Childhood sexual abuse and the role of stakeholders

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By our staff writer

 Child sexual abuse also called child molestation is a form of abuse in which an adult or older adolescent uses a child for sexual stimulation. Forms of child sexual abuse include engaging in sexual activities with a child by asking, pressuring or by other means. It also includes indecent exposure of the genitals or female nipples, child grooming and such child sexual exploitation as using a child to produce child pornography

Child sexual abuse can occur in a variety of settings, including home, school, or work in places where child labor is common. Child marriage is also one of the main forms of child sexual abuse. According to UNICEF, child marriage represents perhaps the most prevalent form of sexual abuse and exploitation of girls. The effects of child sexual abuse can include depression, post-traumatic stress disorderanxietycomplex post-traumatic stress disorder, propensity to further victimization in adulthood, and physical and emotional injury to the child, among other problems. Sexual abuse by a family member is a form of incest and can result in more serious and long-term psychological trauma, especially in the case of parental incest

The global prevalence of child sexual abuse has been estimated at 19.7% for females and 7.9% for males. Most sexual abuse offenders are acquainted with their victims and approximately 30% are relatives of the child, most often brothers, fathers, uncles, or cousins.  Around 60% are other acquaintances, such as “friends” of the family, babysitters, or neighbors. Strangers are the offenders in approximately 10% of child sexual abuse cases. Most child sexual abuse is committed by men. Studies on female child molesters show that women commit 14% to 40% of offenses reported against boys and 6% of offenses reported against girls. 

The word pedophile is commonly applied indiscriminately to anyone who sexually abuses a child, but child sexual offenders are not pedophiles unless they have a strong sexual interest in prepubescent children. Under the law, child sexual abuse is often used as an umbrella term describing criminal and civil offenses in which an adult engages in sexual activity with a minor or exploits a minor for the purpose of sexual gratification.

 The American Psychological Association states that “children cannot consent to sexual activity with adults”, and condemns any such action by an adult. It says: “An adult who engages in sexual activity with a child is performing a criminal and immoral act which never can be considered normal or socially acceptable behavior.” 

While children may exhibit regressive behaviours such as thumb sucking or bedwetting, the strongest indicator of sexual abuse is sexual acting out and inappropriate sexual knowledge and interest. Victims may withdraw from school and social activities and exhibit various learning and behavioral problems including cruelty to animalsattention deficit/hyperactivity disorder (ADHD), conduct disorder, and oppositional defiant disorder (ODD). Teenage pregnancy and risky sexual behaviors may appear in adolescence.

 Child sexual abuse victims report almost four times as many incidents of self-inflicted harm. Sexual assault among teenagers has been shown to lead to an increase in mental health problems, social exclusion and worse school performance. 

A study funded by the USA National Institute of Drug Abuse found that among more than 1,400 adult females, childhood sexual abuse was associated with increased likelihood of drug dependence, alcohol dependence and psychiatric disorders. The associations are expressed as odds ratios: for example, women who experienced non-genital sexual abuse in childhood were 2.83 times more likely to develop drug dependence as adults than were women who were not abused. 

A causal relationship has been found between childhood sexual abuse and various adult psychopathologies, including crime and suicide, in addition to alcoholism and drug abuse. Males who were sexually abused as children more frequently appear in the criminal justice system than in a clinical mental health setting.

A study comparing middle-aged women who were abused as children with non-abused counterparts found significantly higher health care costs for the former. Intergenerational effects have been noted, with the children of victims of child sexual abuse exhibiting more conduct problems, peer problems and emotional problems than their peers. A specific characteristic pattern of symptoms has not been identified, and there are several hypotheses about the causality of these associations. 

Child abuse, including sexual abuse, especially chronic abuse starting at early ages, has been found to be related to the development of high levels of dissociative symptoms, which includes amnesia for abused memories. When severe sexual abuse such as penetration or several perpetrators, lasting more than one year had occurred, dissociative symptoms were even more prominent.  

Because child sexual abuse often occurs alongside other possibly confounding variables, such as poor family environment and physical abuse, some scholars argue it is important to control those variables in studies which measure the effects of sexual abuse. In a 1998 review of related literature, Martin and Fleming state: “the hypothesis advanced in this paper is that, in most cases, the fundamental damage inflicted by child sexual abuse is due to the child’s developing capacities for trust, intimacy, agency and sexuality, and that many of the mental health problems of adult life associated with histories of child sexual abuse are second-order effects.” Other studies have found an independent association of child sexual abuse with adverse psychological outcomes. 

Depending on the age and size of the child, and the degree of force used, child sexual abuse may cause internal lacerations and bleeding. In severe cases, damage to internal organs may occur, which, in some cases, may cause death. Child sexual abuse may cause infections and sexually transmitted diseases. Due to a lack of sufficient vaginal fluid, chances of infections can heighten depending on the age and size of the child. Virginities has also been reported. 

