Child Abuse and Maltreatment

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  Violence against a child always surprises me. Now, I am not a perfect mother, caregiver, or person. I admit that there have been times I've fantasized about putting a "Free Carseat: Baby Included" sign on the front lawn, or have smacked my child's hand during or after a particularly heinous tantrum that involved hitting or kicking at me. I understand the exhaustion, stress, anxiety and frustration that many parents feel from time to time. What I do not understand however, is how societies worldwide have not done more to prevent abuse/maltreatment, stop if from happening when it's evident, or provide better treatment and support to those who have suffered from it.
   
  The World Health Organization (WHO)  defines child maltreatment as "all forms of

  physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power" and identifies 5 broad categories of child maltreatment including: physical abuse; sexual abuse; neglect and negligent treatment; emotional abuse; and exploitation. Internationally, their data reports that a quarter of all adults report being victims of physical abuse as children; and 1 in 5 women and 1 in 13 men have been victims of sexual abuse as children (WHO, 2014). This doesn't take into account the number of children who have been emotionally abused, neglected (physically, emotionally, educationally, medically), or exploitation including human trafficking. 
   
  The Centers for Disease Control have some number of their own, and since numbers speak to people, here's a few from the CDC's 2012 Fact Sheet: 
  • An estimated 686,000 children were victims of abuse and neglect in the US, of those:
  • 78% were victims of neglect, 
  • 18% victims of physical abuse;
  • 9% were victims of sexual abuse, and:
  • 11% were victims of maltreatment including emotional abuse, victims of parental drug/alcohol abuse, or lack of supervision
  • 27% were under 3 years of age, with children under 1 being the most highly represented

  • 1640 children died from maltreatment
  • 70% from neglect and
  • 44% the result of abuse or abuse and neglect. 

   
  And we call ourselves "civilized".  
   
  But isn't simply the acts of maltreatment, violence and neglect that are dangerous; it is the long term effects to the survivors.  The WHO reports in it's Fact Sheet  (2014) that maltreatment can result in:
  • disruption in early brain development. 
  • impaired development of the nervous and immune systems resulting in increased risk for behavioral, physical and mental health problems such as:
  • perpetrating or being a victim of violence

  • depression
  • smoking
  • obesity
  • high-risk sexual behaviors
  • unintended pregnancy
  • alcohol and drug misuse.

  • The behavioral and mental health consequences can contribute to heart disease, cancer, suicide and sexually transmitted infections in young adults. 

   
  Here's the kicker, we've identified risk factors and protective factors, and have developed prevention programs, but it continues to happen every day, in every state across the US. 
   
  We aren't alone, though.  It happens the world over. However, because not all countries have the same (or any) definitions of abuse/maltreatment, reporting structures or practices in place, it can be difficult to find accurate data. And without these types of data, it's easy to see why many don't have prevention or treatment programs in place either. 

  • Ark of Hope for Children reports that internationally: 
  • 40 million children subjected to abuse each year. 
  • Suicide is the third leading cause of death among adolescents worldwide.
  • 30% of severely disabled children in special homes in the Ukraine die before 18 years of age.
  • Approximately 20% of women and 5–10% of men report being sexually abused as children, while 25–50% of all children report being physically abused. 
  • Statistics indicate that 3 million young girls are subjected to genital mutilation every year.

   
  Consider India where 19% of the world's children live. In 2007, UNICEF and the Government of India's Ministry of Women and Child Development published a Study on Child Abuse.  Traditionally in India, the support and care of children has been the responsibility of the family and community, and while children had some rights under the Constitution, "the approach to ensure the fulfillment of these rights was more needs based rather than rights based" (Ministry of Women and Child Development, 2007). General findings included:
  • Children 5-12 were most at risk for maltreatment and exploitation
  • Two out of every 3 children were victims of physical abuse
  • 14975 children were reported to be victims of crimes against children including:
  • Rape, kidnapping, procurement, buying or selling for prostitution, exposure and abandonment, infanticide, etc.
  • 53% of children were victims of sexual abuse, with 21% reporting severe sexual abuse.
  • 50% of the child victims reported knowing their abuser and was often in a position of trust and authority. 
  • 50% of children reported emotional abuse (boys and girls equally)
  • 83% of the abusers were parents
  • 48% of the girls wished they were boys 
    
  The report provides potential risk factors and reasons for the high maltreatment rate: 
  

  "Harmful traditional practices like child marriage, caste system, discrimination against the girl child, child labour and Devadasi tradition impact negatively on children and increase their vulnerability to abuse and neglect. Lack of adequate nutrition, poor access to medical and educational facilities, migration from rural to urban areas leading to rise in urban poverty, children on the streets and child beggars, all result in break down of families. These increase the vulnerabilities of children and exposes them to situations of abuse and exploitation"  (Ministry of Women and Child Development, 2007, p 6).

  
  So, what does this mean for us, for all of us, as co-contributors to child health and development? It means we have work to do. It means that each and every center that works with children needs to train and retrain employees on child abuse risk assessment, identification, and reporting. It means that we, as caregivers and professionals, need to create caring environments free from abuse where children can feel safe, secure, and worthy of love and respect. It means we need to educate children on their worth, rights, and resources; advise them of safety plans; and refer them to professionals training in the assessment and treatment of childhood maltreatment and abuse. It also means supporting parents and communities that have higher risk factors, fewer resources, and little support. Prevention is the key, however, where prevention fails we need to re-double our efforts to protect young lives and mitigate the harm done. 
  
  Links:
  Ark of Hope for Children
  Centers for Disease Control
  Ministry of Women and Child Development, India
  World Health Organization
  UNICEF