Child Sexual Abuse in Pakistan – A Factual Analysis
Children are the assets of our society and how we bring them up determines the future of our country. It is the shared responsibility of the entire society to raise healthy children and in this respect, I believe we as a nation are failing dismally. Our children today face multiple problems such as child labour, physical, sexual and verbal abuse. Perhaps the most serious of these issues is sexual abuse – an impermissible crime which does not receive its due share of attention from social or legal circles in Pakistan. Cultural and religious sensitivities create a hushed aura about this topic, and this article aims to break that and to raise voices against it.
Our silence and general inaction amplifies the psychological, physical and social consequences that sexual abuse has for victims. Every time I watch or read a news report on child sexual abuse, my mind grappled with why and how anybody could commit such a heinous act. We need to examine the issue of sexual abuse, how to prevent it and how to help heal those who have suffered it.
According to NCTSN (2009), “Child sexual abuse is any interaction between a child and an adult (or another child) in which the child is used for the sexual stimulation of the perpetrator or an observer.” In addition, sexual abuse includes touching and non- touching actions. Touching actions may involve touching of penis, vagina, buttocks, breast and sexual intercourse. Non-touching actions may include looking at child with naked body and pornography.
To quote ECSA-HC, in 2011, 223 million children globally were sexually abused out of which 150 were girls and 73 were boys. Child sexual abuse is a major issue in Pakistan, which is increasing day by day. According to Sahil (2014) child sexual abuse cases reported in Pakistan was 2778 in 2012, and 3002 in 2013.
That shows a 7.67% increase in incidence of child sexual abuse in 2013 compared with the previous year. Children of all ages are victims of sexual abuse, but the most vulnerable age group among both girls and boys is 11 – 15 years. In 2013, three infants were kidnaped from hospital after their birth, 217 cases were reported between 1- 5 years, 492 were between 6- 10 years, 880 were between 11- 15 years and 325 were between 16- 18 years.
Risk factors for sexual abuse:
Low socioeconomic conditions
Although all social classes are affected by sexual abuse, but low socioeconomic at higher risk of sexual abuse. Children in low socioeconomic status households are 3 times as likely to be identified as a victim of child abuse (Sedlack, et. al., 2010). Low socioeconomic condition includes poverty, unemployment and illiteracy. In poor families where the adults are occupied full-time working odd jobs, children are left unsupervised.
Children roam around and play in their neighbourhoods where they may fall victim to sexual predators. Additionally, poor people may send their children out to work or to beg on the streets, which is again not safe. Children from uneducated backgrounds are not provided with knowledge of sexuality in early developmental stages, and this lack of awareness means that they are not warned of potential sexual abusers.
Children with disabilities
Children with intellectual, physical and mental disabilities are more vulnerable to sexual abuse as compared to other children. “Children with disabilities are three times more likely than children without them to be victims of sexual abuse.” (Smith & Harrell, 2013). The prevalence of sexual abuse in children with intellectual and mental disabilities is greater than in children with other disabilities. “11.5% of children with intellectual disabilities had been abused while only 1.5 % of children without intellectual disabilities” (Kim, 2010).
There are several reasons behind the sexual abuse of children with disabilities. Firstly, these children are more dependent on caregivers for their daily life activities and so, parents leave them in different institutions. It increases interaction between child and caregiver which increases chances of sexual abuse of children.
Secondly, disabled children are not able to communicate with adults properly due to lack of verbal communication. Owing to this, children may be abused multiple times, but cannot express the trauma they have been subjected to. Finally, children with disabilities have a lower understanding of sexuality and the caregivers have also lacked confidence to provide sexual knowledge to such children.
Families with a history of sexual abuse, living with non-biological father and poor family bonding are also at the risk of sexual abuse. In all these family structure is a very important risk factor. In 70% to 80% of cases of child sexual abuse the perpetrator has a ‘familial relationship’ with the abused child (Sammut, 2014).
The abuser is mostly a man, he could be a family friend, neighbour, relative or father. Children who live with their stepfather or single parent are more likely to be victims of sexual abuse than children living with their biological father. Children who live with a single parent are 20 times more likely to be victims of sexual abuse than children living with both biological parents. (Sedlack, et. al., 2010.
Gender, age and ethnicity
The probability of sexual abuse exists in both male and female of all ages and ethnicity. Gender is a major factor in sexual abuse. Many researchers have showed that girls are at higher risk than boys. Sexual abuse prevalence rates are 1.5 to 3 times greater for females than males (Back & Lips, 1998).
Similarly, age is also significant factor. Children who are of age 11- 15 are more often victims of sexual abuse. Ethnicity and race are important factors to determine sexual abuse. African American and Hispanic ethnicity children are at nearly twice the risk of sexual abuse than non-Hispanic (Sedlack, et. al., 2010).
Indicators of child sexual abuse:
Indicators are the signs and symptoms that appear in a person who has been sexually abused. There are three main indicators which we can use to identify a child who has been sexually abused, these are physical, psychological/ behavioral and social indicators.
