Knowledge of sexual abuse amongst female students in Malawi

Curationis 30(3): x-y ABSTRACT Sexual abuse is an increasing problem in Malawi amongst female students, and is associated with physical and mental health problems. This study aimed to determine existing knowledge of sexual abuse amongst female students in tertiary education institutions in Malawi. A descriptive, comparative, quantitative and contextual research design was used. Participants (n=219) were selected through systematic random sampling from a population of female students aged 18 to 21, at fifteen (n= 15) tertiary education institutions in Malawi. Sexually abusive behaviours demonstrated by a lover and friend were interpreted as not being abusive. There were no significant differences in knowledge o f sexual abuse between the abused and non-abused respondent groups (p > 0.05). The overall prevalence rate of sexual abuse was 41%. Common forms of sexual abuse experienced were touching of breasts (54.4%) and attempted sexual intercourse (47.8%). Completed sexual intercourse was experienced by 18.9% of the respondents. The majority reported that they were sexually abused by men (98.9%). Twenty one percent experienced more than one sexually abusive incident and some respondents were abused by friends (30%). The abusers mostly used physical threats. Only 55.6% reported their sexual victimisation to others. Female students aged 18 to 21 in tertiary education institutions in Malawi had some knowledge of sexual abuse, but there were deficits in the interpretation o f sexually abusive behaviours. The majority o f abusers were male adolescents and young adults. Respondents should know what the Malawi law stipulates and what can be done to control and prevent sexual abuse. The information obtained from the study was used to develop guidelines for sexual abuse prevention programmes.


Introduction and background information
Sexual abuse is a form o f violence, which has mostly affected females (Chen, Tyler, W hitbech & H oyt, 2004:2;K eeton, 2004:313) from all age groups and across cultures.Sexual abuse experiences are associated with adverse psychological and p h y sic a l co n se q u en ce s.Such consequences include public health, clinical care and human rights issues.Violence is a leading cause o f female m o rtality and d isab ility w orldw ide (Fanslow & Norton, 1994;Ryan & King 1992).In this research a student refers to a person aged between 18 and 21 years, who atten d ed a te rtia ry ed u catio n institution in Malawi during the time in which the research was conducted.The definition o f sexual abuse adopted in this study is derived from the definitions by Kempe andKempe (1978, cited in Wilson &James, 1995: 157) and Baker and D uncan (1 9 8 5 :4 5 8 ) and can be summarised as 'the involvement o f a female student in sexual activity to which the victim is unable to give informed consent and that is intended to sexually gratify the abuser'.Sexual abuse can involve acts o f sexual contact and/or noncontact.According to Monteleone and Brodeur (1998:22) acts of sexual contact include, fondling o f genitals, oral-genital sex, penetration with a finger or object, sexual intercourse and sodomy.Other acts such as the touching o f breasts or buttocks are not regularly mentioned in literature, but they are also sexually abusive acts.In Malawi, kissing is not a common practice.Kissing in a sexual way could therefore be regarded as abuse if done w ithout consent.N on-contact involves exhibition o f sexual organs by the abuser or exposing o f genitals to the abuser, watching the abuser masturbate, looking at pornographic material, being filmed for pornographic use and sexual harassment (Dzimadzi, 2002:18).S tu d ies co n d ucted in d ev eloped countries (China, Malaysia and South A frica) display prevalence rates for various forms of child sexual abuse in fem ales (including non-contact and contact) ranging from 6% to 53.2% (Tang, 2002:24;Amar, Wong, & K hatijah, 1996:488;Madu & Peltzer, 2001:312).Higher rates were obtained in a study co n d ucted in G eneva by H alperin, Bourier, Mounoud, Halperin, Bouvier, Jaffe, Mounoud, Pawlak, Laederach, Wicky, & Astie (1996:1328) (33% for girls).In the United States non-voluntary or coercive sexual intercourse has been reported by 7% to 17% o f adolescents and young adults (Nagy, Diclemente & Adcock, 1995:945).
A search o f literature and databases found few studies on knowledge about sexual abuse.C alvert and M unsie- Benson (1999) is one such a study that w as co nducted in the USA , w hich indicated that participants were fairly knowledgeable about child sexual abuse.However, knowledge gaps were found in m en, u nm arried re sp o n d en ts, re sp o n d en ts w ho had no ch ild ren , respondents in younger age groups and resp o nd en ts w ith low incom es and limited education.Poor sexual knowledge has been identified as an individual risk fa c to r th at in creases p e o p le 's vulnerability to sexual victim isation (M cCabe,-1993:379).O ther factors include a lack of sex education (Fenwick, 1994:54) and a lack o f knowledge about sexual abuse preventive skills (Haseltine & Miltenberger, 1990:188).For example, in Malawi written information such as flyers and leaflets, that could equip literate children and adolescents with sexual abuse know ledge, are not available (Dzimadzi, 2002:3).
Sexual abuse occurs in the Malawian society, and cases are reported since the ad v e n t o f freedom o f p ress and expression.However, many o f these cases still go unreported, because in some parts o f Malawi, cultural traditions condone sexual abuse of females in the form of initiation ceremonies (Dzimadzi, 2002:21).The lack of reporting o f sexual abuse in Malawi may be influenced by the M alaw ians' lack o f awareness of hum an rights (Human Rights Needs Assessment Survey, 1999).As a result, female students might not realise that they are abused and that their rights are violated since acts of sexual abuse are regarded as being culturally acceptable.Apart from the police, where abuse is reported, there are no sexual abuse clinics, crisis centres, help lines or related services where victims could potentially report their victimisation.According to the M inistry o f Education, M alaw i's basic school curriculum does not offer sex education.In a study on sexual health know ledge, attitudes and practices, Kawala (2000) identified that Malawian high school adolescents have poor knowledge o f sexual issues, increasing their vulnerability to sexual victimisation (McCabe, 1993:380).As females are more vulnerable to sexual abuse, their risks for acquiring sexually transmitted diseases and suffering psychological effects are higher than that o f males.In Malawi it is estimated that 15% o f the 15-49 years age group are currently infected with HIV (NACP, 2001), indicating the dire need to conduct research about female students' knowledge about sexual abuse.

