Volume 6: Issue No. 1, June 2004
According to the World Health Organisation (WHO), child abuse including child labour, rape, neglet, and physical violence against children, is increasingly recognised as a global public health problem. Abused children require social and health care and the burden of ill-health resulting from such abuse is negatively impacting on the socio-economic development of a country.
The World Health Organisation defines child sexual abuse in a way which includes a range of acts including coerced sex, incest, date rape, virginity testing, forced marriage, sexual harassment, and involvement in prostitution and pornography (WHO 2002).
This research update will focus on child rape in South Africa. South Africa has one of the highest rates of rape cases reported to the police in the world. There are over 20 000 cases of child rape and attempted rape reported to the police each year. One in five of all rape cases are of children under the age of 18. The figures have risen considerably in the past decade. However, many cases are not even reported as rape stigma, fear of retaliation and anticipation of difficult experiences with the police, courts and health services cause many women and girls to remain silent.
The health and welfare services are striving to meet the needs of children who have been sexually abused. In particular, their mental health needs, which are usually not met. It is much more likely that a conviction will be secured in a case where a child is sexual assaulted than an older women. Approximately 80% of all convictions in all family violence and sexual assault cases involve crimes against children (SAPS 2003). None the less most perpetrators remain unpunished.
The Health Systems Research, Research Coordination and Epidemiology Directorate will be supporting North West Province Department of Health when they host a two day conference focusing on "Promoting networking for health research in the province", on the 11th and 12th June 2003.
The brochures on What you should know when deciding to take part in clinical trial as a research participant has been translated into other languages as well and is now available in all South African languages. They can be obtained by placing a request to Benjie Kgweedi at 012 312 0785 or Kgweeb@health.gov.za
The Health Systems Research, Research Co-ordination and Epidemiology Directorate conducts monthly research forums whereby researchers are invited to present important issues of their research findings to the senior managers of the Department of Health. For more information on research forums contact M Ratsaka-Mothokoa at (012) 312 0960 or e-mail: ratsam@health.gov.za
The prevalence of child sexual assault found in a population depends on the definition used and the source of data. In the year 2000 there were 21,427 cases of sexual assault of children (0-17 years) reported to the police. Survey research finds that nationally 1.5% of adult women report being raped before the age of 15 years (Jewkes et al 2002). If a slightly wider definition of sexual assault is used, including unwanted touching, 7.8% of women report this before 15 (Dunkle et al, in press). Madu and Peltzer (2001) found that 54.2% of their sample (n=414) of Limpopo Province school students reported physical contact forms of sexual abuse with an adult or person at least 5 years older or a person in a position of power.
Although the prevalence of child rape is much higher in South Africa than in many other countries, the patterns of rape are not very different from elsewhere. Young children are raped all over the world. Although there is great concern about these rapes in South Africa, the period of greatest risk of rape is the second half of childhood, from about 10-17 years. Girls are much more vulnerable than boys although both are sexually abuse. The most common groups of sexual abusers of children are male relatives, boyfriends, male acquaintances and men in a position of power, notably teachers. It is unusual for children to be raped by strangers. In all countries many child rape perpetrators are themselves children (Jewkes et al, 2004).
The motivations of child rape are complex and varied. Some men rape because they enjoy the feeling of powerfulness over women and girls that it gives them. Some people are sexually attracted to children (or teenagers) and rape to gain sexual satisfaction with them. In some cases child rape is an act of revenge against the child or his or her mother. Boys often perpetrate gang rape, sometimes of the type called streamline or the train, in the course of male bonding activities where the rape of the girl or woman becomes a way of demonstrating male strength and solidarity. Some men force sex on their children as a way of demonstrating that they are the head of the home and asserting that they control the home. Some men seem to rape out of boredom, because it gives them something to do. There has been considerable media interest in child rape motivated by men trying to cure themselves of HIV, but the evidence suggests that this is very rare.
Children are more vulnerable to being sexually assaulted if they are very impoverished, have poor living conditions, parents who are often absent or do not try by all means to protect them or come from homes where substance abuse is a problem. Mothers often fear reporting the perpetrator if the family is financially dependant on him. Men are more likely to sexually abuse children if they believe men to be superior over women, drink alcohol, associate with delinquent peers, hold ideas which are hostile to women, have coercive sexual fantasies, have impulsive and antisocial tendencies, prefer impersonal sex and have difficulty having nurturing relationships with women, come from an emotionally unsupportive and violent family background, and a background of poverty and unemployment (WHO 2002).
Societal reactions to child rape are very important. If a community or society usually blames the victim for causing the rape, if police systems are weak and perpetrators are rarely punished, if there are weak community sanctions against men who rape, and if rape is seen as almost normal for young men it is much more likely to occur (WHO 2002). All of these societal factors are found commonly in communities in South Africa and may explain the high prevalence of child sexual abuse.
Sexually abused children suffer a variety of physical, emotional and developmental problems that can interfere with their ability to live healthy and productive lives [Bowley et.al, 2002]. They may have sexually transmitted infection, including HIV, constipation, genital injuries, recurrent urinary tract infections, abdominal pains and behavioural problems. Women sexually abused as children are at greater risk of substance abuse, depression, mental health problems and engaging in high risk sexual practices when they are teenagers and adults (WHO 2002).
Children who have been sexually assaulted often come to health services at a time which ranges from hours to many years after the assault (or the first assault). Health services for sexually assaulted children range from the very best available in specialist centres such as the Teddy Bear Clinic in Johannesburg to very weak services which are found in many hospitals. For example a recent survey found that only one in four providers of sexual assault services had ever been trained and most providers are not aware of clinical guidelines for managing such cases (Christofides, et al 2003). Meeting HIV prevention needs is a priority and anti-retrovirals should be given where indicated. Health services need to improve other areas of care especially provision of psychological support for children who have been sexually assaulted.
The public health sector needs to improve its ability to respond to child rape through the provision of holistic, high quality services by trained and experienced providers. The Department of Health needs to prioritise finalising its sexual assault policy and clinical management guidelines and ensuring they are disseminated an implemented nationally. The national programme for training sexual assault service providers needs to be finalised and implemented in provinces.
Teachers and other providers of services for children need to be better equipped to identify cases of sexual abuse and other forms of child abuse and to understand how to respond.
There is an urgent need for campaigns to change public attitudes towards rape of children and women so that a consistent message of zero tolerance towards all forms of rape is given. It is essential that the perpetrator of rape is blamed and not the victim. Police and prosecutors need to enhance their responsivenss to all cases of child sexual assault so that levels of conviction of perpetrators are raised.
The Department of Social Welfare needs to consider ways to reduce the extent to which poverty is a barrier to reporting child abuse cases so that fewer mothers have to make the choice between keeping food on the table and reporting an abusive breadwinner.
Compiled by Claudia Shilumani
Reviewed by Rachael Jewkes (Medical Research Council)
For more information on this issue of Research Update contact us:
The National Department of Health Directorate: Health Systems Research,
Research Co-ordination and Epidemiology
Private Bag X 828 Pretoria 0001
Tel: (012) 312 0960
Fax: (012) 312 0784
Research Updates are quarterly publications of the Department of Health, focusing on the important/current research findings.