Child Sexual Abuse in Pakistan: Using Evidence Based Social Ecological Model for Explanation and Policy Formulation

Abstract

Due to recent high profile media reported cases of child sexual abuse in Pakistan a serious public concern is observed with a strong punitive public demand rather than proactive and preventive approach as solution. Instead of reactive approach, it is needed to formulate a policy based on valid causal ground for solution of this problem. Purpose of this cross sectional study is to provide a causal ground based on evidence based social ecological model for holistic policy response for addressing issue of CSA. Using ICAST-R, equal number of male and female 274 university students were asked about experience of CSA, re-victimization, age at the time of CSA, perpetrators, disclosure patterns and social support after disclosure of CSA. On the basis of data, evidence based social ecological model was used for explanation of individual, family, societal and institutional factors related to CSA in Pakistan for formulation of effective prevention strategy. According to findings most frequent age at the time of CSA is between 6th to 18th year of age with 9th year as most frequently reported. Experience of CSA was reported more frequently by boys than girls. Peers were identified as highest reported perpetrators and majority of the perpetrators were known to the child. Instead of reactive and punitive approach towards issue of CSA it is needed to formulate a policy based on social ecological factors of society.

Keywords

child sexual abuse in Pakistan social ecological model sex crimes in Pakistan child protection policy media reporting of child sexual abuse public hanging

Background

Pakistan has observed an increased tendency in media reporting of child sexual abuse^1,2 and public demand for punishment emerged as a response towards this serious issue. Do harsh or capital sentences cause deterrence to halt incidents of child sexual abuse? Is the criminal justice system response sufficient to address issue of child sexual abuse? Is there any other comprehensive systematic approach towards addressing the complex issue of child sexual abuse in Pakistan? Response to violation of child rights in Pakistan is issue to issue based³ and not holistic. In the current study the issue of child sexual abuse is explained in broader social context by applying social ecological framework. It is argued that it can help in understanding the issue of child sexual abuse for creating and implementing broader prevention strategies at various social, cultural and institutional levels.

Recent and earlier history of Pakistan regarding responses towards high profile cases of sexual abuse demonstrate a tendency for addressing punitive public demands rather than taking proactive measures for solutions of this complex issue in broader social and cultural context. On December 17, 2019, Sohail Shehzad the convict in high profile case of raping and murdering four children in Chunian, district Kasur of Punjab was handed three times death sentence and one time life imprisonment by anti terrorism court.^4,a Imran Ali, the convict for sexual abuse of 8 children including Zainab was handed death sentence by Anti Terrorism court in Punjab and prior to this, due to public demand efforts were made by senate committee^b to arrange the public hanging of abuser but later on he was hanged within the prison.⁵

When sexual abuse and murder of child Zainab was reported in media, deadly protests were erupted in Kasur district of Punjab province. Two people were killed and many injured when protesting mob attacked various government offices.⁶ On social media hash tags of #Zainab, #justiceForZainab, #Qasoor and #HangRapist were popular. Prior to arrest and conviction of Imran, another person was killed by police in ‘staged encounter’ to pacify public anger and it was told that murderer of Zainab is killed.⁷ In the past, during General Zia’s martial law era in 1981, abductors and killers of child ‘Pappu’ were hanged by a military court in Lahore. Their bodies were hanged till sunset.⁵

In another case of serial killings of children, the killer who molested and killed 100 children in Lahore was sentenced public hanging under Islamic law and the Judge wrote in the decision, “You will be strangled to death in front of the parents whose children you killed. Your body will then be cut into 100 pieces and put in acid, the same way you killed the children.”⁸ However, before the execution of sentence Javed Iqbal and his accomplice were found dead in their death cells, under somewhat mysterious circumstances. The jail authorities claimed that both of them committed suicide. On February 7, 2020, a resolution for public hanging of child sexual abusers was passed in National Assembly of Pakikstan.⁹ All these cases have a similarity that these cases were widely propagated in media and decisions made were populist, influenced by punitive public demand. Unabated incidents of child sexual abuse even after execution of such harsh sentences raise the question over the value of deterrence.

