Introduction

In March 2013, the United Nations Commission on the Status of Women declared, for the first time, the importance of addressing sexual harassment against women and girls in public places.¹ Considered a form of gender-based violence (GBV) against women,² street harassment can include any act or comment perpetrated in a public space that is unwanted and threatening, and motivated by gender; it may include sexually suggestive comments, unwanted touching, invasion of space, and rape.³

Though epidemiologic research on the public health implications of street harassment is scarce, reports from non-governmental organizations suggest that street harassment can negatively affect women and girls’ health through limiting physical mobility, which can in turn reduce their ability to sustain employment or seek healthcare.^1,2 Street harassment may also impact women’s perceptions of community safety⁴ and their perceptions of connectedness to their community (i.e., social cohesion).^5,6 Extensive research has documented that poor perception of social cohesion is linked to an array of negative health outcomes and behaviors (i.e., chronic diseases, poor mental health).^6,7,8 Additionally, poor social cohesion has been linked to increased crime and violence,⁹ including intimate partner abuse.¹⁰ To date, however, little research has examined street harassment, limiting public health’s ability to quantify the extent of the problem and understand its relationship with other important social determinants of health.

Thus, the aims of this study were to: 1) document the frequency and forms of street harassment, 2) document actions women take to avoid street harassment, and 3) explore the association between street harassment experiences and perceptions of social cohesion among women seeking care in public health clinics in Mexico City. Investigation of street harassment is warranted given Mexico City’s recent investment in women-only transportation efforts to improve safety in public spaces.¹¹

Material and methods

Data were drawn from a baseline survey among women currently participating in a randomized controlled trial (N=952). The overarching study’s objective was to assess the efficacy of a comprehensive screening and counseling program on reductions of intimate partner violence (IPV).¹² Adult women presenting at study clinics were eligible to participate if they reported past-year experiences with physical and/or sexual IPV. After providing informed consent, participants were invited to take a 45 minute spanish survey administered by trained research assistants. The overarching study was approved by human subjects committees at Yale University, George Mason University, National Institute of Public Health (Mexico). Baseline data were collected from April to November 2013 across 42 health clinics in Mexico City.

Exposure to past-month street harassment was assessed via eight items¹³ categorized into binary (yes/no) measures of non-physical and physical street harassment (table I). All women were asked about actions taken to avoid street harassment. The outcome, social cohesion, was assessed through five binary items.¹⁴ Responses were summed; a higher score indicated higher social cohesion (Cronbach’s α=0.71). Demographics included in the analyses were: age, occupation, and health clinic location.

Table I Frequency of and actions to avoid street harassment reported by women presenting at health clinics in Mexico City, Mexico, from April to November 2013 (N=952) 

* Denominator is all women participating in the survey, regardless of reported street harassment experiences

Using complete case analysis, unadjusted and adjusted regression models were developed to assess the relationships of interest in Stata 12

Results and discussion

The mean age of study participants was 29.88 (SD 7.17). Over 6 in 10 (66.7%) reported completing less than a high school education. Over half (66.9%) reported being a homemaker, while 1 in 5 (19.8%) reported some form of employment.

Over 60% (n=598) of women reported experiencing at least one form of street harassment in the past month; the most common being looked at in an uncomfortable way (table I). Over one-quarter (26.8%) reported experiencing physical street harassment. Among all women, 75% reported taking some action to avoid street harassment.

Mean social cohesion was 2.69 (SD: 1.6). Experience of non-physical street harassment was associated with a -0.47 reduction in perceived social cohesion (95%CI: -0.66-0.29) compared to women who did not report such harassment in the unadjusted model. Women reporting physical street harassment had a similar reduction in social cohesion (b=-0.46; 95%CI: -0.69-0.22). The associations between experiences of street harassment and reduced perceptions of social cohesion remained statistically significant after accounting for age, occupation, district and health center (table II).

Table II Unadjusted and adjusted associations between past-week street harassment and social cohesion score (N=952) 

* Note that the social cohesion score was computed as the sum of the five cohesion items (people in this neighborhood generally don’t get along with each other; people in this neighborhood do not share the same values; people around here are willing to help their neighbors; this is a close-knit neighborhood; people in this neighborhood can be trusted). There were 80 missing values generated due to incomplete responses to all five social cohesion items (and thus if we aggregate, we will have a truncated sum). Thus the cohesion score index is defined overall for a total of 873 subjects (for whom information on the five social cohesion items was complete)

‡ Adjusted for age, women’s occupation, region, health center and clustering at the health center level

Street harassment was found to be highly prevalent among this sample of women. The analysis found that experiencing street harassment negatively impacts a woman’s perception of social cohesion, and that women often reported limiting their mobility to reduce street harassment. Study limitations include reliance on a non-random, clinic-based sample of women with recent IPV experiences. It is currently unclear how, if at all, IPV may impact street harassment experiences. Due to the cross-sectional nature of the survey, causality cannot be inferred nor can the temporal ordering of the relationship between perceived social cohesion and street harassment. Future research may also seek to examine how social cohesion at the area-level may impact street harassment. Lastly, study measures of social cohesion have not been validated in this sample.

Though preliminary, study findings indicate that street harassment is pervasive, and reducing it may have important implications for improving women’s perceptions of neighborhood social cohesion within Mexico City.^9,15 Future research on street harassment is needed for this burgeoning urban public health concern.