Journal of Tropical Pediatrics Advance Access published June 30, 2015 Journal of Tropical Pediatrics, 2015, 0, 1–10 doi: 10.1093/tropej/fmv037 Original Paper
Childhood Experiences of Physical, Emotional and Sexual Abuse among College Students in South India by Meenakshi Bhilwar,1 Ravi Prakash Upadhyay,1 Saranya Rajavel,2 Sunil K. Singh,3 Kavita Vasudevan,4 and Palanivel Chinnakali5 Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India-110029 2 Indira Gandhi Medical College and Research Institute, Puducherry, India-605009 3 Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India-110029 4 Department of Community Medicine, Indira Gandhi Medical College and Research Institute, Kathirkamam, Puducherry, India-605009 5 Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India-605009 Correspondence: Palanivel Chinnakali, Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry-605009, India. Tel: þ91-9787825827. E-mail
ABSTRACT Objective(s): To document the prevalence of physical, emotional and sexual abuse during childhood among college students. Method(s): The study was conducted among college students of Puducherry, South India. Stratified random sampling was done to select colleges. Data were gathered using the adapted ‘Ministry of Women and Child Development Questionnaire on Child Abuse for Young adults’. Results: A total of 936 college students completed the questionnaire. Mean 6 SD age of the participants was 19.2 6 1.1 years. Half (48%) of the participants reported being mocked because of their physical appearance. In all, 56% (524/936) of the participants reported that they were beaten during their childhood, of which 13.4% (70/524) required medical treatment. Around 10% reported someone exposing his/her private parts to them, while in 6.4% of the cases, the perpetrator forced the study participants to expose their private parts. Conclusion(s): Emotional, physical and sexual abuse is common in childhood and demands prompt interventions at the familial, community and political levels. K E Y W O R D S : child abuse, physical, emotional, sexual, gender, South India.
INTRODUCTION Children are a reflection of a nation’s future. The early years of life are both valuable and vulnerable, and therefore, the rights of a child should be recognized and their protection should be of utmost importance. Apart from illiteracy, under-nutrition and infections, which have been shown to be common problems in children, abuse during childhood is
equally important, yet an issue seldom addressed. Child abuse or maltreatment is prevalent in all societies. According to the World Health Organization (WHO): ‘Child abuse or maltreatment constitutes all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival,
C The Author [2015]. Published by Oxford University Press. All rights reserved. For Permissions, please email: [email protected] V
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generalized to all. Also, young adults would be in a better position to recognize abuse compared to children, and would feel more comfortable talking about their experiences of abuse in childhood and sharing them with others. With this background information, the current study was planned to assess the prevalence of various forms of child abuse, namely, physical, emotional and sexual abuse, during childhood. MATERIAL AND METHODS It was a cross-sectional study conducted among college students of Puducherry during June-July 2013. Puducherry, formerly known as Pondicherry, is a Union Territory located in the southern part of India with four small unconnected districts: Pondicherry, Karaikal and Yanam on the Bay of Bengal and Mahe´ on the Arabian Sea. This study was conducted among college-going students in Pondicherry district. Both male and female students in the age group of 18-25 years, who consented to participate in the study, were included.
