Rape Prevention Through Empowerment of Adolescent Girls

BACKGROUND AND OBJECTIVE: Sexual assault is a major cause of injury, unplanned pregnancy, HIV infection, and mental health problems worldwide. In parts of sub-Saharan Africa, sexual assault has reached epidemic proportions. This study evaluated the efficacy of an empowerment and self-defense intervention for adolescent girls to decrease the incidence of sexual assault and harassment in Nairobi’s large informal settlements. METHODS: A prospective cohort of 1978 adolescents from 4 neighborhoods near Nairobi were taught empowerment, deescalation, and selfdefense skills in six 2-hour sessions. The standard-of-care (SOC) group (n = 428) received a life skills class. Self-reported, anonymous survey data were collected at baseline and 10.5 months after intervention. RESULTS: Annual sexual assault rates decreased from 17.9/100 personyears at baseline to 11.1 at follow-up (rate ratio = 1.61; 95% confidence interval [CI], 1.26–1.86; P , .001); there was no significant change in the SOC group (14.3 to 14.0, rate ratio = 1.02; 95% CI, 0.67–1.57, P = .92). Sexual assault disclosure in the intervention group increased from 56% to 75% (P = .006), compared with a constant incidence of disclosure (53%) in the SOC group. The majority (52.3%) of adolescents in the intervention group reported using skills learned to stop an assault. CONCLUSIONS: This intervention decreased sexual assault rates among adolescent girls in Kenya. The intervention was also associated with an increase in the disclosure of assaults, thereby enabling survivors to seek care and support and possibly leading to the identification and prosecution of perpetrators. This model should be adaptable to other settings both in Africa and globally. Pediatrics 2014;133:e1226–e1232 AUTHORS: Clea Sarnquist, DrPH, MPH,a Benjamin Omondi, BS,b Jake Sinclair, MD,c,d Carolinah Gitau, BS,b Lee Paiva,e Munyae Mulinge, PhD,f David N. Cornfield, MD,a and Yvonne Maldonado, MDa aDepartment of Pediatrics, Stanford University School of Medicine, Stanford, California; bUJAMAA Africa, Nairobi, Kenya; cJohn Muir Medical Center, Walnut Creek, California; dUJAMAA United States of America, San Francisco, California; eNo Means No Worldwide, San Francisco, California; and fUnited States International University, Nairobi, Kenya