649

ORIGINAL ARTICLE
Frequent factors for women and children subjected to sexual assaults
presenting at Jinnah Postgraduate Medical center, Karachi
Mahjabeen Khan,1 Sina Aziz,2 Nasreen Qamar,3 Jalil Qadir Memon4

Abstract
Objectives: To determine the frequent factors in women and children subjected to sexual assaults seeking medical
care at Jinnah Postgraduate Medical Center, Karachi.
Methods: A cross sectional study was conducted in the Medico legal Department of Jinnah Postgraduate Medical
Center, Karachi, Pakistan. Sexual assault victims seeking medical care and medico legal reports from Jan 2007-June
2010 were included in the study. The sampling technique was non-probability purposive. All women were informed
regarding the confidentiality of their records and written informed consent was taken. In case of female children the
consent was taken from both parents / guardians. The data was analyzed on statistical package for social sciences
version 15.
Results: There were 180 women and children examined and interviewed after the Sexual assault. The mean age
(years) was 19.24±7.33. Mostly reported victims were raped and abused both 162 (90%) and only rape was reported
in 18 (10%).The physical, local, Abdominal and Pelvic examination showed fresh act of violence in sexual assault
victims in 83 (46.1%) cases. The sexual assault was confirmed in 75 (41.7%) cases.
Conclusion: The fresh sexual assault acts confirmed in 41 %. The frequent factors in women and children subjected
to sexual assaults were adult women (18-40 Years), two third victims brought by police after 6-24 hours of rape, 90
% reported both sexual assault and physical violence, in two third cases no weapon used and no external marks of
body injuries observed.
Keywords: Rape, Sexual Assault, Victim, Women, Children, Medicolegal. (JPMA 64: 649; 2014)

Introduction Sexual assault has been a sociocultural, legal and societal

Globally, sexual assault (rape) in women and children is a sensitive issue in all the communities. However, not all
serious health, social and religious concern, as a violation countries define sexual assault in the same way. One of
of women and children's human rights. Sexual assault is the major determinants is the definition and description
defined as any undesired physical contact of a sexual of sexual assault variations in the law, health and social
nature committed against another person.1 Sexual sectors. Child rape/ or rape occurred in victim married to
assault has a demoralizing effect on children and the perpetrator is not considered as sexual assault in
women's sexual and reproductive health. The Sexual some communities. The actual incidence of sexual assault
assault occurrences are more common in developed has been severely under-reported in most of the
countries and according to world rape statistic 2008; a developing countries with poor health care system to
woman is raped in South Africa at every 17th second. A support the sexual victims.
woman is raped every 2 minutes, according to the U.S. of Sexual assault is basically rooted in gender inequality. The
America, Department of Justice.2 According to United United Nation provides a broad framework for gender-
Nations Office on Drugs and Crime, 2012; Lesotho is the based violence (GBV). GBV is defined as any act resulting
country with the highest rate, 91.6 per 100,000 people in, physical, sexual or psychological harm or suffering to
while the rate in America is 28.6 per 100,000 people. The women, including threats of such acts, coercion or
lowest rate of sexual assault recorded is in Egypt 0.1 and arbitrary deprivation of liberty in public or private life.4,5
Armenia 0.3 per 100,000 people.3 Sexual violence against women include acts that take
place in home/community and at working places.6 The
Millennium Declaration (2000), aimed the promotion of
1School of Public Health, Dow University of Health Sciences, 2Depatrment of gender equality and empowerment of women. The
Paediatrics, Karachi Medical and Dental University, Abbasi shaheed Hospital, eighth Millennium Development Goals (MDG) is to
3,4Medicolegal Department, Jinnah Postgraduate Medical Center, Karachi, combat all forms of violence against women. This goal is
Pakistan. to implement elimination of all forms of discrimination
Correspondence: Mahjabeen Khan. Email: [email protected] against women and children. Pakistan is one of the

