Violence and rape in Norway. A national prevalence study with a life course perspective.

Background

Violence in close relationships is a burden to the individual and to society. The use of violence is prohibited by Norwegian law and in conflict with human rights. Physical violence and sexual abuse, as well as psychological violence, have negative consequences in terms of health, social relationships and societal costs. 

In the Government’s Report no 15 (2012 – 2013) to the Storting (The Norwegian Parliament): «Forebygging og bekjempelse av vold i nære relasjoner – Det handler om å leve» (Prevention of and fight against violence in close relationships – It’s all about living , authors translation) it is concluded that more knowledge is needed about the prevalence of violence in close relationships in Norway. 

In the Governmental action plan « Vendepunkt – Regjeringens handlingsplan mot vold i nære relasjoner 2008 – 2011» («Turning point – the Government’s plan of action against violence in close relationships 2008 – 2001», authors translation), the Norwegian Center for Violence and Traumatic Stress Studies was given the responsibility to conduct a prevalence study of violence in Norway. This report presents the results of that study. The study was approved by the Regional Committee for Medical and Health Research Ethics. 

Methods

This is a cross-sectional study of Norwegian men and women from 18 to 75 years of age. Structured phone interviews were conducted during spring 2013. Altogether, 2435 women and 2092 men participated. Of those we were able to reach by phone, 42.9% accepted participation (45.0% women and 40.8% men). The telephone interview comprised direct and behaviorally specific questions about violence and assault in childhood and adulthood, as well as mental health and sociodemographic information.

Telephone interviewing was chosen partly because this procedure allows for follow- up questions for those who report exposure to violence. Telephone surveys on violence have been performed for several years in other countries, but has until now not been used in Norway. IPSOS MMI conducted the telephone interviews. More than 90% of the study participants were willing to be contacted again, with no significant difference between those exposed to violence and the non-exposed. This indicates that the procedure was acceptable for participants. Nevertheless, a system to take care of individuals who may be in need of support after completing the interview is required. In accordance with studies from other countries, we found that few individuals needed or wanted such assistance, but for those who did need it, a follow-up system is important. In this study, the interviewers referred individuals in need of follow-up to the Center for Stress and Trauma Psychology in Oslo.  

Results

Sexual violence

Rape ?

• The prevalence of lifetime rape was 9.4% in women and 1.1% in men .   ?
• Half (49%) of the women who reported rape had been raped before the age of 18.   ?
• There was no indication that rape of young women had decreased over time. As many young as older women reported rape before the age of 18.   ?
• Many of the women who reported rape had been afraid of being severely injured or killed (44%) or were physically injured (29%). 
• Only a few of the women who reported rape had got a medical examination or treatment the first following weeks (11%), and almost a third (29%) had never told anyone about the rape.  

Sexual assault before the age of 13

This study included a question about sexual contact before the age of 13 with a person at least five years older, and follow-up questions to determine if this sexual contact included intercourse, oral sex or anal sex.  ?

• The prevalence of any sexual contact before the age of 13 with a person at least five years older was 10.2% for women and 3.5% for men. 
•  4.0% of women and 1.5% of men reported sexual contact  before the age of 13 that included intercourse, oral sex or anal sex. 
• The median age for sexual contact before the age of 13 that included intercourse, oral sex or anal sex was 8 years.   ?
• One out of four of those abused had never told anyone.  

Sexual assault: Relation to perpetrator ?

• The perpetrators of sexual assault against women were almost exclusively male. Most sexual assaults against men were also perpetrated by men.    ?
• The vast majority of victims knew the perpetrator.   ?
• Both rape and sexual assault before the age of 13 occurred in a variety of social relationships. 
• The perpetrator of rape was most often a friend, an acquaintance, a neighbor, a colleague, or a current or previous romantic partner. The perpetrator of sexual assault before the age of 13 was most often a neighbor, an acquaintance, or family members other than parents or step parents.  

Other sexual assaults ?

• The study included questions covering lifetime exposure to a) touching of genitalia by use of force or by threatening to harm, b) sexual assault when the person was incapable of consenting or stopping it (intoxicated assault),  c) being pressured to sexual acts, and d) other forms of sexual offences or abuse.   ?
• 25.4% women and 8.8% men reported at least one of these four categories of sexual assault/abuse.   

Altogether, one third of the women (33.6%) and one tenth of the men (11.3%) reported some form of sexual abuse or assault lifetime (sexual assault before the age of 13, rape, touching of genitalia by use of force or by threatening to harm, intoxicated assault, being pressured to sexual acts, and/or other forms of sexual offences or assaults).

Violence from parents or parental figures in childhood

Prevalence of physical and psychological violence from parents or parental figures in childhood (parents and parental figures are called ‘parents’ in the following). ?

• More men (33.0%) than women (27.7%) reported ‘less severe’ physical violence from parents in childhood (hair pulling, pinching, slapping).  ?
• As many men (5.1%) as women (4.9%) had experienced severe physical violence from parents during childhood (hit with a fist, kicked, beaten up)   ?
• More girls (15.4%) than boys (11.2%) reported psychological violence from parents during childhood.  ?
• As many boys as girls experienced physical violence between parents during childhood (10%).   ?
• Physical violence from parents most often occurred for the first time at preschool or primary school age.   ?
• Both mothers and fathers used physical violence against their children, although fathers were reported somewhat more frequently.  ?
• Older participants reported ‘less severe’ violence from parents more frequently than did younger participants. This reduction was not as clear for severe physical violence.   

