|Year : 2014 | Volume
| Issue : 2 | Page : 53-55
Child sexual Abuse: Need for a preventive framework in Indian context
Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
|Date of Web Publication||20-Mar-2015|
Department of Psychiatry, All India Institute of Medical Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sagar R. Child sexual Abuse: Need for a preventive framework in Indian context. J Mental Health Hum Behav 2014;19:53-5
As per WHO, Child Sexual abuse (CSA) is defined as 'inappropriate sexual behaviour with a child, acts being committed by a person responsible for the care of a child (for example a baby-sitter, a parent, or a day care provider), or related to the child.'  Globally, CSA affects more than one out of five females and one in 10 males.  In the World Mental Health Surveys, in a representative multi-national sample of 51,945 persons, sexual abuse was reported by 1.6% (SE:0.1) and was seen to be linked to an increased risk for onset of a psychiatric disorder in adulthood.  CSA bears serious consequences for the health and wellbeing of the individual, and has wider implications for family and society as a whole.
Postindependence, India has been showing consistent advances in child health and education indices; however, the issues pertaining to child protection have remained inadequately addressed. It is noteworthy that India is home to 440 million children, that is, one-fifth of world's children. Nearly, 42% of India's population is below 18 years of age.  India is signatory to a host of International Covenants and Instruments focusing on Child Protection (e.g. UN Convention on the Rights of the Child, 1989; SAARC convention on regional arrangements on Promotion of Child welfare in South Asia, 2002, etc.). The constitutional (viz article 14, 15, 21, 39) as well as policy framework (e.g. National charter for children, 2004, National Plan of Action for Children, 2005) in India is geared to protection against violation of rights and abuse of children. Till date, however, these have not been translated into effective systems and mechanisms for ensuring child safety and protection at a national level.
The problem of CSA in India has traditionally remained shrouded in a "conspiracy of silence" due to a multitude of familial, socio-cultural, and economic factors.  There was not much understanding of the extent and magnitude of the problem till a few years back. Existing socio-economic conditions also render some children vulnerable and at risk for abuse.
One of the first large-scale initiatives was taken by Ministry of Women and Child Development (soon after coming into existence in early 2006) in order to document the magnitude and dimensions of child abuse in various forms. The study "child abuse: India (2007)"  covered 13 states with a sample of more than 12,447 children aged 5-18 years, including children from a variety of settings like family, schools, streets, institutional care etc., The findings though cannot be generalized to the general population, but nonetheless, these figures are reflective of existence and seriousness of the problem prevalent across various settings. About 53% of surveyed children reported having faced one or more forms of sexual abuse, with 22% reporting severe forms of sexual abuse. Half of the abuses were by persons known to the child or in a position of trust and responsibility. Most children did not report the matter to anyone. 
In terms of significant developments on child protection in India, the National Commission for the Protection of Child Rights since its inception in 2007 has been working as an autonomous ombudsman to ensure that all policies and mechanisms, etc., carry a child rights perspective and are in consonance with Indian constitution and international commitments. The National Policy for Children, 2013 mandates the State to "create a caring, protective and safe environment for all children, to reduce their vulnerability in all situations and to keep them safe at all places, especially public spaces".  The 12 th 5-year plan (2011-2016) of the Ministry of Women and Child Development has also emphasized on the need for strict preventive measures for child abuse. 
As a legislative measure, the focus on child sexual offences is a more recent development. The Protection of Children from Sexual Offences Act (POCSO Act) 2012 was recently formulated in order to comprehensively address sexual abuse and sexual exploitation of children.  Few parts of it also deal with preventive aspects. Section 19 of POCSO provides for mandatory reporting of sexual offences. This casts a legal duty upon a person who has knowledge that a child has been sexually abused to report the offence; if he fails to do so, he may be punished with six months' imprisonment and/or a fine it mandatory to report upon any person who has an apprehension that an offence is likely to be committed. The Juvenile Justice (Care and Protection of Children) Act 2000 and Delhi Rules 2009 - have some specific preventive provisions such as: Age appropriate segregation of children in residential facilities, effective inter-agency linkages; standards of care for the physical infrastructure; training and sensitization of staff etc. 
Recently, the Delhi Commission for Protection of Child Rights (DCPCR), National Capital Territory of Delhi have drafted and released the Guidelines for the Prevention of Child Abuse.  Prior to this, there were no such guidelines in existence in other states of India. The process carried out in a systematic manner draws on existing literature, best international practices, and extensive consultative process with professionals and various other stakeholders. This initiative underscores the need for wider and collaborative efforts across other states in India aimed at building and strengthening the preventive framework for child abuse, including child sexual abuse (CSA).
