A review of the evidence from developing countries

Although there is increasing evidence of risky consensual sex among young people in developing countries, non-consensual sexual experiences among them have rarely been studied and few interventions have been designed to protect them from the risks of such experiences. However, what is available suggests that coercion and unwantedness may play a considerable role in the sexual relations of young people — girls and young women but also boys and young men. The implications of non-consensual sexual experiences for young people’s rights, their health and development and the risks they pose in the transition to adulthood are enormous. This review collates what is known about non-consensual sexual experiences of young people — those aged 10–24 — in developing countries, synthesises from this a profile of the magnitude and correlates of sexual coercion, and draws lessons for the implementation of appropriate programmes. Notwithstanding significant methodological limitations, the few available studies provide several common insights and have suggested that although definitions, study populations and study designs may differ, making comparison difficult, nonconsensual sex is indeed experienced by disturbing proportions of young people in all settings from which data were drawn. Non-consensual sex is experienced largely by girls and women, but also by boys and men. While studied largely among the unmarried, there is evidence that it is commonplace among married couples as well. It occurs largely among individuals who are acquainted with each other. It covers a continuum of behaviours ranging from unwanted verbal advances to unwanted touch to assault and forced sex, as well as sex in exchange for money, gifts, food or protection. The consequences of sexual coercion are formidable: they are short and long-term; and have physical, psychological and social effects. Sexual health manifestations range from unintended pregnancy, abortion and infection to risk-taking behaviours, including early onset of consensual sex, multiple partner relations and non-use of condoms. Psychological outcomes range from symptoms of anxiety and depression to suicide attempts. School performance can also be affected. A number of obstacles inhibit adolescents from protecting themselves from non-consensual sexual relations and from taking action against a perpetrator or to withdraw from a coercive relationship. Gender double standards and expectations of women and men in the sexual arena dominate these obstacles. Communication and negotiation on sexual matters, moreover, tend to be difficult and are often replaced by actions that include force and violence to resolve differences. The lack of a supportive environment and trusted adults and peers to consult on sexual health matters may also enhance young people’s (and particularly young women’s) vulnerability to coercive sexual relations. And finally, perceptions of institutional indifference — at the community, school, crime and health sector levels — can inhibit help-seeking both among victims as well as others who may wish to seek counselling on how to confront a potentially threatening situation. We conclude with a discussion of programmatic and research priorities.