Physical violence in adulthood

Prevalence of ‘less severe’ and severe physical violence  ?

• A similar proportion of women (5.0%) and men (6.0%) reported ‘less severe’ physical violence the last 12 months (slapping, hair pulling, scratching, pinched hard). Younger men and women were more frequently exposed than older men and women.  ?
• More men (45.5%) than women (22.5%) had experienced severe physical  violence at least once after the age of 18 (hit with a fist or an object, kicked, strangled, beaten up, threatened with a weapon, or attacked physically in other ways).
• 13.9% men and 11.2% women had at least once after the age of 18   experienced severe physical violence where they were afraid of being severely injured or killed.
• Severe violence did occur in many different social relationships. More women than men experienced severe violence from a romantic partner or ex- partner, but many women also experienced severe violence from customers, patients, or clients. Men were more often victims of physical violence from strangers, from friends, acquaintances, neighbors, and colleagues.   

Physical violence in intimate relationships ?

• As many men (16.3%) as women (14.4%) reported ‘less severe’ physical violence from a romantic partner/ex-partner lifetime (pinching, scratching, hair pulling or slapping).  ?
• More women (8.2%) than men (1.9%) had been exposed to severe physical   violence from a romantic partner/ex-partner (kicked, strangled, beaten up). 
• Two thirds both of male and female victims of severe violence from a partner/ex-partner were also exposed to controlling behavior from a partner or ex-partner. 

Stalking  ?

• All types of exposure to stalking behavior were reported more frequently by women compared to men.   ?
• 41.7% women and 30.3% men reported exposure to any type of stalking lifetime.  

Exposure to more than one type of violence ?

• There was a substantial overlap between the various types of violence in childhood. For example: 70% of women who reported physical violence from parents in childhood also reported psychological violence from parents. The corresponding figure for women not exposed to physical violence from parents in childhood was 11.5%.    ?
• Almost half of those who had experienced severe physical violence from parents in childhood also reported physical violence between parents.
• There was a large overlap between physical and/or sexual abuse in  childhood and physical and/or sexual abuse in adulthood. For example: One out of three women (31.9%) who were raped before the age of 18, were also raped as adults. Amongst women not raped before the age of 18, only one in twenty (5.3%) reported rape as an adult. 
• Women reported overall more violence and abusive events than men.  

Exposure to violence and sociodemographic factors ?

• Marital status: Among both men and women, the highest lifetime prevalence of severe physical violence and rape were found in those who were separated or divorced at the time of the interview.    ?
• Education: The prevalence of severe physical violence did not differ between education levels. Women with a high education had a lower prevalence of rape compared to women with a low education.   ?
• Perceived financial situation. Severe physical violence as well as rape occurred more often with individuals who perceived their financial situation as poor. 
• Area of residence: There were no clear geographical patterns in exposure to severe physical violence or rape, neither for women nor for men. Please note that this study only had data on current place of residence. 
• Ethnic minorities are underrepresented in the current study. We cannot describe potential differences in violence exposure between ethnic groups due to small numbers.   

Exposure to violence and mental health ?

• Individuals who were exposed to severe violence and/or rape reported more mental health problems compared to those who were not exposed.   ?
• There was a clear dose – response relationship between the number of violence categories experienced and mental health problems for men and women alike. 
• The increased level of mental health problems in individuals exposed to violence and abuse was observed both for posttraumatic stress reactions and general mental health problems.

Experiences with the court system

Only a small minority of rape cases were known to the police. The proportion of cases known to the police was somewhat higher for severe physical violence.  ?

• 10.5% of the 229 women who experienced rape, reported the case themselves to the police. In total, 17.5% of the cases were known to the police.   ?
• Four of the 24 men who experienced rape reported the case themselves to the police. In total, five cases were known to the police.   ?
• 26.3% of the 548 women who had experienced severe physical violence after the age of 18 reported the case themselves to the police. In total, 32.5% of the cases were known to the police.   ?
• 26.0% of the 928 men who had experienced severe physical violence after   the age of 18 reported the case themselves to the police. In total, 37.4% of the cases were known to the police. 

Conclusions  ?

• Severe physical violence and sexual abuse are prevalent in the Norwegian population, and often occur for the first time at an early age.    ?
• Women are far more exposed to sexual abuse than are men. Women also seem to have a heavier total burden of violence and sexual abuse.   ?
• Perpetrators of sexual abuse are almost exclusively men.   ?
• Violence – exposed  children are often subject to several different types of abuse.
• Individuals who experienced violence or sexual abuse in their childhood were much more likely also to experience violence or sexual abuse as adults.   ?
• The results indicate a reduction over time in physical violence against  children. However, the data did not indicate any reduction over time in rape against young women.  
• Physical violence and rape varied with socioeconomic factors. 
• Physical violence and rape were associated with mental health problems, and constitute serious public health problems. Physical violence and sexual abuse are probably more important for women’s health, because women are exposed to a heavier burden of violence and abuse than are men.   ?
• Rape and physical violence are still hidden. Few seek medical attention, few report the case to the police, and some never tell anyone.