Impact of violence on youth in South Africa: briefing by South African Medical Research Council

NCOP Women, Children and People with Disabilities

31 May 2011
Chairperson: Ms B Mabe (ANC, Gauteng)
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Meeting Summary

 

 

The Medical Research Council’s Safety and Peace Promotion Research Unit provided an overview of the statistics on youth violence in South Africa. South Africa’s injury death rate was nearly twice the global average. That death rate was driven by interpersonal and gender-based violence, followed by traffic injuries, self-inflicted injuries, and other unintentional injuries arising from fires, drowning, and falls. This shows there was a multi-faceted burden on injury. The report noted statistics that showed that violence was profoundly gendered, with young men between 15 and 29 years old disproportionately engaged in violence as both victims and perpetrators. Half of the female victims of homicide were killed by their intimate male partners and the country had an especially high rate of rape of women and girls. With all of these statistics, social factors driving the problem were known – poverty, unemployment, patriarchal notions of masculinity, vulnerabilities of families and exposure to violence in childhood, widespread access to firearms, alcohol and drug misuse, and a weak culture of enforcement and failure to uphold safety as a basic right. The MRC believed that the government should identify reduction in violence and injuries as a key goal and develop and implement a comprehensive strategy against these scourges.

The research presented looked at associative factors such as drugs and alcohol, and examined some of the positive factors that could successfully prevent violence, including relationships with responsible adults, positive school experiences, plans and dreams and future orientation, and the ability to control impulses. Most non-natural deaths in South Africa were caused by sharp objects or firearms. The research had examined these causes in Johannesburg, Pretoria, Cape Town, and Durban.

There was a new study being undertaken now related to injury prevention and safety promotion, looking at data from several countries, including South Africa. The goal of that study was to initiate, implement, evaluate, and maintain safety promotion demonstration programmes.

The
Medical Research Council concluded its presentation with a summary of the statistics related to child abuse. There were over 1 000 homicides to boys and nearly 900 to girls under the age of 14 in 2007. In addition, there were a reported 27 417 sexual offences reported against children under 18 years of age, which was “alarming” as it represented an increase of 36%.

The discussion looked at the following topics: was there a relationship between the rights of children and violence against children; the statistical comparison between Durban and Cape Town; why there was not much research about the relationship between drugs and violence; why the data showed an increase of 36% in sexual offences against children under 18 years; how one could get in touch and involved with the information and statistics; how determinations were made regarding the causes of death of the persons involved in these statistics.

 

 

Meeting report

Opening Remarks
After a brief welcome and introduction of those present at the meeting, chairperson Ms B Mabe (ANC) introduced the presenter, Hilton Donson, a Research Scientist with the Medical Research Council (MRC).

Medical Research Council (MRC) Briefing
Mr Hilton Donson began the presentation by introducing the project, “Safety and Peace Promotion Research Unit,” (SPPRU). This was a name change from “crime, violence, and injury.” The name change was a result of a more positive outlook that reflected the type of work they were doing.

Donson said he was happy to be at the meeting and to engage on these issues, and that he, his organization, and other stakeholders were together on the quest for the reduction of violence, particularly against women and children, as well as to be able to find solutions and answers to these concerns.

Donson’s presentation began with an overview of statistics of violence in South Africa. In terms of homicide and intentional injuries in 2004, collectively labelled violence, the WHO sketched that South Africa was 16th and 22nd in the world respectively. Road traffic accidents were quite high as well. By 2030, all of these statistics were expected to increase – homicide to 16th, suicide to 12th, and road traffic accidents in South Africa among the first ten highest in the world.

Donson next summarised health rankings from a 2000 report that found that interpersonal violence was the second to HIV/AIDS, which indicated a scourge of violence. By comparing rape and injuries to other countries in Africa and across the globe, he said that it did not paint a very good picture.

In terms of interpersonal violence, the comparison of incidents in the entire world compared to South Africa was approximately 4:1. In terms of morbidity – injuries that do not cause death – then 3.5 million people seek health care for non-fatal injuries; 2 million serious crimes occur, including 55 000 reported rapes of women and girls. It was estimated that the latter figure could be nine times higher, which would show widespread victimization.

Donson said that in some instances, the trends in homicide were coming down as traffic went up. But there were not complete systems to give the bigger picture of what was happening that would allow for inroads in analysis.

