Thursday, February 26, 2009
Commonly asked questions about child sexual abuse
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
Saturday, January 10, 2009
FAQ's about Periods
Why does it pain during periods?
Just before the periods start, cells in the inner lining of the uterus die before being shed. This cell destruction produces chemicals called prostaglandins, and may cause pain. The muscular portion of uterus also contracts, so, depending on her sensitivity, a woman may find her lower back, abdomen or thighs hurting. This generally starts on the day of the periods and may continue for a day or two longer.
What is white discharge?
Our body is full of fluids. Eyes have a certain fluid, which they discharge. Ears discharge wax, nose discharges mucus etc. Similarly the vagina and the reproductive organs produce a discharge that is white in colour. This discharge is acidic in nature and it prevents infection. It stains the undergarments a yellowish, brown and this is normal.
Sometimes in case of infection there maybe a foul smell and itching, in which case you can go to a doctor to get it checked.
Can we take tablets to postpone periods? Is it unsafe for further procreation?
The tablets contain hormones and they ensure that you will not get your periods as long you keep taking them (provided the tablets are started 5-7 days before the expected date). They don’t damage you system, but do interfere with your normal cycle. They do not affect future childbearing.
Many girls take these tablets when travelling or to attend religious ceremonies. By taking extra care or by using tampons while traveling one can manage very well and there is no need to postpone periods. God made our bodies and periods are in no way ‘dirty’ or unholy. Breaking the natural rhythm of you body is best avoided. There is no reason to postpone periods.
Can we swim during periods?
Yes but you need to wear tampons to ensure that the menstrual blood does not come out during your swim.
What is hymen?
Hymen is a thin tissue (membrane) that partially covers the vaginal opening. The membrane has an opening in it to let out the menstrual blood. The size of the opening, and the elasticity and number of blood vessels in the hymen varies from person to person. The hymen may tear during vigorous exercise, gymnastics, horse riding, injury or sex. If the hymen opening is large and the hymen elastic, then sex may happen without tearing it. Therefore it is not always possible to ‘test’ for virginity by examining the hymen. It is not true that bleeding should happen during first sexual intercourse.
What is menstruation?
If the egg gets fertilized, it will need a place to grow. This place is the inner lining of the uterus, which becomes spongy and soft during ovulation. This lining has lots of blood and oxygen to nourish a potential baby. The outer edge is also muscular and will stretch as the child grows before contracting as it is delivered.
However, there is the chance that the egg-in the 24 hours that it lives-will not be fertilized. On this occasion, the inner lining (that had been altered to welcome the baby) is shed though the vagina in a process called menstruation. Most of it is made of blood, which trickles out over a period of 4-5 days.
When do girls get their periods?
Menstruation usually begins anywhere from 9 ½ to 16 years – 11 ½ is the mean. This often happens after the breasts have relatively grown, and a considerable amount of pubic hair is present. Pubic hair also first appears about 2 years before menstruation starts, and a mucous-like vaginal discharge is also normal at this time. The pubertal growth spurt has also occurred.
Can I change the timing of my periods?
There is no natural method of doing this. Periods depend on the hormonal balance in the body, and altering this is quite risky. Many claim that exercise increases the blood flow or pre-pones the periods, but this is entirely baseless.
What are sanitary napkins?
Menstrual fluid has mostly blood in it, so women use sanitary napkins to prevent it from staining their clothes. The pad is worn between the legs and covers the vaginal opening. It sticks to the underwear and can be tied to a thin elastic belt around the waist.
I do not get my periods regularly. Is something wrong?
For periods to come regularly, perfect synchronization of all the hormones is needed. This takes quite a while to develop, so for the first 1-2 years after periods start, it is normal for them not to be regular. A girl may bleed only once in 2, 3 or even 6 months.
As a girl grows older, the periods should begin to come regularly. Most have 28-day cycles, but these can be 21-35 day cycles too.
Blood loss is around 30-50 ml during periods. People usually use 10-15 pads per cycle. In the initial years, it is normal to have bleeding for 1-2 days alone. However, heavy bleeding for over 7 days on any occasion is abnormal, and a doctor must be consulted.
