Allied Health Professions: Drug-facilitated sexual assault in Nepal: Enhancing forensic capacity and raising public awareness

Dr Lata Gautam, Prof Michael Cole, Dr Sarah Hall, Dr Agatha Grela

ARU research into methods for detecting drug-facilitated sexual assault (DFSA) has helped improve knowledge and investigation of this offence in Nepal.

Dr Gautam and her collaborators’ research on drug analysis from drinks and human hair, among other sample types, led them to work with a range of stakeholders to improve forensic capacity, policy, education, and public awareness.

The research team

Explore ARU researchers' original work via our open access repository, ARRO

Research summary

DFSA is a sexual act in which the victim is unable to give or withhold meaningful consent due to intoxication with alcohol and/or drugs.

Opportunistic DFSA is when the perpetrator takes advantage of a victim who has voluntarily consumed drugs or alcohol.

Proactive DFSA is when the perpetrator intentionally and covertly administers drugs to the victim, for example, through spiked drinks.

In Nepal, reported annual rape cases rose by 471% between 2009 and 2019. This is just the tip of the iceberg; many victims are unwilling or unable to report because they are ignored or not taken seriously by law enforcement agencies, the judicial system, society and even their own families.

Prior to this research, awareness of DFSA cases was very low in Nepal because the local media often did not differentiate them from other types of sexual assault.

Dr Gautam and her team’s research initially focussed on developing and validating novel and more effective methods of detecting drugs in different samples. The outcomes of this were simultaneous detection of piperazines (compounds which mimic the effects of Ecstasy) and congeners (biologically active chemicals often associated with drink spiking); and the simultaneous detection of 20 drugs of abuse and pharmaceuticals in drinking water.

Dr Gautam and her collaborators additionally investigated the stability and storage conditions for benzodiazepines (sedatives) found in spiked drinks. They found that drug persistence was longer in drinks, but also discovered issues around the stability of flunitrazepam and temazepam (which are most often associated with DFSA cases).

This means that suspect drinks are suitable for forensic analysis, but only if they are collected on time - in other words, if someone notices and raises the alarm about possible drink spiking at the time it happens. This led the researchers to recommend that beverages suspected of being involved in DFSA cases should be routinely collected, and analysed immediately.

The team also investigated the differences between drugs detected in opportunistic and proactive DFSA cases, showing why perpetrators of proactive DFSA may use particular compounds. They additionally reviewed the drugs’ pharmacology and mechanisms of action to explain how they cause their effects, providing useful information for medical professionals and forensic scientists.

Dr Gautam and her colleagues conducted further research on hair analysis. Unlike, for example, blood and urine, hair retains information pertaining to an individual’s drug exposure and history for months or years. This makes it particularly useful evidence in DFSA cases.

By looking at variables such as pharmacokinetic and metabolic responses, hair growth rates, and drug incorporation routes, the team proposed a three-stage analytical approach to help stakeholders such as forensic toxicologists, hair analysis experts, and the judiciary to interpret hair analysis results.

Close-up of the top of a glass of cola with ice and lemon, with fizzy bubbles jumping off the surface

Summary of the impact

  • Helped the two main forensic science laboratories in Nepal to develop the capacity to investigate DFSA using different sample types
  • Influenced Nepalese government policy to provide specialist nurses for schools, and incorporate sex education into the new national school curriculum
  • Increased awareness and understanding of DFSA among teachers, students, senior policymakers, police officers, legal professionals, medical and public health practitioners, and the general public
  • Improved legal practice concerning DFSA

Impact

Influencing professional standards and training: Enhanced forensic services in Nepal

In 2018, Dr Gautam delivered training based on her research at Nepal’s two main state-owned forensic science laboratories, the Central Police Forensic Laboratory and the National Forensic Science Laboratory, in Bagmati Province.

At the same time, the laboratories developed protocols based on Dr Gautam’s research, enabling them to detect and quantify drugs more effectively from different sample matrices (blood, drinks, hair and street drugs).

As a result, 48% of chemistry and toxicology scientists at both labs learned how to analyse beverages suspected of involvement in DFSA cases and quantify drugs from beverages and hair samples. They went on to train new staff in these approaches.

Having gained these new skills and knowledge, lab officials updated their standard operating procedures and training manuals, and helped upgrade the facilities in labs in other provinces.