Sample size and sampling technique Sample size was calculated based on prevalence of physical and sexual abuse reported by the Ministry of Women and Child Development, India, i.e. 49%. Assuming an absolute precision of 5%, a error of 5%, design effect of 2 and 15% non-response rate, the required sample size came to be 920 [5]. Stratified random sampling was done to select colleges. The colleges in the study area were divided into three strata, namely, medical college, engineering college and an Arts and Science college. There were 14 medical colleges, 16 engineering colleges and 8 Arts and Science colleges. One college was randomly selected from each stratum. Students were invited to participate in the study in the selected colleges. All those who consented to participate were included in the study. Operational definition(s) The term ‘Child abuse’ may have different connotations in different cultural milieu and socioeconomic situations. A universal definition of abuse in the Indian context does not exist and has yet to be
Downloaded from http://tropej.oxfordjournals.org/ at UQ Library on July 15, 2015
development or dignity in the context of a relationship of responsibility, trust or power’ [1]. Worldwide, approximately 20% of women and 5–10% of men report being sexually abused in childhood [2]. Also, 23% of people report being physically abused as children [2]. According to the UN Secretary General’s Study on Violence against Children, almost 53,000 child deaths occurred across the globe in 2002 due to child homicide [3]. India is home to almost 19% of the world’s children, and children and adolescents together form approximately 40% of India’s total population [4]. In India, two out of every three children are physically abused, and every second child is reported to be facing emotional abuse. Around 53% of children reported having faced one or more forms of sexual abuse, and almost 50% of abusers are persons known to the child or in a position of trust and responsibility [5]. Abuse and maltreatment during childhood adversely affect the physical and psychosocial development of children. Abuse against children is a complex process and according to an ecological model, it results due to an interaction of some risk and protective factors at four major levels, namely, individual, family, societal and community level [6]. Some of the factors that have been commonly associated with child abuse are low birth weight, unwanted pregnancies, teenage pregnancy, social isolation, drug abuse, poverty, lack of support, unemployment, etc. These factors remain more or less constant between countries [6–8]. India is a country of strong cultural beliefs where care of children is considered the purview of the family predominantly and child abuse, especially sexual abuse, is an issue surrounded by a conspiracy of muteness. It is not until recently that the government has intervened and child’s rights and protection are being given importance. However, lack of substantial information and evidence on child abuse makes it difficult to approach this issue in a comprehensive manner. Another hindrance in addressing abuse in children is eliciting responses from children themselves regarding such a sensitive subject, as they either don’t understand the dimensions of abuse or are scared to reach out for help. Further, the definition of child abuse is not constant among countries, and therefore, data cannot be
Childhood Physical, Emotional and Sexual Abuse
3
students and ensured their participation in the study through friendly dialogue. Informed written consent for participation was taken from each student. Consent forms were also prepared for principals and their consent was taken before the selection of the study respondents was finalized. The students had the freedom to stop participation at any stage of the study. After obtaining written informed consent, students were asked to fill the self-administered questionnaire, in the classrooms. The investigators were available for any further clarification. Participants could skip questions if they felt that some questions were sensitive; however, they were encouraged to share information, as the questionnaire was anonymous. Ethical clearance was obtained from the Institute Ethical Review Committee of Indira Gandhi Medical College and Research Institute, Puducherry, India. Personal identifiers like name and address were not collected to maintain anonymity.
Process of data collection Data on abuse were gathered using the adapted Ministry of Women and Child Development (Government of India, GOI) Questionnaire on Child Abuse for Young Adults, 2007 [5]. The questionnaire was translated to the local language (Tamil) as well, and the participants chose language of questionnaire as either English or Tamil. Data collection was done by trained personnel under the supervision of the principal investigator. The data collectors were sensitized about the ethical issues, including the importance of confidentiality, consent and freedom to participate. They interacted with the
