Review: "Efficacy of Sexual Assault Resistance Program for University Women"

By now you may have heard of the new study published in the New England Journal of Medicine: “Efficacy of a Sexual Assault Resistance Program for University Women”.  The study finds that women who attended a sexual assault resistance program reported about 50% reduced incidents of rape during follow up.

 

You might have heard about this study by some article claiming that “teaching women self-defense is the best method to reduce rape”.  This is untrue.  From a public health perspective, the best method to prevent any kind of public health problem is one that not only addresses the problem but also addresses it equitably, justly, and with respect to the population it is targeting.  In this case, teaching women self-defense and skills to identify potential assailants does prevent them from becoming victims (key word *them*), however it does not prevent perpetrators of sexual violence from committing rape.

 

The study itself admits that this is a flaw, but leaves open the possibility that this strategy could be used in conjunction with programs that seek to educate men (largely the perpetrators of sexual violence) about how to talk to/stand up to friends and be active bystanders.  However, is it likely that schools would implement both programs?  Everything costs money, and given that schools have a responsibility to protect their students, it seems possible that when trying to decide which expensive program to implement they would go for the one that prevents the most rape.  Administrators are not public health experts (always).

 

There exists an important distinction between saying “women who attended the program reported 50% reduced incidents of rape” and “the program reduces rape victimization by 50%”.  The program itself doesn’t actually prevent rape, but rather insures that participants aren’t the victim of rape.  Now, let’s consider three facts:

1.      There is no reason to expect that the number of any potential rapists at any of the schools changed (increase or decrease).

2.      The control and intervention groups existed on the same campus, meaning that some group of women at University X had the training, and others at University X had the control.

3.      Many perpetrators of sexual violence are repeat offenders.  According to the work of David Lisak, many college aged rapists are responsible for an average of 6 total rapes.

It seems quite possible then that the rapes that would have happened to the intervention group simply happened to the control group.  Thus the actual frequency of rape may not have been affected (the authors don’t seem to make a specific reference to the total number of rapes that occurred on campus during their study).   

 

It is also worth noting that his potential displacement could skew that data to make it look like the intervention is more effective than it actually is.  Say for instance that the true number of sexual assaults on campus without an intervention is something like 25%.  However, with the introduction of the intervention, the number is displaced for the experimental group onto the control group.  The researchers assume that the control group at follow up is similar to baseline, but with displacement the rate rises.  Thus the control group follow-up and thus assumed baseline is 30%.  Thus any intervention’s effect is magnified.  As I read the study, I find no reference to the number of reported rapes per year per institution.  According to 1 in 4, roughly 5% of womenreport surviving rape or attempted rape at college every year.  The study found that among the control group, 9.8% experienced completed rape.

 

Let’s say that again, because its important.  We would expect 5% of women who receive that status quo to experience rape or attempted rape (more inclusive).  The study found that almost 10% of women during the study period experienced completed rape (less inclusive).

 

Now take this information and applying it to our previous conversation about what colleges tend to or are able to do.  Is a college likely to implement a 4 session program for all women on campus?  Maybe, but if not, there could be a huge displacement issue.

 

I think the idea of empowering women to protect themselves against violence is a good one.  And while the jury is still out in terms of its efficacy, I believe it is clear that resistance programs are not the equitable, feasible, or just response to the problem of sexual violence.