Research has also shown that traumatic stress, including stress caused by sexual abuse, causes notable changes in brain functioning and development. Various studies have suggested that severe child sexual abuse may have a deleterious effect on brain development. It was also found that a strong association existed between short-term memory impairments for all categories tested (verbal, visual, and global) and the duration of the abuse. 

Incest between a child or adolescent and a related adult is known as child incestuous abuse, and has been identified as the most widespread form of child sexual abuse with a highly significant capacity to damage the young person. One researcher stated that more than 70% of abusers are immediate family members or someone very close to the family. Another researcher stated that about 30% of all perpetrators of sexual abuse are related to their victim, 60% of the perpetrators are family acquaintances, like a neighbor, babysitter or friend and 10% of the perpetrators in child sexual abuse cases are strangers.[18] A child sexual abuse offense where the perpetrator is related to the child, either by blood or marriage, is a form of incest described as intra-familial child sexual abuse

The most-often reported form of incest is father–daughter and stepfather–stepdaughter incest, with most of the remaining reports consisting of mother/stepmother–daughter/son incest. Father–son incest is reported less often; however, it is not known if the actual prevalence is less or it is under-reported by a greater margin. Similarly, some argue that sibling incest may be as common, or more common, than other types of incest: Goldman and Goldman reported that 57% of incest involved siblings. Finkelhor reported that over 90% of nuclear family incest involved siblings; while Cawson et al. show that sibling incest was reported twice as often as incest perpetrated by fathers/stepfathers. 

Prevalence of parental child sexual abuse is difficult to assess due to secrecy and privacy; some estimates state that 200 million children have been victimized by parental incest as children. The initial approach to treating a person who has been a victim of sexual abuse is dependent upon several important factors:

  • Age at the time of presentation
  • Circumstances of presentation for treatment
  • Co-morbid conditions

The goal of treatment is not only to treat current mental health issues, and trauma related symptoms, but also to prevent future ones.

Children often present for treatment in one of several circumstances, including criminal investigations, custody battles, problematic behaviors, and referrals from child welfare agencies. 

The three major modalities for therapy with children and adolescents are family therapygroup therapy, and individual therapy. Which course is used depends on a variety of factors that must be assessed on a case-by-case basis. For instance, treatment of young children generally requires strong parental involvement and can benefit from family therapy. Adolescents tend to be more independent; they can benefit from individual or group therapy. The modality also shifts during the course of treatment; for example, group therapy is rarely used in the initial stages, as the subject matter is very personal and/or embarrassing. In a 2012 systematic review, cognitive behavior therapy showed potential in treating the adverse consequences of child sexual abuse. 

Major factors that affect both the pathology and response to treatment include the type and severity of the sexual act, its frequency, the age at which it occurred, and the child’s family of origin. Roland C. Summit, a medical doctor, defined the different stages the victims of child sexual abuse go through, called child sexual abuse accommodation syndrome. He suggested that children who are victims of sexual abuse display a range of symptoms that include secrecy, helplessness, entrapment, accommodation, delayed and conflicted disclosure and recantation. 

Adults who have been sexually abused as children often present for treatment with a secondary mental health issue, which can include substance abuseeating disorderspersonality disordersdepression, and conflict in romantic or interpersonal relationships. 

Generally, the approach is to focus on the present problem, rather than the abuse itself. Treatment is highly varied and depends on the person’s specific issues. For instance, a person with a history of sexual abuse and severe depression would be treated for depression. However, there is often an emphasis on cognitive restructuring due to the deep-seated nature of the trauma. Some newer techniques such as eye movement desensitization and reprocessing (EMDR) have been shown to be effective. 

The prevalence of child sexual abuse in Africa is compounded by the virgin cleansing myth that sexual intercourse with a virgin will cure a man of HIV or AIDS. The myth is prevalent in South AfricaZimbabwe, Zambia and Nigeria and is being blamed for the high rate of sexual abuse against young children. 

Child rape is on the rise in the war-ravaged eastern Democratic Republic of the Congo. Aid workers blame combatants on all sides, who operate with much impunity, for a culture of sexual violence. South Africa has some of the highest incidents of child rape including the rape of babies in the world. A survey by CIET found around 11% of boys and 4% of girls admitted to forcing someone else to have sex with them. In a related survey conducted among 1,500 schoolchildren, a quarter of all the boys interviewed said that “jackrolling”, a term for gang rape, was fun. More than 67,000 cases of rape and sexual assaults against children were reported in 2000 in South Africa, compared to 37,500 in 1998. Child welfare groups believe that the number of unreported incidents could be up to 10 times that number. The largest increase in attacks was against children under seven. The virgin cleansing myth is especially common in South Africa, which has the highest number of HIV-positive citizens in the world. Eastern Cape social worker Edith Kriel notes that “child abusers are often relatives of their victims – even their fathers and providers.” 

A number of high-profile baby rapes appeared since 2001 including the fact that they required extensive reconstructive surgery to rebuild urinary, genital, abdominal, or tracheal systems. In 2001, a 9-month-old was raped and likely lost consciousness as the pain was too much to bear. In February 2002, an 8-month-old infant was reportedly gang-raped by four men. One has been charged. The infant has required extensive reconstructive surgery. The 8-month-old infant’s injuries were so extensive, increased attention on prosecution has occurred. 

