Violence against Children and the consequences for South Africa

Social Development

02 September 2014
Chairperson: Ms M Capa (ANC)
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Meeting Summary

The Medical Research Council briefed the Committee on the results of its study that had been carried out into violence against women, but which had included a separate investigation into violence against children, and the effects on South African society. It was explained that violence included physical, emotional and psychological violence, and that it could take the forms of child murders or homicide, sexual exploitation and trafficking, harmful traditional and cultural practices, child labour, bullying and indirect violence, perpetrated in the home, school and community and at institutional levels, by adults and other children. Some of the events, such as infanticide or abandonment, generally occurred before the age of one year, but others, such as neglect or sexual abuse spanned the full seventeen years of childhood. Risk factors ranged from accepted societal norms, including lack of maternal care, gender disparities and attitudes, and it was stressed that these were not unique to South Africa and that the results of the study in South Africa to a large extent mirrored what was happening in the rest of the world. Other external factors compounding the problem were cited as lack of adequate housing, poverty, high rates of unemployment, emotionally-detached parents, substance abuse by the care giver, inability to care for those with mental health issues, and risks around problematic behaviour of children.

It was noted that in 2009, 1 018 children (or three per day) were murdered, with the boy child murders being slightly higher. 45% of children had been murdered through instances of child abuse and child neglect, with mothers being the worst perpetrators, and 74% of children killed in these circumstances were under five years old. The prevalence of deaths from fatal child abuse was greater in girl children, and rape homicides probably accounted for 10% of children killed. Between 40% and 50% of rapes reported to SAPS (the real figure was probably higher) involved children under 18. Risk factors associated with this included greater likelihood of teen pregnancy, infections, and victims starting to engage in risky sexual behaviour. It was noted that beating of children at school and in the home were still prevalent, and emotional abuse was also seen in one-third of children, whilst one-fifth were made to feel unwelcome in their homes.

Around 28% of abuse cases related to physical abuse and around 42% to emotional abuse. The victims showed increasing tendencies to suicide attempts, substance abuse, increased use of alcohol, delinquent behaviour, mental health problems and conduct problems. Similar results were seen in victims of bullying, and indirect bullying. Participants in the study had been asked to cite what type of treatment they saw as abuse and many had cited emotional neglect and substance abuse by their parents, physical hardships such as not being provided with food or clothing, and physical punishment or sexual abuse. The study, as well as other studies in previous years, had looked into how many children felt that their first sexual experience had been forced or had followed trickery. The point was made that whenever abuse took place, it was likely that the perpetrator had possibly been abused himself or herself as a child.

Other results were presented on a study on the psychological impact of sexual assault on 8-17 year olds, which showed that this resulted in high mental health problems and anxiety, compounded by the fact after a sexual assault few children were able to access the correct level of post-traumatic counselling or assistance. In Khayelitsha, for instance, there was only one NGO trying to offer counselling services, and the Thutuzela Care Centre services had a long waiting list. The fact that so many children still showed symptoms highlighted the huge barrier to services and the need for more specialists and experts. The impact of sexual abuse in particular led to HIV and depression and alcohol abuse in women, and mainly impacted itself as alcohol abuse in men.

An interesting aspect of the study had been a comparison across similar economic and age groups amongst different races and this highlighted that there was not necessarily a strong link between poverty or background and violence, since sexual violence was at 10% within black communities, 5% within coloured, 10% within Indian communities and 17% within white communities. Parenting interventions were most important. One intervention, Skhokho, was being tested in Gauteng and aimed to prevent sexual and intimate partner violence among teens, working in the schools and with parents and teachers, but the results would be available only in 2016. Finally, the MRC emphasised that the numbers were probably under-reported, in part due to weaknesses in identifying the cause of death, but that all society needed to work together to prevent such deaths and protect children.

