Sexual violence and rural health

Sexual violence affects all people, but it does not impact all people equally. Women living in rural and regional areas are more likely to experience interpersonal violence, including sexual violence, than those living in urban or suburban settings. Their experience of violence is also more likely to be severe, with higher rates of hospitalisation.

The experience of violence by women living in rural and regional areas is similar to that of women living in other areas, in that it is driven by gender inequality and impacts health directly and indirectly across the lifetime and across generations. However, there are some particular aspects in the experience of violence for women in rural and regional areas.

Isolation is a risk factor for serious harm; no one to hear, see or intervene when violence occurs. It can be harder to phone for help and can take the emergency services (much) longer to reach the victim. There may be no support structures nearby that can help them to escape, such as accommodation, transport, health, legal, psychological and social supports. These difficulties are compounded for those from diverse groups such as recent immigrants, the LGBTIQ+ community or male victims.

Barriers to leaving may be overwhelming. To leave a relationship may mean that the victim needs to leave the town or station where they live. In the Indigenous context, this may mean leaving family, culture, language and country for a place where they do not feel they fit in. Additional barriers include fear of authority and institutions, with fear of removal of their children or grandchildren typically uppermost. On a station, where assets are typically tied up in complex intergenerational trusts, leaving a relationship may mean walking away from an inheritance and future income for someone with a limited skill set. Fear of family condemnation or reprisal from the perpetrator’s family should not be dismissed and occurs across most rural cultures.

Notions of gender roles, self-reliance and privacy can be pronounced in rural and remote communities. This may mean that the victim can take longer to recognise the violence as wrong and not their fault, posing additional barriers to seeking help. Gossip and lateral community violence can compound the harm from violence within intimate relationships. Importantly, a lack of privacy (actual or perceived) can extend directly to engagement with healthcare professionals. Access to firearms and other weapons can increase the risks from, and fears of, violence. Rural and regional communities are also more likely to be adversely affected by natural disasters, which are in themselves risk factors for violence and cause damage to infrastructure, communications and services. Social structures related to other forms of diversity may also be more rigidly applied, and discriminatory, compounding the effects for people from diverse communities, such as the LGBTIQ+ community.

Healthcare practitioners must have an awareness of, and sensitivity to, the unique risks and impacts and understand the referral options. Considerations include an awareness of privacy and confidentiality and a requirement to address these directly with patients.

Practitioners need to have a sense of self and be aware of their own sensitivities when managing patients who have experienced violence. They need to be mindful of self-care and vicarious trauma and risks to themselves when working in remote and regional settings.

Healthcare practitioners are uniquely placed to play an important role in awareness, prevention, intervention and treatment of sexual violence in the community. Professional networks can also strengthen the practitioner’s capacity to respond and refer and may be an important element in their own support and welfare.

There are national and local services, including 1800RESPECT, that can provide information.

To register for free CPD-accredited training on responding to adult patients who have experienced sexual violence go to: www.monash.edu/medicine/sphpm/study/professional-education/responding-to-sexual-violence

This training is funded by the Australian Government Department of Social Services under the Fourth Action Plan of the National Plan to Reduce Violence against Women and their Children 2010–2022.