RESULTS A total of 936 college students completed the study questionnaire. Socio-demographic characteristics of study participants are described in Table 1. Mean (SD) age of the participants was 19.2 (1.1) years and range was 18–25 years. Of the total, 44.1% were male and 55.6% were female students. The mean (SD) number of members in the family of the study participants was 4.42 (1.1). In all, 39.6% of females felt that being a girl was a disadvantage for them in the family setting. Genderbased differences were observed in choice of schools, attention/care received at home and delegation of
Statistical analysis Data collected were entered in EpiData entry software. All statistical analyses were done using EpiData analysis software (Version 2.2.2.180). Prevalence of physical, emotional and sexual abuse was calculated as proportions with 95% confidence intervals (95% CI). Mean and standard deviation were used to summarize continuous variables. Prevalence of abuse among males and females was compared using the chi-square test. A p-value of
Childhood Experiences of Physical, Emotional and Sexual Abuse among College Students in South India by Meenakshi Bhilwar,1 Ravi Prakash Upadhyay,1 Saranya Rajavel,2 Sunil K. Singh,3 Kavita Vasudevan,4 and Palanivel Chinnakali5 Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India-110029 2 Indira Gandhi Medical College and Research Institute, Puducherry, India-605009 3 Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India-110029 4 Department of Community Medicine, Indira Gandhi Medical College and Research Institute, Kathirkamam, Puducherry, India-605009 5 Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India-605009 Correspondence: Palanivel Chinnakali, Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry-605009, India. Tel: þ91-9787825827. E-mail
ABSTRACT Objective(s): To document the prevalence of physical, emotional and sexual abuse during childhood among college students. Method(s): The study was conducted among college students of Puducherry, South India. Stratified random sampling was done to select colleges. Data were gathered using the adapted ‘Ministry of Women and Child Development Questionnaire on Child Abuse for Young adults’. Results: A total of 936 college students completed the questionnaire. Mean 6 SD age of the participants was 19.2 6 1.1 years. Half (48%) of the participants reported being mocked because of their physical appearance. In all, 56% (524/936) of the participants reported that they were beaten during their childhood, of which 13.4% (70/524) required medical treatment. Around 10% reported someone exposing his/her private parts to them, while in 6.4% of the cases, the perpetrator forced the study participants to expose their private parts. Conclusion(s): Emotional, physical and sexual abuse is common in childhood and demands prompt interventions at the familial, community and political levels. K E Y W O R D S : child abuse, physical, emotional, sexual, gender, South India.
INTRODUCTION Children are a reflection of a nation’s future. The early years of life are both valuable and vulnerable, and therefore, the rights of a child should be recognized and their protection should be of utmost importance. Apart from illiteracy, under-nutrition and infections, which have been shown to be common problems in children, abuse during childhood is
equally important, yet an issue seldom addressed. Child abuse or maltreatment is prevalent in all societies. According to the World Health Organization (WHO): ‘Child abuse or maltreatment constitutes all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival,
C The Author [2015]. Published by Oxford University Press. All rights reserved. For Permissions, please email: [email protected] V
1
Downloaded from http://tropej.oxfordjournals.org/ at UQ Library on July 15, 2015
1
2
Childhood Physical, Emotional and Sexual Abuse
generalized to all. Also, young adults would be in a better position to recognize abuse compared to children, and would feel more comfortable talking about their experiences of abuse in childhood and sharing them with others. With this background information, the current study was planned to assess the prevalence of various forms of child abuse, namely, physical, emotional and sexual abuse, during childhood. MATERIAL AND METHODS It was a cross-sectional study conducted among college students of Puducherry during June-July 2013. Puducherry, formerly known as Pondicherry, is a Union Territory located in the southern part of India with four small unconnected districts: Pondicherry, Karaikal and Yanam on the Bay of Bengal and Mahe´ on the Arabian Sea. This study was conducted among college-going students in Pondicherry district. Both male and female students in the age group of 18-25 years, who consented to participate in the study, were included.