Members noted that although the Department of Social Development had committed itself to dealing with Early Childhood Development, there were still numerous problems that required concerted efforts by those within and outside government. The MRC pointed out that there was a need for a national study on violence against children, as the only national survey so far related specifically to child homicide. Members were concerned whether there was enough information on persons with disabilities, enquired as to the findings in rural areas, and whether it was possible to assess in which provinces there was the highest level of abuse. Members asked if there were plans to roll out Skhokho to other provinces, if there were figures on how many sexual assault cases were perpetrated against babies, commented on the demographic findings, and noted the strong links between violence and substance abuse. They asked how existing government projects could best be used, and urged the need to tackle the role of the family, society, traditional leaders and the importance of achieving social cohesion.
 

Meeting report

Violence against Children, and the effects on South Africa
The Chairperson welcomed the Medical Research Council (MRC) and its research into the vulnerable sectors of society. She said that the MRC had given “scientific clout” to the issues that were reported in the media and that needed to be discussed.

Professor Glenda Gray, President, South African Medical Research Council, defined violence against children as including physical, sexual and psychological violence. She stated that these factors included child murders or homicide, sexual exploitation and trafficking, harmful traditional and cultural practices, child labour and bullying. She stated that violence against children was being perpetrated by adults, mostly in a physical and emotional sense, and by other children, through physical, verbal, and indirect violence. She explained that this could lead to substance abuse, alcohol abuse, delinquent behaviour, mental health problems as well conduct problems in the abused child.

Professor Gray said that there were various forms of violence that could be perpetrated against child victims throughout their childhood, ranging from infanticide or abandonment at birth to one year, child abuse and neglect that could span the whole childhood up to 17 years of age, child sexual abuse from birth to 17 years, dating violence from the age of around 14 to 17, and male teenage violence in the teenage years from 12 to 17 years.

She said that violence could occur at the individual level, the level of the home, community level (including school) and institutional level (in the care and justice systems). She identified some risk factors, which could include societal norms, such as a lack of maternal care whilst women were at work, and not having sufficient social support. Other societal norms that could promote violence included gender issues and cultural beliefs and practices that denied the rights of children. Throughout the world, there were cultural and social norms that perpetuated violence against children. She stated that within the community, there was the problem that violence tended to be tolerated, as well as gender and social inequality.

All of these issues were also compounded by other external factors, such as the problem of lack of adequate housing, poverty and high rates of unemployment that added to the issue of violence against children. At the level of relationships, there were issues of emotionally-detached parents, substance abuse by the care giver, inability to care for those with mental health issues, as well as care-giver isolation.  At the individual level, risk factors included age, gender, the possibility of being abandoned (especially when under the age of one), those abused due to their mental disabilities and the risk of problematic behaviour.

Professor Naheemah Abrahams, Researcher, MRC, spoke to the issue of child murders in South Africa, explaining that MRC had, some years ago, conducted a female homicide study to determine how substantial the problem of femicide was. When that study was repeated in 2009, MRC had added the element of children being murdered to its research. The MRC had investigated the mortuaries and seen how many children had been murdered, then arranged for autopsies and had spoken to the investigating officer in order to see how big the problem was. The sample had not been large enough to compare the problem across provinces, but rather represented a national sample of what had been happening.

She said that 1 018 children had been murdered in 2009, which amounted to three children murdered every day. The boy child showed had a higher rate of child mortality, with the female rate slightly lower. She explained that the MRC had wanted to know the circumstances around the death, including who the perpetrator had been. It had been found that 45% of children had been murdered through instances of child abuse and child neglect, and this mirrored the findings internationally. Mothers had been the most common perpetrators of murders, and 74% of children killed in these circumstances had been under five years old.

Professor Abrahams said that, in terms of fatal child abuse, more girls’ deaths were linked to child abuse and neglect, and this was consistent across all ages except for the under-5 age group. She said that rape homicides were suspected in 10% of child homicide cases and this problem mainly affected girls.

Professor Abrahams also spoke about child sexual assault, saying between 40% and 50% of the rapes reported to SAPS involved children under the age of 18 years. Other risk factors included greater likelihood of teen pregnancy and Sexually Transmitted infections (STIs), increased indulgence in risky behaviours such as sex with many partners and unprotected sex, as well as starting to engage in sexual relations at a younger age. She stated that there was a need to think about the consequences whenever there was violence against children.