How does one reduce the pain during periods?
Doing yoga or being physically active reduces the pain during periods. One may also take a few painkillers, particularly those with mefenamic acid (Meftal spas), but only with food. Using three or four of the latter per month is neither ‘habit-forming’, nor does it cause any long-term damage.
How does a girl maintain genital hygiene?
It is very important to wash the pubic area with soap and water during a daily bath. The folds of skin – the labia minora and labia majora – must also be cleaned, as secretions tend to collect there. After passing fecal matter, always wipe from the front to the back, so as to prevent the vagina from being infected.
Some people think the hair should not be washed during menstruation. This is entirely baseless – a woman can wash her hair whenever she wants to.
What are tampons?
Tampon is a thin, narrow bundle of tightly packed cotton that can be inserted into the vagina to absorb menstrual blood. It has a string attached, so it can be removed easily. When a tampon needs changing, the string is usually soaked. Tampons should be changed when soaked or every 4-6 hrs, which ever is earlier. The advantage of using these items is that one can go swimming during menstruation. They are also small, and may be flushed in any toilet. The disadvantage is that, since tampon cannot be seen, there is a serious risk of forgetting it is there and removing it. Bacteria will be attracted to the blood, especially if the tampon isn’t changed in 6 hours. Toxic Shock Syndrome is a dangerous infection of the blood stream caused by a forgotten tampon.
Should one shave the pubic hair off?
Pubic hair is there to protect the sensitive genital area and trap the natural body odour, so shaving is off is rather pointless. The hair may get matted with blood during menstruation, but this only requires some thorough washing to handle. If you do wish to trim it, use a scissors, but be careful not to cut the skin.
Pubic hair doesn’t interfere with having sex, so one doesn’t have to shave it off before marriage. In fact since it traps one’s natural pheromones (chemicals in body secretions) it helps in sexual arousal.
Should there be food restrictions during menstruation?
Certainly not. If anything, Indian women need more iron-containing foods during their periods, as 80% of them are anemic. Menstrual blood in no way harms plants or foods – if that were the case, women would have been incapable of farming. In addition, there should not be any physical restrictions; exercising doesn’t increment blood flow.
Friday, January 9, 2009
What is the Safe Time to Have Sex and avoid Pregency?
Also the ovum is alive for a 1- 1 ½ days so 14th is very unsafe i.e. there is very good chance of getting pregnant. Next period may not come on 28th May but 3-4 days early or late. If it comes 4 days early, then ovulation would have happened on 10th may and if late, then on 18th May.
Another important thing to be kept in mind is that the sperm can stay alive inside the uterus for about 3 days so if sex happened 3 days before ovulation it is not safe. So effectively the time from 7th May till 19th May is not safe for sex. The rule for a 28 day cycle is that 7 days from the day of starting periods is safe, and the last 7 days of the cycle (21st to 28th ) are safe. Middle 14 days or two weeks are not safe.
This is not a effective method of contraception to use as we are calculating based on an unknown fact (the next period).
Thursday, January 8, 2009
OVULATION & MENSTRUATION
The ovaries start maturing and releasing the ova (female reproductive cell). This occurs about once a month (one ovary releases one egg in one month, the other ovary releases an egg the following month). This process is called Ovulation.
Once the ovum has been released by the ovary it is picked up by the Fallopian tube. The ova stays alive in the fallopian tube for about 12 - 24 hrs. There after it dies and is absorbed by the body. If the sperms have been deposited in (or sometimes even at the opening of) the vagina, they swim up the uterus and into the fallopian tube to meet with the Ovum. This process is called Fertilization. The fallopian tube is joined to the uterus and helps move the fertilized Egg to the uterus. Here the egg will implant itself in the nourishing lining of the uterus called the Endometrium and develop into a baby in 9 months.
If fertilization does not take place, the soft endometrium is not required and is expelled from the body through the vaginal opening. This process is called menstruation or the period.
Menstruation lasts anywhere between 2 to 7 days. The blood that is expelled is absorbed on a pad or a tampon. Sometimes girls experience backaches and abdominal cramps during this time. All this is normal.
