Understanding Child Sexual Abuse
WHO (1999) defines Child sexual abuse (CSA) as the involvement of a child in sexual activity that they do not fully comprehend, is unable to give informed consent to, or that violates the laws or social taboos of society. To simply articulate, CSA is any act, using a child for the sexual gratification of the more powerful person where the later derives power by the differential of age, gender, cognitive difference, socioeconomic differential, religion, and caste. Child Sexual Abuse is mostly committed by someone who is in a position of power and/or authority and a position of trust. Child Sexual Abuse is a violation of the child’s body as well as of the child’s trust and is against the law.
It includes both contact and non-contact sexual behaviours. Child Sexual Abuse encompasses sexual assault, sexual harassment and use of a child for pornographic purposes (POCSO Act 2012). Contact and non-contact sexual abuse encompass the following behaviours and acts:
Contact Sexual Abuse
Non-Contact Sexual Abuse
Child Pornography or involving a child for pornographic purposes involves the sexual representation of child/children through any medium like print, electronic, computer or any other technology including preparation, production, offering, transmitting, publishing, facilitation and distribution. It also includes storing/possessing of any such material.
As technology advances, new forms of child sexual abuse is happening online which commonly includes grooming, live streaming, consuming child sexual abuse material, and coercing and blackmailing children for sexual purposes (Interpol 2018).
CSA in the Global Context
Child Sexual Abuse is a social problem with considerable magnitude.
WHO estimates that approximately 20 per cent of girls and 5 to 10 per cent of boys are victims of sexual abuse (cited in Finkelhor 2012). Systematic reviews from across the world including different age-cohort samples have observed rates of CSA, with averages of 18±20% for females and 8±10% for males. A recent systematic review in 2018 of 55 studies from 24 countries concluded that rates of CSA ranged from 8 to 31% for females and from 3 to 17% for males (Choudhry et al 2018). About 1 in 10 children is estimated to be sexually abused in the USA (Townsend and Haviland 2016) and about in 1 in 20 children in the UK have been sexually abused (NSPCC 2019).
CSA in the Indian Context
In the Indian context, a large-scale national study conducted in 2007 by Ministry of Women and Child Development (MoWCD), to assess the extent and nature of child abuse in India, uncovered some alarming statistics. More than half (53 %) reported experience of sexual abuse among 12,447 children interviewed. This study reported 52% are boys and 47% are girls. According to National Crime Record Bureau 2018 data, 39827 cases involving 40810 children were registered under the Protection of Children from Sexual Offences Act which accounted for 29% of all cases of crime against children. A total of approximately 109 Child Sexual Abuse cases were reported in a day and five cases in an hour. The maximum number of cases under the Act were reported in Maharashtra (16%) followed by Uttar Pradesh (14%) and Madhya Pradesh (7%). These three states together accounted for 35% of all POCSO cases reported in India. In 94.9 % of cases of POCSO Act (Section 4 & 6), the offenders were known to the victim. In 8% cases, offenders were family members, in 48% of cases offenders were family friends/ neighbours/ other known person and in 43% cases offenders were friends/online friends.
Socio-cultural Factors Reinforcing Child Sexual Abuse
Despite its high prevalence, violence against children is often hidden, unseen or under-reported. It is not widely acknowledged or understood. Child Sexual Abuse occupies a unique space where there are selective denial and acceptance. It is both recognized (happens with ‘others’) and denied (does not happen with my child by my family members) simultaneously. There is a silence around the issue of Child Sexual Abuse stems from the fear of shame, denial and social stigma and the foundational belief in the family being sacred and family honour being supreme. Along with this, the belief that children are the property of their parents and power differentials based on socio-economic condition, caste, class, religion, sexual preferences make children vulnerable to sexual abuse.
There is consensus in the research literature that most people who experience sexual abuse in childhood do not end up disclosing until adulthood, and when disclosure does occur in childhood, significant delays are common. This is also reinforced in case of incest as the family uses various techniques such as blaming and naturalizing to keep the family honour intact.
To add to this, the vocabulary to communicate around sexuality and sexual abuse is non-existent. There is negligent conversation at the institutional and community level. Legal, medical, justice systems are often ineffective or inadequate and there is an ineffective implementation of laws and policies which rather than supporting children and families who follow legal recourse retraumatize them.
Impact of Child Sexual Abuse
CSA is being recognized as one of the 24 risk factors that add fundamentally to the global burden of disease, and just one of the few preventable factors (Gretchen 2009). A systematic review concluded that CSA was systematically related to higher rates of subsequent physical health symptoms, including general health, gastrointestinal, pain and cardiopulmonary symptoms, and obesity (Vrolijk-Bosschaart, 2018).
Several studies across the globe have made a strong connection between Child Sexual Abuse (CSA) and the associated health burden. While the impact of the abuse can vary based on a variety of parameters, CSA has consistently been found to impact the life of the child at the physiological, psychological and social levels and impact sexual behavioural patterns in adulthood. Several models have been developed in an attempt to explain the adverse negative impact of CSA. One of the established conceptual frameworks on the impact of CSA is the Traumagenics Dynamics Model (Finkelhor and Browne 1985). This model highlights the four important trauma-causing factors that victims may experience, which are traumatic sexualization, betrayal, powerlessness, and stigmatization.
The physical impact of CSA can include pregnancy, tears to the vaginal or anal area, sexually transmitted diseases, repeated urinary infection and psychosomatic illness. The psychological impact can include unusual or unexplained fear of people or places, nightmares, eating and sleeping disturbances, anxiety, hyper-vigilance, clinging behaviour, indifference, frequent daydreaming, dissociation, lack of trust in self and others, regressive behaviours such as thumb sucking, soiling and bedwetting. It can also lead to depression, anxiety, and Post Traumatic Stress Disorder (PTSD). The most profound impact can include suicide. Social impact can include sudden withdrawal, overly pleasing behaviour, increased hostility, aggression and drastic change in academic performance. Sexual abuse in childhood can cause a drastic and visible change in sexual conduct and mannerisms.
It is difficult to separate the short-term impact from the long-term impact as the former may often be the commencement of a long-term problem. Some of the long term impacts can be:
However, when children who experience sexual abuse are believed and supported by their guardians/trusted adults/loved ones and have access to counselling and therapy they could recover very quickly. Indeed, some children and adult victims, especially those with a strong emotional support system before the abuse, might not show any impact of Child Sexual Abuse.
Despite the negative mental health impact of CSA, there is a broad variety of practical, cultural, individual and family-related barriers that restrict initialization and adherence to therapy and counselling. Family members also fear that their children would be stigmatized as mentally ill if they access mental health services (Sahay 2010). In this context, it takes a lot of courage for the survivors of sexual abuse to take the first step towards healing.