Professor Gray spoke to physical and emotional abuse in children, saying that beating of children was still prevalent in schools, and one-third of children included in the study said they had been beaten by teachers within the last three months. Emotional abuse included being singled out to do household chores, being threatened with bad grades, threatening to call ghosts and spirits, or even telling children that they were a burden. She also said that one-third of children had been called ‘dumb or lazy’ and one-fifth did not feel welcome in their homes.

Professor Gray spoke to the prevalence of any one form of physical and emotional abuse occurring at the hands of adults at least once in 2013. 28% experienced physical abuse and 42% percent had experienced emotional abuse. This had been associated with suicide attempts, substance abuse, increased use of alcohol, delinquent behaviour, mental health problems and conduct problems on the part of the victims.

Professor Gray said that bullying could take the form of physical bullying, verbal bullying and indirect bullying, each of which came in various forms. She said that the forms of bullying also had various links to the victims’ responses. Physical bullying had been linked to attempts at suicide, increased use of alcohol, delinquent behaviour, mental health problems and conduct problems. Verbal bullying had been associated with suicide attempts, mental health problems, increased alcohol consumption, delinquent behaviour and conduct problems. Indirect bullying had been associated with suicide attempts, delinquent behaviour, mental health problems and conduct problems.

Professor Abrahams spoke to maltreatment of children, and noted that much of the work had come from the Gender and Health Unit. When MRC had started the study, it had asked children whether they considered certain types of behaviour to amount to maltreatment. People in the focus group had been asked what they saw as emotional neglect and they had spoken to issues such as parents being too drunk to look after them, parents not knowing where their children were for long periods of time and parents moving from home to home. The group had said that emotional abuse had included statements such as being told they were stupid and ugly. Physical hardship had been identified as not having anything to eat, or being sent to school dirty, and similar situations. Physical punishment had been identified as being very prevalent, as many within society still used physical abuse on children. Sexual abuse was also identified.

She spoke to forced sex and said that only when participants were made to feel comfortable were they prepared to give answers. She said that it had been found, in a study in the Eastern Cape, that out of 1 415 females, 18.8% felt their first sexual encounter had been forced or that they had been tricked into having sex. The responses from 1 367 men indicated that 1.4% felt that their first sexual experience had been forced upon them or they had been tricked into it. In the Western Cape, a study in Khayelitsha done in 1995-6 showed that 31.9% of pregnant women, and 18.1% of non-pregnant women, both groups under the age of 19, had felt that their first sexual experience had been forced upon them or they had been tricked into it. In Soweto, in a similar study conducted in 2001-2, 7.3% percent of those participating in the study had felt they had been forced into their first encounter and 8% percent reported that they had been raped as a child, before the age of 15. In Gauteng, a study done in 2010 showed that 8.5% of participants in the study felt that their first sexual encounter had been forced upon them.

Professor Abrahams said that it was impossible to separate violence against women and children, saying that if a woman was being abused then often a man was being abused as well. It had also been found that men who had witnessed abuse were more likely to abuse and women who had witnessed abuse were more likely to be abused in the future. She said that childhood exposure to violence possibly increased the acceptance of violence, either as a victim or perpetrator.

She spoke to a study that had been conducted on the psychological impact on 8-17 year olds, after a sexual assault. This showed that there were high levels of mental health symptomatology, with nearly half of the children meeting the clinical diagnostic criteria for anxiety. She further said that over two thirds of children meeting the criteria had shown full symptoms of Post Traumatic Stress Disorder (PTSD) and several children still showed clinically significant levels of anxiety nearly six months after disclosure of the sexual assault. 43.3% of children still met the criteria for full diagnosis of PTSD nearly six months after disclosure.  She emphasised that few children accessed mental health services, as there had been service level barriers and support by caregivers had not always been adequate or sustained. She said that one of the most disturbing factors was that when the children and their care givers had been contacted after six months, to ask if they had been accessing care services, it was found that many had not been captured by the health system or by Childline.

