Why Is There A Shortage of Rape Kits In Canadian Hospitals?

You’ve experienced sexual assault, and you want to access a rape kit, so you head to your local hospital—only to discover they don’t have any on hand.

This is a shockingly common scenario in Canada, where 41 percent of hospitals do not stock sexual assault evidence collections kits, or rape kits, according to the 2021 “Silenced Report,” published by sexual assault survivor advocacy group She Matters. In Ontario, this number is 39 percent—a statistic that spurred lawmakers to call for an increased supply of kits in hospitals this year. In Alberta, it’s 45 percent. And in Manitoba, it’s 52 percent. To varying degrees, the issue affects every province and territory.

As part of a rape kit, DNA evidence as well as other evidence, including clothing and debris, is collected, transported and stored at a local police station to help enforcement identify and prosecute perpetrators. Timely access to care is crucial, allowing for as much evidence collection as possible before the individual takes a shower.

When asked about the probable cause behind the lack of kits, founder and director of She Matters Jacqueline Villeneuve-Ahmed says: “It’s definitely not a funding issue.” Many of the hospitals that She Matters contacted for their report told the organization they don’t have kits simply because they do not conduct sexual assault evidence collection. That’s in part because there isn’t a federal mandate requiring Canadian hospitals—the only place to receive a rape kit—to have kits on hand. Another barrier: Staff must be trained to administer kits. If no staff in an ER is trained to collect evidence for a rape kit, survivors are turned away and redirected to another hospital, which could be many kilometres away.

The decision to stock kits is often at the discretion of the hospital in many cases, says Villeneuve-Ahmed. But often, “it’s not [always] as straightforward as… just having a kit,” says Sheila Macdonald, director of the Ontario Network of Sexual Assault/Domestic Violence Treatment Centres. “It’s a lot more than that.”

Emergency department staff, MacDonald says, are not usually trained to provide the support and care that an individual who has experienced sexual assault needs. Sexual assault evidence collection is not a part of most nursing curricula, as it requires that nurses undergo a special training to become a sexual assault nurse examiner (SANE). SANEs are not only trained to collect evidence from a sexual assault, but also in providing trauma-informed care. SANEs are usually employed in an on-call or casual position, according to Macdonald. But due to staff shortages, sexual assault centres are often “competing” with other departments for nurses. Changing the current employment model for SANEs is a priority for Macdonald. In Ontario, she says, “we've been working with the Ministry of Health… so that we have more [full] nurses and that it is not a casual or on-call position.”

Related: The Hidden Costs Of Sexual Assault

No matter the reason, when survivors are turned away by a hospital, it can leave them feeling ostracized. According to Dr. Cathy Carter-Snell, co-founder of the Canadian Forensic Nurses’ Association, the collection of evidence for the kit takes just 45 minutes, not including other medical tests. But it’s the emotional care that takes the longest and has the greatest impact on survivors. “If they receive a compassionate, comprehensive approach to their care, they’re more likely to have a positive recovery and they may choose to proceed with reporting to the police,” she says.

The lack of nurse training combined with a stigma surrounding sexual assault that still exists—both for survivors and staff, especially in rural areas where everyone knows one another—often makes it difficult for survivors to feel safe in hospitals. Emergency staff, untrained in trauma informed care, also unknowingly continue to perpetuate stereotypes of sexual assault, like asking seemingly benign questions such as “Why didn’t you come sooner?”

“There’s [staff] that isn’t willing to do [the] because they’re uncomfortable with it. And that’s why we developed this [SANE] role,” says Carter-Snell.

There’s also the question of who provides the kits to hospitals from province to province. In Alberta, kits are provided by law enforcement. In order to receive a kit, hospital staff is required to contact law enforcement. A survivor, who is afraid and unsure if they want to pursue legal action, might be less likely to request a kit at a hospital where they are provided by law enforcement because first contact with law enforcement can imply the requirement of legal action. Each province and territories’ individual control over their health and justice systems makes it a gamble on who provides the kit and whether a survivor feels secure in accessing help.

Related: What To Know About Hockey Canada’s Sexual Assault Crisis

Currently, there are two bills—Bill 20 and and Bill 59—in the province of Ontario seeking to support sexual assault survivors by making it mandatory for hospitals to have 10 kits on hand at all times—a direct response to reported shortages. Bill 20 also seeks to make SANE training mandatory for all nursing students.

Although well-intended, Carter-Snell says these bills aren’t without flaws—particularly the proposal of mandatory SANE training for nursing students. “You’re not even considered competent in nursing until you’ve worked for at least six months post-graduation,” says Carter-Snell, based on her own work experience. SANE training is inappropriate for a student nurse who does not have the required skills and experience of a professional nurse, she adds. More appropriate is more general comprehensive training. One such training, led by Carter-Snell, teaches how to provide collaborative support in a rural area where a SANE may not be available.

Another solution, which is currently available in the U.S., U.K., and Australia, is an at-home kit. These kits allow the user to self-collect DNA evidence and other samples and send it to a lab. “They could be an option for a sexual assault that happens in a rural region [where] there's no in-person care,” says Chloe Hunt, product manager of Leda Health, a U.S.-based company whose founding product is their Early Evidence Kit (EEK). While self-collection kits are yet to be used in a legal capacity, Leda Health is currently working with Canadian law enforcement to potentially begin the use of EEKs as a supplementary step until an individual is able to receive adequate care.

Correction: This story has been updated to clarify who provides rape kits in certain Canadian hospitals.