By Misty Pratt

Worldwide, it has been estimated that one-third of women have experienced sexual violence from an intimate partner, and seven percent have been sexually abused by non-partners. Although women experience the highest rates of sex and gender-based violence, there is still a lack of knowledge and understanding of sexual violence against boys, men, and trans or non-binary people.

Sexual assault survivors require complex and trauma-sensitive care, which can include medical, psychosocial, and legal support. “Access to urgent healthcare is especially important in some cases, especially when there are physical injuries, possible HIV exposure, or the need for a forensic evidence kit” says Dr. Kari Sampsel, Emergency Physician and Medical Director of The Ottawa Hospital Sexual Assault and Partner Abuse Care Program and assistant professor at the University of Ottawa

Unlike urgent care provided for unintentional injuries, survivors of sexual violence can be uncomfortable disclosing their assault and can have difficulty accessing specialty care services when visiting emergency departments (ED). As a result, many cases are undocumented and untreated. Of those who do seek care in the ED, two-thirds will complete a Sexual Assault Evidence Kit (SAEK) and less than one-third choose to release the kit to the police.

New data shows that healthcare crises, such as the COVID-19 pandemic, also have an impact on survivors’ access to care. In a recent study published in JAMA Network Open, administrative health data at ICES was used to track annual patterns of ED encounters for sexual assault in Ontario, Canada, from January 11, 2019, to September 10, 2021. Within that period there were 10,523 sexual assault cases, with 88 per cent among female individuals.

The authors found that ED encounters for sexual assault unexpectedly increased 20 to 25 per cent just prior to March 2020 lockdown measures, a pattern that was similar across sex, age group, community size, and income levels. Following the first lockdown, cases dropped 50 to 60 per cent and stayed below typical levels seen prior to the pandemic; however, there were seasonal patterns to ED visits, with numbers increasing over the summer months as restrictions eased.

“Rates of ED encounters for sexual assault in the two months leading up to the pandemic could reflect the increased stress in society,” says lead author Dr. Katherine Muldoon, assistant professor at the University of Ottawa, senior research associate at The Ottawa Hospital, and collaborating researcher at ICES. “We know from previous research that job insecurity, financial-related stress, and social isolation are all factors that increase the risk for violence.”

Dr. Muldoon says that the findings from this study underline the need for specialized clinics within emergency departments, where physicians and staff are trained in how to provide trauma-informed care. “Specialized clinics are the best solution for encouraging survivors to come to EDs following a sexual assault,” she says. “However, clinics need to be accessible even during healthcare emergencies, and communication should be clear that survivors can visit the emergency department despite public health restrictions,” she says.

In the province of Ontario, there are currently 37 Sexual Assault/Domestic Violence Treatment Centres, out of close to 200 emergency departments. This network of specialized clinics aims to address health, psycho-social, and forensic needs of survivors of sexual violence and/or domestic violence.

“The goal of trauma-informed care is to minimize the chance that survivors will feel re-traumatized when they seek health care,” says Dr. Kari Sampsel. “If a survivor doesn’t present for care because they think they won’t get the care they need—maybe because they can’t access a specialized treatment program, or if they think the ED is too busy—then we’re really only seeing a fraction of cases that occur in the general population.”

Survivors may choose not to seek medical care at all or will turn to community-based organizations and other non-hospital services. While these services are vital for emotional support and information, there can be long-term effects for people who have survived violence but who didn’t get the medical care they needed.

Additionally, the culture of shame, silence, and stigma around sexual assault are factors that perpetuate violence and continue to allow predators to prey on people, from children to elders. ‘Most sexual assaults are committed by a known perpetrator and this can make it harder to come to healthcare system for care if someone is still living with the perpetrator” says Dr. Muldoon.

As the province of Ontario continues to experience disruptions to emergency care and overcrowding in the ED, it is just as important as ever to improve public education and develop policies that address the barriers that survivors of sexual violence continue to face.

Misty Pratt is a Senior Communications Officer with ICES in Toronto, Ontario.