Abortion Bans Increase the Need for Survivor Support

Gov. Greg Abbott’s hollow promise to “eliminate all rapists” doesn’t reflect the cruel reality of reporting rape. The culture of dismissing and punishing survivors for reporting remains strong.

A protester carries a sign referring to Texas Governor Greg Abbott during the Women’s March and Rally for Abortion Justice in New York, on Oct. 2, 2021. (Kena Betancur / AFP via Getty Images)

In Roman mythology, the Trojan princess Cassandra, daughter of the king and queen of Troy, is cursed with making true predictions that no one believes after she rejects the sexual advances of the god Apollo. She tells the truth, but her family dismisses her as insane, locking her away. She is kidnapped during the fall of Troy, raped, forced into sexual servitude and later murdered, despite accurately warning everyone of these events.

Cassandra is brutalized several times over—first by a powerful male figure who punishes her for asserting control over her own body, then for the rest of her life as she is subjected to male violence in a society that refuses to believe and protect her.

As women rapidly lose bodily autonomy in a world that dismisses their cries against sexual violence with derision and skepticism, the myth of Cassandra remains highly relevant today.

Gov. Greg Abbott’s Misunderstanding of Rape

It is estimated that over 64,000 pregnancies have occurred as a result of rape in the 14 states with near-total abortion bans ever since the 2022 Dobbs decision that overturned Roe v. Wade, according to a study recently published in JAMA Internal Medicine. Of the 14 states studied, the five with rape exceptions have strict gestational limits and a requirement that survivors report their rape to the police.

But rape exceptions are unnecessary, declared Gov. Greg Abbott (R-Texas) defending Texas’ total abortion ban at six weeks gestation, for Texas will “eliminate all rapists from the streets.”

I find Abbott’s reasoning highly problematic. His hollow avowal to eliminate rape hasn’t borne fruit and echoes the myth that rapists are strangers to their targets, lurking in the streets, poised to attack an innocent victim. In truth, 80 percent of rapes are committed by someone known to the victim. That percentage increases among juvenile survivors of sexual violence. Of rapes reported by minors, 93 percent are committed by someone known to the victim; in 34 percent of these cases, the perpetrator is a family member.

The best thing that we as physicians can do is to believe women, holding their hands and offering our unconditional support as we guide them through the pain and connect them to the healthcare resources that suit their best interests.

Difficulty of Reporting Sexual Assault

But Abbott’s statement has another problem—it doesn’t reflect the cruel reality of reporting rape for many survivors. The culture of dismissing and even punishing survivors for reporting remains strong. 

I can speak to this culture in medicine. The reality of our attitude towards survivors of sexual violence is often diametrically opposed to our stated values of supporting and protecting them.

I recall a damning dialogue about a patient who was convicted for aggravated rape of a minor. My colleagues offered sympathy to the patient, but not to his young victim: Such a nice guy. He was probably high out of his mind and didn’t know what he was doing. This is why I tell my sons, ‘You meet a girl in a bar, make her prove her age. You gotta make them take out that ID and prove their age before you take them home, or you could end up in the same nightmare.’

When the perpetrator is one of our own, we often fail to hold them accountable and blame or silence the victim. The medical world is rife with examples of predatory physicians whose institutions protected them for decades at the expense of the patients they abused.

After I reported abuse and alleged sexual misconduct by a colleague, I was cautioned about “defaming” the individual in question, who moved on to the next level of training with no tangible consequences, despite the institution’s privately stated concerns about him.

I was told that discussing the experience might be “problematic” if the individual’s employability would be affected—as though my speaking about his alleged actions were worse than the actions themselves. Protecting his reputation was a higher priority than protecting the people he allegedly harmed.

This is an attitude that pervades our society—that the alleged perpetrator’s reputation carries more value than a survivor’s pain. This begs the question, Why would a survivor go through the pain and effort of making a report?

It is estimated that that only 21 percent of survivors report their rapes, according to the U.S. Department of Justice. Fewer of those reports will get referred to a prosecutor, and less than 1 percent will result in a felony conviction. Given the historical callousness of law enforcement towards rape survivors, including coercive interrogation tactics that often compel women to recant and overestimation of false rape allegations, it comes as no surprise that most survivors prefer not to report at all.

The Dangers of Reporting

More perniciously, survivors who report rape can easily become the targets of investigations and criminal charges themselves, the outcome of a dirty tactic common among perpetrators and enabled by our institutions that Jennifer Freyd, Ph.D., identified in the 1990s as DARVO—Deny, Attack, Reverse Victim and Offender. 

