WORK A Journal of Prevention,

Assessment .. Rehabilitation

ELSEVIER

Work 10 (1998) 279-291

Global health issues

Social origins and implications of child labor Pureza P. Budd*, Donna McIvor Joss Worcester State Col/ege, Occupational Therapy Deparlment, 486 Chandler St., Worcester, MA 01602, USA

Abstract Child labor continues to present a serious health threat to millions of children worldwide. Not all work is detrimental to children, and under carefully controlled conditions can benefit them in terms of physical and intellectual development as well as make positive contributions to their financial status. Unfortunately, most situations where children are used as a labor force are not designed with the health of the laborers as a primary concern. This article will review the current status of child labor, present theories regarding the social, cultural and economic bases of the practice, discuss its health implications and finally, explore possible solutions to this complex problem. © 1998 Elsevier Science Ireland Ltd. Keywords: Children's rights; Human rights; Child labor; Occupational therapy

1. Introduction

When one thinks of childhood, one imagines days filled with play, exploration and education. However, for millions of children around the globe, their childhood is one of sweat and toil. The United Nations Children's Fund (UNICEF) stated that child labor can take place on a continuum. At one end, work is not necessarily bad for the child, but rather is beneficial. As long as work does not interfere with the child's opportunity for school, play and rest, it can be a positive experi-

*Corresponding author. Tel.: + 1 508 9298119; fax: + 1 508 7938184.

ence. Work can promote and enhance a child's development physically, cognitively and socially. However, at the other end of the continuum, child labor can be destructive to a child's development (United Nations Children's Fund, 1997). Therefore, it is important to distinguish between beneficial and exploitative children's work. United Nations Children's Fund (1997) characterizes child labor as exploitative if it involves the following: • • • •

full-time work at an early age too much time spent at work work that poses physical or psychological hazards inadequate pay

1051-9815/98/$19.00 © 1998 Elsevier Science Ireland Ltd. All rights reserved. PII S1051-9815(98)00011-4

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• • • •

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too many responsibilities work involving living on the streets work that prevents access to education work that undermines self-esteem.

labor, its ramifications, and global efforts to address it, including the role of occupational therapy. 2. Causes of child labor

Child labor is utilized in numerous settings which cut across regions. The major types of child labor are forced or bonded labor, domestic servitude, commercial sexual exploitation, street work, work for the family, and industrial and plantation work (United Nations Children's Fund, 1997). Accurate statistics on child labor are elusive because of some impediments to data gathering. Many governments in developing countries do not have the required resources for the implementation of extensive or accurate surveys. Additionally, some governments are reluctant to document the extent of child labor practices, as this could indicate a violation of international standards and of their country's domestic laws. There are also different opinions as to what constitutes child labor. Finally, children are often employed in non-formal sectors such as family farms, which makes it more difficult to obtain accurate data (Longford, 1995; Lansky, 1997; The tragedy of child labor, 1997). Although it is not possible to obtain a single authoritative number, Human Rights experts estimate that there are roughly 200 million child workers around the globe (The tragedy of child labor, 1997). For a sense of where these children are working, see Fig. 1. The majority of child workers are found in Asia, Africa, and Latin America. The International Labor Organization (ILO) estimated that Asia has - 153 million working children, Africa has 80 million, and Latin America has 17.5 million (International Labor Organization, 1996). While child labor is concentrated in Asia, with India at its forefront, the percentage of children who are involved with child labor is actually higher in Africa than in Asia. (Tucker and Ganesan, 1997; United Nations Children's Fund, 1997). Although child labor is primarily a problem of the developing countries, it also exists in industrialized nations such as Great Britain and the United States (Lemen et at, 1993). This paper will look at the origins of child

The origins of child labor can be traced to several major factors: poverty, the lack of educational opportunities, cultural attitudes, the preference of employers for child rather than adult workers, and the country's position in the global economy. Poverty is cited as a major contributor to child labor. In countries where child labor is prevalent, poverty is rife (Longford, 1995; The tragedy of child labor, 1997). The survival of poor households often depends on the contributions of working children. Although they are not paid well, working children are significant contributors to the family's income. In fact, wages of working children often represent between 20 and 25% of the family's income (Siddiqi and Patrinos, 1997; United Nations Children's Fund, 1997). This contribution can be decisive in preventing starvation for the struggling family. For example, the mechanization of large plantations in Brazil has expelled thousands of adults from the workforce, thereby leading to their loss of livelihood. Consequently, because of the diminished family earnings, children are forced to work to bolster the family'S income (Weissman, 1997). Due to poverty, many families venture from rural areas into the cities, where their children end up in the workforce. While those families fled in the hope of finding 'greener pastures' in the cities, they frequently remain mired in poverty. This is because there are not enough employment opportunities for all of the migrants from the countryside. As a result, many children are forced to work, just as they were back in the countryside. It is estimated that the number of child workers in the urban areas of developing countries will increase by 40% by the year 2000. This dramatic rise is attributed to both the growing rural to urban migration and the worsening economic trends of many of these countries (Siddiqi and Patrinos, 1997). However, poverty is not the only driving force

