Mobilizing Action to End Violence Against Children: Lessons from around the world

James A. Mercy, PhD

Division of Violence PreventionNational Center for Injury Prevention and Control

Centers for Disease Control and Prevention

MOBILIZING GLOBAL ACTION TO END VIOLENCE AGAINST CHILDREN:

LESSONS FROM AROUND THE WORLD

IMAGINE IF…

Violence Across the Lifespan

EARLYCHILDHOOD ADOLESCENCE ADULTHOOD

Bullying Youth Violence

Child Maltreatment: physical, sexual, emotional, neglect

Dating Violence

Sexual Violence

Intimate Partner Violence

ElderMaltreatment

Violence Against Children is Common in the U. S., NatSCEV, 2008

Finkelhor, D., Turner, H., Ormrod, R., Hamby, S., and Kracke, K. 2009. Children’sExposure to Violence: A Comprehensive National Survey. Washington, DC: U.S.DOJ, OJP, OJJDP, CDC.

HIV/AIDS

Chronic LungDisease

Fractures

PregnancyComplications

Cancer

Burns

Unintendedand Adolescent

Pregnancy

FetalDeath

Internal Injury

Diabetes

Heart Disease

HIV

STDs

ViolenceAgainstChildren

AlcoholAnd Drugs Unsafe

Sexual Practices

Violence Against Children Is Costly and Destructive

Maternal andChild Health

Injury Non-Communicable Disease

Communicable Diseaseand Risk Behaviors

Stroke

Alcohol

Smoking

Obesity

PhysicalInactivity

Multiple Partners

Head Injury

Mental HealthProblems

Suicide

Depression and Anxiety

PTSD

Assault

Paths From Violence to HIV and Back Again

Direct transmissionCompromised negotiation

Reduced self efficacyForcing children out of homes

HIV Risk Behaviors

Risk for violence post-diagnosis

Social isolation & vulnerabilityStigmaStress

Violence Against Children

HIVInfection

Violence Damages Body Via Impact on the Brain

ViolenceAgainst

Children/Youth

Mental and Physical Health and CognitiveDevelopment

Infancy Adulthood

RiskBehaviors

And Conditions

Premature Aging

ToxicStress

Violence Against Children Surveys

(VACS)

Photo by Nadia Todres

Together for Girls: A Global Partnership

Generate data to guide actionSupport governments in evidence-based prevention and response

Mobilize action through communication strategies

Centers for Disease Control and Prevention United Nations Children’s Fund President’s Emergency Plan for AIDS Relief The Joint United Nations Programme on HIV/AIDS World Health Organization United Nations Development Fund for Women United Nations Population Fund Becton, Dickinson and Company CDC Foundation Nduna Foundation Grupo ABC

VACS Addresses Key Issues

MEASURES violence and its’ IMPACT on children’s lives with a strong gender lens

Uses data to foster POLITICAL ENGAGEMENT AND PROGRAMMING to prevent and respond to violence against children


Completed, Planned, and PotentialViolence Against Children Surveys (VACS)

Swaziland

Cote D’Ivoire

MozambiqueMalawiIndonesia

Cambodia

KenyaTanzania

Zimbabwe

Haiti Nigeria

Zambia

UgandaRwanda

Botswana

Laos PDR? Thailand

? Malaysia? Vietnam

? Guatemala

? Colombia

? Mexico

? Papua New Guinea

? Nepal? India

? Philippines

? China

VACS Methods

National household survey Three-stage cluster sample

survey design Randomly select one eligible

female or male aged 13-24

years in each household

Swaziland – girls only; All subsequent surveys both girls and boys

Surveys carried out by in-country institutions Extensive efforts to protect child respondents

Violence is

Common in the Livesof Children


LESSON #1

+ Please do not share these data because data for some of these countries have not been officially released.

* Only girls interviewed in Swaziland

Prevalence of Sexual Violence Prior to Age 18 Reported by Females and Males 18-24 Years of Age

in Seven VACS Country Sites+

Swazi-land*

Zimbabwe Kenya Tanzania Haiti Malawi Cambodia0

5

10

15

20

25

30

35

40

45

50

38

33 32

27 26

22

4

9

18

12

21

15

6

Females

Males

Seven Country Comparison

Prevalence of Physical Violence Prior to Age 18 Reported by Females and Males 18-24 Years of Age by Parents, Adult

Caregivers, and Authority Figures in Six VACS Country Sites+

Kenya Zimbabwe Haiti Tanzania Cambodia Malawi0

10

20

30

40

50

60

70

80

90

100

66 6461

55 53

42

7376

5753 54 54

Females

Males

Six Country Comparison


Prevalence of 12-month Sexual Violence for Females by Age Group,

Tanzania, 2009

13-14 15-16 17-18 19-20 21-22 23-240

5

10

15

20

25

Age Group

Prev

alen

ce (%

)