Research questions
The following research questions were raised and guided the research aims and objectives:

Research aim and objectives
The aim o f the study was to determine the knowledge about sexual abuse and its prevalence amongst female students in tertiary education institu tio n s in Malawi.To achieve this aim the following objectives were set: were that all the participants preferred the English version o f the questionnaire and that the questionnaire was completed by m ost participants within 25 minutes.P articip an ts provided feedback that questions and instructions were clear.
Data was collected using an anonymous self-administered questionnaire.This was used due to the sensitive nature o f the data.Open-and close ended questions w ere u sed .The q u estio n n aire w as prepared in both English and the local language, C hichew a.

Results
Data was collected from 228 participants.Nine questionnaires were incomplete and therefore discarded.This report is an an aly sis o f the re m a in in g 219 q u e stio n n a ire s th a t w ere larg ely complete, providing a response rate of 96% .F indings w ere described and summarised using descriptive statistics.
C ontent an a ly sis o f o p en -en d ed questions was conducted.The statistical significance o f differences betw een variables was established using Fishers E xact and C h i-sq u are tests.The conventional level o f significance, p = 0.05, was used.Due to natural variations entailed in human research, conclusions drawn about findings and generalisations beyond the data always involve a certain degree of uncertainty (Brink, 1989:89).A p = 0.05 indicate that there is a probability of 5 in 100 that the findings may have a result of chance errors.

Demographic information
Similarly, only 48.9% (n = 107) indicated touching o f their breasts by a lover without permission as an abusive act.
Respondents were able to identify adults' sexual behaviours towards children that constituted sexual abuse.Most o f the respondents 93.6%, (n = 205) identified sexual intercourse that involves an adult and a child as sexual abuse.Some respondents 25.9% (n = 59) felt that a lover touching their breasts w ithout permission was not an abusive act.
Similarly, 23.7% (n = 52) indicated that touching o f their private parts by a friend was not a sexually abusive act and as many as 25.6% (n = 56), did not know if the act was abusive.T here was no s ta tistic a lly sig n ific a n t d iffe ren c e between the knowledge o f abused and non-abused respondents (see Table 2).The majority o f respondents (93.6%) were aware that sexual abuse is a crime.

Prevalence, forms and frequency of sexual abuse
The results reveal that sexual abuse begun as early as 4 to 8 years, while 42.2% (n = 38) indicated they were sexually abused between the ages o f 14 and 21.Ninety respondents (41%) admitted to having been sexually abused in their lifetime.Among the eight behaviours listed (refer to Figure 1), touching of breasts in a sexual way was the most common sexually abusive act followed by attem p ted sexual in terc o u rse.However 18.9% (n = 17) experienced abuse involving sexual intercourse.O f the respondents who were abused (n = 90), 2 1 % (n = 19) indicated that they had been regularly abused, 7 6 .6 % (n = 69) were not regularly abused and 2% (n = 2) did not respond to this question.