When confronted, the perpetrator will deny their actions, attack the reporter, and cast themself in the role of victim, obfuscating their victim’s report of their violence with claims that their victim was in fact the abuser. It is a tactic that I am all too familiar with, both at a personal level and as a function of my job. These efforts to undermine the victim’s credibility include insinuating that they were overreacting or misinterpreting events, suggesting that they played a role in their own attack by “provoking” the perpetrator, mischaracterizing memory lapses typical for traumatic events as lying or labeling the victim as “vindictive” or “angry.”

The gendered character attacks work. Our culture holds survivors to an impossible standard of perfection, while repeatedly offering perpetrators the benefit of the doubt. “Imperfect” victims can find themselves under more scrutiny than perpetrators.

There is no winning for the victim when the DARVO smear campaign begins. A perpetrator may declare that failure to fight back or to call the police is an indication that the victim is lying. The perpetrator, or even the justice system, may also classify fighting back as an unnecessary escalation of violence, weaponizing self-defense by a frightened victim by labeling it aggression against them. And then, they may describe the survivor’s eventual disclosure to higher authorities as “vindictive,” misogynistically painting her as a woman intent on harming his reputation and deliberately misrepresenting her desperate call for accountability. The repugnant tactics of perpetrators and their enablers in abusing and silencing their victims are seemingly infinite. 

In a world that instinctively assumes women are lying when they report rape or abuse, even after the rare instance when our justice system supports them, Abbott can never make good on his promise to eliminate rape.

Institutional Perpetuation of Rape Culture

Institutions play right into the false narrative that the survivor is lying and often further traumatize or punish her. Freyd has written extensively about institutional betrayal and its profoundly traumatizing effects on survivors. So again, with the very real threats that reporting sexual violence pose to the victim, why would a victim feel able to report?

We’re seeing this culture of victim-blaming and outright persecution play out on a larger national scale in Carroll v. Trump. After disclosing her rape by Donald Trump, E. Jean Carroll faced vitriolic personal attacks from both the former president and his supporters. Even when a civil trial concluded with the verdict that Trump had sexually abused her, Trump continued to attack Carroll’s credibility and character, claiming that she was lying to sell books and declaring her “a very sick person.” And even after the jury in the subsequent trial ordered Trump to pay $83.3 million to Carroll, Trump blames everyone but himself, even alleging that the New York jury was biased against him.

Donald Trump arrives to speak at CWA (Concerned Women for America) Summit—a right-wing women’s group—in Washington, D.C, on Sept. 15, 2023. (Mandel NGAN / AFP Getty Images)

Our justice system has sided with Carroll not once but twice at this point, and Trump has repeatedly demonstrated that he is not credible throughout the proceedings. Yet Carroll cannot escape insidious implications that she must be lying to hurt Trump politically. Headlines from Fox News characterize the verdict that held a known sexual abuser appropriately accountable for his crimes as weaponization of the justice system by Democrats. Lauren Boebert (R-Colo.) released a similar statement on X attacking Carroll and lamenting the “terrifying” precedent that the trial’s outcome has for men. And, of course, there is always someone who makes the unoriginal and misogynistic argument that Carroll is too physically unattractive to be Trump’s rape victim.

God forbid a man be held accountable for violent crimes that he committed.

In a world that instinctively assumes women are lying when they report rape or abuse, even after the rare instance when our justice system supports them, Abbott can never make good on his promise to eliminate rape. In a world in which abusers feel entitled to not only target vulnerable people, but to punish them for speaking up, we can never end violence against women and girls.

The best thing that we as physicians can do is to believe women, holding their hands and offering our unconditional support as we guide them through the pain and connect them to the healthcare resources that suit their best interests. This includes access to safe, legal abortion, a narrow avenue for recourse that recent and current GOP candidates threaten to narrow further.

But I am one doctor. There is only so much that I can do. I cannot singlehandedly change our society.

And so, the pregnancies from rape will continue. In this inhumane societal context, the message that Abbott and his ilk have sent to women nationwide is this: You may be violated in the worst possible way. If you speak out against it, you will be scrutinized and punished. Your body is not yours to control, either during the violation or in the years after. And you must accept the fate we have decided for you.

Up next:

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Chloe Nazra Lee, MD, MPH, is a resident physician in the Department of Psychiatry at the University of Rochester Medical Center in New York. Her professional interests include women’s mental health, trauma disorders, and working with survivors of abuse.