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Kids at Work

Estimated percentages of children who work lun or part time In selected countries. 1995 data

SOU",: In/'IIIlliol",' Llbo, Olll.nil.,ion

Appendix A. (Used with permission from TIME For Kids Magazine, Copyright 1996)

behind child labor. This becomes evident when one realizes that the rates of child labor can vary dramatically between countries facing similar

economic hardships (Weissman, 1997). This is also true within countries. For example, the Indian state of Kerala has a much lower incidence of

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child labor than its neighboring states, despite their comparable levels of economic development (International Labor Organization, 1996). In addition to poverty, a lack of educational opportunities is another primary cause of child labor. It has been argued that the major reason why India has the largest number of child laborers is because 82 million of its children do not attend school (Siddiqi and Patrinos, 1997). Similarly, Pakistan's large population of child workers has been traced to the fact that its educational system is only able to accommodate one third of its school-aged children. For those children unable to attend school, their options are limited to either entering into the workforce, or becoming beggars (Silvers, 1996). United Nations Children's Fund (1997) claims that child labor exists where it is culturally tolerated. Cultural attitudes represent another causative factor to child labor. In fact, Weiner (1991), an expert on developing societies, argues that the Indian belief system is a greater contributor to child labor in that nation than its low per capita income. The Indian caste system mitigates any societal concern about the plight of child workers. This is because work is seen as the natural situation for children of the lower castes (Tucker, 1997). Racial or ethnic prejudice is another cultural attitude which contributes to the prevalence of child labor. There is often little concern for children engaged in hazardous occupations when these children are minorities, refugees, immigrants, or other societal outcasts. For example, in northern Europe, child workers are likely to be Turkish or Mrican. Similarly, child workers in the United States are primarily of Asian or Latin American backgrounds. In Brazil, child workers tend to be the children of slaves or of indigenous people (United Nations Children's Fund, 1997). A final way that cultural attitudes permit and sometimes promote child labor is in the beliefs of the children and their parents. When the children see their parents struggling to survive, they feel obliged to help out. In the Philippines, the strong sense of familial ties and responsibility induces children to seek employment (Philippine Center for Investigative Journalism, 1996). At the same

time, many parents feel that their children should work to contribute to the family's meagre income. One study concluded that 62% of all child workers are brought into the workforce by their parents (Siddiqi and Patrinos, 1997). The origins of child labor lie not only in the large supply of child workers, but also in the great demand for those workers (International Labor Organization, 1996). There are a number of reasons why employers prefer child workers (International Labor Organization, 1996; United Nations Children's Fund, 1997). For example, employers perceive children to be more dexterous because of their nimble fingers. In South Asia, this dexterity enables children to produce fineknotted carpets. Also, employers believe that children are less aware of their rights, more obedient, and more malleable. Because children lack an awareness of their rights, they are less likely to stage a strike against oppression. In addition, employers hire children because they can be paid less than their adult counterparts. For example, a Pakistani factory owner admits that he could get three or four boys to work for the same wages as one adult. Not only are children cheaper than adults, but they are also less expensive than machinery. A land owner in Pakistan claims that working children are cheaper to maintain than tractors (Silvers, 1996). A final factor which contributes to the prevalence of child labor is the country's position in the global market. In order to promote exports, many governments in developing countries are encouraging the development of labor intensive industries (The tragedy of child labor, 1997). These industries rely on cheap labor, often that of children. In fact, some developing countries try to compete with other developing countries in offering the cheapest labor as a way to encourage investment by multinational corporations (Weissman, 1997). In promoting cheap labor, government officials are facilitating the exploitation of child workers. 3. Ramifications of child labor

Exploitation of child workers has serious ramifications and repercussions for the physiological,

