Sexual violence (SV) is a worldwide phenomenon and public health concern that bears physical, mental, emotional, and in some cases, economic effects on survivors. Sexual violence encompasses unwanted acts that range from verbal harassment to forced penetration, and an array of types of coercion, from social pressure and intimidation to physical force (1). It covers several activities ranging from rape to other physically less intrusive attempted or completed sexual contact. It typically embodies a lack of consent; the use of physical force, coercion, deception, or threat (1). SV results in a wide range of health problems in the immediate and long-term scope. These include physical injuries, Human Immunodeficiency Virus (HIV), sexually transmitted infections (STIs), unintended pregnancies, mental health conditions such as depression and anxiety, and sexual dysfunction in later life (2).

Globally, one in three women aged 15–49 years experienced physical or sexual violence mainly from a person well-known to them (3). Whereas global prevalence of sexual violence among men may be difficult to establish, reports have indicated that 1 in 10 men have experienced sexual violence in their childhood (4). The 2013 UN multi-country study further revealed that SV prevalence rates among adult men aged 18–49 years can range from 6% to 23% depending on the country (5) with higher rates of upto 24% observed in conflict zones (6). In Kenya, the 2019 Violence Against Children (VAC) survey reported that about 32% of girls and 16% of boys experience sexual violence before the age of 18 years (7). A 2018 study on school-related gender-based violence in Kenya further denoted that 68% of female students and 32% of male students experienced some form of school-related gender-based violence (8). A 2019 study on an Integrated Care Model for Survivors of Sexual Violence at the GBVRC at Coast Provincial General Hospital, Mombasa, Kenya also showcased that the majority of sexual violence survivors were under the age of 16 years and in every ten cases, eight were by perpetrators well known to the survivor (9).

Rooted in gender inequality, women disproportionately experience sexual violence. In addition, due to socioeconomic imbalances, women have fewer options and autonomy in their education, finances, and employment opportunities (10). Sexual violence among adolescents and children is also provoked by society's inability to recognize and protect their rights (11).

Access to justice by SV survivors is limited in low-resource settings (12). In different communities, a culture of tolerance and silence on sexual violence, in addition to power relations that undermine the position of women in society, discourage families from reporting sexual violence (13) where according to the VAC study, only one in ten of all survivors of sexual violence reported it to someone (7). Other factors which discourage survivors from reporting include stigma, survivor blaming, and fear of retaliation where the perpetrators are well known to the survivors (9). Limited proximity to reporting sites and non-prosecution of sex offenders also contributes to low reporting will among survivors (13).

Kenya has several laws and frameworks guiding preventative and responsive GBV measures, such as the National Constitution 2010, The Children Act No. 8 of 2001, and more recently the Children's Act 2022 among others. Specifically, the National Policy for Prevention and Response to Gender-Based Violence is cognizant of the need for concrete and efficient systems to operationalize laws and plans for effective GBV prevention and response. The 2014 policy was designed to hasten attempts towards coordinated approaches in GBV programming, enforcement of laws, and advanced access to quality, comprehensive care (14). While these policies and frameworks offer a national backdrop for GBV prevention and response, county-specific strategies that are evidence-driven are equally important.

Successful SV prevention strategies require comprehensive documentation on the trends in SV (clinical, psychosocial, and legal) to inform prevention practice (15). Clinical management of SV has been documented by numerous studies, detailing the expectations and loopholes within health facilities, including gender-based violence and recovery centers (16). However, there is limited documentation on the legal follow-up of SV cases and challenges that deter access to justice at each stage of the legal process. Focus has often been on healthcare, but there is a need for a comprehensive approach to include a legal rights perspective. The study is a follow-up to our previous 2018 study on an integrated care model for survivors of SV (9), intending to detail the component of legal follow-up further. This study, therefore, sought to explore and report on the legal structures and cascade for SV cases in Mombasa County, Kenya.

This study explored the assault characteristics and reporting patterns of survivors attended to at the GBVRC CGTRH from the year 2017 to 2023, along with the legal outcome of the cases. The majority of the survivors were children aged 15–17 years, and most perpetrators were known to the survivors, with over half of perpetrators aged 16–30 years. Case reporting at the police station was high, though cases proceeding to court were almost half the number reported. A fifth of the reported cases proceeded to court and had judgments pronounced, with over half of the cases resulting in a sentencing of 5–30 years. Trends in judgments made appeared to be fluctuating across the years, with the highest dip being between 2019 and 2020. The lack of evidence, poor witness testimonies, or failure of witnesses to present themselves in court were causes for the withdrawal and acquittal of some of the cases, which is expected given the prevailing realities of out-of-court settlements, intimidation and mishandling of evidence that reportedly affect the country's judicial system (17).

This study's finding that the majority of survivors were 14 years old corroborates other studies that indicate a higher prevalence of SV among adolescents aged 12–16 years (9, 18). Consistent with other research that place high victimisation of sexual violence in Africa among adolescent girls and young women (19, 20), this study further presents that most survivors were females under the age of 17 years confirming that the burden of sexual violence in the country like other low and middle income countries (LMICs) is on young adolescents and women. Kenya recently rolled out a triple threat campaign to reduce the prevalence of three interconnected threats affecting adolescent girls that is GBV, HIV infections and teenage pregnancies (21). These study findings suggest a need for greater emphasis on tackling adolescent health concerns among younger adolescent girls under 17 years who are at a higher risk of sexual assault, particularly in countries that are not highly ranked in gender equality—Kenya is currently ranked 135 out of 139 (22). This would require targeted efforts to address inequitable gender, social, political, and economic norms in order to reduce the subordination of women and vulnerable groups in society (23).