J Pak Med Assoc

Frequent factors for women and children subjected to sexual assaults presenting... 650
signatory but non-achievers countries of MDG.7 The Table: Characteristics of female rape victims reporting at tertiary care center, Karachi
actual and reported data is scarce for sexual assault and (n=180).
victims have not been given sociocultural, legal,
Characteristics of study subjects Number Percentage
psychological and health care support even for very few
reported cases in urban and rural areas of Pakistan. Mean Age (years)
Minimum age 5 (Years) 19.24 ±7.330
This study was conducted to determine the frequent
Duration lapsed after rape and
factors in women and children subjected to sexual reported for examination
assaults seeking medical care at Jinnah Postgraduate 1.6-24 Hrs 66 36.7
Medical center, Karachi. 2. 4 -7 days 36 20
3. 1 -2 weeks 67 37.2
Methodology 4. 1-2 months 11 6.1
A cross sectional study was conducted in the Medico legal Patient brought by
Department of Jinnah Postgraduate Medical Center 1. father 16 8.88
(JPMC), Karachi, Pakistan. Sexual assault victims seeking 2.brother 18 10
3. mother 11 6.1
medical care and medico legal reports were included in
4. relative 2 1.1
the study. The study was conducted during the period Jan 5. police 120 66.6
2007-June 2010. The sample size for the research is 180. 6. husband 13 7.22
According to the Grossin study8 at 12% of incidence Sexual assault and physical abuse
examined in emergency at 95% level of significance with 1. Rape only 18 10
margin of error at 5% the sample size was 163. The loss for 2. Both 162 90
follow-up and refusal added and the final total sample Secondary sex
1.not developed 25 13.9
size was 180. (OpenEpi, Version 3, open source calculator-
2. developed 155 86.1
SSPropor). The sampling technique was non probability Nature of injuries
purposive. Sexual assault victims were referred from 1. Nil 141 78.3
investigating police authorities. All women were informed 2. simple 33 18.3
regarding the confidentiality of their records and written 3. grevious 6 3.3
informed consent was taken. Women and children were Pelvic bimanual Examination
given full coverage for their medical management. The 1. fresh act attempt 83 46.1
informed consent for female children was taken from 2. not Virgo Intacta 97 53.9
Weapon
both parents/guardians. A structured Performa was used
1. Nil 139 77.3
for the record of the demographics and medico legal 2. sharp 17 9.4
examination report. 3. hard 24 3.3
Final Report of rape assaults
Initially women and children were physically examined; 1. confirmed rape event 75 41.7
treatment given and reports were provided for further 2. not confirmed event 105 58.3
proceedings. Women and children with stable health
status were given information regarding the study
objectives and an informed written consent was taken. Mostly rape victims were brought by police 133(73.9%).
Women and children not in stable conditions and refusing Women and children mostly reported for sexual assault
for the medical examination and informed consent were and abused both 162 (90%) and only sexual assault in 18
excluded from the study. The data was analyzed on (10%). Women had well developed secondary sex
statistical package for social sciences version 15. characters 162 (90%) as shown in Table. There was no
external body injuries observed in 141 (78.3%) cases. The
Results Physical, local, Abdominal and Pelvic examination showed
There were 180 women and children reporting at Medico fresh act of sexual assault in 83 (46.1%) cases. In more
Legal Department, Jinnah Postgraduate Medical Center than three quarter cases (77.3%) no weapon was used.
from January 2007 to June 2010. Mean age was The sexual assault was confirmed in 75 (41.7%) cases as
19.24±7.33 years. The minimum age of rape victim was 5 shown in Table. Rape and physical abuse in the form of
years. The reporting time after the event of rape varied burn and mutilation was found in 83(46%) sexual victims.
from 6 hours to 2 months. Mostly victims were examined The study reported morbidity in 3 children and 2 women.
by woman medico legal officer after 1-2 months 67 There were 13 cases brought by husband directly for the
(37.2%) and within 6-24 hours 66 (36.7%) respectively. medico legal examination and report.