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mental, and psychological health of the toiling child. Working children are deprived of a healthy physical and mental development (Siddiqi and Patrinos, 1997). In fact, working children are exposed to several health hazards which range from physical to psychological to chemical (International Labor Organization, 1996). These hazards are commonly seen in various industrial and agricultural settings. Workplace hazards have a greater impact on children than on adults, and interfere with the children's physical, cognitive, and emotional development (Weissman, 1997). Working children are exposed to a number of physical hazards in their working environment (International Labor Organization, 1996). Physical hazards include poor sanitary facilities, unsanitary work areas, unguarded machinery, lack of protective equipment, inadequate ventilation, and poor lighting (Berger et a!., 1991). Additionally, blocked exit doors, open fuse boxes, and undiscarded combustible materials all contribute to serious fire hazards (Pollack et a!., 1990). Climatically, the working environment can be extremely hazardous. For example, working children in glass factories in India are routinely exposed to temperatures which can reach as high as 140 degrees fahrenheit (US Department of Labor, 1995). Similarly, working children in tropical plantations are regularly exposed to poisonous snakes, disease-carrying insects and climatic conditions which contribute to fatigue and dehydration (Bonnet, 1993). While the physical ramifications of child labor are easiest to see, the psychological impact is equally significant. The psychological hazards at work pose serious threats to the children's development. Working children are often denied the time to rest and play (United Nations Children's Fund, 1997). Long hours of work accompanied by fatigue drain the children of the energy to play and keep them from interacting with peers (Berger et a!., 1991). Oppressive working environments can result in serious psychological damage. Working children who are demeaned or oppressed at work will have low self-esteem (United Nations Children's Fund, 1997). Working children not only experience neglect by employers, but live with verbal and sexual

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abuse as well. In Pakistan, a girl reported that her best friend got very ill after being raped by their master (Silvers, 1996). In fact, the physiological and psychological damage inflicted by sexual exploitation is considered the most detrimental to children. Children in the commercial sexual industry face serious health risks, which include mv and other sexually transmitted diseases, unwanted pregnancies, and drug addiction. As a result, the world views these children as a menace to society. In return, the exploited children view the world as violent, scornful, and full of people who cannot be trusted (United Nations Children's Fund, 1997). Even in the absence of sexual abuse, working children still experience psychological and emotional damage. In a study of child domestic workers in Haiti, psychologists found that the subjects suffer from depression, sleep disorders, anxiety, and chronic fears (United Nations Children's Fund, 1997). These maladies are the product of extreme deprivations of play, social interactions and emotional support from family members. Children are exposed to hazardous chemicals in numerous work situations. In fact, in virtually every setting children experience exposure to some type of hazardous chemicals (International Labor Organization, 1996). The International Labor Organization (1996) cited several chemicals which are detrimental to children's health. For example, children are exposed to asbestos in the construction, mining, and brake repair industries. In the rug-making industry in South Asia, the children are exposed to harmful aniline dyes. Similarly, dangerous solvents and glues are used in the leather industry. Children in the gold mining industry handle mercury with their bare hands. Finally, throughout the agricultural sector children handle fertilizer and pesticides without protective gloves (US Department of Labor, 1995). Since children start work at a young age, they have more years of exposure to these chemical hazards. There is a need for further research on the relationship between exposure to different dangerous chemicals and illnesses which have long latency periods (Pollack et a!., 1990). Studies indicate that work hazards are more detrimental to children than adults (US Depart-

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ment of Labor, 1995). The International Labor Organization (1996) cited several reasons why children are more susceptible to occupational hazards. Generally, children's anatomical, physiological, and psychological make up are different from adults. Specifically, children's bones are not yet fully developed. The open epiphyses can subject working children to growth retardation and skeletal deformities. Excessive stress on the pelvis before the epiphysis has closed can cause back deformities. Similarly, since children have lower heat tolerance, it makes them more vulnerable to heat stress. Furthermore, because children have thinner dermis and epidermis, there is increased absorption of dangerous chemicals, and severe burns from hot liquids and objects (Berger et aI., 1991). Occupational hazards have more adverse effects on children due to their small physical size, which renders them less strength (Lemen et aI., 1993). Additionally, their immature cells make them more vulnerable to genetic damage. Finally, children's bodies fatigue much faster than adults' (International Labor Organization, 1996). Lack of experience may pose an additional risk for child workers (Pollack et aI., 1990). The International Labor Organization (1996) claims that cognitively, children have lower levels of concentration than adults. In addition, children's lack of safety awareness, lack of precautionary measures (International Labor Organization, 1996), and insufficient knowledge of work processes (Beque Ie and Myers, 1995) make them more accidentprone. The likelihood of an accident at work is enhanced because the tools and machinery are not proportionally designed for children (Berger et aI., 1991). The fact that equipment and precautionary measures, such as protective garments, are geared toward adult workers further contributes to the frequency of accidents among child workers. For example, children often experience fatigue and injury after using hand tools which are designed for adults (International Labor Organization, 1996). Similarly, because the protective equipment does not fit them, children are often forced to work without it (Lemen et aI., 1993). In