Physical indicators are such as injuries in the genital area, bruises, infections, pain (in genitalia, stomach and head), infections, and bleeding. Sometimes a child shows inappropriate sexual behaviors like frequent touching of genital parts. According to WHO (2013) unexplained genital injury, vaginal and penile discharge in girls and boys, infection in vagina of girls, bedwetting beyond the usual age, pain during voiding and defecation, infection in urinary track, STIs, pregnancy and presence of sperm in female reproductive system are some of the physical indicators.
These are signs and symptoms of social dysfunction in a child. The victim becomes isolated from friends, family members and other community members. He/she doesn’t participate in social activities like games and social gatherings.
They have poor social boundaries, loneliness, and difficulty in making intimate relationship. When the children failed to cope with sexual abuse they adopt negative coping styles such as using drugs, smoking and alcohol in later life. These negative adopting styles badly affect the concentration level of a person which ultimately impacts the academic performances.
Sexual abuse has a devastating psychological impact on the child. It creates short term and long term psychological and mental problems that vary from person to person and situation to situation. Women who experienced familial abuse reported higher current levels of depression and anxiety when thinking about the abuse” (Hall &Hall, 2011).
The short and long term problems includes depression, anxiety, PTSD, stress, aggression, guilt, self-blaming, powerlessness, low self-esteem, schizophrenia, bipolar disorders and phobias. In all these depression is common and long term problem. “Depression has been found to be the most common long-term symptom among survivors” (Hall &Hall, 2011).
Sexual abuse survivors are susceptible to suicidal thoughts, anorexia and problems with body image; they may feel ugly or be dissatisfied with their appearance. Victims experience irritability, anger, withdrawal, guilt and fear. Childhood sexual abuse also affects a person’s later life; they fail in building trust relationships, fear of intimacy and difficulty in making personal boundaries.
During my MHN clinicals I encountered a patient with such mental problems. She was a 16 year old girl in Karwan-e–Hayat Psychiatric Hospital, suffering from depression and PTSD. On interviewing, I came to know that she belonged to a poor uneducated family. On further investigation I found that she had lost her father in an accident and now she was living with her stepfather.
Her non-biological father had sexually abused her seven months ago. She said at that time she had been very tense and frustrated, had tried on many an occasion to tell her mother about it but didn’t, and she turned to drugs for escape. On interviewing, her mother said that she was getting aggressive, socially isolated and physically weak day by day. Her aggression reached a point where she would throw things about in her tantrums. After this scenario, she was admitted in hospital for further treatment.
Child sexual abuse is minimized by taking actions on an individual level, community level and national level. On individual level everyone should raise their voice against sexual abuse. They should be given awareness about causes and indicators of sexual abuse so that they able to help the survivors. Children should be taught self-protection skills, and to never allow any person to touch their private parts etc.
Similarly, on a community level there should be awareness sessions to support the people to fight against such people who are involving such criminal activities. There should be institutions and NGOs that legally fight cases of child sexual abuse. Likewise, government should make such laws and policies so that immediate action should be taken against criminals.
Besides this, psychotherapy and counselling are also important in helping survivors through the process of recovery. In psychotherapy, both individual and group therapy are useful, for example Trauma-Focused Cognitive Behavioral Therapy focuses on cognitive, behavioral and familial aspect of a person. According to Child Welfare Information Gateway (2012), “It is designed to reduce negative emotional and behavioral responses following child sexual abuse.” In the same way, there should be one-on-one counselling of individuals and parents (biological parents and non-biological).
In a nutshell, child sexual abuse is sexual contact between a child and perpetrator. Low socioeconomic status, gender, age, family and child with disabilities are some risk factors of sexual abuse. It affects the victim’s social behavior, physical and mental health. Certain strategies on individual, community and national level can help decrease the rate of sexual abuse. Psychotherapy and counselling are two key channels of support for a child who has fallen prey to sexual abuse.
Child Sexual Abuse Fact Sheet. (2009), 1. Retrieved from http://nctsn.org/nctsn_assets/pdfs/caring/ChildSexualAbuseFactSheet.pdf
Guidelines for the Clinical Management of Child Sexual Abuse East, Central and Southern African Health Community July 2011. (2012)
A compilation of statistics on child sexual abuse of reported cases in Pakistan. (2013) ( pp.
14-15). Retrieved from http://sahil.org/wp-content/uploads/2014/06/Cruel-Number-2013.pdf
Who.int,. (2015). WHO | Interventions for preventing child abuse. Retrieved 21 July 2015
Kim, Y. R. (2010). Personal safety programs for children with intellectual disabilities.
Education and Training in Autism and Developmental Disabilities, 312-319.
Smith, N., & Harrell, S. (2013). Sexual Abuse of Children with Disabilities. A National
Snapshot. Retrieved from http://www.vera.org/sites/default/files/resources/downloads/sexual-abuse-of-children-with-disabilities-national-snapshot-v2.pdf
Sammut, J. (2014). The new silence: family breakdown and child sexual abuse.
Back, S., & Lips, H. (1998). Child sexual abuse: victim age, victim gender, and observer
gender as factors contributing to attributions of responsibility. Child Abuse & Neglect, 22(12), 1239-1252. doi:10.1016/s0145-2134(98)00098-2
Hall, M., & Hall, J. (2011). The long-term effects of childhood sexual abuse:
Counseling implications. Retrieved from http://counselingoutfitters.com/vistas/vistas11/Article_19.pdf
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