Assessment of knowledge on child sexual abuse among school going adolescent girls (age 14-17 years) in urban slums of Kakinada, Andhra Pradesh:

International Journal of Community Medicine and Public Health Garapati S et al. Int J Community Med Public Health. 2024 Dec;11(12):4921-4927 http://www.ijcmph.com pISSN 2394-6032 | eISSN 2394-6040

DOI: https://dx.doi.org/10.18203/2394-6040.ijcmph20243664

Original Research Article

Assessment of knowledge on child sexual abuse among school going

adolescent girls (age 14-17 years) in urban slums of

Kakinada, Andhra Pradesh

Sridevi Garapati1*, Sujatha Peetala1, Krishna B. Goru2

1Department of Community Medicine, Rangaraya College of Medicine, Kakinada, Andhra Pradesh, India 2Department of Community Medicine, Maharaja Institute of Medical Sciences, Vijayanagaram, Andhra Pradesh, India Received: 04 October 2024 Revised: 21 November 2024 Accepted: 22 November 2024 *Correspondence: Dr. Sridevi Garapati, E-mail: shridevigarapati@yahoo.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT Background: Child sexual abuse (CSA) is a hidden, psychologically complex, and socially sensitive issue. The Protection of Children from Sexual Offences (POCSO) Act, 2012 defines different forms of sexual abuse. Child sexual abuse can result in both short-term and long-term consequences including physical, mental, and behavioural among victims. It is very important to understand and improve public awareness of sexual abuse prevention. Objectives were to study the awareness on child sexual abuse among adolescent girls between 14 to 17 years of age and to identify the socio-demographic factors related to their awareness on child sexual abuse. Methods: A cross-sectional study was conducted among adolescent girls in 3 urban slums in Kakinada, Andhra Pradesh during September to November 2019 using a semi-structured questionnaire. A total of 343 children participated in the study. Data analysis was done with statistical package for the social sciences (SPSS) version 16. Results: Mean age of the study population was15.82±1.08 years. Half (53.9%) of them belong to BC, 73.8% Hindu, 87.4% of the participants have parents and 70.6% belong to nuclear family. Overall knowledge on child sexual abuse was 60.3%, majority (67.1%) do not know where sexual abuse can take place. Knowledge on getting physical, mental, and behavioural problems due to abuse was 72.0%, 69.1% and 46.1% respectively and none of them were aware of POCSO act. Conclusions: Knowledge gaps and misperceptions about child sexual abuse are widespread. Children, Parents, caregivers, professionals in health and education and law enforcement should be prime targets for awareness-building and empathy-building for disclosure and appropriate response. Keywords: Child sexual abuse, Knowledge, Adolescent girls

INTRODUCTION

Child sexual abuse (CSA) poses a great challenge for public health, social justice, human rights, gender equality and science.1 Child sexual abuse is also called child molestation. It is a form of child abuse in which an adult or older adolescent uses a child for sexual stimulation.2,3 Child sexual abuse includes engaging in sexual activities with a child (whether by asking or pressuring, or by other means), indecent exposure (of the genitals, and female

nipples), child grooming, and child sexual exploitation including using a child to produce child pornography.2-6 The Protection of Children from Sexual Offences (POCSO) Act, 2012 defines different forms of sexual abuse -penetrative sexual assault (inserting any object or using any part of body to cause penetration into any part of the body of the child or making the child do so), Sexual assault without penetration (touching penis, vagina, anus, breast of a child with sexual intent, making physical

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contact to child with sexual intent or making the child do so) and sexual harassment.7

Child sexual abuse is endemic worldwide: 12.7 per cent of all children experience sexual abuse out of which 18.0% girls and 7.6% boys. Girls are two to three times as likely as boys to be victimized.8 Burden of this global issue is reflected by the United Nations to respond to sexual abuse in the 2015 sustainable development goals. These goals have added two new targets acknowledging child abuse as a fundamental obstacle to health and calls for a coordinated action. Target 16.2 aims to end abuse and exploitation of children, and target 5.2 aims to eliminate all forms of violence against women and girls, including sexual exploitation.