the Philippines, children as young as 7 or 8 years old work in sugar plantations. The use of sharp knives, without gloves, to cut sugar cane has resulted in serious injuries (Institute for Labor Studies, 1994). In addition to accidents, working children also suffer from a number of ailments due to occupational hazards (US Department of Labor, 1995). Because children are more susceptible to these occupational hazards, child labor has a significant negative impact on the children's health. This impact can manifest itself throughout the principal systems of the human body. Some of the major settings where children work, and the health problems associated with them, will be discussed below. According to the International Labor Organization (1995), the greatest prevalence of child labor is found in the agricultural sector. For example, 82% of the working children in Bangladesh work in agriculture (United Nations Children's Fund, 1997). Farm work exposes the working children to a number of ailments which include, but are not limited to, lung diseases and dermatological problems. For example, while working in sisal production, children continually inhale sisal fibers which can cause a lung disease called byssinosis. Additionally, the sisal liquid can irritate the skin, which can lead to severe itching (US Department of Labor, 1995). In Zimbabwe, children plucking tea with their bare hands suffer tea ulcers, which are characterized by lacerations and callouses on the fingers (Loewenson, 1995). Furthermore, exposure to steam, smoke, dust, and ethylene dibromide in tobacco plantations can lead to asthma, tuberculosis, and other lung diseases (Tucker, 1997). Due to their nimble fingers, children are often recruited to work in garment factories. Children's dexterity is useful in weaving and piecework sewing (US Department of Labor, 1995). A number of studies indicate serious health repercussions of child labor in these factories. Children suffer back strain and leg cramps from long hours of squatting before the looms (Reecer, 1996). They also experience eye strain and allergic reactions due to the textiles (US Department of Labor,

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1994). Pakistani children working in garment industries were observed to have labored breathing, which indicates tuberculosis (Pollack et aI., 1990). In many countries in Mrica, Asia, and Latin America, children are employed in the mining industry. Due to their small size, children are particularly well-suited for this extremely hazardous occupation. Children are ideally-sized to pass through the low and narrow passageways of coal or gold mines. However, as they hunch over and wind their way through the mine shafts, they strain their backs, causing spinal deformities (Weissman, 1997). Several years of intense physical labor, such as carrying heavy loads, can retard the growth of a child by up to 30% (United Nations Children's Fund, 1997). According to the International Labor Organization (1996), because children work in the mines without protective equipment and proper training, they are further exposed to such hazards as harmful dust, gases, and fumes. These elements can lead to respiratory diseases, such as emphysema, silicosis, and pulmonary fibrosis. In addition, children in the gold mining industry are endangered by mercury poisoning (Philippine Center for Investigative Journalism and ILO, 1996). Finally, children often injure themselves while wielding their mining tools. Another hazardous occupation that working children engage in is deep-sea fishing. This is particularly common in Indonesia, the Philippines, and Thailand, and involves children banging on the coral reefs to drive the fish into the nets. The working children in this area stay in the water for several hours without protective equipment. Due to high atmospheric pressure, children often suffer from ruptured eardrums, decompression illness, drowning, attacks from sharks, and other injuries due to malfunctioning equipment (US Department of Labor, 1994; International Labor Organization, 1996). Ceramic and glass factory work represents another hazardous occupation. In this setting, children not only suffer from eye strain due to poor lighting, but they are also exposed to toxic fumes, such as carbon monoxide and sulphur dioxide. Working children often incur hearing impairment due to the extremely high level of noise from

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glass-pressing machines. Additionally, because children work in rooms with high temperatures and little ventilation, they can suffer from heat stress and cataracts (International Labor Organization, 1996). Children also face the danger of broken glass particles. For example, a 9-year-old Indian boy was unable to open his eye due to a piece of glass that got lodged in it while he was working at a glasswork factory (Hammond, 1994). A final example of a hazardous work setting is the matches and fireworks industry. The production of matches and fireworks poses a high risk of fire and explosion, because it usually occurs in small, unventilated rooms. Due to the lack of ventilation, children as young as 3 are exposed to high concentrations of dangerous substances like asbestos and potassium chlorate. Exposure to these chemicals can lead to intoxication and dermatitis (Philippine Center for Investigative Journalism and ILO, 1996). There are numerous other settings where children can be found working. In these disparate settings, children are subjected to hazards comparable to the ones discussed above. The obvious conclusion is that wherever children are engaged in exploitative labor, there are potential serious health ramifications involved. Child labor not only poses a serious threat to the overall health of the working children, but to their education as well. Education is important for the cognitive, emotional, and social development of the child as well as for her future health and economic well-being. Unfortunately, child labor interrupts these developmental processes. United Nations Children's Fund (1997) enumerated a number of reasons why child labor interferes with education. First, working children spend so much time at work that school attendance is impossible. Second, work often makes children too exhausted to go to school. Third, some seasonal jobs, such as harvesting, force the working children to skip school for several days or weeks. Finally, working children who are abused or mistreated in the workplace may be unable to concentrate on school work. In looking at the impact of child labor, the ramifications also contribute to the causes. For example, one of the origins of child labor is the

