Commonly asked questions about child sexual abuse

Child sexual abuse (CSA) is very common both in India as well as worldwide. Adults can help in fighting this menace by learning about all aspects of CSA - how it happens, why it happens, why the child does not tell, what can be done if one finds out about it, how to support the child and what to do about the perpetrator.

Answers to some commonly asked questions about child sexual abuse (CSA).

Is Child sexual abuse common in India?
In 1993 -1994, Samvada, a Bangalore based NGO did a pioneering study in the history of CSA work in India by organizing a series of workshops for 348 girls (15 – 21 yrs old) from 11 schools and colleges in Karnataka.
They found that 47% of the respondents had been molested or had experienced sexual overtures, 15% when they were less than 10 yrs old. 15% had experienced serious sexual abuse, including rape. Of these 31% were less than 10 yrs old when abuse started.

The Ministry of Women and Child Development, Govt of India, Prayas and UNICEF, 2007 reported that out of 12,447 children (hailing from all strata of society), 53% reported sexual abuse. Out of 12,447 children, 21% reported severe sexual abuse.

Many reports (e.g.RAHI) prior to the recent report had indicated that child sexual abuse of girls was high in India. Now it appears that incidence of sexual abuse of boys is also on the rise. 52% of boys and 47% of girls have reported sexual abuse of one form or the other in this study. More boys than girls have reported severe form of sexual abuse.

Does this mean that 50% of our men (or women) are abusers?

No. This is because one abuser abuses many children. In a study in the USA, a convicted abuser had on average, abused 76 children. By exposing the abuser in the society, the abused child’s family can save many children from abuse. Hence it is very important to tell all the family members, friends and neighbours about this person. He/ she may be an influential person or a religious leader – but if he/she is a child abuser, he will not stop unless acted against. Though legal action is a way out, it may take a long time. Talking about this person among the family and neighborhood – “be careful with this person. I have heard that children are not safe with him/her” will keep children around him/her safe.

What is considered child sexual abuse?
Under the law, "child sexual abuse" is an umbrella term describing criminal and civil offenses in which an adult engages in sexual activity with a child or exploits a child for the purpose of sexual gratification.
Acts considered CSA may be:
Fondling – Touching genitals.
Violations of child’s privacy
Exposing children to adult sexuality
Behavior involving penetration.
Exploitation – giving or receiving money for using a child for sexual gratification.

An adult who engages in sexual activity with a child is performing a criminal and immoral act which can never be considered normal or socially acceptable behavior.

At what age does Child Sexual Abuse start?
One of the youngest victims of sexual abuse was a one and a half months old baby. However, in majority of cases, sexual abuse begins around 5 years of age, peaks at around 12 -14 years of age and then begins to decline (as per the Govt. report). It can, however, continue into adulthood.

Why do children keep quiet about CSA? How does CSA continue?
Children don’t talk about the abuse because they feel they won’t be believed, that they will be blamed for it or because they don’t want the family to break up. Often the abuser is a family member or is very close to the family. As the child has grown up loving and trusting that person, the person starts 'grooming' the child for sexual abuse by touching him/ her in an 'unsafe' way. The family remains unaware of this and the child feels confused.

If the family has brought up the child to think that anything to do with the reproductive tract is "dirty' or "shameful" the child will find it very difficult to report the grooming process. In the mean time the abuse continues and becomes more severe. The child now feels trapped and thinks 'I did not tell anyone when it first started. How can I tell now? Every one will blame me for not resisting or not telling earlier. Anyhow, I feel too ashamed to explain all this to my mother/ parent/ teacher. May be it will stop." The abuser, emboldened by the silence, goes ahead. He / she also uses bribes, threats, secrecy, promises, blackmail and emotional manipulation to keep the child from telling anyone.

A child’s brain is pitted not just against an adult brain of the abuser, but also against the silence and shame built around the current social perceptions of sexuality. The child can win only with the support of the family members, in a society that accepts and respects each individual's personhood and sexuality.
In some instances, the child informs the parents in a round about way or directly, and the child is either not fully understood or not believed or simply denied protection. CSA therefore continues.

If we don’t make a fuss about the abuse, won't the child forget it?
Children do not forget abuse. It remains with them and affects their behaviour and personality in many ways. In the present it can result in falling academic performance and a lack of interest in activities the child used to enjoy earlier
It may cause the child to become excessively sexualized in his or her behaviour, or it may cause the child to dislike themselves. The child may start keeping the body dirty and unattractive, wearing many clothes or baggy clothes to avoid attracting attention.
The adolescent may start behaving aggressively or become totally submissive. At times a very resilient child may appear to be ‘unaffected’. The psychological effects may however surface later in life.