She noted that this study had been done in Khayelitsha, where there was only a single child abuse NGO that had been offering children counselling services. The Thutuzela Centre had being offering one service, but there had been a waiting list. She explained that what was generally seen was that a woman coming in with her children had quite good and positive experiences on the first visit, but then were referred to another person for a follow-up and further treatment, but the appointment could only be arranged two months down the line, and often the caregivers would assume that, after this time had elapsed, the children’s state had improved and there was no need to continue with the visit, or other factors such as work pressures prevented the appointment from being kept. The children thus ended up not actually being see by a mental health counsellor. 

Professor Abrahams reiterated that there were children who still showed evidence of mental health problems after assault, and this had merely highlighted the huge barriers to services and the need for experts. She stated that there was so much violence and trauma within South Africa, that virtually all counsellors needed to be experts at managing mental health.  There had been too few of these service providers to date, and one counsellor had said that it was difficult to work with children, as speciality input and skills were required.

Professor Abrahams spoke again to the impact of childhood adversity or maltreatment saying that in women, there was an increased risk of HIV and depression and alcohol abuse in adulthood associated with sexual abuse and emotional neglect in childhood. For men, the impact was mainly seen in alcohol abuse associated with childhood physical hardship, sexual and emotional abuse.

She reiterated the urgent need to look at the issue of services and the ability to provide services.

Professor Gray spoke about violence experienced across racial groups, saying that this study had particularly wanted to look at the “post-apartheid” child. There had been high levels of sexual violence within communities irrespective of race. In terms of reported sexual violence, the numbers had been reported as being 10% within black communities, 5% within coloured, 10% within Indian communities and  17% within white communities.

Professor Abrahams said that interventions needed to be driven by what had been witnessed as risk factors. Across the world, it had been shown that parenting interventions had a great impact, as they had the potential to prevent violence against children, as well as having a greater impact on the children as they grew into adults.

One intervention, Skhokho, spoke to the prevention of sexual and intimate partner violence among teens, and was being tested within Gauteng. A workbook had been created for Grade 8s on life orientation and the group also had workshops with teachers in order to allow them to engage with the life orientation curriculum, whilst the last step of the initiative worked with parents to teach positive discipline and better ways in which to communicate. She said that the results of this would only be available in 2016.

Professor Gray concluded by summarising the main findings – namely, that the homicide study had showed that more than one thousand children had died from homicide in 2009, or nearly three children per day. The study had highlighted three distinct problems, abandoned babies, fatal child abuse and male teenage interpersonal violence. Fatal child abuse and neglect deaths were underestimated due to weaknesses in identifying such deaths. She said the murder of children was preventable and there was a responsibility to see that children were protected. She rounded off by saying that it would be essential for all within the sector collectively to develop and implement a national strategy to address child murders in South Africa.

Discussion
The Chairperson said that the Department had committed itself to deal with Early Childhood Development, which included the gestation period of a child. She said that even though this report had not been tabled to the Minister or the Committee, there was a sense that all was not well. She personally knew in the Eastern Cape there were children who were literally left naked. She said that although there were strides being made, the problem was huge and could not be dealt with by the Department of Social Development alone.

Professor Abrahams agreed that this was a complex issue which needed to have a multi sectoral approach, but that there was a need to adopt an approach that understood the complexities and allowed for something to be actually done. She said that South Africa had never done a national survey into violence against children, and all of these surveys had been small and restrictive. The MRC had been in discussion with partners to try to amass money for a national survey. The only national study that had been done was the child homicide study.

Persons with disabilities
Mr S Mabilo (ANC) asked for information in terms of children with disabilities and whether there were any studies in this particular aspect.

Ms V Mogotsi (ANC) said that it worried her that one of the risk factors was disability. South Africa had failed to comply with the obligations to report on the status of persons with disabilities, in line with the UN Convention and she asked for comment from the MRC on that point.

Ms L van der Merwe (IFP) said that there was widespread abuse of children with disabilities, especially in terms of their care and misuse of their grants and asked if there was anything being done to address that.