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lack of educational opportunities, yet child labor closes off those same opportunities. Similarly, while poverty is a major cause of child labor, the former is also a product of the latter. This is what is referred to as a vicious cycle (Longford, 1995). In other words, poverty leads to child labor, which in tum leads to lack of education, which causes poverty (United Nations Children's Fund, 1997). 4. The quest for solutions to child labor Finding solutions to the problem of child labor is very complex. Some solutions, whose intentions are positive, can prove to have detrimental ramifications. For example, in 1992 Senator Tom Harkin (D-Iowa) proposed the Child Labor Deterrence Act, which would forbid the importation into the United States of any item made by child labor. While the intentions of Senator Harkin's bill are certainly honorable, it has produced some negative results, even though it has not even been approved by the US Congress. When word of the Harkin Bill reached Bangladesh, the Bengali garment makers laid off thousands of children in order to guarantee their continued access to the American market. Sixty percent of Bangladesh's garments, representing roughly US $900 million, goes to the United States (Hammond, 1994; Wildavsky, 1995; United Nations Children's Fund, 1997). Thus, despite its noble intentions, the Harkin Bill ended up driving thousands of Bengali children onto the streets, where many of them ended up in prostitution or situations more exploitative than the garment industry. In devising solutions to child labor, it is important to avoid actions which can have negative repercussions. While a total ban on child labor sounds like a worthwhile goal, it is problematic. If such a ban is passed, it would only serve to drive the children further into the 'underground' economy, where they are more likely to be exploited. In addition, since many children work in order to make money for their educations, a total ban on child labor, if unaccompanied by additional legislation, would only serve to deny the working

children of the opportunity to attain an education. A study in Bolivia found that children who were not employed actually had lower levels of educational achievement than the working children, many of whom were working in order to be able to attain an education (Siddiqi and Patrinos, 1997). International institutions such as the United Nations and the ILO have played, and continue to play, a significant role in the fight against child labor. In 1989, the United Nations ratified the Convention on the Rights of Children. Signatories to the Convention pledged to protect the rights of children. Specifically, they promised to protect children from economic exploitation, as well as from hazardous work, and anything which could interfere with their educations (US Department of Labor, 1995; International Labor Organization, 1996). Similarly, the majority of member states of the ILO have ratified Convention No. 138, which sets the minimum age for children to be allowed to work. Convention No. 138 states that children under the age of 18 should not be involved with hazardous occupations. For light, or nonhazardous, work the minimum age is 12 or 13, depending upon the country's level of economic development (International Labor Organization, 1996). United Nations Children's Fund (1997) argues that since the causes of child labor are complex, the solutions must be comprehensive as well. Some potential solutions include: promoting education/reforming the educational system, empowering the poor, changing the cultural attitudes which promote child labor, mobilizing society, enhancing corporate responsibility, and enacting legislation. Since child labor has serious ramifications for the education of the child, promoting education is seen as an important way to address the problem (Dewees and Klees, 1995; Siddiqi and Patrinos, 1997; United Nations Children's Fund, 1997). The ILO has documented higher incidence of child labor in areas of low school enrolments (International Labor Organization, 1992). Similarly, a 1971 study by the Indian Government reported that

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only 1.9% of children in the Indian state of Kerala worked, whereas 7.1% of all Indian children work (Weiner, 1991). In Kerala, the government's expenditure on education is roughly twice that of the other state governments, despite the fact that it is not a wealthier state. Evidence of this fact come from Weiner (1991) who showed that Kerala spent 3.6% of its GDP on education while the richer state of West Bengal spent only 2.1%. Weiner attributes this difference to different societal attitudes in Kerala, which he attributes in part to the influence of christian missionaries (Weiner, 1991). Virtually all children between the ages of 6 and 11 are in school in Kerala, and 88% of children between the ages of 11 and 14 attend school in that state. For the latter age group, the national average is only 38% (Weiner, 1991). Many children work because they lack the opportunity to attain an education. By making education more readily available, the number of working children will decline. Nations with high incidence of child labor must devote a greater amount of their scarce resources to education. Unfortunately, the opposite trend has been observed during the past decade. Due to pressure from the World Bank and the International Monetary Fund, many developing countries have actually reduced expenditures for education (Weissman, 1997). Increasing the availability of education alone will not solve the problem. Educational reforms are also necessary in order to make the educational system more responsive to the children's needs. For example, school schedules need to be adjusted around the work schedules of the children, particularly in rural communities. Such changes would involve adjusting the school calendar so that the children would be on vacation during harvest time, when their help is most needed by their families (United Nations Children's Fund, 1997). Since many children do not receive their nutritional requirements at home, the schools should fill this role. Furthermore, the educational system must provide the students with the skills which they will need in order to get a better-paying job than their parents could attain. Finally, since many