Some Categories of Children are

Especially Vulnerableto Violence

LESSON #2


* Statistically significant, p<0.05

Unwanted Sexual Touch-

ing

Attempted Sex Pressured Sex Forced Sex0%

10%

20%

30%

19%

13%

5%6%

26% 26%

8%6%

Female Non-RestavèkFemale Restavèk

Type of Sexual Violence

Pre

va

len

ce

(%

)

*

*

Prevalence of Childhood Sexual Violence inFemale Restavèks Compared to Non-Restavèks

*


Household Authority Figure EV0%

10%

20%

30%

40%

50%

60%

33%

* 55%

Female Non-RestavèkFemale Restavèk

Type of Emotional Violence (EV))

Pre

va

len

ce

(%

)

*

Prevalence of Childhood Emotional Violence in Female Restavèks Compared to Non-Restavèks,

Haiti, 2012+

+ Please do not share these data because data for this country has not been officially released.


Household Authority Figure EV0%

10%

20%

30%

40%

50%

60%

26%

*50%Male Non-RestavèkMale Restavèk

Type of Emotional Violence (EV)

Pre

va

len

ce

(%

)

*

Prevalence of Childhood Emotional Violence in Male Restavèks Compared to Non-Restavèks,

Haiti, 2012+


Prevalence of Sexual Violence Prior to Age 18 Reported by Females and Males 13-24

by Camp Status, Haiti, 2012+

Females Males0

5

10

15

20

25

30

35

40

45

50

34.7

24.321.6 19.6

Camp

Non-Camp

Any Sexual Violence Post Quake in Haiti


Children Know Their Perpetrators

LESSON #3

Top Three Types of Perpetrators of Childhood Sexual Violence Reported by Females 13 to 24 Years of Age,

Swaziland – 2007 and Tanzania, 2009

SwazilandPrimary perpetrators: Male neighbors- 32.3% Boyfriends - 26.2% Relatives - 14.0% (excludes parents)

Age Difference: 60% 5 or more years

older

TanzaniaPrimary perpetrators: Male neighbors- 32.2% Strangers - 32.0% Boyfriends - 24.7%

Age Difference: 40% 10 or more years

older

Cambodia Haiti Malawi Kenya Zimbabwe0

10

20

30

40

50

60

70

80

90

23.928.9

33.4

47.3

77.7

Sources: UNICEF. CDC, and KNBS. Violence Against Children in Kenya: Findings from a National Survey, 2010. Nairobi: UNICEF- Kenya Country Office; 2012; ZIMSTAT, UNICEF, and CCORE. National Baseline Survey on Life Experiences of Adolescents, 2011. Harare: ZIMSTAT. 2013. + Please do not share these data because data for some of these countries have not been officially released.

Percentage of Females in Five VACS Sites Reporting First Sexual Violence Incident Prior to Age 18 was

Perpetrated by a Boyfriend/Partner+

Per

cen

tag

e (%

)

Violence Impacts theHealth

of Our Children


LESSON #4

Association Between Childhood Sexual Violence and Selected Health Conditions, Females 13 to 24 Years

of Age, Swaziland, 2007

STDs

Pregn

ancy

Com

plica

tions

Alcoho

l Use

Unwan

ted

Pregn

ancy

Suicid

al Id

eatio

n

Feelin

g Dep

ress

ed

Attem

pted

Sui

cide

Difficu

lty S

leep

ing

Cigar

ette

Use

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

3.73.5

3.0 2.9

2.3 2.32.0 1.8 1.2

Ad

jus

ted

od

ds

ra

tio

*

HIV /

*Adjusted for age, community setting, SES, and orphan status

Source: Reza A, et al. Sexual violence and its health consequences for female children in Swaziland: a cluster survey study. Lancet 2009;373(9679):1966-72 .SES, Socioeconomic statusSTDs, Sexually transmitted diseases

None or Infrequent Condom Use in the Previous 12 Months by Experiences of Childhood Sexual Violence - As Reported by

19-24 Year Olds Who Ever Had Sex, Tanzania 2009

0

10

20

30

40

50

60

70

80

90

100

46.156.9

24.4 30.2

Experienced Childhood Sexual Violence

Per

cen

tag

e (%

)

MaleFemale

Source: United Republic of Tanzania, UNICEF, CDC, Muhimbili University. (2011). Violence Against Children In Tanzania: Findings from a National Survey 2009.