Response of police towards reported cases of child sexual abuse is highly questionable. Episodes of child sexual abuse and pornography in village Hussain Khan Wala of Kasur district in Punjab province were reported¹⁰ where sexual abuse and pornography of children continued for six years. Police did not register the cases despite demand by the parents of children. However, when these cases were highlighted in media, the police not only registered the cases but also added sections of Anti Terrorism Act in 20 FIRs (First Information Reports). The irony in this case is that under the same Anti Terrorism Act, FIRs were registered against the parents of abused children by police when parents staged protests demanding registration of the cases. In contrast with the ‘routine’ reported cases of child sexual abuse which are registered under sections 376 and/or 377 of Pakistan Penal Code there is a tendency of adding Anti Terrorism Act’s section 7 in high profile and media highlighted cases. Fact finding report on Kasur episode of sexual abuse¹⁰ declared the police as guilty of misconduct in this scenario including siding with the accused.

Literature Review

As reflected in the above stated cases, public perception and responses towards the child sexual abuse in Pakistan are based on isolated cases reported in media and mostly public demands for taking measures on this issue are punitive and reactionary rather than proactive and well thought in broader social perspective. Harsh sentencing in such cases can only cause false expectations amongst the community who are misled to feel that they are safe after punitive legislative measures.¹¹ Mostly, the concern behind the populist punitive legislation and policies is not due to its effectiveness of legislation to curb a social problem but winning the polls by addressing punitive public attitudes.^12,13 According to Finkelhor¹⁴ people generally endorse and demand the harshest punishment and longer sentences for child sexual abusers and pedophile. This approach is based on their wrong perception that child sexual abusers are bad strangers abusing children on public places, but, in reality majority of abusers are people known to the child among whom one third are juvenile sex offenders.¹⁴

Reporting pattern of media about issue of child sexual abuse is a serious issue in Pakistan. It is media which builds the public perception about the issue of child sexual abuse and media reporting of child sexual abuse cases influences the public policy.¹⁵ Media channels sensationalize ‘stranger danger’ by creating panic about sex crimes in society and victim perpetrator relationships or other important factors gain very less attention.¹⁶ Analysis of three years news coverage in a study¹⁵ revealed that media tend to report only high profile cases of sexual abuse and it is also maintained that it report only the criminal justice system response towards such cases rather than preventive aspects and broader social context of the child sexual abuse incidents. Moreover, research¹⁷ revealed that most of the coverage of child sexual abuse is episodic and concentrated on single isolated incidents of child sexual abuse. Such pattern of reporting fails to awaken any serious social concern in broader scenario¹⁸ for protection of children.

It is now well established a fact that a policy or statute formulated to solve a social problem without establishing a valid causal theory cannot provide a sound implementation process.¹⁹ Based on such theory the legislation or policy identifies important factors and causal linkages of a problem and the implementation process is structured for achieving the desired change.¹⁹ There is a growing trend regarding utilization of social ecological model for explanation of causation and prevention of child sexual abuse.^20–23 In the current study, for multi-level explanation of child sexual abuse, ecological model of Uri Bronfenbrenner²⁴ has been used for identification of recurring patterns which can help in devising a comprehensive strategy for addressing issue of child sexual abuse. At individual, interactional, relationship and societal level, interplay of many factors increases or decreases the risk of individual violence.²⁵

The ecological model has four main social ecological layers for analysis. In terms of the analysis of child abuse and protection, micro system is about the individual related factors such as age and gender of the child. Second layer meso-sytem includes family, peer, immediate surrounding around the child, school and religious institutions among others. Third layer exo-system encompasses neighborhood, extended family, family friends, mass media, state institutions and social welfare etc. Fourth layer of interaction macro-system is about broader attitudes and ideologies of the culture. In Pakistan’s situation the problem of child sexual abuse can be explained in a broader perspective through this model by analyzing the multiple factors in play at various levels. Interventions focused at a single level are limited in scope but the social ecological model of child sexual abuse addresses the etiology of child sexual abuse at multiple levels. Therefore, this model provides a scope for multilevel solutions.²⁶

The present research uses the ecological model, based on seminal work of Uri Bronfenbrenner²⁴ which explains the child maltreatment in broader perspective and encompasses the multiple aspects of child’s life and ecology around the child. Built on previous work including Bronfenbrenner’s, model, ecological model of Kelly et al.²⁷ is also helpful for explanation and prevention of child sexual abuse. This model²⁷ explains the issue of child sexual abuse on the basis of (i) personality characteristics (such as age and gender), (ii) event provoking individual and community response and (iii) environment, which includes community characteristics such as social norms and the services.