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children work in order to pay for their school tuition, making education free of charge would eliminate this need for child labor. By improving the quality of the educational systems, education will come to be seen as an essential factor for ensuring the future success of the child (Siddiqi and Patrinos, 1997). Due to the correlation between poverty and child labor, attacking poverty represents another way to address the problem. By improving the economic situation of the family, it will free many children from the responsibility of contributing to the family's income. For example, governmental subsidies could be used in order to assist the poorest families (Siddiqi and Patrinos, 1997). An attack on poverty would also involve the empowerment of the poor. According to UNICEF, empowering the poor represents an important step towards the elimination of poverty (United Nations Children's Fund, 1997). The empowerment of poor families would enable them to lift themselves out of poverty. To do so, the poor must be given greater representation in the political process, and greater access to credit so that they can improve their standard of living. The success of the Grameen Bank's program of extending credit to the poorest families in Bangladesh is indicative of the way in which empowering the poor contributes to the reduction of poverty (United Nations Children's Fund, 1994). In so doing, it also contributes to the reduction of child labor. According to the United Nations Children's Fund (1997), the mobilization of society represents a third way of addressing the problem. In several countries, non-governmental organizations (NGOs) have played a decisive role in mobilizing popular support for ending the exploitation of children. For example, in the Philippines the Kamalayan Development Center has conducted a number of highly successful raids on factories employing children (Philippine Center for Investigative Journalism and ILO, 1996). Similar raids have been undertaken in India by the South Asian Coalition on Child Servitude (United Nations Children's Fund, 1997). In mobilizing society against the exploitation of children, the NGOs have a strong ally in the

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media. The media has played a critical role in mobilizing popular sentiment against child labor. The Philippine Center for Investigative Journalism has publicized the plight of child laborers in newspaper and magazine articles, as well as in a film which it produced in conjunction with the ILO. When the popular Philippine tourist spot, Pagsanjan, became a center of child prostitution, attracting pedophiles from the Western nations, a local NGO coordinated a media campaign which highlighted the problem. This media campaign was conducted on the national and international levels. As a result, Pagsanjan is no longer a magnet for people in search of child prostitutes (United Nations Children's Fund, 1997). In July 1996, a conference on children's rights in Asia was held in Manila. Delegates to the conference came from 27 Asian nations, and included government ministers, representatives from NGOs, and the media (United Nations Children's Fund, 1997). Through such conferences, societal attitudes towards child labor began to change. Attitudinal change represents another way of addressing the problem of child labor. Weiner (1991) traces the prevalence of child labor in India to the belief systems of the Indian bureaucracy, educators, social activists, union leaders, and middle class. Specifically, he argues that Indian views on the appropriate societal roles of the different castes, and the belief that the educational system should maintain the differences between these castes, contribute to the view that child labor among the lower castes is the natural scheme of things. For Weiner, the way to combat child labor in India is by working to change the Indian belief system (Weiner, 1991). If societal attitudes must change in order to address child labor, so too must the attitudes of big business. Specifically, business needs to develop a greater sense of corporate responsibility. Many companies deliberately relocate their companies to areas of cheap labor, even if that labor involves child workers. Furthermore, some companies have actually begun to recruit child laborers, whose wages are lower than adults, as a way to enhance their competitiveness in the global

marketplace (United Nations Children's Fund, 1997). However, some progress has been made in promoting greater corporate responsibility. For example, Reebok has announced that it will restructure its soccer ball production efforts in Pakistan. In the past, Reebok distributed the panels for its soccer balls to different villages, where they were stitched together. In such a production system, Reebok had no control over who was actually doing the stitching, and in most cases it ended up being children (Reecer, 1996). To eliminate this problem, Reebok announced that it would build a factory where the balls would be made, and that no one under the age of 15 would be employed at the plant. In addition, Reebok agreed to contribute to the educational and vocational training of Pakistani children who had previously been involved in the production of soccer balls (Reecer, 1996). Reebok's decision to change its production system was the result of pressure from societal groups. Such pressure is not always effective, because it can be difficult to prove that a product was made by child workers. For example, Nike has been under pressure to eliminate the use of child labor in the production of its products in Indonesia. Indonesian children, some as young as 11 years old, are paid 14 cents an hour to cut out the pieces for Michael Jordan's line of sneakers. However, since these sneakers are ultimately assembled in Taiwan, where there is not a child labor problem, Nike officials have consistently denied that child labor is involved in the production of this line of sneakers (The tragedy of child labor, 1997). The prevalence of sub-contracting in production often makes it difficult to determine whether a product was made with child labor. In the face of growing popular opposition to child labor, a number of companies have voluntarily submitted to codes of conduct. These codes represent a series of guidelines which the company agrees to follow. One such guideline would stipulate that the company would neither use child workers in its factories, nor distribute production contracts to companies utilizing child laborers. For example, the Rugmark campaign