Percentage of Males 18-24 Years of Age Who Reported Sexually Transmitted Disease or Transactional Sex by Experience of Sexual

Violence as a Child: Kenya, Haiti and Cambodia

Penile discharge or sore Transactional sex0.0%

4.0%

8.0%

12.0%

16.0%

13.5%

3.8%

6.7%

0.9%

Experienced Sexual Violence Never Experienced Sexual Violence

Adjusted OR = 1.9P-value < 0.01

Adjusted OR = 3.8P-value < 0.01

Percentage of Females 18-24 Who Reported a Pregnancy Resulting from Forced and/or Coerced Sex Prior to Age 18

in Four VACS Country Sites+

24.5

30.3

16.0

34.3

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

Haiti

Tanzania

Kenya

Zimbabwe


Our Children Aren’tGetting the Help

They Need

LESSON #5


Received services for

sexual violence

Sought services for sexual violence

Told someone aboutsexual violence

Girls Boys0.4% - 6.6%2.7% - 10.0%

4.3% - 38.9% 2.1% - 5.9%

38.3% - 61.2% 20.6% - 64.7%

Source: Violence Against Children Surveys in Tanzania

Disclosure and Service Usage by 18-24 year old Victims of Sexual Violence Prior to Age 18, VACS


Percentage of 13-17 Year Old Girls and Boys Tested for HIVAmong Those Who Experienced Sexual Violence

in the Past 12 Months+

Zimbabwe Kenya Haiti0

5

10

15

20

25

30

35

40

45

50

37.5

44.6

23.8

9.2

39.2

5

Females

Males

Per

cen

tag

e

Impact of the VACS Data


VACS Catalyzes Action

Advocacy tool

Breaks the silence

Creates a new

conversation

Guides action

Multi-Sector Task Force

USGIn-Country

Multi-LateralAnd Bi-lateral

Agencies

Civil Society & NGOs

Universities

UNICEF In-Country

Other Government

Ministries

GovernmentMinistry Lead

HEALTH• Child abuse

screening • Access to

services, including comprehensive post-rape care

JUSTICE & POLICE• Child-

and women-friendly policies and laws

• Police stations and courts

• Legal aid

SOCIAL SERVICES• Child

helplines• Child

protection centers

• Increase social welfare officers

COMMUNITY• Parenting

support• Safe

spaces• Helping

children manage risks

• Social norm change

EDUCATION• Teacher

codes of conduct

• Early childhood education

• End corporal punishment

• Keep girls in school

Multi-sector Interventions

IndividualRelationshipCommunitySocietal

Examples • National education campaign• Weekly children’s radio program

Examples• Every police station has trained officers• First shelter established for survivors• First counselling center established • First child-friendly court established

Examples • Sexual Offenses Bill• Child Welfare Bill • Gender, children’s and

education policiesstrengthened

Scope of Policy and Programs Influenced by the Violence Against Children Survey in Swaziland

1) Mauritius

2) Namibia

3) Tunisia

4) Libya

5) Morocco

6) Kenya

7) South Africa

8) Malawi

9) Algeria

10) Cape Verde

11) Rwanda

12) Burkina Faso

13) Madagascar

14) Botswana

15) Senegal

16) Seychelles

17) Egypt

18) Mali

African Child-Friendliness IndexRankings in 2013 and 2008

Source: The African Child Policy Forum (ACPF)

2008 Ranking1) Mauritius

2) South Africa

3) Tunisia

4) Egypt

5) Cape Verde

6) Rwanda

7) Lesotho

8) Algeria

9) Swaziland

10) Morocco

11) Seychelles

12) Libya

13) Togo

14) Malawi

15) Senegal

16) Botswana

17) Nigeria

18) Ghana

19) Burkina Faso

20) Gambia

2013 Ranking

…45) Swaziland

Tanzanian Multi-Sector Task Force:A National Response to Violence Against Children

Comprehensive child protection response Education Social Welfare Legal and Justice Public Health Community State and Civil Society

Partnerships Local Government Service

Delivery Public Awareness Campaign

Zimbabwe Protocol on Management of Sexual Abuse and Violence

• T raining in parenting for caretakers

• H ousehold economic strengthening

• R educe violence by legislative protection

• I mprove services for victims of violence

• V alue norms that protect children

• E ducate and build life skills

• S urveys to monitor trends and progress

Key Actions Needed to Prevent and Respond to Violence Against Children - THRIVES

The Strategic Importance of Preventing Violence Against Children

Big Human Rights, Public Health, and Social Problem Influences many different health and

social outcomes Economic costs are substantial

Viable Prevention Programs and Policies Exist

Scientifically Grounded

Politically Feasible

“One of the most powerful waysto change the world

is to make it better for kids.”

Jack P. ShonkoffNational Scientific Council for the Developing Child

For more information

Visit CDC’s National Center forInjury Prevention and Control web site:

www.cdc.gov/ncipc

The findings and conclusions of this presentationhave not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent

any agency determination or policy.

Disclaimer

Government & Nonprofit

Mobilizing Action to End Violence Against Children: Lessons from around the world