by Summer Gaines- Wheeler, SAFE/SART Policy Advocate
Socioeconomic status refers to the position of a person in society based on their income, overall financial security, and where and how they grew up. It is also a social determinant of health. Social determinants of health are nonmedical factors that influence a person’s health, such as education attainment, transportation access, neighborhood safety, quality of housing, etc. (CDC, n.d.). Research shows that financial vulnerability, particularly poverty, is linked to higher rates of sexual violence and can impact a survivor’s economic well-being (Greco & Dawgert, 2007).
Lower-income populations are more vulnerable and may experience barriers to care because of their socioeconomic status. Financially marginalized survivors of sexual assault may face challenges accessing important resources, including health services. These health resources are necessary to help with survivors’ possible health difficulties such as eating and sleep disorders, HIV and sexually transmitted diseases, unwanted pregnancy, physical and mental injuries, etc (Greco & Dawgert, 2007). Low-income women’s lack of access to healthcare may be due to various barriers:
The costs of rape-related health complications has placed a burden at the societal level that can lead to economic hardships including "homelessness, missed work and lost wages, unemployment, interrupted education, among other economic consequences” (Fedina, 2018). In the United States, rape costs about $122,461 per victim and $3.1 trillion to the economy over the lifetimes (National Sexual Violence Resource Center, n.d.). Prior research suggests that survivors and victims of sexual assault seek medical care at higher rates than non-victims, however, many survivors may not access healthcare because they cannot afford treatment (Fedina, 2018). Even thought rape crisis centers offer many free services to survivors, without health insurance, victims of sexual assault are less likely to receive the help they need, including counseling (Dawgert & Greco, 2007).
Various other studies demonstrate that survivors who are of low-income encounter additional barriers to services. For example, survivors with limited resources may live in areas where there is a lack of low-cost transportation options. Access to basic needs, such as food, shelter, and microloans (or short term business loans for those in need of immediate financial backing) can be difficult for financially struggling survivors to get. Housing instability has also been identified as a factor that can lead to few return visits to a hospital-based sexual assault clinic (Bach et al., 2021).
In addition, income and race are closely linked to higher rates of sexual violence. Researchers notice that populations of racial and ethnic minority women disproportionately affected by sexual violence also face a socioeconomic disadvantage. These economic disparities also correlate to disparities in healthcare. According to one study, 34.8% of African American women, 37.4% of Latina women, and 23.9% of White non-Hispanic women victims needed to see a doctor but could not afford it (Fedina, 2018). Moreover, research (Fedina, 2018) documents the intersection between economic insecurity, poverty, and sexual violence for African American women; African American women affected by sexual violence may not seek medical professionals as often as White women because of financial barriers. Latina women face unique additional barriers to seeking care due to immigration and citizenship status, language, culture relevance, and eligibility for services for undocumented women (Fedina, 2018).
Solutions have been proposed to improve access to healthcare for low-income survivors. Practitioners supporting survivors should develop culturally competent sexual violence prevention and intervention approaches. Culturally responsive strategies should acknowledge the effect of societal trauma (intergenerational trauma, race-based trauma, cultural violence) on women of color to better support their health priorities (Fedina, 2018). It is important to operate using an intersectional framework, a theory that acknowledges the combined effects of a person’s multiple identities. Intersectionality allows doctors and medical providers to better understand their patients and how to best deliver care (Bach et al., 2021).
Targeted programs should be available to reduce barriers to those seeking healthcare. For example, establishing victim assistance programs, transportation, and community-located Sexual Assault Nurse Examiners (Maria et al., 2019). Although a lack of funding is an ongoing challenge, removing cost barriers should still remain a goal to guarantee equal access for survivors (Bach et al., 2021).
Lastly, it is important to remain survivor-centered and trauma-informed. Survivor-centered responses entail listening to survivors and responding to their priorities and concerns. It is valuable to include survivors belonging to underserved groups in the evaluation of services (Bach et al., 2021). Furthermore, quality and comprehensive medical care, including for mental health, is necessary to prevent long-term chronic health issues (Fedina, 2018) and should remain a priority.
Maryland’s Rape Crisis and Recover centers offer free crisis-intervention, referral, and accompaniment services for survivors. You can visit our website here to find your local RCC and learn more. Maryland survivors can also contact the Sexual Assault Legal Institute to learn more about their legal options.
References
Bach, M., Hansen, N., Ahrens, C., Nielsen, C., Walshe, C., & Hansen, M. (2021). Underserved survivors of sexual assault: a systematic scoping review. National Library of Medicine. Retrieved January 2025, from here.
DeGue, S. (2018). The Cost of Rape. National Sexual Violence Resource Center. Retrieved January 2025, from here.
Fedina, L. (2018). Understanding the Health Consequence of Sexual Victimization: Assessing the Impact of Social and Economic Factors. Retrieved January 2025, from here.
Greco, D., & Dawgert, S. (2007). Poverty and Sexual Violence: Building Prevention and Intervention Responses. Pennsylvania Coalition to Advance Respect. Retrieved January 2025, from here.
Maria, D., Breeden, K., Drake, S., Narendorf, S., Barman-Adhikari, A., Petering, R., Hsu, H.-T., Shelton, J., Ferguson, K., & Bender, K. (2019). Gaps in Sexual Assault Health Care Among Homeless Young Adults. National Library of Medicine. Retrieved January 2025, from here.
Social Determinants of Health (SDOH) | About CDC. (2024, January). CDC. Retrieved January 2025.
