THE HARSH REALITY OF CHILD ABUSE
The harsh reality of child abuse Child abuse violates the most basic rights of children and adolescents. As documented in the main article of this issue of Challenges, child abuse is a massive, daily and underreported problem that affects the population of Latin America and the Caribbean. It manifests itself in different forms, including physical and psychological aggression, rape and sexual abuse, and takes place in the home, in neighbourhoods, at school, at work and in legal and child protection institutions. Abuse tends to be transmitted from one generation to the next, and the individuals most often responsible are parents or other adult members of the household. Despite the difficulty in comparing the information available from different countries due to disparate samples and methodologies, in the 16 countries studied for this article the percentage of those interviewed who acknowledge personal or family abuse is quite high (ranging from 33% and 83%). Reported cases are only a partial indication of the scale of abuse, however, since many cases go unreported for fear of reprisals, lack of information on how to file a complaint, or because many simply assume that physical and verbal punishment are a natural part of discipline and socialization. In the testimonials column, four children explain what violence means to them; in viewpoints, a world-renowned Colombian expert on child abuse shares her perspective; the learning from experience section highlights a Peruvian programme that identifies and prevents child abuse in the health sector; and, finally, there is a brief account of recent events and key documents on the theme.
Child abuse: A painful reality behind closed doors
Child abuse constitutes a violation of the most basic rights of children and adolescents, which are enshrined in the Universal Declaration of Human Rights. All persons under the age of 18 have the right to physical and psychological integrity and to protection from all forms of violence. Article 19 of the Convention on the Rights of the Child (CRC) –adopted by the United Nations in 1989– exhorts States parties to take “all appropriate legislative, administrative, social and educational measures to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse, while in the care of parent(s), legal guardian(s) or any other person who has the care of the child”. Similarly, the United Nations International Committee on the Rights of the Child has emphasized the importance of member countries prohibiting all forms of physical punishment and degrading treatment of children (CRC, 2006). Nonetheless, we know that for various social and cultural reasons, children and adolescents suffer violence in the home, at school, in legal and child protection systems, at work and in the community. Thus, children and adolescents are abused precisely in those spaces and places that should offer them protection, affection, developmental stimulation, shelter and promotion for their rights. One of the factors that makes them highly vulnerable is their lack of autonomy due to their young age and the consequent high levels of emotional, economic and social dependency on adults or institutions (Pinheiro, 2006), which make it difficult for them to put a stop to the abuse, request help or report the situation. Violence is understood to be “the intentional use of force or physical power, either by act or threat, against oneself, another person or a group or community, which causes or has substantial likelihood of causing injuries, death, psychological harm, developmental disruptions, disturbances or deprivations” (WHO, 2002). In the same sense, child abuse is defined as “acts or omissions carried out with intent to cause immediate harm to the victim. The abuser perceives the harm caused as the ultimate goal of their actions. A syndrome is created in surviving victims, known as battered-child syndrome. There are three main types of child abuse: physical, emotional/psychological and neglect/abandonment. These forms of abuse lead to lasting physical and emotional injuries, death or other serious harm” (Latin American Regional Office of the Report on Violence against Children and Adolescents, 2006). The manifestations of violence suffered by children are diverse. They range from physical punishment to other forms of cruel and degrading treatment at the hands of their parents or other family members, or by persons responsible for their care in child protection facilities, schools or the workplace. Even at the social level, children identified as “a danger or threat to society” may be abused by the police. Children and adolescents, especially girls, may also be subjected to psychological violence and sexual abuse in the different environments where they grow up (Pinheiro, 2006). Evidence suggests that only a small part of the violence perpetrated against children is reported to the legal system and investigated by the authorities, and few offenders are brought to trial. Furthermore, while in many places in the world there are no reliable systems for filing complaints, there are estimates that every year 275 million children around the world are the victims of violence in their households, and some 40 million persons under 15 suffer violence, abuse and neglect. These incidents are reportedly taking place in different contexts: in families, in schools, in the community, on the street and in work situations (UNICEF, 2007a). The family and the household are socially and