Main findings
This study evaluated the prevalence of harassment in women during medical internships in Lima, Peru. We found that the prevalence of sexual harassment was approximately 70%, compared to 3 previous studies that have been performed in Peru (8, 17, 18). In addition, we observed that, compared to a previous study, only 1% had filed a complaint, indicating that only 2 out of 100 women victims of sexual harassment formalize their complaint (19). Most respondents who had experienced sexual harassment lacked knowledge of the law (84.4%), in contrast to the findings of a previous study addressing factors related to sexual harassment on health teams (20). The highest prevalence of harassers was men (71%), and 39% of them were clinical instructors. In that context, it was found in public universities in Peru that students are the ones who most prevalently harass women (16%), followed by teachers (8%) (17).
Prevalence of harassment
We identified a remarkably high prevalence of harassment compared to that reported in previous studies. The research results at two public universities in Peru were similar, with prevalences of 63.6% and 77.5%. Another source, backed by a private entity located on the official Peruvian government website, reported that approximately 34% of Peruvian women had experienced sexual harassment at some point. Finally, at a different public university in Peru, a population of 3,603 students from 19 majors was surveyed for a prevalence of 28% (8, 17, 18). The variability in percentages involves various factors, such as the location of the universities, the survey methodology, the population size, and the primary selection. Despite this, the average prevalence of harassment was 40% for women in environments with various hierarchies, a considerably lower figure than that found in our present study. Our research was conducted in hospitals with specific and limited roles, which could increase the occurrence or simply the reporting of cases, considering that our surveys were anonymous and directed exclusively to women.
The identified aggressions encompassed various forms, from sending sexually explicit images (the most prevalent) to verbal violence (sexual jokes), nonverbal (lecherous gazes), and physical (touching, kissing, caressing) forms. This finding demonstrates that the issue of sexual violence is broad and not limited to rape. Looks that make women uncomfortable and make them feel bad constitute a form of sexual harassment. However, the lack of physical evidence or determinants often prevents this factor from being seriously considered a crime. Part of the solution to this lies in conducting talks and normative education. Similarly, harassing messages, sexual jokes, and inappropriate touching, even if not in intimate areas, constitute sexual harassment and are often not perceived as such. It is crucial to highlight the various forms of sexual aggression present in a hierarchical environment since they are often not obvious, leaving the aggressor in an advantageous position over the victim (21).
Few complaints and normative knowledge
In our study, only 1% had filed a complaint, following what was expected at the beginning of the research and what previous studies indicated (2, 12, 22). In 2022, the private company GenderLAb conducted the first report on sexual harassment in Peru, covering 32 thousand people from various companies (19). Only 2 out of every 100 women who experienced sexual harassment filed a formal complaint. The remarkable discrepancy between the reported cases and complaints could be due to various factors. Our research showed that a significant portion of victims lacked sufficient knowledge to file complaints and that, if they had had such knowledge before the harassment, 67% indicated that they would likely file a complaint (according to their perception). This finding agrees with the Peruvian National Superintendence of University Higher Education (SUNEDU) analysis, where only 47% of female university students knew how to file a complaint for sexual harassment; on average, 34% had never received information on the subject (22).
While Law 27942, addressed in this article, is clear about the need to disseminate its regulations and support victims, its essence does not reach a large part of the population. In addition, fear and shame also play essential roles in the low number of complaints; this is a structural problem that cannot be resolved with immediate measures but can be resolved with years of work to raise awareness and the struggle to overcome the obstacles generated by the patriarchy that still prevails in South America (23, 24). As mentioned in the introduction, it is essential to reiterate that the patriarchal system is not the only mechanism that perpetuates the problem addressed in this study. Our results reveal powerful statistics: Many respondents did not know about Law 27942 and answered that they would probably have filed a complaint if they had known the law during the incident.
Association between knowing the law and being harassed
Although no direct statistically significant association was found between knowledge of the law and sexual harassment (Table 5, question 22), an association was observed between harassment and ignorance of the applicability and effects of the law, such as the right to compensate for the damage of the harassed student, the obligation of centers to disseminate the law and conduct prevention workshops, the complaint process to the dean and referral to the possible aggressor, and strict teacher evaluation and possible sanctions according to university law (as per Table 5 questions 25, 27, 28 and 30).
It is proposed that knowledge could act as a protective factor by allowing women to identify harassment and, therefore, defend themselves, as evidenced in an Iranian study (20), which addressed several contributors to sexual harassment in health teams, highlighting the lack of safety measures in hospitals, the lack of constant training in preventing sexual harassment, long working hours, and the composition of small workgroups.
Characteristics of harassers
We found that 71% of the aggressors were men and that 39% were clinical instructors. In that context, it was found in public universities in Peru that students are the ones who most prevalently harass women (16%), followed by teachers (8%) (17). However, it is essential to clarify that sexual violence between two people of equal hierarchy (for example, a male student and a female student) constitutes sexual harassment where there are no situations of hierarchy or subordination. However, when a professor commits sexual violence against students, this is determined to be harassment since there is a position of more incredible to lesser. In this case, our definitions support the finding of our study that teachers commit this crime the most.
It is crucial to highlight that despite the majority of aggressors being male, 29% of them are women, predominantly clinical instructors. We did not find relevant data in the literature on women in harasser roles, and in general, it is not known whether they sexually harassed students, whether male or female (in our study, all respondents were female). Since this aspect is scarcely addressed, victims may not consider women to be possible aggressors, which makes it challenging to identify and subsequently report the crime. In this sense, the underreporting of these cases could be hypothesized. Therefore, it is essential to delve deeper into this aspect in future research.
The United Nations also includes child abuse as a possible contributor to a cycle of sexual violence in the future, encompassing sexual harassment, either as an aggressor or victim. In this study, no contact was established with possible harassers. As for the women who responded positively to the questionnaire, the reasons behind the lack of reporting were not explored in depth. Emotions such as fear, shame, or others could have deeper roots, with child abuse possibly being one of these causes. Addressing this aspect could be interesting for future projects.
LIMITATIONS OF THE STUDY
It is essential to highlight that this study has some limitations. The information collected is very delicate, which made it difficult to achieve the planned number of responses. In addition, bias is possible due to possible emotional triggering during the survey, which leads respondents to stop responding or respond to anything to finish an uncomfortable topic. In addition, since this was a study with nonprobability sampling, the results may need to be more generalizable.
This study's strengths include using an anonymous questionnaire platform, where no names, emails, or identity information was accessed. This approach allowed respondents to answer without fear what they wished to share. Second, the relatively low cost of the research stands out. Finally, the versatility of the study is remarkable since the survey can be used by people and professionals from different fields in different environments with different power dynamics.