In the recently drafted DCPCR guidelines,  the broad guiding principles emphasize on a zero tolerance policy for child abuse in any form. A set of procedures and processes for schools, residential facilities, and other institutions have been laid down, as follows - (a) Recruitment processes: No recruitment of a person with criminal record of sexual and/or physical violence within institute, need for verification of references and prior employment. (b) Capacity Building: Staff training for knowledge and skills in the use of existing legislative/other provisions. (c) Child protection safeguards: Each institution shall have a standard and uniform child protection policy applicable to all employed persons and persons visiting institution. (d) Formation of Child Abuse Monitoring Committee, including representatives from parents, children, and independent members, with responsibility of monitoring and implementation of these guidelines within the institution. (d) Age appropriate training modules for children and teaching the "safety rules" such as moving in groups, alerting school personnel if a stranger is on school premises, etc., (e) Transport related guidelines: Need for a female ward/guard till last child is dropped, bus to wait for parent or caregiver while dropping off the child, etc., In addition, guidelines have been prescribed for Outdoors and picnics etc., online safety and media reporting in a responsible manner.
Another recent development is the Indian Medical Association IMA-UNICEF initiative on CSA conducts training of the trainers (doctors with min 5 years experience) through regional workshops and train doctors of various medical colleges of the country. This significant initiative had also resulted in development of information booklet for doctors and health care professionals titled "Child Sexual Abuse-prevention and response" (http://www.ima-india.org). Doctors are sensitized and trained on various aspects of CSA, including identification and examination, preventive aspects and approach. The Child line number (1098) should be displayed in their clinics and hospitals for reporting any case of known or suspected child abuse or neglect.
In India, the policy and legislative framework for child protection have been evolving over the past decade. Some attention has been paid toward the issues related to prevention of CSA, but much more needs to be done at a wider level. Further, these policies need to be implemented effectively at the ground level to long-term sustainable, evidence-based preventive programs. In India, there are still no programs or large-scale efforts geared toward primary and secondary prevention of child abuse.
Traditionally, the joint family system and societal values as a whole have generally been oriented toward care and protection of children in India, with only a minimal presence of the State. However, at times, family members have also acted as a barrier to effective identification of child abuse and a tendency to "protect" the perpetrator of the CSA within the family. Further, with recognition of state's responsibility toward citizens and changing societal norms, it is important to build the necessary systems and organizational structures to prevent CSA, in addition to familial and community level measures aimed at awareness and empowerment against CSA.
The need of a prevention-oriented approach is clear, and now, it is also important to discuss about the type and approaches to prevention. In the spectrum of prevention model (from Individual to organization level), Cohen and Swift has pointed to key role and importance of an organizational level approach.  It has been argued that the political goals and legal frameworks have to undergo a change on the organizational level in order for prevention to be effective. In India, the organizational or structural aspects are still in the process of being strengthened and made more child-oriented. The alternate approach of the social-ecological model  identifies four levels of a person's social environment as necessary for abuse prevention viz. individual level, the relationship level, the community level, and the societal level.
Some key aspects of a successful prevention program have been reviewed in recent literature. ,,,,,,,,,,,,, It has been seen that effective prevention strategies operate on multiple levels: On the level of minors; adults who live or work with children; on the level of societal norms, legislative level, and finally, on the level of conscious or "less than conscious" attitudes and structures which protect the abuse perpetrators.  Further, the implementation of programs should be done periodically by professionals/trained personnel using easily understandable and appropriate language. It should also take into account gender and culture-specific aspects. Moreover, studies indicate the role of building networks and collaboration with counseling services, nongovernmental organizations, police and legal system. ,
Prevention programs have focused on enhancing knowledge and awareness (content) and on building and strengthening the institutional support and assistance (structures). While the structural aspects are important for long-term sustainability of preventive measures, the content aspects determine to a large degree how effective a preventive measure or program is in changing the behavior of minors or adults. There are several research and practical difficulties in reviewing the efficacy or effectiveness, of prevention programs because of heterogeneous studies, diverse measures of outcomes and associated ethical aspects. Most studies have focused on a change in knowledge or skills as an outcome. In a meta-analysis (n = 27 studies) on the effectiveness of school-based child abuse prevention programs, the average effect size for all programs was 1.07. The programs with four or more sessions that allowed children to become physically involved produced the highest effect sizes.  In another review (n = 22 studies), almost all studies found a small but significant average gain in self-protective knowledge; the actual impact on skills was unclear. Programs with the largest effect sizes and with multiple outcome gains consistently used each of these three components: (a) Modeling, (b) group discussion, and (c) role play. 
As seen from above, the research evidence can provide some guidance toward the type of approaches, methods, target groups, components, mediums, and contexts of prevention. It is, however, difficult to predict which type or which combination of different strategies will be most effective. It is also important that the prevention programs are suitably adapted in nonwestern settings like India to relevant specific cultural contexts and needs.
To conclude, a child lives within the broader confines of Family, Schools/Institutions, Society, and State. It is the responsibility of each and everyone concerned to take the necessary preventive steps towards ensuring child protection and safety. India has made some advancement in the recent decade at policy and legislation level. However, we are still far from providing effective state protection to the vulnerable children and ensuring child safety. It is important to devise and implement the culturally sensitive and evidence-based prevention programs, aimed at all levels from individual to family, society, and institutes. The national guidelines for prevention of child abuse should be put into place to begin with, followed by their effective implementation and translation into programs and action plans in order to have a broader impact at a national level.
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