.3
Sexual	21.5	25.6	23.5	23.4	24	27.5
Emotional/
physical	28.8	25.6	25	32.8	26.9	23.5
Emotional/
sexual	20.2	25.6	28	26.6	22.9	22.2
Total	100	100	100	100	100	100

Outcomes of sexual abuse

Women who identified sexual abuse as the most serious were asked whether they feared a range of conditions – STDs, including HIV/AIDS, pregnancy, abortion and infertility – after the incident. Questions dealt with whether there were concerns, whether these had materialised, and their experiences with STDs, pregnancy and HIV.

Of the 111 women who responded to this section, most indicated a surprising lack of fear regarding the outcome of sexual abuse. This could relate to the fact that sexual abuse was defined widely in the study to include touching and kissing, for example. Hence, most of the outcomes discussed in this section would not have been relevant in those cases.

Of those who were concerned about these conditions, the most common single fear was that of contracting an STD (39%). This was followed by a concern for becoming pregnant (36%) and having a child (33%). Less than a third (30%) were worried about contracting HIV. Few women (14%) were worried about infertility as a result of the abuse (Figure 13).

Of the 111 women who responded, 15% said they contracted an STD and 5.5% contracted HIV. Pregnancy was reported by 14% of women who were sexually abused. Seven percent had an abortion; 6% had a child as a result of the abuse; and 6% said they had to make a decision on having an abortion. Four per cent were infertile as a result of the attack (Figure 13).

When probed for further details about these conditions, some women preferred not to answer. The sensitive nature of sexual abuse, as well as fatigue among participants are probable reasons. As a result, the numbers are too small for statistical analysis. A brief descriptive overview is therefore provided.

Sexually transmitted diseases

Of the seventeen women who contracted an STD, thirteen said the incident in question occurred during the past five years. When asked how the STD had affected them, many referred to the unpleasantness of the physical symptoms and the tendency for the symptoms to reappear. One woman mentioned her fear of telling her husband about the STD.

Over three-quarters had received some kind of treatment for the disease. Nine women received help in hospitals or clinics, three at the doctor’s rooms and one from a traditional healer. Four women were still receiving treatment at the time of the interview. Five had paid for the treatment privately and three used their medical aid to cover the costs. The remaining three women said the state covered their expenses. Among the eight women who paid for treatment, costs were said to have varied widely depending on the woman’s specific treatment. Of the thirteen women who contracted an STD, nine said the cost of treatment had little effect on them. However, one woman said that she had used the last of her money to pay; another said she could not cover her living expenses as a result of the cost.

HIV/AIDS

Of the six women who had contracted HIV, three were sexually abused during the last five years. Only one of these women received treatment for HIV. This highlights the plight of these women with a terminal illness, all of whom had at least one child and no source of income at the time of the interview.

Pregnancy

Of the sixteen women who became pregnant as a result of sexual abuse, seven said the incident occurred in the last five years.

When describing how the pregnancy affected them,19 three said they were shocked and feared their family’s reaction. A further two said they felt helpless: one said she could not cope, the other said she had accepted the pregnancy. One participant (who was young when the incident happened) was forced out of her home. Another had to leave school because of her pregnancy. Two women said they knew nothing about sex at the time of the abuse; one was surprised that she became pregnant, the other said she was psychologically damaged as a result of the incident. One woman said she no longer wants children.

Of all sixteen women who became pregnant, ten received medical care. Two of those who did not, said their parents refused to pay for treatment and they could not afford to cover the costs themselves. One said she did not seek treatment because it was taboo to have a child.

Of the seven women who became pregnant in the past five years, four had an abortion: three of these were legal and one was performed by a traditional healer. One women said she was “given tablets and told to bath in cold water for three days.” Two women described prenatal care at a clinic. Six of the seven women said the costs for treatment were low and were covered by the state. One said her medical aid covered the costs.

Abortion

Eight women said they had had an abortion as a result of the worst incident of sexual abuse.20 In all eight cases, the incident of sexual abuse that led to the pregnancy occurred in the past five years. When asked how the abortion had affected them, women expressed a wide range of emotions such as guilt, depression and not wanting to have children. One woman said she had not yet come to terms with having had an abortion.

Medical doctors conducted five of the abortions; the remaining women did not answer the question. Only four of the eight women received medical attention after the abortion was performed, two of whom said the treatment cost less than R50, others said they did not require treatment.

Children

Of the seven women who said they had had a child from sexual abuse, six said the incident occurred within the last eleven years; the other incident had occurred over 24 years ago. This means that the children of most of these women were still in need of parental care at the time of the interview. Five women said they cared for the child themselves; one was in the care of foster parents. Only two women said the abuser was paying maintenance for the children.

When asked how having a child had affected them, two women said they had disliked the child and a further two said their lives were no longer enjoyable. One woman commented on the resulting financial burden.

Infertility

Four women were willing to discuss their infertility as a result of sexual abuse. Only one participant had received treatment. When asked to describe the effects, two mentioned physical aspects such as physical pain. Others referred to the psychological aspects: one said she felt indifferent and did not want children; the other said she felt ‘useless’ and suicidal.