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has targeted South Asian companies in the carpet industry, and has gotten them to agree to a code of conduct on child labor (Hilowitz, 1997). In return for such an agreement, carpets made by these companies bear the Rugmark label, which Western consumers have learned to look for when purchasing an Oriental rug (Leipziger and Sabharwal, 1995; Weissman, 1997). A major problem with these corporate codes of conduct is that they are totally voluntary, and lack a proper monitoring mechanism. As a result, many people argue that the way to address child labor is through legislation. Where child labor is pervasive, the government must take the lead in enacting comprehensive legislation to address the problem. Such legislation should include the following: setting a minimum age at which children can start working, with a higher age for certain, more hazardous jobs; determining which jobs are hazardous, exploitative, or morally objectionable and thus closed off to child workers; setting of standards for the workplace; and prohibiting over-time and physical or mental abuse of the child workers. Such legislation has been adopted in numerous countries, both developing and developed (Longford, 1995). Unfortunately, legislation alone is not sufficient. Without an established monitoring and enforcement mechanism, the legislation is worthless. For example, the Pakistani Government enacted the Employment of Children Act of 1991, as well as the Bonded Labor Act of 1992. However, since the government failed to provide for the enforcement or implementation of either Act, they ended up accomplishing little (Silvers, 1996). A mechanism for monitoring and enforcing legislation is essential due to the pervasive problem of corruption (Hilowitz, 1997). The police are often bribed to look the other way when they inspect factories employing young children. In some cases, the police even collude with the employers, providing them with young children who are either runaways, kidnap victims, or orphans (Silvers, 1996). In addition to corruption, a lack of political will has often prevented government officials from enforcing child labor legislation. Due to their fear of losing political or financial sup-

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port, they resist enforcing such laws (Wildavsky, 1995). Due to the complexity of the problem of child labor, there is no single solution. Instead, it will take a concerted effort, uniting government officials, social activists working in NGOs, the media, the business sector, concerned consumers, as well as the child workers and their families (International Labor Organization, 1996; United Nations Children's Fund, 1997). Additionally, it is important to avoid solutions which actually cause further problems. Due to the severity of the problem and the complexity of its causes, the complete elimination of child labor is not feasible. Therefore, the most exploitative situations of child labor must be attacked first. Accordingly, United Nations Children's Fund (1997) has proposed that the following six steps be taken: • • • • • •

eliminate hazardous forms of child labor provide free and compulsory education strictly enforce laws against child labor register all children at birth collect accurate data on child labor develop codes of conduct for businesses.

5. Child labor and occupational therapy As part of the concerted effort to combat child labor, occupational therapists can play a significant role. Occupational therapists could be involved with the rehabilitation of child workers, both in terms of physical and psychosocial dysfunctions, workplace modification, and in the instructions of body mechanics to the children. United Nations Children's Fund (1997) argues that there is a need to rehabilitate former child workers, and to protect those children who continue to work as much as possible. Occupational therapists can play a significant role in both respects. There is a need to rehabilitate former child workers (International Labor Organization, 1996; United Nations Children's Fund, 1997). For example, those children who develop early signs of arthritis from working in the garment industry

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could benefit from intervention prescribed by occupational therapists. Similarly, their psychosocial problem could be addressed by a number of treatment techniques. The low self-esteem of a former child worker in the commercial sex industry could benefit from the opportunity to express his/her feelings through art. According to Joss (1996), survivors of traumatic experiences can benefit greatly from using the arts to express their emotions. Occupational therapists could not only play a significant role in the rehabilitation of child workers, but also in the prevention of work site injuries. Occupational therapists could analyze the work setting in order to ascertain potential physical hazards (Jacobs, 1995). In so doing, they could create a plan for the removal of the hazards. Furthermore, the occupational therapists could work to adjust equipment and tools, tasks and schedules to fit the physical and developmental characteristics of the working children. In addition, occupational therapists can play the role of educators and lobbyists. Occupational therapists can educate parents about the dangers of child labor and about human rights issues. Also, occupational therapists can playa powerful role as lobbyists in the struggle against child labor. Due to their knowledge of physical and psychosocial development, occupational therapists would be credible witnesses to the ramifications of child labor. 6. Conclusion

