1. Child Abuse in Latin America and the Caribbean Dr. Stewart BMR 3105

2. Presentation Format Definitions Risk Factors Studies/Situation PAHO ’ s Role Summary

3. General Definition of Child Abuse 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, development or dignity in the context of a relationship of responsibility, trust or power. (WHO, 1999)

4. Components of the Definition Physical Abuse Results in actual or potential physical harm from an interaction or lack of an interaction by the parent or caregiver. May be a single or repeated incident

5. Components of the Definition (cont.) Emotional Abuse Belittling Threatening Ridiculing Non-physical These cause the child not to develop emotional stability focusing on mental, spiritual, moral and social development.

6. Components of the Definition ( cont.) Neglect and negligent treatment Failure to provide basic necessities for the child which could result in harm to the child. Failure to properly supervise and protect a child from harm as much as possible, which could lead to harm.

7. Sexual Abuse Involvement of a child in sexual activity that he or she does not understand. Unable to give informed consent. Violation of the laws or social taboos.

8. Situation WHO estimates 40 million children 0-14 years suffer from abuse. Injuries, unintentional and intentional accounted for 16% of the global burden of disease in 1998. US alone: one million children were proven victims of child abuse or suspected child abuse.

9. Situation (cont.) Sexual abuse common in the Caribbean. Corporal punishment high in Latin America. Neglect occurs in families with many children.

10. Health Consequences of Child Abuse Physical Sexual Emotional Long-term Fatal

11. Health Consequences of Child Abuse Physical -Bruises, welts -Ocular damage -Fractures - Injuries in central nervous system -Poisoning

12. Health Consequences of Child Abuse Sexual Abuse -Unwanted pregnancy -Sexually-transmitted Infections -HIV/AIDS -Adverse outcomes for reproductive health

13. Health Consequences of Child Abuse Emotional and behavioral Poor self-esteem Self -inflicted injury Sleeping disorders Eating disorders Depression and anxiety Feelings of shame and guilt

14. Health Consequences of Child Abuse Long-Term Developmental effects Disability Alcohol/drug abuse Reproductive health outcomes At risk of being abusive Violent behavior

15. Consequences of Child Abuse Fatal Homicide Suicide Infanticide HIV/AIDS

16. Risk Factors for Abuse History of child abuse Substance abuse Witnessing abuse Education level Low socio-economic Level Lack of social support

18. Source: PAHO, HPP Maras Study 2001

19. Sexual Abuse Studies Barbados: 30% of female participants were sexually abused. Costa Rica: 32% of female participants were and 13% of male participants sexually abused, Nicaragua: 26% of female participants and 20% of male participants were sexually abused.

20. Sexual Abuse Studies Leads to high-risk Behavior Sexual activity starts an early age. Increase in STIs. Increase in unwanted pregnancies. Repeated sexual encounters. Mental health problems Gang activity

21. Corporal Punishment Survey in Mexico found Corporal punishment is viewed as a necessary, positive practice to produce good citizens. Father ’ s education had no direct effect. Mother ’ s education level effected parenting. Mother ’ s occupation did not effect parenting. Abuse higher in families of suspected abuse: Internal consistency high (Frías-Armenta et al.)

22. Corporal Punishment Survey in Chile among parents whose children attend public and private schools (Vargas et al.).

23. “ Candies in Hell ” Cross-sectional study in Leon, Nicaragua. Nearly half the women reported their children witnessed their abuse. Children of abused women more than twice as likely to suffer from learning, emotional and behavioral problems. seven times as likely to be abused (Ellsberg, E.)

24. Nicaragua Study Children of women who witness physical or sexual abuse are six times more likely to die by the age of five. (Asling-Monemi et al., Jejeebhoy et al.)

25. Results 938 surveys validated: 80% boys (“homeboys”) 20% girls (hainas). Age: Mean = 20.2 y- Range: 7- 25y Age for becoming a gang member: 7-10 -----> 2% 11-15 ----> 52% 16-25 ----> 46% ( Santacruz-Giralt et al.)

26. Reasons for Involvement in Gangs Hanging around Family Problems Peer Presssure Weak Parental Relationship Protection 10 % 20 % 30 % 40 % 50%

27. ACTIVA Study Describes the prevalence of aggressive behavior towards their children. Describes the prevalence of corporal punishment. Describes the association between parent ’ s victimization and aggressive behavior.

28. ACTIVA Study (cont.) 29% of the parents reported spanking their children. 11% hit them with an object during the 12 months prior to the survey. Spanking 20% in San José, Costa Rica. 36% in Cali, Colombia.

29. ACTIVA Study (cont.) Hitting with an object 3% in Santiago, Chile. 3% in Madrid, Spain. 20% in Cali, Colombia.

30. ACTIVA Study (cont.) Parents as children 77% reported being spanked as a child at least occasionally. 13% reported being spanked almost every day.

31. ACTIVA Study (cont.) Parents spanked as children are more likely to hit their children (OR =2.6). hit their children with an object (OR=3.5). slap their partner (OR=2.6). hit their partner with an object (OR=3.6). hit a non-family member (OR=2.8).

32. ACTIVA Study

33. Unfavorable living conditions Family characteristics “ Cost-benefit ” being in gangs Hanging out leads to social recognition Access to drugs Involvement in Gangs Socialization learned in the street Increase in drug use Fulfilling Violent obligations to remain in the gang Risk Factors Perceived Reasons for Gang Involvement Santacruz-Giralt et al.

34. See you next week…