Integrating Human Rights and Public Health to advance research on sexual violence

Guest blog post by Carlene McAvoy, Glasgow Caledonian University. 

This post is part of a series of guest blog posts written by PhD researchers and SHRC’s LLM Human Rights Dissertation Placement Student who took part in our Human Rights Research Knowledge Exchange Showcase last year. 

Gender Based Violence (GBV) is a global and pervasive public health issue as well as a violation of human rights. Estimates suggest that globally one in three women have experienced physical and/or sexual violence in their lifetimes[1]. Across Europe, at least one in six women have been raped and in 2023/24[2] there were, on average, 21 rape and/or sexual assaults every day in Scotland.[3] Some of these figures are likely underestimations as it is known that many survivors do not report their experiences to police.[4], [5] The real figures may therefore be much higher with the World Health Organization referring to GBV and Violence Against Women (VAW) as a ‘problem of pandemic proportions’.[6] This short blog will consider GBV, in particular sexual violence, and focus on research that is being completed in Scotland using both a human rights and a public health approach.

GBV and sexual violence are issues that are likely to have affected every woman at some point in their lives. Whether they have directly experienced sexual violence themselves or know a friend or family member that has. With GBV comes a myriad of consequences – not least of which is a gross violation of human rights. GBV directly undermines Article 1 of the Universal Declaration of Human Rights (UDHR)[7] – the right for equality and freedom from discrimination. It also violates several other UDHR Articles including:

  1. The right for equality and freedom from discrimination (Article 1)
  2. The right to life, liberty and security of person (Article 3)
  3. The right not be tortured or treated in an inhumane or degrading way (Article 5)
  4. The right to equal protection under the law (Article 7)
  5. The right to equality in the family (Article 16)
  6. The right to an adequate standard of health and well-being, including access to medical care (Article 25).

A key cause and consequence of GBV is gender inequality which is a violation of Article 1 and has been highlighted as a key target for prevention and response under goal number five of the Sustainable Development Goals.[8] The Sustainable Development Goals are a global call to action, an agenda for the world to pursue global peace and prosperity. Goal number five aims to ‘achieve gender equality and empower all women and girls’. Many targets are provided to help achieve this goal including a specific target for countries to ‘eliminate all forms of violence against women and girls’. GBV undermines these goals as well as the UDHR and can have a myriad of consequences both for the individual and for society at large. 2025 is a pivotal year as we see the 30th anniversary of the Beijing Declaration and Platform for Action Approaches.[9] This declaration, passed back in 1995 by the United Nations, provided a comprehensive plan to achieve the equal rights of women and girls. Its anniversary stands as a reminder of how far equality has come as well as how much more still needs to be achieved.  Additionally, only five years remain on the Sustainable Development Goals agenda and although some progress has been made, the United Nations has warned that insufficient progress has been made and the issue must be urgently prioritised.[10]

Progressive work and research have been achieved in the fields of justice to help women access and exercise their legal rights in regards to sexual violence (9,10). However, much less attention has been paid to the health sector and the right to access medical care and support (Article 25). This is important because sexual violence and other forms of GBV can and often do result in negative health outcomes. Although not an exhaustive list such outcomes can include: sexually transmitted diseases, pregnancy, health outcomes affecting the brain and nervous system, gastrointestinal system, reproductive system and musculoskeletal system.[11],[12],[13],[14] Psychological outcomes can include: anxiety, depression, post-traumatic stress disorder, suicide ideation, alcohol and drug abuse, eating disorders and sleep deprivation.[15],[16],[17],[18],[19] Without appropriate access to healthcare to treat these outcomes, the right to health and wellbeing is being undermined.

Access to healthcare is a human right but our understanding of access to such care, after an experience of sexual violence, is limited. Some research has been completed in North America, but very little is known about how survivors experience, access and interact with healthcare in the UK and in Scotland. Limited data provides some very basic insights that general disclosure to healthcare in Scotland is low – at 17.9 per cent but no further attention or research has been completed to elaborate or understand this further. [20] To advance this, a PhD study at Glasgow Caledonian University is being undertaken to specifically focus on this topic and is therefore timely in order to advance such understandings. Funded by the Scottish Graduate School of Social Science, the research focuses on those who have experienced sexual violence and their disclosure experiences to healthcare. Importantly, the research acknowledges that not all experiences are the same – survivors are likely to experience healthcare disclosure and help-seeking differently and for some, additional barriers linked to structural inequalities may make disclosure harder. Using an intersectional lens, and a qualitative approach, the research targets those traditionally less heard in order to amplify their voices and their experiences. Although the research will be open to all women in Scotland, it aims to recruit a number of women from working class backgrounds as well as, for example, women from different ethnic backgrounds. Qualitative interviews are being used to generate focused narratives around women’s decisions to disclose as well as the responses to those disclosures from healthcare professionals. Not only will this promote a human rights approach to research through focusing on epistemic justice, it will also uncover more diverse understandings of survivors needs and motivations for seeking help and accessing healthcare. This, in turn, could help build the need for future research and for more inclusive health interventions.

Given the concerns raised by the United Nations on the insufficient progress made in GBV,[21] the issue must be urgently prioritised globally and within Scotland. A vast number of women in Scotland experience sexual violence every day and the experience can affect and impact their health and wellbeing outcomes. Understanding the views of survivors and how they access healthcare will provide much needed insights linked to their fundamental human right to access healthcare. With five years remaining on the Sustainable Development Goals agenda, all sectors must support and prioritise the issue. Improving healthcare needs and access supports these global goals and crucially, gives the opportunity for the improvement of health and wellbeing outcomes for women in Scotland. At its core, this research will help to amplify the experiences of survivors in Scotland because their experiences and their voices deserve to be heard.

