When translating international research on strangulation during sex specifically, an estimated 1.2-1.6 million students across UK higher education institutions will have had this experience.
Content warning: strangulation, choking, sexual violence, suicide, homicide
Strangulation is not widely discussed in UK university settings, but it should be, and universities can be very well-placed to respond to this topic across many different contexts.
With a new academic year beginning, particularly in the context of the Office for Students’ harassment and sexual misconduct new regulation and prevalence data, now is the time to consider the best approach to strangulation for new and existing cohorts of students.
What is strangulation?
Strangulation – or “choking” as it is sometimes called in the context of sex – is the application of external pressure to the neck, which results in the restriction of air and/or blood flow, through obstruction of the windpipe and/or major blood vessels.
Whilst ‘choking’ is sometimes a term that is sometimes used interchangeably, this term is more technically applied to an internal obstruction in the throat which restricts breathing (e.g. choking on a piece of food).
The Institute for Addressing Strangulation (IFAS) was established in October 2022, following the introduction of new legislation, presenting strangulation as a stand-alone offence in England and Wales.
There is not yet research specifically on the prevalence of strangulation during violence and abuse in universities in the UK. This in itself is a risk to an effective response. However, from research we do have available, we can see how students could be affected by strangulation.
In the context of sexual violence, research from a Sexual Assault Referral Centre in England showed that around a fifth of victim/survivors of sexual assault and rape by a current or ex-partner had been strangled at the time of the assault. A higher proportion of victim/survivors who were strangled were “In education”, compared to those who weren’t strangled (12 per cent compared with 9 per cent).
For those in domestic abuse relationships, there is an increased risk to the victim/survivor once they have been strangled. Research has shown that there is a seven-fold increased risk of the victim being killed by the perpetrator when non-fatal strangulation is in the abuse history.
From April 2022 – March 2023, the Vulnerability Knowledge and Practice Programme (VKPP) showed that 10 per cent of suspected victim suicides following domestic abuse (SVSDA) related to victims aged 16-24. Of all the SVSDA cases in the same year, the VKPP reported that non-fatal strangulation was noted in the abuse histories of 20 per cent of cases.
The risks of an act of strangulation on its own can include loss of consciousness (possibly indicating acquired brain injury), stroke, seizures, motor and speech disorders, and death.
If universities have an awareness of the abuse and violence their students are subjected to, is the knowledge around strangulation a missing piece of a bigger puzzle?
Strangulation during sex
Strangulation or “choking” during sex is disproportionately prevalent amongst younger age groups.
A survey conducted by us at IFAS late last year showed that 35 per cent of respondents aged 16-34 had been strangled during sex by a partner at least once. This was sex they had entered into willingly, but the strangulation was not always with prior agreement from all parties.
Of the respondents who had previously been strangled during sex, only 50 per cent reported to us that this strangulation was always agreed in advance.
When looking at university populations internationally, the prevalence of engaging in strangulation during sex appears to be higher than in the general population sample referenced above. In the United States, it has been reported that 42 per cent of undergraduates have been strangled during sex and 37 per cent have reported strangling someone else – in Australia, 56 per cent of students had an experience of having been strangled and 51% had done this to a partner.
Researchers in the United States have also looked specifically at the risks of strangulation during sex. They found that individuals who had frequent experience of partnered strangulation had heightened levels of a blood biomarker that indicates inflammation within the brain and cell death.
Even when used during sex, research consistently shows that there is no safe way to strangle. This is beginning to be better recognised, including with action by the government to criminalise the depiction of strangulation in pornography.
What should higher education institutions be doing
Strangulation may be missing in universities’ broader responses to sexual misconduct, domestic abuse, and sex and relationships education. Whilst not applicable to all institutions, the principles outlined in the swiftly upcoming Office for Students Condition of Registration (E6) may serve as a useful framework in which to integrate this topic.
Non-judgemental engagement around strangulation is vital. Students who are thinking about or who are engaging in strangulation during sex should feel able to discuss this with trusted staff who can provide helpful and objective information.
Students who have been strangled in other settings – for instance, in domestic abuse or sexual violence – also require opportunities to disclose and seek specialist support. Integrating responses to strangulation under the appropriate support requirements of E6 could be suitable, particularly when disclosed as part of abuse or misconduct.
It is necessary that questions are asked of students in relevant contexts such as sexual misconduct support services, given that spontaneous disclosure may be rare. It is important to remember the range of terminology that could be used to describe the same act, particularly across different contexts.
Staff should be confident they are talking with students in a way all parties can understand and from which appropriate action can be taken.
As would be the common practice for other disclosures such as domestic abuse, limits to confidentiality and escalation procedures should also be appropriately discussed and understood by all.
In E6, the Office for Students notes the importance of capturing data on behaviours in order to inform both prevention and response initiatives. Including strangulation as a specific variable to consider within this data capture process would be valuable for universities. The more staff know about strangulation in different contexts, the better and more specialist the response can be. If questions are not asked about strangulation, and opportunities for disclosure are limited, prevalence data are unknown.
The higher education sector has long been an advocate for evidence-based practice, and sexual misconduct has been a recent example of where understanding the issue has led to more concerted efforts to address these unacceptable behaviours (see e.g. the Office for Students’ pilot sexual misconduct survey).
Staff should collate data on strangulation disclosures and reports (for example, through disciplinary proceedings), and be able to monitor and report on these data independently and in the context of other behaviours such as sexual misconduct. Where possible, it would be beneficial to consider how strangulation is captured on disclosure tools, reporting forms, risk assessment templates, and case management systems. Staff should consider how their university’s strangulation data form part of reporting through existing governance structures.
Strangulation is still an emerging – and can be taboo – topic of conversation which means relatively little is known and shared. Myths and misconceptions thrive in these environments which can lead to victim blaming and poor outcomes for those involved. Education for whole institutions on what is known objectively about this behaviour in different contexts is needed.
This education can come in the form of, for example, training for staff and students around sexual misconduct and other forms of abuse and harassment – particularly when discussing consent and the requirement for prior and informed consent for all sexual behaviours. As universities have been reviewing their training provision to align with, and hopefully go beyond, the requirements of E6, this seems like a suitable framework for the appropriate inclusion of this topic.
Individual conversations with students and staff seeking support are also good opportunities to share information and resources for further support. Staff in specialist roles such as student support workers, and disciplinary investigators and panel members may benefit from more specialist training interventions in order to feel confident and competent to support the education of others.
The topic of strangulation is a nuanced one, not least because of the varied contexts in which it may be occurring. It therefore requires a careful approach by universities, but this is not an insurmountable task. We would encourage institutions to follow the trajectories they should already be taking to address harassment and sexual misconduct and apply appropriate learning to this important topic.
Please visit the IFAS website for more information.