Child labor is a problem that has cut across the centuries and the different regions of the globe. This paper has revealed the complexities which surround this issue. It has shown how many developing countries are trapped in a vicious cycle where the origins of child labor create the conditions which perpetuate it. In order to break out of this cycle, complex solutions will be required. However, it is imperative that those solutions do not end up contributing to the problem. It will take a concerted effort of government officials, non-government organizations, media, consumers, big businesses, and health care providers to address this problem. Until that happens, mil-

lions of children will be perpetually consigned to lives of toil, deprived of their rightful childhoods, and continuously threatened by physical and psychological hazards. References Bequele and Myers, 1995. Berger LR, Belsey M, Shah PM. Medical aspects of child labor in developing countries. Am J Ind Med 1991;19:697-700. Bonnet M. Child labor in Africa. Int Labour Rev 1993;132:371-389. Dewees A, Klees SJ. Social movements and the transformation of national policy: street and working children in Brazil. Compar Educ Rev 1995;39:76-100. Hammond R. The littlest workers: third world economies depend on child labor to keep wages low. Utne Reader 1994;63:20-21. Hilowitz J. Social labelling to combat child labour: some considerations. Int Labour Rev 1997;136:215-232. Institute for Labor Studies. Comprehensive study on child labor in the Philippines. Manila: Author, 1994. International Labor Organization. World labor report. Geneva: Author, 1992. International Labor Organization, 1995. International Labor Organization. Child labour: targeting the intolerable. Geneva: Author, 1996. Jacobs K. Preparing for return to work. In: Trombly C, editor. Occupational therapy for physical dysfunction. Baltimore, MD: Williams and Wilkins, 1995:329-349. Joss DM. Human rights and health: a workshop for health professionals. Work: J Prevent Assess Rehab 1996;7: 213-219. Lansky M. Child labour: how the challenge is being met. Int Labor Rev 1997;136:233-257. Leipziger D. Sabharwal P. Companies that play hide and seek with child labor. Bus Soc Rev 1995;11-13. Lemen RA, Layne LA, Castillo ON, Lancashire JH. Children at work: prevention of occupational injury and disease. Am J Ind Med 1993;24:325-330. Loewenson R. Child labor in commercial agriculture in Zimbabwe: report of a case study. Harare: ILO International Programme on the Elimination of Child Labour, cited in US Department of Labor (I995). By the sweat and toil of children, volume II: the use of child labor in US agricultural imports and forced and bonded child labor. Washington, DC: Author, 1995. Longford M. Family poverty and the exploitation of child labor. Law Pol 1995;17:471-482. The tragedy of child labor. Available on the Internet: http/ /www.vais.netj-woa/articles/chldlabr.htm. 1997. Philippine Center for Investigative Journalism. The perils of Angelie. I nvest Report Mag 1996;2:26-28.

P.P. Budd, D. Mcivor Joss / Work 10 (1998) 279-291 Philippine Center for Investigative Journalism, and ILO. No time for play [videotape], 1996. Pollack SH, Philip JL, Mallino DL. Child labor in 1990: prevalence and health hazards. Ann Rev Public Health 1990;11 :359-376. Reecer M. Children without childhoods. American Educator, 1996. Siddiqi F, Patrinos HA. Child labor: issues, causes and interventions (working papers). Human capital development and operations policy. Available on the Internet: http:/ / www.worldbank.org/htmljhcovp/workp/wp-, 1997. Silvers J. Child labor in Pakistan. Atlantic Month 1996;277:79-92. Tucker L. Child slaves in modern India: the bonded labor problem. Hum Rights Q 1997;19:572-629. Tucker L, Ganesan A. The small hands of slavery: India's bonded child laborers and the world bank. Multinational Monitor 1997:18. United Nations Children's Fund. The state of the world's children 1994. New York: Oxford University Press, 1994.

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United Nations Children's Fund. The state of the world's children 1997. New York: Oxford University Press, 1997. US Department of Labor. By the sweat and toil of children: the use of child labor in US manufactured and mined imports. (A report to the Committee on Appropriations, US Congress). Washington, DC: Author, 1994. US Department of Labor. By the sweat and toil of children: the use of child labor in US agricultural imports and forced and bonded child labor. (A report to the Committee on Appropriations, US Congress). Washington, DC: Author, 1995. Weiner M. The child and the state in India. Princeton, NJ: Princeton University Press, 1991. Weissman R. Stolen youth: brutalized children, globalization and the campaign to end child labor. Multinational Monitor 1997:18. Wildavsky B. A noble cause, unintended harm? Nat! J 1995;27:2897.

Social origins and implications of child labor.

Child labor continues to present a serious health threat to millions of children worldwide. Not all work is detrimental to children, and under careful...
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