The MRC had found that the problem in South Africa, as a backdrop, was that women and children found themselves in a low status of power. Violence and injury were the second-leading cause of death and lost disability-adjusted life years in South Africa behind HIV/AIDS. For years, injuries and violence represented two different categories, but they were now grouped together. South Africa’s injury death rate was nearly twice the global average. That death rate was driven by interpersonal and gender-based violence, followed by traffic injuries, self-inflicted injuries, and other unintentional injuries arising from fires, drowning, and falls. This shows there was a multi-faceted burden on injury.

The report noted statistics that showed that violence was profoundly gendered, with young men between 15 and 29 years old disproportionately engaged in violence as both victims and perpetrators. Donson said that some people believe these individuals were the same people, and were both victims and perpetrators.

Half of the female victims of homicide were killed by their intimate male partners and the country had an especially high rate of rape of women and girls.

With all of these statistics, Donson said the social factors driving the problem were known – poverty, unemployment, patriarchal notions of masculinity, vulnerabilities of families and exposure to violence in childhood, widespread access to firearms, alcohol and drug misuse, and a weak culture of enforcement and failure to uphold safety as a basic right.

Donson said that the MRC believed that the government should identify reduction in violence and injuries as a key goal and to develop and implement a comprehensive strategy against these scourges.

The MRC’s mission was to build a healthy nation through research, with a mandate to inform, share, and do interventions that could prove best practices and build relationships with committees and groups such as this to keep you informed.

The MRC’s position was that violence, like polio and other public health threats, could be prevented. It was not a disease, it was a condition, a state of the mind, and the state of how things were in our communities.

Donson said that the research showed that violence was learned in the home, by being victimised by intimates, and from peers. More than three million children witness domestic abuse in their homes each year. Effects of that exposure could include traumatic stress reflected in high levels of depression and anxiety, attention and learning problems, and greater likelihood of developing aggressive and anti-social behaviour.

In the United States, for example, nearly a million children were maltreated a decade ago. The experience of child abuse and neglect increased the likelihood of arrest as a juvenile by 53%, which he called a “phenomenal increase.” In addition, committing a violent crime increased 38%. Both numbers provided evidence supporting a plan for violence prevention.

Regarding victimization by intimates and the peer influence on violence, Donson said that one in seven school children was a bully or had been the victim of a bully. Based on some international literature, between 10 and 30% of teens experienced violence while dating.

Donson said the MRC had done a study in schools where the nature of the injury was more towards the head – a disregard for the person. More than 50% of the injuries were of an intentional nature, showing that there was a scourge of school violence during the latter half of the last decade.

Donson said there was a strong association between alcohol and violence, with 50% of youth homicide victims having an elevated blood alcohol level, as well as 50% of youth who commit homicide. Yet he noted that the country had often decriminalized alcohol, because it was socially accepted. Since the year 1999, there had been a system that was introduced looking at the concerns of violence and injury in South Africa and a consortium was brought together and they looked at trauma and drug abuse in injury. In particular, in the context of non-fatal injuries, which were four to five times more than those in medical labs that had died as a result of injuries. So there was a big burden on the sectors of health care if you survived the injury.

Donson next looked at youth gangs, which he said were responsible for a disproportionate share of criminal offences, both violent and non-violent. In contrast, the research had found that there were many factors which protected youth, including relationships with responsible adults, positive school experiences, plans and dreams and future orientation, and the ability to control impulses. All this information was out there calling for action, but bringing it all together was challenging.

Donson mentioned the
National Injury Mortality Surveillance System (NIMSS), which was an attempt to measure where injuries happen, how they happen, and when they happen in order to give a face to injury. He noted however that “the why” of the deaths and injury often eluded researchers because of the difficulty in data collection.

The primary goal of NIMSS was to describe the incidence, causes and consequences, particularly of non-natural deaths subjected to medical legal investigation. The next goal was to prioritize injury and violence and prevention actions, in other words, to find out what should be done first. Donson said this was important because while children were dying of all sorts of causes, there was only so much that could be done to a large problem.

As of 2007, there were 21 mortuaries in six provinces, which had now grown to between 40 and 60 nationwide. Other mortuaries were not part of the NIMSS system due to lack of infrastructure, manpower, etc. This system was intended to last only two years, but it had proven to be sustainable. Because of this system, the MRC knew that between 60 and 80 thousand deaths occur every year in a non-natural way. Donson said that this should not happen. The NIMSS system caught over 50% of them, which was better than nothing.