Child sexual abuse consequences include anxiety, depression, post-traumatic stress disorder, and suicidal tendency.9 It is associated with subsequent sexual victimization, unwanted pregnancy and risk of getting human immunodeficiency virus (HIV).10 The trauma associated with sexual abuse can contribute to arrested development and a host of psychological and emotional disorders, that children may never overcome. Most child sexual abuse is committed by men; studies on female child molesters show that women commit 14% to 40% of offenses against boys and 6% of offenses reported against girls.11-13 Child sexual abuse can occur in a variety of settings, including home, school, or work. Most sexual abuse offenders are acquainted with their victims; The World Health Organization estimates that much of this sexual violence is inflicted by family members or other people residing in or visiting a child's family home- people normally trusted by children and often responsible for their care.14

Child sexual abuse is also a serious and widespread problem in India, having the largest population of children in the world. Census data from 2011 shows that India has a population of 472 million children below the age of eighteen covering 40% of its population, out of which 69% of Indian girls are victims of physical, emotional, and sexual abuse.15,16 New Delhi, the Nation’s capital, has an abuse rate over 83%. Andhra Pradesh, Assam, Bihar and Delhi reported the highest percentage of sexual abuse among both boys and girls.17 Crimes against children in Andhra Pradesh have increased by around five per cent in 2020, when compared to the previous year’s according to data published by the National Crime Records Bureau. Protection of children by the state is guaranteed to Indian citizens as per Article 21 of the Indian constitution and also mandated given India's status as signatory to the UN Convention on the Rights of the Child.18,19 The Parliament of India passed the 'Protection of Children Against Sexual Offences Bill (POCSO), 2011' regarding child sexual abuse on 22 May 2012, making it an Act.20-22 A guideline was passed by the Ministry of Women and Child Development, India. Under this act to provide a robust legal framework for the protection of children from offences of sexual assault, sexual harassment, and

pornography, while safeguarding the interest of the child at every stage of the judicial process.

The girls were often victims of sexual assault by their ‘friends’ and adult men. In closed domains like home and schools, they were helpless when faced with such abuse and are left to suffer in silence. Disclosure by children is often inhibited by feelings of shame and fear, and the lack of a trusted confidante. Children are frequently ignored, blamed or punished when they do disclose; and cultural norms and gender constructions constitute further powerful deterrents.23-25 Knowledge gaps and misperceptions about child sexual abuse are widespread in the society. The current study was conducted to assess the knowledge about child sexual abuse and to identify the sociodemographic factors related to their knowledge and address the need to empower and protect the children.

METHODS

This cross-sectional study was conducted among school going adolescent girls of age group 14 to 17 years in 3 urban slums comes under urban field practice area of Rangaray Medical college, Kakinada during the months of September to November 2019. Knowledge among adolescent girls was assumed as 50% and absolute error as 6% and non-response rate at 15% the required sample size was 328, however 343 study participants were included. All school going adolescent girls with equal representation from 3 urban slums were included. Those who were not willing and not going to school and married were excluded from the study. The study was conducted after obtaining permission from Institutional Ethical Committee and informed consent from parents or guardian. Assent was obtained from each adolescent who were willing to participate. Purpose of the study and all related matters were discussed with parents of each participant. The data was collected by means of the semi structured questionnaire which included the elements of POCSO act and analyzed by using statistical package for the social sciences (SPSS) 16 version, Chi square test was used to find out association with demographic variables.

RESULTS

Nearly 2/3rd (63.3%) belongs to 16-17 years; mean age was15.82±1.08 years. More than half (53.9%) belongs to backward caste and majority were Hindu (73.8%), resides in nuclear family (70.6%) and live with their parents (87.4%). Families having two children constitute 56.6%. Illiteracy was found to be 21.3-24.4% among parents and above high school education was found in 8.5-10.1%. Fathers of all these children were working, while 55% of the mothers are working.