Sample size and sampling technique Sample size was calculated based on prevalence of physical and sexual abuse reported by the Ministry of Women and Child Development, India, i.e. 49%. Assuming an absolute precision of 5%, a error of 5%, design effect of 2 and 15% non-response rate, the required sample size came to be 920 [5]. Stratified random sampling was done to select colleges. The colleges in the study area were divided into three strata, namely, medical college, engineering college and an Arts and Science college. There were 14 medical colleges, 16 engineering colleges and 8 Arts and Science colleges. One college was randomly selected from each stratum. Students were invited to participate in the study in the selected colleges. All those who consented to participate were included in the study. Operational definition(s) The term ‘Child abuse’ may have different connotations in different cultural milieu and socioeconomic situations. A universal definition of abuse in the Indian context does not exist and has yet to be
Downloaded from http://tropej.oxfordjournals.org/ at UQ Library on July 15, 2015
development or dignity in the context of a relationship of responsibility, trust or power’ [1]. Worldwide, approximately 20% of women and 5–10% of men report being sexually abused in childhood [2]. Also, 23% of people report being physically abused as children [2]. According to the UN Secretary General’s Study on Violence against Children, almost 53,000 child deaths occurred across the globe in 2002 due to child homicide [3]. India is home to almost 19% of the world’s children, and children and adolescents together form approximately 40% of India’s total population [4]. In India, two out of every three children are physically abused, and every second child is reported to be facing emotional abuse. Around 53% of children reported having faced one or more forms of sexual abuse, and almost 50% of abusers are persons known to the child or in a position of trust and responsibility [5]. Abuse and maltreatment during childhood adversely affect the physical and psychosocial development of children. Abuse against children is a complex process and according to an ecological model, it results due to an interaction of some risk and protective factors at four major levels, namely, individual, family, societal and community level [6]. Some of the factors that have been commonly associated with child abuse are low birth weight, unwanted pregnancies, teenage pregnancy, social isolation, drug abuse, poverty, lack of support, unemployment, etc. These factors remain more or less constant between countries [6–8]. India is a country of strong cultural beliefs where care of children is considered the purview of the family predominantly and child abuse, especially sexual abuse, is an issue surrounded by a conspiracy of muteness. It is not until recently that the government has intervened and child’s rights and protection are being given importance. However, lack of substantial information and evidence on child abuse makes it difficult to approach this issue in a comprehensive manner. Another hindrance in addressing abuse in children is eliciting responses from children themselves regarding such a sensitive subject, as they either don’t understand the dimensions of abuse or are scared to reach out for help. Further, the definition of child abuse is not constant among countries, and therefore, data cannot be
Childhood Physical, Emotional and Sexual Abuse
3
students and ensured their participation in the study through friendly dialogue. Informed written consent for participation was taken from each student. Consent forms were also prepared for principals and their consent was taken before the selection of the study respondents was finalized. The students had the freedom to stop participation at any stage of the study. After obtaining written informed consent, students were asked to fill the self-administered questionnaire, in the classrooms. The investigators were available for any further clarification. Participants could skip questions if they felt that some questions were sensitive; however, they were encouraged to share information, as the questionnaire was anonymous. Ethical clearance was obtained from the Institute Ethical Review Committee of Indira Gandhi Medical College and Research Institute, Puducherry, India. Personal identifiers like name and address were not collected to maintain anonymity.
Process of data collection Data on abuse were gathered using the adapted Ministry of Women and Child Development (Government of India, GOI) Questionnaire on Child Abuse for Young Adults, 2007 [5]. The questionnaire was translated to the local language (Tamil) as well, and the participants chose language of questionnaire as either English or Tamil. Data collection was done by trained personnel under the supervision of the principal investigator. The data collectors were sensitized about the ethical issues, including the importance of confidentiality, consent and freedom to participate. They interacted with the
RESULTS A total of 936 college students completed the study questionnaire. Socio-demographic characteristics of study participants are described in Table 1. Mean (SD) age of the participants was 19.2 (1.1) years and range was 18–25 years. Of the total, 44.1% were male and 55.6% were female students. The mean (SD) number of members in the family of the study participants was 4.42 (1.1). In all, 39.6% of females felt that being a girl was a disadvantage for them in the family setting. Genderbased differences were observed in choice of schools, attention/care received at home and delegation of
Statistical analysis Data collected were entered in EpiData entry software. All statistical analyses were done using EpiData analysis software (Version 2.2.2.180). Prevalence of physical, emotional and sexual abuse was calculated as proportions with 95% confidence intervals (95% CI). Mean and standard deviation were used to summarize continuous variables. Prevalence of abuse among males and females was compared using the chi-square test. A p-value of