legally conceived as spaces for protection and safety for children and adolescents. In this regard, the CRC considers the natural environment for child development to be the family, while still recognizing that this can be a dangerous space. While violence “behind closed doors” has been difficult to detect and measure, perhaps the most complex aspect is accepting that those who are expected to protect children –generally the parents– are precisely the ones who strike, assault, threaten, punish or abuse them. Until now, and despite the efforts that have been made, the countries in this region have not developed an effective response to child abuse. One of the main difficulties in developing such a response lies in the lack of information on the true scope and characteristics of abuse, especially when it takes place in the home and in the family context. The scope of child abuse At the international level, the 2003 World Health Organization (WHO) publication on violence as a public health problem throughout the world, and the preparation in 2006 of the United Nations Study on Violence against Children1 with its in-depth investigation of the phenomenon of child abuse, are great contributions towards assessing this issue at the global level, and help to evaluate progress, share good practices and highlight pending challenges. Studies show that in addition to being one of the most unequal regions of the world, Latin America and the Caribbean –with a population of more than 190 million children– has the highest rate of violence affecting women and children (Pinheiro, 2006). According to the Secretary-general’s study, in this region violence against children and adolescents in the family is manifested mainly through physical punishment –as a form of discipline– sexual abuse, neglect and economic exploitation. Notwithstanding the above-mentioned limitations, one of the main sources of information for learning about and analyzing the scope of physical abuse in the region’s countries is the compilation of official statistics on complaints registered with social services, police stations, hospitals and children’s services. These complaints, however, only provide a partial picture of the reality of abuse, and it is believed that the available data show only the tip of the iceberg in terms of real problem of intra-family violence. This demonstrates that the phenomenon is more widespread than it appears and cannot be adequately measured using only this method. Since records have been available, it has been observed in all the countries that reports of physical and sexual abuse of children made by different institutions in sectors like health and education, or by family members themselves, are increasing every year. This does not necessarily mean an increase in cases; rather, it likely reflects an increase in social awareness of the problem, the promulgation of laws for the protection of children and punishment of violence, and the implementation of more accessible and efficient mechanisms for handling complaints. A cursory analysis of the records of complaints leads to the conclusion that, in most cases, the abusers are known to the victims, and in large proportion are family members; and that physical abuse is inversely proportional to the age of the child, while sexual abuse generally occurs when the victims, mainly girls, are between 7 and 11 years of age. This latter form of child abuse is the one least reported, especially when committed by parents or close family members. Another important source of information in Latin America and the Caribbean are the studies designed to detect child abuse in the population, which have been conducted since the 1990s. Population studies Studies on child abuse conducted in the region have been designed with the important purpose of providing data to adequately reflect the situation. However, as evidenced in the following tables, the lack of harmonization of methodologies used to measure the different kinds of abuse and the differences among the samples has meant that data is not comparable between the countries. In some cases children are asked specifically about the child-rearing practices used by their parents (Chile); in others, in addition to questioning the children, the parents also are consulted about child-rearing styles (Uruguay). In other countries, like Argentina, the studies are retrospective and ask adult persons whether they suffered violence as children at the hands of their parents, and in the case of the Plurinational State of Bolivia, for example, the consultation focuses on whether the person interviewed person knows anyone who suffers violence at home. The vast majority of the studies focus on physical violence, but some of the countries of South America also incorporate psychological violence, and in the Caribbean countries there has been special interest in measuring sexual violence, which is closely linked to gender violence. Girls have a much greater risk of becoming victims of sexual abuse by family members or strangers. Studies in the region show that for every boy that is sexually abused, three or four girls are victims of the same crime. In South America, the family is clearly a place where a large percentage of the situations of violence against children and adolescents occur. In most of the countries, approximately
Worldwide, 275 million children a year are victims of violence in their homes – a place that should offer protection, affection and protection of their rights.