Endnotes

[1] World Health Organization. Global and regional estimates of violence against women [Internet]. 2013 [cited 2022 Oct 14]. Available from: https://www.who.int/publications-detail-redirect/9789241564625

[2] European Union Agency for Fundamental Rights, Eurostat and European Institute for Gender Equality. EU Gender-based Violence Survey. Publications Office of the European Union [Internet]. 2024; Available from: https://fra.europa.eu/sites/default/files/fra_uploads/eu-gender_based_violence_survey_key_results.pdf

[3] Scottish Government. Recorded Crime in Scotland, 2023-24. 2024 [cited 2024 Sep 20]; Available from: https://www.gov.scot/binaries/content/documents/govscot/publications/statistics/2024/06/recorded-crime-scotland-2023-24/documents/recorded-crime-scotland-2023-24/recorded-crime-scotland-2023-24/govscot%3Adocument/recorded-crime-scotland-2023-24.pdf

[4] Decker MR, Holliday CN, Hameeduddin Z, Shah R, Miller J, Dantzler J, et al. “You Do Not Think of Me as a Human Being”: Race and Gender Inequities Intersect to Discourage Police Reporting of Violence against Women. J Urban Health. 2019 Oct;96(5):772–83.

[5] Sabina C, Ho LY. Campus and College Victim Responses to Sexual Assault and Dating Violence: Disclosure, Service Utilization, and Service Provision. Trauma, Violence, & Abuse. 2014 Jul;15(3):201–26.

[6] World Health Organization. Violence Against Women Prevalence Estimates 2018: Global, Regional and National Prevalence Estimates for Intimate Partner Violence Against Women and Global and Regional Prevalence Estimates for Non-Partner Sexual Violence Against Women. Executive Summary. 1st ed. Geneva: World Health Organization; 2021. 1 p.

[7] United Nations General Assembly. OHCHR. 1993 [cited 2022 Dec 8]. Declaration on the Elimination of Violence against Women. Available from: https://www.ohchr.org/en/instruments-mechanisms/instruments/declaration-elimination-violence-against-women

[8] United Nations. United Nations Sustainable Development. 2024 [cited 2024 Dec 23]. Goal 5:  Gender equality and women’s empowerment. Available from: https://www.un.org/sustainabledevelopment/gender-equality/

[9] United Nations. United Nations. United Nations; 1995 [cited 2025 Mar 14]. Fourth World Conference on Women. Available from: https://www.un.org/en/conferences/women/beijing1995

[10] United Nations. The Sustainable Development Goals Report 2023: Special Edition [Internet]. United Nations; 2023 Jul [cited 2024 Dec 23]. Available from: https://www.un-ilibrary.org/content/books/9789210024914

[11] Brookmeyer KA, Beltran O, Abad N. Understanding the Effects of Forced Sex on Sexually Transmitted Disease Acquisition and Sexually Transmitted Disease Care: Findings From the National Survey of Family Growth (2011–2013). Sexual Trans Dis. 2017 Oct;44(10):613–8.

[12] Basile KC, Smith SG. Sexual Violence Victimization of Women: Prevalence, Characteristics, and the Role of Public Health and Prevention. American Journal of Lifestyle Medicine. 2011 Sep;5(5):407–17.

[13] Black MC. Intimate Partner Violence and Adverse Health Consequences: Implications for Clinicians. American Journal of Lifestyle Medicine. 2011 Sep;5(5):428–39.

[14] World Health Organization. Guidelines for medico-legal care of victims of sexual violence [Internet]. World Health Organization; 2003 [cited 2022 Oct 14]. Available from: https://apps.who.int/iris/handle/10665/42788

[15] Campbell R, Dworkin E, Cabral G. An Ecological Model of the Impact of Sexual Assault On Women’s Mental Health. Trauma, Violence, & Abuse. 2009 Jul;10(3):225–46.

[16] Krug E, Dahlberg L, Mercy J, Zwi A, Lozano R. World report on violence and health [Internet]. World Health Organization, editor. Geneva: World Health Organization; 2002 [cited 2023 Sep 23]. Available from: http://apps.who.int/iris/bitstream/handle/10665/42495/9241545615_eng.pdf?sequence=1

[17] Jordan CE, Campbell R, Follingstad D. Violence and Women’s Mental Health: The Impact of Physical, Sexual, and Psychological Aggression. Annu Rev Clin Psychol. 2010 Mar 1;6(1):607–28.  

[18] Groff Stephens S, Wilke DJ. Sexual violence, weight perception, and eating disorder indicators in college females. Journal of American College Health. 2016 Jan 2;64(1):38–47.

[19] Jina R, Thomas LS. Health consequences of sexual violence against women. Best Practice & Research Clinical Obstetrics & Gynaecology. 2013 Feb;27(1):15–26.

[20] Scottish Government. Scotland’s Gender Equality Index 2023 [Internet]. 2023 [cited 2024 Sep 10]. Available from: https://www.data.gov.scot/genderindex/gender-equality-index-2023.html#11_women-specific_healthcare_domain

[21] United Nations. The Sustainable Development Goals Report 2023: Special Edition [Internet]. United Nations; 2023 Jul [cited 2024 Dec 23]. Available from: https://www.un-ilibrary.org/content/books/9789210024914