In Afghanistan, some boys are forced to participate in sexual activities with men. They are also termed ‘dancing boys’. The custom is connected to sexual slavery and child prostitution. In Bangladesh, child prostitutes are known to take the drug Oradexon, an over-the-counter steroid, usually used by farmers to fatten cattle, to make child prostitutes look larger and older. Charities say that 90% of prostitutes in the country’s legalized brothels use the drug. According to social activists, the steroid can cause diabetes and high blood pressure and is highly addictive. 

In the United Kingdom, reported child sex abuse has increased, but this may be due to greater willingness to report. Police need more resources to deal with it. Also parents and schools need to give children and adolescents regular advice about how to spot abuse and about the need to report abuse. Software providers are urged to do more to police their environment and make it safe for children. 

Child sexual abuse is outlawed nearly everywhere in the world, generally with severe criminal penalties, including in some jurisdictions, life imprisonment or capital punishment. An adult’s sexual intercourse with someone below the legal age of consent is defined as statutory rape, based on the principle that a child is not capable of consent and that any apparent consent by a child is not considered to be legal consent.

The United Nations Convention on the Rights of the Child (CRC) is an international treaty that legally obliges states to protect children’s rights. Articles 34 and 35 of the CRC require states to protect children from all forms of sexual exploitation and sexual abuse. This includes outlawing the coercion of a child to perform sexual activity, the prostitution of children, and the exploitation of children in creating pornography. States are also required to prevent the abduction, sale, or trafficking of children. 

Child sexual abuse became a public issue in the 1970s and 1980s. Prior to this point in time, sexual abuse remained rather secretive and socially unspeakable.[citation needed] Studies on child molestation were nonexistent until the 1920s and the first national estimate of the number of child sexual abuse cases was published in 1948. By 1968 44 out of 50 U.S. states had enacted mandatory laws that required physicians to report cases of suspicious child abuse. Legal action began to become more prevalent in the 1970s with the enactment of the Child Abuse Prevention and Treatment Act in 1974 in conjunction with the creation of the National Center for Child Abuse and Neglect. Since the creation of the Child Abuse and Treatment Act, reported child abuse cases have increased dramatically. Finally, the National Abuse Coalition was created in 1979 to create pressure in congress to create more sexual abuse laws.

 Childhood sexual abuse is unfortunately a widespread problem that is associated with stigma, shame and a tendency to secretly push under the carpet. Thus, in most instances, it often goes unreported. The family may also wish to avoid the societal stigma and public humiliation if it were to become common knowledge. All of these factors act independently and in tandem to ensure that we hardly ever hear about these cases, even though they may be happening right under our noses. 

This culture of silence and secrecy is unhelpful. On the one hand, it results in a situation where perpetrators often go scot-free. They escape sanctions as well as public ridicule and humiliation for their actions. On the contrary, the burden of shame and emotional turmoil and scars are borne by the young and innocent survivors (and their families) for the rest of their lives. 

What are the emotional consequences for such people who have had these experiences? How can we help?

Individuals who have had such experiences often feel that they are somehow ‘damaged’ and not like others. Thus, they may suffer from low self-esteem and lack self-confidence.  They may constantly feel weak and vulnerable. Such perceptions are wrong and should be countered. The reality is that they are ‘survivors’ who have every reason to hold their heads high because they were able to withstand the adversity and cruelty of the adult perpetrators and they still have their entire life ahead of them. They need to stop looking back, or at best, do so only to the extent of taking away some lessons from the experience. But they should be forward-looking, with optimism and work towards achieving their dreams and goals.

In nine out of every ten cases, the perpetrator is usually a known and trusted adult who may be in the family – and that includes household staff such as drivers, gatemen and so on – a teacher, a neighbor or religious personality. So, a relationship of trust and safety becomes turned on its head and replaced with fear, hurt, threats and intimidation. The sense of betrayal is usually very strong, leading to a lifetime of difficulties with trusting others. 

This usually has complications for them as far as their ability to develop emotional relationships leading up to marriage is concerned. And even where they succeed in getting married, the past experience may continually colour their perceptions and negatively affect their relationships or quality of marriage.

Childhood sexual abuse often results in confusion and several unresolved questions for the child. Why is he doing this to me? But my parents tell me that there is a God who watches over us all? Why didn’t my parents protect me? Who can I talk to? Was it my fault? Did I do something wrong? Should I be angry at myself, my parents, the perpetrator or everyone else? So, an admixture of feelings of guilt, shame, fear, anger and despair may persist with such ‘survivors’ for the rest of their lives.

This is why leaders at all levels, traditional, religious, educational, political leaders and parents must encourage their children to come forward to reports incidents of child sexual abuse to the authorities for necessary action and government should make facilities available in its healthcare delivery system to accommodate such victims in cases that are daily becoming the trend in the Nigerian society.

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