Perception and Utilization of Health Care Services by
Women Survivors of Childhood Sexual Abuse: A
Preliminary Study
by Tuula Heinonen, Anne Merrett-Hiley,
Lynn McClure, Sari
Tudiver and Christine Kreklewetz
The prevalence of childhood sexual abuse (CSA)
amongst women particularly, has been described as
"shockingly frequent". For some time health care
providers and researchers have been aware of the
lengthy emotional and physical effects from childhood
abuse but there has been very little information
regarding survivors' experience when looking for, and
using health care services. As a result of comments
made by some women survivors of CSA attending a
primary health care centre care centre, it appears
that many survivors avoid health care until it is
absolutely necessary. There are many similarities
between childhood abuse and interactions in the health
care system. These can include being left alone with a
person of greater power, feeling without control, and
anxious about examinations or tests that may be
painful and/or upsetting. Often the client is
undressed, lying on an examination table while the
doctor or health care provider stands above her,
clearly in control. Not only can health care
interactions difficult for some women there are also
challenges for the health care providers who
frequently are not aware of, or prepared for a woman's
story of CSA.
This research project asked eleven women about their
experiences in seeking and using health care resources
from a variety of health care practitioners and
facilities (doctors, nurse practitioners, dentists,
physiotherapists, hospital laboratories etc.). All the
women interviewed, ranging in age from 25 to 40 years
of age, had received counselling therapy due to their
background of CSA, and expressed a willingness to talk
about their health care experiences. Questions were
asked regarding each woman's individual health
background, and important life events such as the beginning of
menstruation, childbirth, breast feeding, parenting,
and any concerns about menopause. The link between the
childhood abuse and health was explored for each woman
and considerable attention was given to the nature of
the interactions these women had with health care
services. We were interested in hearing about positive
experiences that might be helpful for other women and
their health care providers. Specific questions were
asked about telling your doctor ( or other health
care person) that you have a history of abuse, when
and how this should be enquired about by a care
provider, and what type of response would be
considered as supportive and helpful.
The women participating in this study suggested
several recommendations that would improve health for
all women, and especially those who have a history of
CSA. These fall under three main categories: 1)
structural/procedural changes in health care
environments; 2) coordination and information about
health resources and 3) education and awareness for
health providers who care for women, particularly
sexual abuse survivors. This exploratory study
demonstrates that for some women survivors of CSA,
'confronting their demons' with support can be a
positive liberating experience. The recommendations
provide a starting point for health care providers and
administrators to consider when developing improved
services for women survivors of CSA.
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