Donson said that the NIMSS researchers also examined the apparent manner of death, because it could take between five and six years for the courts to rule on the cause of death. Prevention efforts could not wait for the courts, so the NIMSS worked with forensic pathologists to determine the likely cause of death. Research would then prove or disprove these initial conclusions once the official cause was determined.

Donson said that the data showed that for children of all ages, the apparent manner of death was primarily the scourges of violence and traffic – 35% and 20% respectively. These were the main issues for South Africa. Violence was preventable, as was traffic. But we needed to take small bites to be able to intervene and prevent these from happening.

By examining the apparent manner of death for children, Donson noted that there was a considerable drop in looking at how transport and unintentional injuries played themselves out – 33 and 36% respectively. Unintentional would include drowning and fire deaths. But violence still comprised “an unacceptable” 10% of the deaths. Donson said this showed the need on the ground for prevention, especially around violence.

As the age range expanded to 19 years, violence jumped from 10% to 25%. When looking at young people aged 15 to 29, that number grew to 47%. That was nearly twice the number of transport deaths that occur within this age group.

The NIMSS had also found that there was a sharp upswing in violent deaths between the ages of 14 and 15. Donson said this scourge of youth violence was a constant threat to South Africa’s economy. 40% of those deaths were caused by sharp objects such as knifes, followed by firearms at 25%, and blunt force objects at 22%. The male to female ratio was exacerbated when looking at sharp force and firearms in particular, at 11:4 and 4:0 respectively.

By examining the external cause of fatal youth violence, there was a large contingency of blunt object-caused deaths in all age groups, from 0-4, 5-9, 10-14, and 15-19 years old. Firearms also played a factor at the earliest ages, though that increased with age. For the 5-9 year old group, Donson said it was a particular concern that over 30% of them were caused by firearm. Knifes and sharp objects play a larger role as age increased as well.

The NIMSS data also showed that there was a downward trend in the violence mortality rates, but that it was still unacceptably high relative to the rest of the world and other countries in the region. Particularly in Pretoria and Durban there had been a decline, while the numbers had evened out more in Johannesburg and Cape Town.

Donson said it was also evident that violence was a gendered problem, which underscored that men were an “endangered” species in South Africa, and that it was mostly men that died. Donson said it was also the intention of the NIMSS to determine who the perpetrators were, because this was a critical piece to the prevention work.

Donson then returned to the statistics relating alcohol to violence and said that “this was the story that would never die.” He also said that there was a lot of movement by different groups to address this issue and stem the tide of alcohol’s influence on violence and other scourges of injury. Where firearms were concerned, over 40% of victims had alcohol in their blood stream. In sharp force incidents, that number increased to nearly 80%, and the data had shown a large proportion of alcohol-positivity in those killed with blunt force. Donson said there was a large association, which could help researchers in their effort to determine the causal nature of that relationship.

The NIMSS was created to look at all provinces across South Africa, but because the system honed in on forensic pathology, there was only full coverage of non-natural deaths in Gauteng, Mpumalanga, and also in Western Cape. Donson said that as a result, creating inferences could be difficult, although there were numbers and proportions available in other areas. But he noted that it was hard to say what the true effect of violence was without the entire collection of quality data, particularly in rural areas. In contrast, the urban-centric data did allow for a comparison between Durban, Cape Town, Tshwane/Pretoria, and Johannesburg, even though the system needed to grow. Donson said there were some inter-city differences, which might help show what was happening in provinces generally. Firearms were the leading cause of fatal youth violence in all those cities except for Cape Town, which saw sharp objects as the leading cause. Sharp objects were the second-leading cause in the other cities, with firearms as the second-leading cause in Cape Town.

Donson said that every year it seemed there was a debate about which statistics were correct – the MRC’s, the Police figures, etc. But he said that these represent distinct data and one must be careful in interpreting these different figures. Moreover, he said the MRC had indicated a desire to make these data sets compatible so that all the stakeholders could talk on the same terms as each other and collectively work towards violence prevention.

Donson next went onto another portion of the research on violence against children – the Safety and Peace Promotion Research Unit (SAPPRU). It had been charged with conducting trans-disciplinary research to champion violence and injury prevention, as well as peace and safety promotion. It had worked towards developing appropriate tools to assess the magnitude, trends, and occurrences of crime, injuries and violence, and the conditions that promote safety and peace. This unit had also studied the risks, and had worked to identify what worked best, how to control for injuries and violence, and to encourage research translation. This required a good relationship with Parliament to provide relevant information in an effective manner. Finally, the unit had aimed to build primary prevention and safety and peace promotion research and interventions between researchers, policy-drivers, community-based workers, and practitioners.