Study results further acknowledge the prevalence of sexual violence among males, where the age group of 0–10 years accounted for 61% of male survivor cases. Interestingly, from the age categories of 11 years onwards, there are fewer male survivors, which is consistent with another 2020 Médecins Sans Frontières (MSF) study that posited a higher proportion of child male survivors compared to other age groups, including adolescents aged 12–17 years (24). This may suggest that younger males are more vulnerable than their older male counterparts, but this could also suggest reluctance in reporting among older males due to stigma or victimisation where they fear being ridiculed, emasculated, and questioned for their sexuality (25, 26). Studies show that male survivors may adopt several post-trauma coping mechanisms such as self-blame, drug abuse, withdrawal, and at times reckless/harmful sexual behaviour (27), which could encourage a cycle of abuse where survivors could become offenders (28). Ignoring trends in sexual abuse among males, who also grapple with gendered narratives that affect how they cope with the trauma, could therefore further ignite an upsurge of sexual violence and inhibit progress towards addressing the vice (29). Alternatively, Thomas and Kopel (30) suggest that appreciating the impact of victimisation on reporting among both males and females can increase and encourage more survivors to report cases of sexual violence. Recognizing and validating the experiences of male survivors may encourage them to come forward, seek help and participate in sexual violence prevention and support efforts.

Transfer and prosecution of cases along the legal cascade appear to be the main challenge in sexual violence case management. Though the use of a paralegal system at the GBVRC-CGTRH may account for 97% of case reporting, during the follow-up process, a notable drop of 29% (535/1,864) of cases under investigation at the police station was recorded. This suggests a challenge in handling cases at the police station, which could result from survivor intimidation leading to non-followup, poor documentation and mismanagement of evidence; all of which compromise the integrity of cases filed (31).

Moreover, out of the 94% of cases that proceeded to court, only 21% resulted in a judgment, eliciting further concerns about case prosecution within the court system. The study showed that 23% of cases filed at the court were acquitted and withdrawn, potentially due to fear of retaliation, threats, payoffs, and stigma often experienced by survivors, especially where the perpetrator is well known (32). Social norms that blame survivors for the assault or those that prioritize family honor over the survivor's well-being also discourage follow-up of sexual violence cases among survivors (33). Such occurrences pose a significant challenge to achieving better legal outcomes for survivors and deter ongoing efforts towards curbing violence in the community.

The 21% of judgments made across the years further suggest a drag in sexual violence case management, which was also reflected in the national COVAW 2022 study, where out of the 3,791 sexual offences cases filed within a selection of 7 courts from 2017 to 2021 in Kenya, only 37% were officially closed (32). Adjournments, unsynchronised court diaries, non-appearances of medical doctors and investigating officers, missing files, scanty investigations, limited support for vulnerable witnesses, unavailability of witnesses, a lack of specialized courts, and the transfer of officers were cited as the key causes of delayed judgments as per the report which may explain the lag as seen in this study (32).

Limited coordination between family and criminal courts, the reluctance of the police to investigate cases and the limited availability of resources within the court system have also been cited as some additional inhibitors to justice for sexual violence survivors (12). National legislation in many developing countries is often inferior to traditional law and community-level justice systems that possess greater cultural authority. Subsequently, informal punishments such as pay-offs to the survivor's family or marrying off the survivor to the perpetrator are common, ultimately compromising legislative enactments on sexual violence crimes (34). At the law enforcement level, once cases have been reported to the police station, there is mismanagement of files, misconduct among officers, negative community interference and intimidation. Collectively, this may result in the dropping of charges by the survivors and their families (30), potentially explaining the 38% drop in cases referred to the police and those filed at the police station across the years.

Several potential reasons for the drop in cases under investigation have been highlighted above, along with reasons for the delay in judgment. Although only 21% of judgments were made, this is still higher than in some African countries, where, in South Africa, for example, only 340 (8.6%) cases were finalised with a guilty verdict (35, 36). This suggests the potential of a well-coordinated paralegal approach in case management that supports follow-up and tracking from reporting to determination of judgment.

Despite the advantageous ranking of 21% judgment compared to other countries, there were fluctuating trends in judgment across the years, with notable plunges in judgments between 2017 and 2018 (18%), 2018 and 2019 (25%), and 2019 to 2020 (24%). The change in regime in Kenya between 2017 and 2018 may have affected the drop of 18% in judgments within that period, further positing a lack of independence within the judicial system, where country politics can potentially interrupt the flow of legal services by changing the legal systems, leadership and administration (37). Judicial adaptations may have also influenced the change in trends over the years. According to the “Rule of Law in the time of COVID-19: Kenya, 2020” report, the courts were closed at the onset of the pandemic, which may explain the drop in 24% of judgments made between 2019 and 2020. However, a 19% increase in judgments observed in 2022 may be attributed to the implementation of courtroom digitization, introduced to sustain operations Covid-19 crisis (38). This digital shift has been infused into Kenya's judicial system to minimize delays and enhance efficiency in court proceedings. Judicial adaptations are therefore not only necessary in improving case management in routine cases but can have an extensive impact during unforeseen disruptions such as a pandemic.

In this research, younger females under 17 years bear the highest burden of sexual violence, though younger males under 11 years accounted for most of the male survivors. Though community-level reporting was high and there were strong linkages between the GBVRC and the police, there were notable challenges in the retention of cases along the legal cascade, with a drop between cases reported and those filed for investigation. Further delays in judgment were observed across the years, which may be due to systemic shortcomings suggesting shortcomings within law enforcement and the judicial system. This study presented a legal cascade of SV cases in Mombasa, while positioning several challenges in case management within the region. We sought to highlight the legal component which, though often overlooked, is integral to comprehensive care for SV survivors. We anticipate that these findings will advise sexual violence programming within the County and inform legislative and community-level interventions on legal follow-up and security.