Occupation pattern distribution is as follows in the parents, unskilled, 25.3-37.1% semiskilled, 15.5-32% skilled 10.1- 13.3% and engaged in business or clerical work constitute 4.3-17.6% mothers and fathers respectively (Table 1).

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Knowledge on child sexual abuse

Among the study population 60.3% do not know about what is child sexual abuse. Half (50.7%) of them know that child sexual abuse involves sexual acts and nearly 2/3rds (65.3%) were unaware of non-sexual acts. Awareness regarding various acts of child sexual abuse was reported

as - Touching one’s private parts by other person 45.9%, asking for touching other’s private parts 47%, exposure of private parts by others 52.1%, asking for exposure of your private parts 60.4%, showing pornographic material 59.1%, penetration with finger or any object 58.5%, kissing with a sexual intent 71.2% and forcing for sexual intercourse was 52.6% (Figure 1).

Figure 1: Knowledge on child sexual abuse.

Table 1: Socio-demographic characteristics.

Continued.

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Awareness regarding various acts of child sexual abuse was reported as - touching one’s private parts by other person 45.9%, asking for touching other’s private parts 47%, exposure of private parts by others 52.1%, asking for exposure of your private parts 60.4%, showing pornographic material 59.1%, penetration with finger or any object 58.5%, kissing with a sexual intent 71.2% and forcing for sexual intercourse was 52.6% (Figure 1).

It is reported by 38.8% that there will be physical evidence if sexual abuse takes place. More than 3/4th (70%) opine that no one has right to touch their body except for medical reason. Only 30% knows that a child has no right to give consent for sex or any other activity that can have sexual gratification and 60.9% believe that they can say no or to refuse for any kind of sexual activity. Majority (67.1%) do not know regarding where does sexual abuse can take place and 53.1% believes that it can take place outside the house. Nearly half (45.2%%) of them believe that once a child is sexually abused there is a further risk of getting victimized and 73.5% are unaware of getting sexually abused by a known person. Many (70.8%) believe that the child requires the supportive family environment to overcome the situation of sexual abuse. Disclosure of the incident was opined by 58.3% and forgetting or mask the incident by 45.2%. In our study significant association was found between the study participants’ knowledge on CSA with their parental education status (p<0.05). Type of family has

no significant association with the levels of knowledge (p>0.05).

Awareness on physical health hazards associated with child sexual abuse was reported among 72.0%, mental health problems like fear, anxiety, feeling ashamed, depression, suicidal tendencies in 69.1% of participants. Knowledge on risk of getting early pregnancy, sexually transmitted diseases like HIV and developing learning and behavioural problems was 67.1%, 60.1% and 46.1% respectively (Figure 2).

Figure 2: Knowledge on consequence of child sexual

abuse.

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No pressure from peers was seen in 89.8%. Only half of them (55.7%) believes CSA is not a child’s fault, it is a crime (81.9%) and the abuser is punishable (74.6%). None of them were aware of POCSO act. Nearly half (49.3%) of the participants want to be taught by their teachers about prevention of child sexual abuse. Respondents indicated they would like to know more about the prevention and control of sexual abuse.

DISCUSSION

Adolescence is the period from the onset of puberty in preteen years until adulthood. It is a period of intense development with profound physical changes as well as transition between childhood and adulthood. Adolescents are less able to manage their emotions than adults, use good judgment, and engage in thoughtful decision- making. Child sexual abuse (CSA) is one of the hidden serious problems faced by adolescents and it is the worst form of child abuse. CSA will result in serious physical, psychological and social trauma in the survivors.