Discussion of results
The fin d in g s in d icate th at m ost respondents were aged 20 to 21 years in the first y ea r o f study at te rtia ry education institutions in Malawi.All twenty-seven districts and the major and minor Malawian tribes were represented; th ere fo re d iffe re n t cu ltu re s w ere represented in the sample.
M ost re sp o n d en ts p erceiv ed that sexually abusive behaviours towards ch ild ren c o n stitu te sexual abuse.
Respondents were also aware that sexual abuse is a crime, as observed from the reasons given.Although the majority identified elements that constitute sexual abuse, some respondents demonstrated limited knowledge.These respondents were unable to identify certain sexually abusive behaviours, particularly when demonstrated by a friend or lover.The responses may also reflect the cultural beliefs in the M alawian society.The limited knowledge displayed may hamper the exercise o f their rights and expose them to the risks associated with sexual abuse.R isks co u ld include early pregnancy and contracting sexually transmitted diseases.The findings in this study are high when compared to similar studies in which a broader definition was made.Amar et al., (1996:489) identified a p re v alen ce rate o f 6.3% am ong M alaysian female students.A nother study conducted by Tang (2002:34) among Chinese college students yielded a prevalence rate o f 7% for females.An explanation o f difference in this study's findings compared to the Chinese and Malaysian studies could be the fact that a national sample o f students was used in the former and not in the latter.Cultural differences that exist in the different countries may also have contributed to the findings.This may also be true o f a study conducted in Geneva by Halperin et al. (1996Halperin et al. ( :1328) ) in which a national sam ple o f stu d en ts was used.It concluded that the prevalence rate for females was 33.8%, higher than the one obtained in this study in which a national sample was also used.
The prevalence o f sexual abuse in adolescence in the present study (16.4%) is higher than the 13% reported by Nagy, Adcock & Nagy (1994:574).Sexual abuse amongst respondents between 18 and 21 could be related to date and acquaintance rape that this age class is susceptible to The occurrence of sexual abuse involving sexual intercourse was 18.9% (n = 17).This rate is high compared to prevalence studies conducted in both western and developing countries (compare Halperin et al. 1996;Amar et al. 1996 andTang, 2002).S exual ab u se in v o lv in g penetration, such as intercourse may lead to the spread o f STIs/H IV w hich is already prevalent in Malawi.The duration for respondents who w ere regularly abused ranged from two days to nine years.This was lower than the findings by Amar et al. (1996) in which repeated episodes of abuse were reported in 59.5% cases.Respondents, who experienced sexual abuse for more than one year, are m ore lik ely to id en tify w ith the perpetrator, through exploiting others or engaging in an tiso cial b e h a v io u r (Burgess, Hartman, M cCausaland & Powers, 1984:660).Most o f the abusers were closely associated to their victims.These results correlate with that of Miller, Monson & Norton (1995:1292), who found that higher proportions (78% and 89%) of sexual assaults were perpetrated by persons known to the victim.The fact that one respondent (1.1 %) admitted that her sexual abuse experience was part o f a cultural initiation ritual provides evidence that the ritual exists, although it may also be interpreted that the ritual is no longer b eing p racticed w idely in M alaw i.
A lte rn a tiv e ly it is p o ssib le that respondents did not perceive this aspect to be sexually abusive.

Guidelines for the development of sexual abuse preventive programmes
Conclusions made from data analysis w ere u sed as a basis to fo rm u late guidelines.The researcher further added proposed actions using inductive and deductive logic.Guidelines and actions were developed in the areas o f limited knowledge o f sexual abuse, prevalence o f sexual abuse, common sexual abusive acts, perpetrators o f sexual abuse, their victims and the lack o f reporting of sexual abuse.

Limitations of the study
KAWALA, L. 2000: Sexual H ealth Knowledge, Attitudes and Practices of High School Students in Lilongw e, Malawi.Lilongwe: University o f Malawi (Unpublished).

KEETON, C 2004 :
Sexual Abuse on the rise in Africa -governments must act.B u lletin o f the W orld H ealth Organization, 82 (4), p313 KEMPE, RS & KEMPE, CH 1978: Child Abuse.(In Wilson, K. & James, A 1995: The C h ild P ro tectio n H andbook. London: Bailliere Tindall.MADU, SN & PELTZER, K 2001: Prevalence and Patterns o f Child Sexual A buse and V ictim P e rp e tra to r Relationship Among Secondary School Students in the Northern Province (South Africa).Archives of Sexual Behaviour.30 (3), pp 311 -321.McCABE, MP 1993: Sex Education Programm es for People with Mental Retardation.Mental Retardation, 31, pp.377-387 M IL L E R , BC; M O N SO N , BH & NORTON, MC 1995: The Effects o f Forced Sexual Intercourse on W hite Female Adolescents.Child Abuse and Neglect, 19 (10), pp.1289-1301.Violence against Women: Clinical Issues, NLN Publications.41 (2472), pp.127-133.TANG, CS 2002: Childhood Experience o f Sexual Abuse among Hong Kong Chinese College Students, Child Abuse and Neglect, 26 (1), pp 23-37.
The second section focused on knowledge regarding sexual abuse.It incorporated two questions to determine what the participants knew about sexual abuse.R esp o n d en ts w ere asked to indicate "Yes", "No" or "Don't know" to a list o f sexual behaviours.
1.0), the clo ser the strength o f the relationship between the two variables is to perfection (positive or negative) (De Vos, S try d o m , F o u ch e & D elp o rt, 2006:242).The questionnaire had four sections.The first section requested dem ographic information such as age, district o f origin, tribe, living arrangements and year o f study.students who didn't want to participate were given the option to leave the room.The students who remained behind and agreed to participate in the study were given consent forms to sign.Autonomy was ensured by voluntary participation and assurance that they could withdraw from the study at any tim e w ithout

Age distributions of abusers at the time of sexual abuse
reasons.These are the victims' fear o f consequences and lack o f knowledge th at they w ere b ein g ab used.Respondents indicated they would like to know more about the prevention and control o f sexual abuse and relevant legalFigure 2.
The study has no t only p ro v id ed descriptive inform ation about sexual abuse but also indicated direction to its prevention and intervention in Malawi.