Methods

Using ICAST-R (International Child Abuse & Neglect Screening Tool-Retrospective) by ISPCAN (International Society for the Prevention of Child Abuse and Neglect) data was collected from a sample of 18–24 years old 274 students of BS Social and Behavioral Sciences program in University of the Punjab in Lahore using simple random sampling technique. Prior to recruiting the participants, approval was taken from heads of all the departments of university where the participants were studying. Equal numbers of male and female students were asked about sexually abusive experiences during their childhood before attaining the age of 18 years. ICAST-R instructional manual was followed to gather data and tool was piloted before actual data collection. Ethical issues were identified and addressed. Before conducting the study consent of the participants was sought. They were told that their participation was voluntary and during filling the questionnaire they can withdraw their participation at any stage. Confidentiality and anonymity of the participants was also ensured. Questionnaire was filled in class room setting and seats were arranged in a way to ensure confidentiality while filling the questionnaire. Recalling the experiences of child sexual abuse could be traumatic therefore respondents of the study were informed about the available resources in case of need for mental health support. Data were analyzed using Statistical Package for Social Sciences software. Social ecological framework was applied to analyze data about gender, re-victimization, perpetrators, age at the time of sexual abuse, disclosure patterns and social support after disclosure of sexual abuse to generate evidence for explanation of child sexual abuse in broader social scenario as causal ground for laying foundation of rational prevention strategies.

Findings

Type of Abuse and Gender of Victims

Highest reported sub-form of sexual abuse reported was ‘touching of private parts’ which was reported by 75 respondents (males 32 and females 43) (Table 1). Second highest reported form was ‘looking at private parts’, reported by 71 (37 males and 34 females) respondents. ‘Speaking in sexual way’ was reported by 41 respondents (22 males and 19 females). ‘Sexual intercourse’ was reported by 23 (15 males and 8 females) respondents. Someone ‘made sexual videos or photographs’ was reported by 16 (9 males and 7 females) respondents. Overall, male respondents reported more frequent sexual abuse than female but touching of private parts was reported more frequently by female than male respondents.

Table 1.

Frequency of Sexually Abused Respondents (N = 274).

Looking at private parts			Made sexual videos or photos			Touched private parts			Speaking in sexual way			Unwanted sexual intercourse
Gender		Total	Gender		Total	Gender		Total	Gender		Total	Gender		Total
M	F	Total	M	F	Total	M	F	Total	M	F	Total	M	F	Total
37	34	71	9	7	16	32	43	75	22	19	41	15	8	23

Patterns of Re-Victimization

Total 225 victimizations of all forms of sexual abuse were disclosed by respondents among which 24 occurred too many times, 35 victimizations occurred 10–50 times and 166 victimizations occurred less than 10 times (Table 2). ‘Touching of private parts’ is reported as most frequent re-victimization overall.

Table 2.

Child Sexual Abuse Re-Victimization Frequency (N = 274).

How many times abused (frequency)	Looking at private parts			Made sex videos			Touched private parts			Speaking in sexual way			Forced sexual intercourse			Total perpetrations of all forms
	Gender		Total	Gender		Total	Gender		Total	Gender		Total	Gender		Total	Gender		Total
	M	F	Total	M	F	Total	M	F	Total	M	F	Total	M	F	Total	M	F	Total
Too many times	2	5	7	2	1	3	5	1	6	4	3	7		1	1	13	11	24
10-50 times	9	2	11	1	3	4	5	4	9	3	5	8	3		3	21	14	35
Less than 10 times	26	26	52	6	3	9	22	38	60	15	11	26	12	7	19	81	85	166
Total	37	33	70	9	7	16	32	43	75	22	19	41	15	8	23	115	110	225

Relationship of Perpetrators to the Victims

Peer or friends (65) followed by strangers (51) and relatives (46) were the highest reported perpetrators overall in all five sub-forms of sexual abuse out of 281 frequencies of 10 perpetrators listed (Table 3). However, in the case of female victims strangers (36) are the highest reported perpetrators followed by relatives and in the case of male sexual abuse victims friends/peer (53) are the highest reported perpetrators. Least reported perpetrators overall are the parents, someone at home and someone at work (7, 7 and 7 respectively). Highest number of perpetrators overall are the perpetrators known to the child.