Professor Abrahams replied that there were no figures on children with disabilities. She stated that the Demographic and Health Survey was going to include questions on disabilities, violence against children and women, and hopefully by the end of 2015 there would be more information.

Professor Gray agreed that South Africa had not been very good at handling mental issues, but this was not only a problem within South Africa, but one that applied universally.

Rural areas
Mr Mabilo asked what if there had been any specific findings on what was happening in the rural areas.

Ms S Tsoleli said that within rural areas there was less ability to pick up bullying by learners than in urban areas.

Professor Abrahams replied that the problem was exacerbated in the rural  areas and hopefully when a national study was done, then a deeper study within these areas would also be produced.

Child abuse within provinces
Mr Mabilo asked which of the provinces experienced the highest rate of child abuse.

Professor Abrahams repeated that there had not been a big enough sample to allow for a comparison.

Intergovernmental challenges
Ms Mogotsi asked what the challenges of working with government had been.

Margin of error
Ms E Wilson (DA) said that the figures stated were probably lower than they were in reality, given the fact that people, for various reasons, tended not to report abuse. She wondered what the margin of error might be.

Professor Abrahams replied that there were no figures against which to compare, and the MRC had preferred to err on the side of expressed a lower number, to avoid allegations that it was over-stating the issue.

Skhokho
Ms van der Merwe asked if there were future plans to roll Skhokho to other provinces.

Professor Abrahams replied that the MRC was looking into how this worked, and money had been given by the development body DFID to examine how well programmes such as this were working. This had been a randomised control trial, and it had taken a long time to work with the Department of Education, as sometimes departments were not always convinced that such studies were useful. The Skhokho programme would not be rolled out on a widespread basis until there was certainty that it worked. The Department of Education had seen some successes and was keen to roll out now, but the MRC wanted firstly to check that the programme worked.

Sexual assault of babies
Ms K de Kock (DA) asked how many of the cases of sexual assault involved babies.

Professor Abrahams replied that SAPS had this data but did not provide the data by age. She urged the Committee to request that the data provided could be broken down into age categories.

Abuse within races
Ms de Kock asked about the higher instance of abuse within white communities, and questioned for clarity, as there had often been links cited between abuse and poverty and the white communities tended to be those who were less affected by poverty.  

Professor Gray replied that this was a study that had been done within Johannesburg, where all study samples had been matched by socio-economic status and age group. This data showed that abuse was not necessarily linked to race and socio economic status, but rather related to how people valued their children. She argued that it was only through a change of social norms that the issue of violence could be changed. This was why there was a need for national campaigns on how to care for children and raise them properly

Tackling poverty as government
Ms H Maxon (EFF) asked if there was any research that could show how government could intervene into poverty which played a key role, and how government could be capacitated.

Substance abuse
Ms Tsoleli said that it was not possible to talk about violence against children without noting the issue of substance abuse, and asked if there had been particular research done on this contributing factor, and what types of substances were being abused.

Professor Gray replied there was a need to penetrate communities more deeply in order to properly tackle this problem.

Impact of legislation and programmes by government
Ms H Malgas (ANC) asked if research had been done on the impact that government programmes and legislation had had on violence against children.

The Chairperson wanted to know how existing government projects could be utilised in the best way.

Professor Gray replied there was a need for involvement with government in order to put policies into practice.

Involvement of the family unit and of traditional leaders
The Chairperson said that one issue that had not been tackled was the role of the family in this whole process. There was sometimes a disruption of the family unit – and if a mother was given money for child support, that money might well end up being used to buy alcohol for the mother. The migration of labour had destabilised the family units, which had never recovered. She said that there was a need to look if there was sufficient protection of “the family”, who acted as parents, who was actually looking after the child, and such fundamental issues had to be addressed.

The Chairperson added that there was a need to engage with traditional leaders as well as religious bodies, stressing the need for a holistic approach, particularly given that these were problems affecting present-day society that had not been seen in the past. She argued that the research had neglected the historical nature of the family unit in society, and the fact that social cohesion was important. Every context presented its own unique challenges.

The meeting was adjourned.
 

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