Donson said that one of the large studies being undertaken now, with significant funding from the University of South Africa, was called the Ukuphepha Study. The MRC-UNISA had expressed a desire to make a full presentation on this study in the future. This initiative was a multi-country, multi-level research study on child injury prevention and safety promotion, and was the first of its kind. The study would work towards reducing injury rates among children, and involved Uganda, South Africa, Mozambique, Australia, Bangladesh, and other countries. Ukuphepha was an indigenous South African word meaning “safety.”

Donson said there were three primary aims of Ukuphepha. First, to initiate, implement, evaluate, and maintain safety promotion demonstration programmes. Second, to facilitate and convene African-centred injury prevention and safety promotion group of scholars to generate critical Africa-centred knowledge and knowledge systems. Finally, to stimulate a network of injury prevention and safety promotion service-based agencies that would both draw on and act as a resource to development of skills linked to technological improvement and innovation and provide contextual relevance.

Donson said the idea was that the MRC was mandated by the Department of Health to bring together different ministries as a collective to develop policy around an integrated strategy for violence and injury prevention. As the initiative began recently, he said there was a lot of work that needed to be done. The vision was to work together to live in a safe and peaceful environment, free from injuries and violence. The mission was promoting safety and peace through evidence, coordination and collaboration. There were also guiding principles, goals, objectives and a large focus, particularly on the cross-cutting key action areas on children and the cycling of violence.

Donson concluded his presentation with a summary of the statistics related to child abuse. There were over 1 000 homicides to boys and nearly 900 to girls under the age of 14 in 2007. In addition, there were a reported 27 417 sexual offences reported against children under 18 years of age, which he said was “alarming” as it represented an increase of 36%. The initiative had also identified the key distal factors and proximate factors leading to those numbers. The group had also identified strategies to be able to prevent these occurrences of abuse, as well as identifying gaps in the policies and the service delivery priorities and lead departments. This was the start of a process of negotiations and consultations that were meant to happen among all ministries relevant to child injury prevention.

Discussion
The Chairperson thanked Mr Donson for the presentation and noted that the MRC could provide an overview of violence issues that children face in South Africa, and the presentation did address that. She said that violence was one of the common priorities the Committee was working to fight.

Mr G Mokgoro (ANC) began the discussion segment, and said that the report was mind provoking. He said that the central point – violence against children – was a new phenomenon. By looking at childrearing through past generations, he was never exposed to anything that would qualify as violence against children. Children were reprimanded when they did something wrong, following warnings. When the children do not want to hear with the ears, parents would inflict some pain on their bodies so that they would listen. The need to raise children – to provide for their security, safety, and protection – was embedded in the minds of the parents and the community. He asked if children were acting violently because they had not been reprimanded at home, as a result in the increase of legal protections for children.  To him, it seemed as if the lack of parental ability to reprimand had impacted how children behave.

Mr D Worth (DA) thanked Donson for the presentation, and asked about the statistical comparisons between Durban and Cape Town. Particularly, he wanted to know why these cities had a reversal in the primary cause of non-natural death among youth. In Cape Town, that cause was sharp objects, while in Durban it was firearms.

Mr Worth also asked why there was not much research about the relationship between drugs and violence. There was a lot of violence as a result of drugs, but the research presented did not go beyond the impact of alcohol. He wondered if this was because some drugs were hard to trace, or if there were limitations due to post-mortem forensic analysis. The drug-related part was not documented enough. There were also figures showing an increase by about 36% in sexual offences against children under 18 years. Was this increase due to a greater awareness of the need to report these incidents, whereas they were covered up in the past?

Ms N Magadla (ANC) asked how she could get in touch and get involved with the information and statistics.

Ms A Qikani (ANC) wanted to know how determinations were made regarding the causes of death of the persons involved in these statistics

Chairperson Mabe (ANC) said that what was most important for her was prevention, and that it could only be prevented through awareness. She would like to facilitate partnerships with all the stakeholders at a national level to raising awareness in areas that do not have coverage, possibly focusing on those areas, the deep-end of rural areas. She said that the main issue was having sufficient resources, but that the Committee had an obligation to prevent this type of violence, and it could start working towards that.

Ms Mabe wanted to ensure that the efforts to stem violence did not focus solely on girls while forgetting the boys. Both should be embraced, empowered, and protected by government efforts.