Impact on health and wellbeing through policy change and outreach in schools

Dr Gautam’s research led her to engage with the Head of the National Examinations Board in Kathmandu. This resulted in the introduction of the “one school one nurse” policy in Bagmati Province in 2018, which places nurses in schools to provide counselling on sex education and reproductive health to female students.

By the end of December 2020, this new policy had been successfully implemented at 19 state-run schools, with plans for it to be rolled out to a total of 119 schools in the province.

In 2018-19, supported by the National Examination Board, civil society organisations and professional bodies, Dr Gautam delivered outreach activities on DFSA in schools and colleges.

By June 2020, these had reached 13 schools (990 students) and 11 college/university-level institutions (1,102 students) as well as more than 163 teachers/academics. Both students and teachers reported that the activities had influenced their attitudes, awareness and understanding of DFSA.

Feedback from one of these outreach activities in 2018 led to the inclusion of topics on sex and relationships, as well as drug-related issues, in a revised curriculum implemented in 2020. Some schools have addressed the issue of sex and relationships by hiring female staff and through drama, essay competitions and invited speakers.

Dr Gautam’s work has influenced how hospital staff assess apparent victims of DFSA. It has also helped at least one student victim to report that she had been sexually assaulted. As a result, she received the necessary support and was referred to a specialist NGO.

About more about the impact on health and wellbeing through policy change and outreach in schools.

Influencing public policy on DFSA: Raising awareness among policymakers and professionals and changing legal practice

Dr Gautam’s research led to engagement with the then Joint Secretary of the Office of the Prime Minister of Nepal in 2018, which resulted in three national-level workshops with a variety of relevant stakeholders, including representatives from different government departments, school education and curriculum officials, teachers, students, police officers, forensic scientists, lawyers, medical professionals, public health experts, human rights activists, and media.

The workshops provided opportunities for advocacy efforts on incorporating DFSA issues in education policies and school curriculum. They also highlighted how much of a social taboo still surrounds DFSA in Nepal, leading Dr Gautam, in the third workshop, to introduce the use of alternative tools such as drama, poems and mind-mapping to communicate and facilitate learning on this sensitive topic. These ideas have already been applied in schools.

The workshops led to changes in legal practice. One district judge and their legal cohort changed how they assessed DFSA cases after learning more about sample types and the memory loss associated with DFSA.

Nepal’s Minister of Education, Science and Technology, who was the chief guest in one workshop, highlighted the need for policy measures, scientific investigation, and teaching methods to effectively address DFSA.

He subsequently invited Dr Gautam for a follow-up meeting where she shared her research findings and assessment of media coverage on DFSA cases with the minister, providing a list of recommendations based on her research and feedback from the workshop.

About more about influencing public policy on dfsa.

Increasing public awareness of DFSA and changing attitudes

Dr Gautam’s workshops attracted significant media attention in Nepal. In 2018-19, she took part in invited TV interviews and panel discussions, was interviewed on BBC Nepali Radio, and published an article with a local medical doctor in a Nepali medical professionals’ outlet.

Several of these interviews and articles were disseminated on social media, collectively reaching an online audience of more than 5 million people, or 19% of Nepal’s total population.

Dr Gautam also shared her research findings at community events, reaching parents, teenagers and students through a variety of media, both face-to-face and (during the Covid-19 lockdown) online.

Gautam has started to transfer the insights from her work in Nepal to other countries, co-supervising an MSc research student in Botswana, taking part in public events in the UK, and delivering an invited webinar on DFSA hosted by Amity University, India.

United Nations Sustainable Development Goals

We have mapped our REF 2021 impact case studies against the United Nations' Sustainable Development Goals (SDGs).

The 17 SDGs, adopted by all UN Member States in 2015, are an urgent call for action. They recognise that ending poverty and other deprivations must go hand-in-hand with strategies that improve health and education, reduce inequality, and spur economic growth – all while tackling climate change and working to preserve our oceans and forests.

This case study is mapped to SDG 5: Achieve gender equality and empower all women and girls, target 5.2.

See also

Read the full REF 2021 impact case study for UoA 03: Drug-facilitated sexual assault in Nepal: Enhancing forensic capacity and raising public awareness (PDF)

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