Perception and Utilization of Health Care Services by Women Survivors of Childhood Sexual Abuse:

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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.