Tuesday, December 23, 2008
ERECTION, EJACULATION & WET DREAMS
Under the influence of testosterone, the testicles start producing sperm – the male reproductive cell. Both the testicles are contained in a sac called the Scrotum- which helps in regulating temperature as sperm producing cells are very temperature sensitive. Sperms move from the testis into the Epididymus where they mature. Ejacualation is the process where the sperms are released from the body through the penis. Just before ejaculation the sperm move from the epididymus into the Vas deferens. Here they collect Semen - a whitish fluid that provides the sperm with nourishment. Semen is a combination of the fluid given by the Seminal vesicles, Prostate Gland and the Cowper's Gland.
Ejaculation can occur only when the penis is erect. When sexual feelings arise in the brain, it releases chemicals that increase blood flow into the Penis. The penis become hard, engorged and erect because of this rush of blood and this is called an erection. At the height of sexual pleasure the semen is released from the body through the Urethra- the same tube that is used for urination. There is a special mechanism that prevents urine from coming out during ejaculation. Once semen has been released, the blood flow returns to normal and the penis returns to its original state.
A man produces millions of sperm everyday. There are approximately 100 million sperms in 1ml of semen. Typically 2-5 ml of semen is released with each ejaculation.
During puberty a boy may experience erection and ejaculation during sleep. This is called a wet dream or night fall and is very normal.
Changes during Puberty / Adolescence
The process of physical maturation is called puberty while adolescence includes the psychological and emotional changes as well.
Physical changes during puberty
Girls mature about 2 years earlier than boys. Here is a short summary of the physical changes which occur.
Changes that occur in Girls
- Height Increases rapidly. Starts at around 9 years and peaks at around 12-13 years. About 6cms are added on after the periods start.
- Structure Pelvis widens for childbirth. Store more fat in the body.
- Voice deepens and becomes less high pitched
- Thyroid gland slight, temporary increase
- Development of pubic hair starts at 10 years Can begin as early as 8 years.
- Underarm hair develops last, sometimes after menstruation begins.
- Blushing at slightest provocation during puberty.
- Pimples start 1-2 years after onset of puberty and remain till late adolescence, subside on their own
- Breast Development starts around 9- 10 years, develops by 14- 16 years.
Breast and areola are enlarged, nipple projects outwards. - Development of reproductive organs Lips of vulva thicken and enlarge. Mucus like vaginal discharge starts about 2 years before menses starts- often leaves yellowish stains on underwear.Menstruation usually start about 2 years after pubic hair starts appearing. Normally around 11-12 years, but range is 9-15 years.
Similarly boys also undergo some physical changes. Here is the summary of changes in boys
Changes that occur in Boys
- Height Increases rapidly. Starts around 10-12years and peaks at around 14-15 years.
- Structure Shoulders broaden. Develop more muscle in the body.
- Voice first cracks, then deepens
- Thyroid gland Slight, temporary increase
- Development of pubic hair Starts around 10 years.
- Underarm hair Last to develop.
- Blushing at slightest provocation during puberty.
- Pimples start 1-2 years after onset of puberty and remain till late adolescence, subside on their own
- Breast Development Breast develops slightly during puberty. May be sensitive to touch
- Development of reproductive organs Penis and testes start enlarging at around 10 years and continues till 15 years. Erection of the penis during a bath or on getting up from sleep is common from younger age, but ejaculation develops by 12-14 years.
As the body is changing there are also some Emotional & Psychological changes that both boys and girls go through. here is the list...
- Forming one’s identity
- Setting goals
- Forming one’s values
- Looking for independence
- Desire to explore, take risks
- Need for acceptance- especially by the peer group.
- Wanting to fit in with peer group
- Mood swings
- Self –conscious
- Curiosity about body and how it works
- Feelings of sexual attraction
Tuesday, December 16, 2008
Are you a Victim of Child Sexual Abuse?
Believe in yourself. You are unique, you are good and that no one can deny. Once you start believing in yourself, things will improve. Things will change for better. And probably you would save a fellow human being from infected by this virus.
So, don't be shy, don't be afraid. It is not YOUR fault.