Adult survivors of child sexual abuse may have difficulty in maintaining relationships, experience inability to trust close family and friends, develop harmful sexual behaviour or have marital problems.

Shouldn't we protest against only severe forms of CSA?
No. If we tolerate minor forms of abuse such as fondling, hugging, kissing children or exhibitionism then that becomes the norm. Let us have Zero tolerance for CSA.

Will 24 hour surveillance of the child prevent sexual abuse?
No. For one, it is not possible for a single adult to look after a child 24 hours a day. It is much better to empower the child. The child can be taught personal safety, personal space rules, and safe and unsafe touch, just as we teach our children about how to protect the body from heat, cold, fire and injury. Ask the child to come and tell you if anyone ever breaks the body rules.

Won't explaining about personal safety to the child unnecessarily frighten the child?
No. The child will not be frightened if we explain about personal safety as a choice and introduce the concept in a comfortable and non-threatening manner. We can tell the child that “you are the boss of your body. No one can touch you in a way you don’t like (this includes pinching and slapping and hitting etc)”.
Talk especially about the parts covered by the undergarments. How no one can touch them there except to keep them clean and healthy (mother, doctor). Talk about personal space – the space around our body that we consider to be our own. Talk about safe and unsafe touch. You may use a doll to explain to the child.
Children are told about strangers and robbers and kidnappers. Similarly tell them about their body rules and personal space. Do not frighten the child. Explain that most adults want to help and protect children. There are a few ‘bad’ people who want to hurt children. We need to protect ourselves from such people.

If society gets to know of the abuse, won't the child have more to lose than the abuser?
No. The silence of the abused and the people who know about it, is the main reason that sexual abuse continues. By exposing the abuser in a way which does not traumatise the child, helps the child to heal as well as stops other children from being abused. Every one wants to “Look Good” and have a “good” reputation. The criminal has his reputation to lose. The child is a victim, blameless and innocent and will heal faster from the trauma if he / she perceives that justice has been done.

Is Social ostracism of the abuser really a powerful option available to the family of the abused child?
Yes. Social ostracism often works better and faster than legal recourse. It also safeguards other children in the neighbourhood and in the extended family.

Do we have an obligation to protect not only our child, but other children in our community as well?
Yes. If our sister or neighbour knew that the person our child is associating with is an abuser, wouldn’t we expect her to warn us? Similarly should we not inform our relatives, friends and neighbours about an abuser we know of? We don’t need to prove his or her crime in a court of law. We believe our child. We wish to protect our nieces, nephews and the children in our community. We just need to let them know that they need to be aware and careful in the presence of a certain individual who has behaved in a reprehensible manner with a child. We can do this without exposing the identity of the child.

How can I detect a child victim of sexual abuse?
The majority of cases of CSA may go unrecognized unless we are aware and look for signs that may be suggestive of sexual abuse. How abused children can be detected through their behaviour is varied. The way the child presents can be demonstrated by the picture of an iceberg. What is obvious, or comes to the surface is only the tip of the problem.

The following is a pictorial representation of presentation of CSA, developed by Dr Shekhar Seshadri, Child Psychiatrist, NIMHANS, Bangalore, and a co-author of this workbook series. He is one of the first few psychiatrists in India to begin detailed work and research on child sexual abuse.

Obvious abuse:
1. Disclosure by the child
2. Detection (obvious) - pregnancy, child suffering from Sexually Transmitted infections , child having genital injuries

Suspicious of abuse:
_3. Sexualized behaviour, clear hints given by the child__
4. Clear symptoms like depression, post traumatic stress disorder
5. Sudden unexplained change in behaviour - school refusal, people avoidance_
6. Symptom patterns - sudden onset of bed wetting, aches, pains, general ill health
7. Children who do not report, hint or decompensate - because they are resilient,
have been threatened, manipulated etc.

Presentation of Child Sexual Abuse: By Dr Shekhar Seshadri, NIMHANS


When do I suspect child sexual abuse?

1. A change in the social behaviour of the child – a happy child becomes introverted, silent, refuses to participate in group activities. The child may become insecure and cling to a trusted adult, or become excessively fearful. Occasionally the child may become violent, easily enraged. The child tries to avoid coming in contact with a particular person.

2. A change in the personal grooming of the child – neglects personal appearance, deliberately tries to look unhygienic, shabby or unattractive. May begin to wear multiple layers of clothing, inappropriate for the weather.