50% of all children and adolescents suffer some kind of violence. Physical violence, considered less serious, is also the most frequent kind and consists of slapping, pinching, and blows to the arms, legs and head. More serious violence is less common, and consists of blows with objects, whippings, threats and even in some cases, use of weapons. Finally, psychological abuse is also habitual, in the form of insults, teasing, discrediting, isolation and even expulsion from the home, and generally is not considered violence as such, since –like the less serious violence– it is justify ed as a form of discipline. While child abuse is found in all social strata, in terms of characterizing parents, in some countries like Peru the highest levels of punishment occur among mothers in the lowest socio-economic strata, with the least education. In Chile, serious physical violence is greater in lower income strata, but psychological violence in greater at the higher-income levels. In Mexico and Central America, physical punishment is justified as a mechanism used by parents to correct or “straighten out” their children’s behaviour, so forms of violence like beating, pinching or kicking children are not considered to be harmful (Costa Rica). In terms of sexual abuse, the perpetrators are mostly men between 18 and 30 years of age. Research from the Nicaragua study suggests that in 90% of all cases the most frequent perpetrators of abuse against adolescents are fathers, step-fathers, brothers or boyfriends. Only 10% of perpetrators were strangers.2 While in the Caribbean there are different manifestations of violence –as in all the rest of the region (UNICEF, 2006a)– studies have focused mainly on researching sexual abuse, considering it to be an widespread, endemic problem (Dominica, Jamaica and Haiti). It is believed that there are many affected children, although levels of reporting are quite low. Some of the reasons that would explain this phenomenon include fear of reprisals and of the perpetrator of the violence, shame among family members and the persistent view that such abuse is a private matter. There also are issues of economic dependence, families’ lack of awareness of the abuse, negligence by parents, other adults and professionals (police, teachers, health professionals and others) and finally, the lack of effective formal informative procedures. In the Caribbean there is much less information on the predominance of emotional abuse over physical and sexual abuse. However, studies have described verbal aggression and threats against children as frequent household practices. In Belize, 80% of the children interviewed in schools said they did not feel loved by their mother, and in Jamaica 98% of children aged 11 and 12 affirm they had been verbally abused by an adult. Generally, parents are said to be the most frequent perpetrators of emotional abuse in the home, especially mothers. In addition, studies in the Caribbean identify neglect and negligence of children’s and adolescents’ needs as widespread forms of child abuse –Granada, Belize and Barbados- (UNICEF, 2006a). The use of corporal punishment as a form of discipline is common in this region, just as it is in those previously described. It should be stressed that this “hidden” behavior is also reflected at the social level, since in the Caribbean, only Haiti has laws prohibiting this practice, which would seem to indicate a “legitimatization” of the practice. According to the World Report on Violence and Health, (WHO, 2002) physical punishment of children is a widespread practice in Latin America and the Caribbean which, when “moderate”, is considered to be an appropriate form of discipline, since it makes children clearly perceive who has the authority and restricts critical or autonomous behaviour. Indeed, studies show that most children report having received punishment for disobeying their parents’ authority. As is the case with studies on reporting, these studies confirm that children suffer more violence when they are youngest. In some countries, abuse is more prevalent for children 4 to 6 years old (Argentina, the Plurinational State of Bolivia, Chile and Uruguay). In all the countries, violence and abuse suffered by the father and mother when they were children is the most relevant risk factor for violence against the children in their families, since it leads to an intergenerational transmission of violence. Furthermore, child abuse in the home is closely related to –and increases with– the presence of violence against women, either when they were girls or as mothers and wives. One of the most brutal forms of gender-based violence is the feminicides that occur every year in the region. Children are the indirect victims, often being orphaned by the suicide of a feminicidal father, and in an increasingly alarming percentage of cases, they become the direct victims of the misogynist violence of their fathers. The fate of these children and adolescents after such an act takes place becomes uncertain if they cannot find someone to assume responsibility for their protection. Many of them are left with other family members or elderly grandparents already living in precarious subsistence conditions, 3 or else in child protection institutions, without adequate treatment for their traumatic experience. Pending challenges the information presented here confirms that violence against children and adolescents is a serious human rights problem in Latin America and the Caribbean. More than half of all children in the region are victims of physical or emotional abuse, negligent treatment or sexual abuse. In response to this scourge, and based on the ratification of the Convention on the Rights of the Child, which reaffirms the condition of children as bearers of rights, there have been important advances towards addressing the problem in the region, and breaking the silence regarding this serious human rights violation in the family environment. At present there is greater awareness of the need to condemn violence against children, which has led to the implementation of concrete actions to produce the needed changes – among them new laws, victim attention programmes, improvements to the systems for filing complaints, punishment of perpetrators and studies designed to determine the scope and complexity of the violence. As affirmed in the United Nations Secretary-General’s Report, no form of violence against children is justifiable and all violence is preventable (Pinheiro, 2006). Thus, the real challenge lies in ending child abuse now, and all necessary efforts must be made to change the mentality and culture that sanction violent behaviour as a method of discipline. In order to advance toward this goal, priority must be given to prevention and early intervention, incorporating all the institutions that have contact with children and adolescents. The implementation of effective policies calls for precise and reliable data on the scope, characteristics, risk and protection factors, and the impact of violence against children in the family environment. This information must be comparable among the region’s different countries. Having figures that show the true scope of child abuse in the family environment will allow us to adequately formulate public policies, allocate resources and, above all, design and implement the prevention policies that are currently lacking in the region.
