June 11, 2013 - By Erin Digitale
Rape is shockingly common in the slums of Nairobi, Kenya, where as many as one in four adolescent girls are raped each year. But a short self-defense course can dramatically reduce the girls’ vulnerability to sexual assault, according to a new study from the Stanford University School of Medicine, Lucile Packard Children’s Hospital and an organization called No Means No Worldwide.
“Self-defense training taught these young girls to stand up and say ‘no’ with confidence, and empowered them to escalate their own defense to a higher level, if necessary,” said Neville Golden, MD, senior author of the new study, which is now available online on the Journal of Adolescent Health website. “To our knowledge, this is the first study to demonstrate that a self-empowerment/self-defense course can reduce the incidence of rape in adolescent girls,” added Golden, who is a professor of pediatrics at Stanford and the division chief of adolescent medicine at Packard Children’s.
The study looked at 402 girls who participated in a self-defense program developed by a Kenya-based nongovernmental organization, No Means No Worldwide, that taught them verbal and physical self-defense techniques, and gave them information about how to get help if they were assaulted. Conducted in high schools, the program was designed to combat a culture in which discussing sexual assault is taboo.
In the 10 months after receiving self-defense training, more than half of these girls reported using what they had learned to fend off would-be attackers. The proportion of them who were raped fell from 24.6 percent in the year before training to 9.2 percent in the 10-month period after.
“There is a strict code of silence among rape victims in Kenya, especially with the stigma of HIV and AIDS,” said Jake Sinclair, MD, the lead author of the new study and a pediatrician at John Muir Medical Center in Walnut Creek, Calif. “Typically, no one is going to admit that they were raped. Victim-blaming is the norm.” Sinclair and his wife, Lee, co-founded No Means No Worldwide and have developed sexual-assault prevention curricula for several audiences in Kenya, including self-defense programs for girls and women, and educational programs to help boys recognize the harm inflicted by sexual assault.
The subjects of the study were 522 high school girls, ages 14 to 21, in two impoverished Nairobi slums: 402 received 12 hours of self-defense training over six weeks, as well as two-hour refresher courses at three-, six-, nine- and 10-month intervals; 120 in a comparison group received a one-hour life-skills class that is the current national standard in Kenya. Before and 10 months after the training, both groups answered anonymous questionnaires about their recent experiences of rape.
At the start of the study, nearly one in four girls reported that they had been forced to have sex in the prior year; 90 percent of the victims knew their attackers. The study focused on rape and did not assess the entire range of behaviors classified as sexual assault under U.S. laws.
Among girls who received self-defense training, 56.4 percent used the skills they learned to fend off attackers in the subsequent 10 months. Of these girls, half used verbal skills alone, one-third started with verbal skills and added physical skills, and 17 percent used physical skills alone. Not only did total assaults drop sharply, but assaults by the two most common groups of perpetrators, boyfriends and relatives, decreased significantly. After receiving training, girls who were raped were more likely to seek help following an attack.
In contrast, among girls who had life-skills classes, the proportion who became victims of rape remained about the same.
“We were pretty stunned that the self-defense training was so effective,” Sinclair said. “From the testimonials we collected, we saw that even a small girl could disable an attacker and get away, again and again.”
The self-defense classes, which trained and employed local Kenyan women as instructors, were also cost-effective: Providing the training cost $1.75 per student, whereas immediate after-care for rape in Kenya costs $86, a figure that does not account for long-term costs such as new HIV infections or unwanted pregnancies.
No Means No Worldwide is now testing the effectiveness of their curriculum for boys, which focuses on teaching them not to perpetrate sexual assault. They are also working to disseminate the girls’ self-defense curriculum more widely.
“Often, people focus on women as victims,” said Cynthia Kapphahn, MD, a clinical associate professor of pediatrics at Stanford and an adolescent medicine specialist at Packard Children’s who was also an author of the study. “This work shows that it’s also important to focus on them as empowered beings; that approach can have an important role in a woman’s ability to protect herself.”
The study was funded by Ujamaa-Africa, a nongovernmental organization that promotes health, personal security and economic empowerment for vulnerable women and children.
Stanford Medicine integrates research, medical education and health care at its three institutions - Stanford University School of Medicine, Stanford Health Care (formerly Stanford Hospital & Clinics), and Lucile Packard Children's Hospital Stanford. For more information, please visit the Office of Communication & Public Affairs site at http://mednews.stanford.edu.