3. Change in the academic performance, poor concentration, distracted, sleepy (since abuse may cause sleepless nights/ nightmares/ disturbed sleep), lack of interest.

4. Replaying the abuse with another child generally younger or same age as them. This is known as sexualized behaviour.

5. Change in eating habits: Child starts losing weight or may eat excessively, thus putting on weight.

How do children report sexual abuse? How can I encourage my child to report a disturbing incident?
A very small percentage of child victims of sexual abuse actually report it (12%). The reporting is often ambiguous because the young child may not have the vocabulary to explain what has happened or feels too shy to narrate the incident clearly.
You can encourage the child to disclose by accepting and understanding what the child is trying to convey. For example:


How can I probe the issue further if I have a doubt that my child is being abused?

Have a conversation with the child in private, in a casual setting.

1. Ask about the child’s feelings and emotional well being:

Do you feel happy; feel cheerful; feel jittery or restless; feel sad; feel like crying; feel afraid or scared; worry about things; feel, unhappy; feel nervous; feel bothered or upset?

2. Ask about how the child feels about him/herself:
How good or bad do you feel about:
yourself; your school work; your friendships; your body and your looks; the way others (peers and adults) treat you, the way others touch you?

3. You may ask leading questions about personal safety.

Has anyone ever embarrassed you and you did not talk about it with anyone?
Has anyone ever touched you in a way you didn’t like? Has any one – related or unrelated to you, known person or strangers, ever touched you in a way that made you feel uncomfortable / shy / yucky?

4. To make the child feel comfortable and reassured, state:
• I am asking you this because if this happens, you can always come and tell me
• Things that trouble you, need not be kept bottled up inside you.
• Yucky things are best let out.
• The person may tell you that it's all right, no need to tell any one, may try to bribe or even threaten you. But for your safety, it will be best to tell an adult you trust about it.
• You can tell me.
• When an adult or older person troubles (abuses) a child, it is never the child’s fault. The adult or older person is responsible for what they did.

How should I respond if a child confides about abuse?
The best way to respond to the child who has been abused:

• Tell the child you believe her / him.
• Praise the child’s courage in coming and telling you about it. Acknowledge the child’s feelings.
• Tell the child it was not her/ his fault. The adult was at fault. The adult is guilty of a crime – even if the child did not tell when the abuse first started, the child was not responsible for the abuse continuing.
• Tell the child that you would like to take the help of other adults (family members, institutions, staff members) to help the child, with the child’s permission.
• Do not make false promises like “I will send the abuser to jail. I will beat him /her up etc’
• Do not question or blame the child - “Why did you not shout for help?” “Why did you not tell me earlier?” “Why did you not fight?” Remember, it is a child and the abuser is a person known to the child – trusted and loved by the child.
• Do not ask the child to “Forgive” “forget” or “adjust”.

If you feel you are unable to support the child, you can always take the help of a competent, empathetic and trained counselor. In any case, you can always believe, accept and continue to care for the child. Taking the help of mental health professionals – Depending on an assessment of the child’s behaviour, symptoms and coping skills, mental health professionals need to be consulted. Severe symptoms, suspected or apparent self harm behaviour warrant a prompt consultation with a mental health professional with expertise in dealing with victims of child sexual abuse.

What possible strategies can be used to deal with the Abuser?
1. Counseling for the abuser, if repentant and willing
2. Community awareness – informing the abuser’s community about his / her actions. Community action
3. Para legal / quasi legal actions - a third person reporting abuse
4. Legal recourse
Certain basic principles need to be kept in mind while interacting with a child who has experienced sexual abuse:
1. Need for strict confidentiality
2. Best interests of the child.
3. Checks and balances in the reporting and decision making process. Do not hesitate to consult people who have experience in this field.





To sum up, I would like to quote Dr Shekhar Seshadri from his article on Good Practice in Child Sexual Abuse (CSA) Interventions (in AAINA,a mental health advocacy newletter July 2001):
"Child Sexual Abuse is a child issue, a sexuality issue, an abuse issue, a gender issue, a patriarchy issue and a power and domination issue. And good practice means one should be aware of all these dimensions and develop skills to intervene across these issues.

Author:
Dr Sangeeta Saksena, MD (OBG)
Enfold Proactive Health Trust
Facilitator: Life skills, Human Sexuality and Personal Safety programs for school and college students, parents and teachers.
Co author of “On Track” a workbook series on Life skills and Personal safety for school children