Routine administration of medical forensic exams for sexual assault (commonly known as “rape
kits”) in emergency medicine is one of the most significant reforms associated with the anti-rape movement in the United States. Beginning in the 1970s, early nurse reformers were key allies who advocated for changes in medical routines to advance social movement objectives in hospitals emergency departments. They created new clinical guidelines that linked specialized medical care and forensic evidence collection as standard of care for survivors of sexual violence. Nearly two decades later, as transnational advocacy to end violence against women rose to prominence in the 1990s, their work informed the first World Health Organization (WHO) guidelines on post-rape care, which international organizations used to adapt rape kits and their protocols for use with refugees and internally displaced persons. Extending the framework of legal mobilization to the domain of medicine, I examine the challenges of attempting to align the institutional logics of clinical medicine and criminal law in this way.
Bringing together approaches in medical sociology, socio-legal studies, and feminist science and technology studies (STS), I argue that new clinical guidelines transformed the ‘rape kit’ into an assemblage of instruments, medical routines, and new ways of thinking about sexual assault that fundamentally transformed what constituted a human right to health in humanitarian medicine.
Methodologically, I combine archival research, fieldwork at international meetings, and over 50 in-depth interviews with experts and activists to follow ‘rape kit’ protocols from U.S. nursing to their uptake by the WHO and United Nations High Commissioner for Refugees to their implementation in settings of armed conflict to document rape as a war crime. After connecting the domestic and humanitarian contexts through the transnational trajectory of the protocols, I then analytically separate them in order to compare and contrast the impacts and ethical concerns that arise in each context.