Many of the study population were in the age group of 16-17 years (63.3%), belongs to OBC by community (72.6%) and Hindu (73.5%) by religion, belongs to nuclear family (70.6%) and living under parental care (87.4%). Majority (74.6-78.7%) of their parents had primary school education whereas 21.3-25.4% were illiterate. Significant association (p<0.05) was found between the level of knowledge related to CSA (35.4- 81.8%) and parental education status. Type of family has no significant association found with the participants’ knowledge. Studies conducted by Sumanpreet et al in Punjab and Kalkute et al observed similar findings.26,27

In our country more than 2/3rd of girls are victims of physical, emotional and sexual abuse. Since early age of initiation of sexual activity puts adolescents at risk of pregnancy, social and health consequences. It is essential that they need to be educated on these aspects. Current study reveals knowledge on risk of getting early pregnancy, sexually transmitted diseases like HIV and developing learning and behavioural problems was found to be 67.1%, 60.1% and 46.1% respectively. A similar study conducted among adolescent girls by Das et al in Kolkata found that many had poor knowledge on matters related to sexuality, sexually transmitted diseases and they also suggested that regular surveys on sexual attitudes, knowledge and behaviours are essential in understanding the epidemic of sexually transmitted diseases.28 In the present study 38.8% of participants believe that sexual abuse will have physical evidence whereas 67.5% of the participants opined the same in a study conducted in Adayar, Chennai by Jose et al.29 Studies have shown that children are most likely to be abused by persons who are familiar to them. Most sexual offenders are known to the child and strangers were a minority. Sexual abuse of girls was very often a pre- planned insidious abuse of a relationship by an abuser over the girl; approximately 30% are relatives of the girl,

most often brothers, fathers, uncles or cousins; around 60% are other acquaintances such as 'friends' of the family, babysitters or neighbours; strangers are the offenders in approximately 10% of sexual abuse cases.11,30 In our study majority (73.5%) don’t know that there is a risk of getting sexually abused by a known person and about risk of getting further victimization (54.8%). Similar findings were observed in study conducted by Jose et al (78.5%) and Dube et al (83.6%).29,31 If a child is sexually abused, 58.3% of study participants believes that it is correct to disclose the incident to someone they trust and this knowledge is found to be more (88%) in a study conducted by Mathew et al.32 In the present study majority (81.9%) knew that CSA is a crime and abuser is punishable (74.6%), when compared to a study conducted by Jose et al.29 More than half of them (55.7%) believe CSA is not the child’s fault, Dube et al reports a similar finding (79.0%).31 Nearly half (49.3%) of the respondents indicated that they would like to know more about the prevention and control of child sexual abuse from their teachers. There are several studies that mentioned about the same importance among the study participants.29,32

Limitations

Only school going adolescents were included, knowledge of those who were not attending the schools was not considered.

CONCLUSION

In the present study many of the participants do not have adequate knowledge on child sexual abuse, where can child sexual abuse occurs, from whom they can get victimized and about the harm and serious consequences. They do not know that child sexual abuse is a punishable offence under POCSO Act. Lower educational status of the parents of the participants was significantly associated with child sexual abuse. Knowledge on matters related to child sexual abuse prevention is the felt need identified.

Recommendations

Awareness of the nature of child sexual abuse is required at individual, institutional, and societal levels. Intensive programmes and campaigns for awareness, education and behaviour change should be directed to make young adults aware and sensitized about CSA including legal rights/child rights. Awareness activity related to CSA to be included in curriculums of primary, secondary and college education. Sensitization training should be mandatory for teachers on the issue of CSA. The child sexual abuse prevention programme should be focused primarily on educating children on how to recognize instances of abuse, safe touch and unsafe touch and teaching them personal safety skills. Encouraging children to disclose such instances to parents or other responsible adults should be given priority to save the victim. Research promotion should address the risk factors that can lead to child sexual

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abuse and measures to identify and prevent it. Disclosure can prevent victimization and punish the perpetrators according to POCSO act.

ACKNOWLEDGEMENTS

The authors would like to acknowledge all the participants and parents in the study. They also acknowledge the guidance of professors Dr. Sujatha and Dr. Krishna Babu.

Funding: No funding sources Conflict of interest: None declared Ethical approval: The study was approved by the Institutional Ethics Committee

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