Vol. 64, No. 6, June 2014

651 M. Khan, S. Aziz, N. Qamar, et al

Discussion increased length of time after the assault and

Sexual assault is a problem of all socioeconomic classes examination. The victims were brought after 1-2 weeks
and impacts the physical, mental, social, psychological 67(36.7%) and after 6-24 hours in 66(36.7%) cases. This
and spiritual health status of women and children delays the justice for the victims. Christian also reported
throughout their life. Mostly sexual assault has been the same in their study and reasoned that mostly sexually
underreported, underrated and unsupported worldwide. abused women and children were not identified
The evidence and possible legal ramifications for affected immediately after assault. The timing of the examination
women and children has not been managed properly in require provision of physical and emotional support by
legal and health care system of Pakistan. the availability of standard medical examination.12 The
minimization of time is dependent on the victims and
Mostly sexual assault victims were referred from their relatives’ decision for the timely report of sexual
investigating police authorities. Only few 09 cases were assault, police authority and role of medico legal officers
self-reported and police authorities were informed by the in collecting the evidence. After the sexual assault the
medico legal department. The medical report and medico legal examinations has been focused on specific
chemical analysis confirmed sexual assault in 75(41.7%) hymenal findings that suggest a child/woman has been
cases only. sexually abused. The healing of genital injuries may occur
All sexual assault victims were seen by the senior women before the medico legal examination. Therefore the
medico legal officers in emergency room of JPMC. The interpretation of medical findings may be
history taking, physical examination, evidence of difficult/misguided.13-15
chemical and pathological sample collection, medical Several studies have found that the physical evidence of
treatment, and appropriate follow-up were provided at trauma was neither predictive nor essential for conviction;
JPMC on behalf of Government of Sindh, Health therefore non-medical evidence must be collected by the
Department. Grosin also analyzed 418 cases of sexual medical examiner. The medico legal report should be an
assault and found that victims had different instrument to explain the presence or absence of physical
characteristics according to the time between the sexual findings. The significance of discrepancies between an act
assault and the examination similar to our analysis.8 of assault and clinical findings require careful
Medical management of the sexually assault victims evaluation.16-18
needs both physical and psychological support in
emergency room. Mostly the victims were brought by police 120(66.6%),
brother 18(10%) and husband 13(7.22%). The study found
The place of the sexual assault occurrence was not that trauma may range from minimal physical injury to
reported in the medico legal forms. The gap between the death particularly as seen in other developing countries.19
medical and crime scene evidence to establish the final
report require joint investigation by the prosecution to The key part of the medical assessment of an act of sexual
provide justice to the victims. This study showed that assaulted child is the medical history which requires a
weapon used for harassment and physical abuse was nonjudgmental approach by the woman medico legal
sharp in 17(4.4%) and hard in 24(3.3%) cases. On medical officer.20 In this study medical history has been taken in
examination there was simple injury in 33 (18.3%) and detail and physical examination has been conducted in
grievous in 06(3.3%) cases. There was no injury in emergency department with the collection of maximum
141(78.3%) sexual assault victims however, the absence of evidence at the time of examination.
injury does not exclude the possibility of sexual act,
In Pakistan there is absence of legal definitions regarding
whether with or without consent.9 Saint Martin analyzed
Child Sexual Assault and accompanying laws. The true
that the medico-legal findings were associated with
prevalence and incidence rates lacks in literature. This
conviction of the assailant. The presence of general body
social issue is sensitive and difficult, but certainly not
and/or genital trauma was not associated with
impossible.21
conviction10,11 similar to our study.
The definition of sexual assault provided by the World
The minimum age of sexual assault victim was 5 years.
Health organization (WHO) seems to be more
This study revealed morbidity in 3 children and 2 women
comprehensive and unambiguous. The accepted
due to haemorrhage.
definition is "the involvement of a child in sexual activity
The frequent factors in this study found were time of that he or she does not fully comprehend, unable to give
medical examination after the sexual assault and informed consent, or else act that violates the laws or

J Pak Med Assoc

Frequent factors for women and children subjected to sexual assaults presenting... 652
social taboos of society.22 MA, et al. Risk factors for femicide in abusive relationships: results from
a multisite case control study. Am J Publ Health 2003; 93: 1089-97.
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Med 2006; 13: 172-80.
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Vol. 64, No. 6, June 2014