How widespread is child abuse in Latin America? What are its main causes? What priority should governments give it?
The scope of child abuse in Latin America is epidemic, without regard for social class, ethnicity or gender. Information on the phenomenon of child abuse –even though it cannot be compared between one country and another– comes from two main sources: the legal and the health sectors. The two speak different languages when describing the problem of maltreatment and sexual abuse suffered by our children and adolescents. The main causes of the abuse of children have changed very little since 1962, when Dr. Henry Kempe, a paediatrician in Denver, USA, described the battered-child syndrome to the world: 1. The parents have histories of psycho-affective deprivation, neglect or physical or sexual abuse as children. 2. The child is perceived as not deserving love. 3. There is a family crisis. 4. The family is nuclear and isolated from community support systems. The most effective policies are those aimed at improving people’s living conditions, and include positive child rearing, post-partum home visits, strengthening of affective ties, education for family life, educating parents and care-givers about the stages of child development, working on peaceful conflict resolution, early detection of sexual abuse and distancing the identified abusers from the children. Governments should give priority to designing comprehensive public policies that allow the legal, health and protection sectors to work in conjunction, and have sufficient funding to provide for the interventions needed to improve the situation of the children and adolescents of the Americas.
Learning from experience challenges The first intervention strategies to combat child abuse in Peru’s health service institutions came about through the Child Abuse Care Units (MAMIs, for their Spanish acronym), implemented as part of the child protection policy promoted by the Government of Peru beginning in the 1990s. In late 1994, as a result of the political will of what was then called the National Sub-Programme on Mental Health (PNSM) under the Ministry of Health (MINSA), the Technical Committee on Child Abuse (CTMI) –which created the MAMIs– was borne out of a framework agreement signed by the PNSM and UNICEF. The idea behind this initiative is a novelty in care practices, using a comprehensive and multidisciplinary approach, teamwork, training, instruction and networking. The members of the MAMI teams come from different specializations such as traumatology, gynecology, and psychology, outpatient social and personal assistance, are sensitive to the issue of abuse and alert to any suspicion of violence, which immediately triggers a joint consultation. In order to implement the MAMIs in the national hospitals, participation and commitment from the health center administrators was needed to provide a physical space for the teams, and to officially appoint team members. At the central level, the Ministry of Health is responsible for training the unit’s personnel to perform diagnoses and timely intervention, and for implementing awareness-raising campaigns for all the personnel. To date, 32 MAMIs have been created in all of Peru and 25 of them are located in hospitals. The experience thus far has underscored the need for regulations to facilitate and standardize the operation of the units and guarantee the sustainability of the strategy. At present UNICEF, the Ministry of Health and the directors of the MAMIs are preparing draft regulations to be approved by ministerial resolution. These regulations stress the importance of keeping systematic records on cases to improve follow-up and understanding of the cases that have been referred. A significant example of the effect of the methodology being used can be found in the North Lima legal district, where child and adolescent victims of violence and sexual abuse have received multi-disciplinary treatment. The findings of the psychological evaluation of cases referred by the prosecutor’s office are received in sealed envelopes by the MAMI at the Cayetano Heredia Hospital which then initiates therapy, and seeks to avoid the victimization of the child or adolescent.
Extracted From: UNICEF