Five things we learned from research on child survivors of violence

Understanding prevalence, characteristics and motives of disclosure, help-seeking and reporting of violence against children

 Violence against children is a pervasive global phenomenon. Estimates indicate over 1 billion children under the age of 18 experience emotional, physical or sexual violence every year from a range of perpetrators – including parents, peers and intimate or dating partners. Despite these high figures, official figures of VAC are just the tip of the iceberg.How much do we know about children’s disclosure, help-seeking and reporting of violence? Most studies in low- and middle-income countries have narrowly focused on either reporting intimate partner violence among adolescent girls, on specific types of violence, or in specific settings. A new publication, analyzing nationally representative Violence Against Children Survey data from six countries, aims to broaden the focus. The publication, just released in BMC Public Health, led by UNICEF Innocenti, in collaboration with other UNICEF offices and government counterparts, examines data from Cambodia, Haiti, Kenya, Malawi, Nigeria and Tanzania.The study had three objectives:

• Measure the prevalence of informal disclosure (to family and friends among others), formal help-seeking (from social, health and legal services), formal reporting, and receipt of formal help;
• Document characteristics associated with disclosure and health seeking;
• Understand reasons why children did not seek help.

 Using nationally representative data from six countries, the study analyzed reports from children aged 13 to 17 who experienced any physical and/or sexual violence in their lifetimes. These samples of child survivors of violence represented a high percentage of total children across countries: physical violence among children ranged from 50 to 84%, while that for sexual violence ranged from 6 to 36%. What did we learn in terms of disclosure and reporting? 

1. Most children have never told anyone about the violence they experience: Across countries the percentage of children who ever told someone informally about their experience was low—23% in Cambodia and 32% in Kenya, to 42% in Tanzania and 54% in Malawi. These estimates show that children may be telling survey interviewers about violence for the very first time and confirms that violence is largely under-acknowledged and “hidden in plain sight.” It also means that children’s existing social networks—including family, friends, and neighbors are often a first source of disclosure and possible support system for children survivors.

 

2. Formal services are rarely accessed or utilized by child survivors: The percentage of children who reported to formal sources was low—ranging from under 1% in Cambodia to 25% in Tanzania (formal disclosure)—and the percentage who received help was even smaller (1% in Nigeria to 11% in Tanzania, this outcome was not measured in Cambodia or Haiti). These statistics confirm that only a fraction of children attempt to contact health, social or legal services and even fewer receive any support, highlighting the importance of expanding accessibility and reach of assistance.

 

3. Factors encouraging disclosure, help-seeking and reporting varied by country: Identifying factors that encourage these behaviors could help target services or develop secondary prevention programming. However, few factors were consistently positively correlated with help-seeking behaviors—including factors that are hypothesized to help, like household wealth and residing in urban settings. This lack of pattern underscores the importance of context and the challenges in targeting services using observable characteristics of child survivors.

 

4. Self-blame, apathy and not needing or wanting services were top factors deterring children from disclosure: Across countries, common reasons cited for not seeking help were responses like “I felt it was my fault (self blame)”, “I did not think it was a problem (apathy)” or “I don’t want or need services.” For example, in Cambodia, the most common reason for not seeking help for physical violence was self-blame, mentioned by 56% of children, while the most common reason in Kenya, Malawi and Nigeria was apathy (25%-39%). Fewer children reported fear of repercussions or helplessness, while lack of access and financial constraints were rarely mentioned. These reasons highlight the role of shame and how the normalization of VAC is pervasive.

 

5. Better data and methodological innovation is urgently needed: This study underscores the need for innovation in research methodologies to accurately estimate prevalence of sensitive topics. Improvements might include methods allowing self-administration of questions and those which allow for greater confidentiality. In addition, future surveys should include a wider range of household and community level indicators to understand underlying dynamics surrounding the child’s environment—for example, parental (mental health, parenting, time use), household (social and economic vulnerability factors), and community (gender norms, service availability) characteristics.

 What should we take away from these results? One concrete implication is that statistics based on violence against children reporting to formal sources such as data from health systems, police, or NGO reporting are likely to underestimate the total prevalence ranging from 4 to 940-fold depending on the country. This has implications for the analysis of such data during COVID-19, where there have been fears that children are even less able to access services—and that many cases of violence are uncounted. Our results show this is a huge issue and must be accounted for when interpreting the dynamics stemming from administrative data.Other implications relate to how to improve use of services for survivors. One strategy is to address barriers including social norms that normalize violence, and how these manifest in different contexts. Another is to improve linkages and raise awareness of child protection services and common touchpoints  for children, such as those within the education, health and community-based structures, which are likely to interact with children on an informal, daily basis. These trusted individuals in children’s lives are important entry points for formal services.It is also important to strengthen the capacities of professionals working in health, education and social sectors to be able to identify risks and respond using a survivor centered approach. Given the wide under-reporting and pervasive nature of violence against children, services which are targeted to only one setting or population are unlikely to result in broad uptake of services and assistance. Multi-sectoral responses and well-networked referral systems are necessary.Much more research is needed to unpack the dynamics around help-seeking and secondary prevention for survivors. We hope this analysis will serve as a starting point to advance research and practice to end violence against children and the long-lasting negative effects experienced by children over their lifetimes.***Special thanks to Alessandra Guedes, Alina Potts and Mary Shawa for helpful comments.Amber Peterman, Ph.D. joined UNICEF Office of Research – Innocenti in 2015 as a Social Policy Specialist and now works as a consultant with joint affiliation as an Associate Adjunct Professor at UNC Chapel Hill. Amber focuses on gender, violence and adolescent wellbeing and safe transitions to adulthood with the Transfer Project evaluations of social protection and cash transfers in Africa.Audrey Pereira is a Doctoral Student in Public Policy at The University of North Carolina at Chapel Hill.Tia Palermo is Associate Professor of Epidemiology and Environmental Health at the University at Buffalo (State University of New York) and an Affiliated Researcher with the Transfer Project. Full citation: Pereira A, Peterman A, Neijhoft AN, Buluma R, Kaloga IF, Harvey R, Islam A, Kheam T, Kitembe M, Lund-Henriksen B, Maksud N, Maternowska MC, Potts A, Rottanak C, Shawa M, T Palermo (2020). Disclosure, reporting and help-seeking among child survivors of violence: A cross-country analysis. BMC Public Health 20(1051).