Regarding the issue of children killing each other, she said it was scary that boys at the age of nine were taking a seven year old, molesting him, burning him with cigarettes and stabbing him. She said a child was doing such things because he was abused by his own father, who did those things to him until one day he practiced that on another child.

Ms Mabe said that at some point the Committee needed to get someone to come and present on the rights of children – so they could ask where the loopholes were and to determine how Parliament could best strengthen current efforts to make sure the law was on the right track.

Finally, she requested that the Committee prepare a statement for next week in relation to the launch and the recognition of Children's Week.

Mr Mokgoro wanted to emphasize the issues the Chairperson brought up regarding male and female children. One had to to be careful of the consequences of just promoting prevention of violence against female children. It might result in a sour relationship between male and female children.

Responses
Donson said that he came to the meeting with great trepidation and anxiety, but wanted to say thanks for the opportunity. He said that the Committee represented an important forum.

Donson first talked about the changing social norms of parenting. In the past, children were afraid of telling their fathers when they acted out at school and the principal beat them, because it would result in “another hiding” for being disrespectful to their elders and their peers. Donson said those cultural norms and practices he believed had gone by the wayside in different ways. In some families, there were good norms in society, but there was an influence in other institutions – children were exposed to violence at school, in their friendship circles, in clubs and all sorts of things. Perhaps there was an irresponsible parent who did not have time because he was working too hard. Donson said that the latest age of technological advancement was supposed to give more leisure time, but people filled up that time with other things and robbed children of a caring responsible parent.

Donson said that he prescribed to the idea of bringing back those norms, because they were the best practices when implemented. The answers might lie in the community where there was a close-knittedness of caring, of love, of concern. He also acknowledged that there were communities with destructive things happening – children out on the road at 10 o’clock, 12 o’clock at night because the parents want to do some “hanky-panky stuff.” There were bodies of research that had looked at these issues, but on behalf of the MRC, it could be a voice in informing on this in a way that was easy to assimilate and that the Committee could then use. Donson said he could be a liaison to ensure the Committee was informed on a regular basis about many issues. He would get more feedback as well from colleagues regarding any associations between the rights of children and violence by children.

Donson addressed the difference in the use of sharp objects and firearms in Durban and Cape Town, stating that he believed there might be socioeconomic factors contributing to this difference. There may be greater means of obtaining firearms in Durban than in Cape Town.

Donson said that with regard to the rise in reports of sexual abuse, he suspected this had to do with a culture that allowed such forthright reports. While as before people were often shamed into maintaining silence and living with that pain, now there was the ability to come forth and be transparent.

Donson went on to discuss why there were not more statistics about drug-related, non-natural deaths. He said there was a six-year backlog on drug analysis because of manpower and funding issues at the forensic chemical laboratories. Donson acknowledged the difficulty in stemming a drug trade in South Africa when there was no knowledge of what was happening.

Regarding the engagement with statistics, the Committee was informed from the MRC, and through the department, etc. The Committee could connect with these groups on a regular basis and could get research summaries directly for their analysis and consumption. Committee members simply need to ask for specific information and these research groups could provide that to them. That information told the who, what, when, where, and how, but the only problem was providing the why. One does not always know why. We know associative factors, like alcohol.

Donson also noted that while the information was incomplete, they were trying to get full coverage across South Africa. In Durban, for example, the MRC did not collect information from the north, but was working to expand to the northern areas of the region as well.

Ms Mabe responded and said that there had been a lot of work done around children, children’s’ rights and child protection, but she noted that many of these individuals were working by themselves. She wanted to know what the MRC’s relationship was with UNICEF, for example.

Donson said that his unit was called the Centre for Peace Action, which was a world health collaborating centre, not only on violence and peace promotion, but other countries in Africa were certified through that Centre for the work they did on these issues. The Centre’s link with UNICEF was primarily around child protection in traffic-related issues. The Centre also had connections with the World Health Organization, the Center for Disease Control in the United States, and with the National Research Fund.

Ms Mabe also indicated a desire to hold a summit with all the organizations working on children’s issues to come and present and share their experiences to see how they could best help each other to avoid competition and duplication. Somewhere, there was a solution to all these challenges. She would like to involve the Departments of Arts and Culture and of Sports as well, and would like to have them present a report as to what they could do to keep children off the streets and off drugs. These things required proper planning.

She thanked Mr Donson and told him he was welcome to come back. She wanted people to monitor effectively.

The Committee then adopted the outstanding reports and the meeting was adjourned.

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