Table 3.

Frequency of Child Sexual Abuse Perpetrators (N = 274).

Perpetrator	Looking at private parts			Made sex videos			Touched private parts			Speaking in sexual way			Forced sexual intercourse			Total
	Gender		Total	Gender		Total	Gender		Total	Gender		Total	Gender		Total	Gender		Total
	M	F	Total	M	F	Total	M	F	Total	M	F	Total	M	F	Total	M	F	Total
Parents	3		3	1		1		1	1	1		1	1		1	6	1	7
Other Relative	4	14	18	2		2	2	16	18	3	2	5	1	2	3	11	34	46
Sibling	2		2	2	2	4	3	1	4	1		1	2	1	3	10	4	14
Someone at home		2	2					2	2		1	1	1	1	2	1	6	7
Teacher	8	2	10	1		1	4	3	7	5	2	7	4		4	19	8	29
Friend / Peer	15	4	19	3		3	17	4	21	12	4	16	6		6	53	12	65
Someone at work		1	1	1	1	2	2	1	3		1	1				3	4	7
Neighbor	8	4	12	1	3	4	7	4	11	4		4	5	3	8	25	14	39
Stranger	7	11	18				4	16	20	3	9	12	1		1	15	36	51
Other	4	4	8	1	1	2	3	2	5		2	2	1	1	2	9	10	19
Total	51	42	93	11	7	19	42	50	92	29	21	50	19	9	30	152	129	284

Age of Victims at the Time of Sexual Abuse

Overall, highest reported year of sexual abuse is 9th year of age, however highest reported years in any single form of abuse are 12th, 13th and 16th years in the cases of ‘looking at private parts’, ‘touching private parts’ and ‘speaking in sexual way’ respectively (Figure 1 and Table 4). Accumulative years of all forms of sexual abuse mentioned were 534 and in 15 incidents of sexual abuse the respondents could not remember the exact year in which sexual abuse occurred. As shown in graph (Figure 1) there is gradual increase in occurrence of sexual abuse from 6th year of age to 18th years of age.

Table 4.

Year of Experience of Sexual Abuse Frequency (N = 274).

Year of abuse	Looking at private parts			Made sex videos			Touched private parts			Speaking in sexual way			Forced sexual intercourse			All forms of sexual abuse
	Gender		Total	Gender		Total	Gender		Total	Gender		Total	Gender		Total	Gender		Total
	M	F	Total	M	F	Total	M	F	Total	M	F	Total	M	F	Total	M	F	Total
1							1		1	1		1				2		2
2	1		1	1		1	1		1	1		1				4		4
3		1	1				1		1	1		1				2	1	3
4							1		1	1		1				2		2
5		4	4		1	1	1	4	5	1		1				2	9	11
6	2	9	11	1	2	3	2	6	8	3		3	2	1	3	10	18	28
7	6	8	14	1	1	2	2	11	13	5		5	2		2	16	20	36
8	5	7	12	1	1	2	4	9	13	4		4	3	1	4	17	18	35
9	6	7	13	1	6	7	5	10	15	6	2	8	3	4	7	21	29	50
10	9	4	13				7	7	14	6	2	8	5	1	6	28	16	41
11	10	3	13	2	2	4	7	3	10	7	3	10	2	2	4	28	13	41
12	11	5	16	3	1	4	7	6	13	7	3	10	1	2	3	29	17	46
13	6	5	11	1	2	3	7	9	16	4	3	7	1	1	2	19	20	39
14	5	4	9	1	1	2	7	6	13	5	3	8	1		1	19	14	33
15	6	3	9	1		1	8	4	12	6	6	12	1	1	2	22	14	36
16	5	7	12	1		1	5	2	7	5	7	12	1		1	17	16	33
17	5	7	12	4		4	8	7	15	8	8	16	2		2	27	22	49
18	3	5	8	2		2	3	3	6	5	7	12	2		2	15	15	30
Can’t remember	1	2	3		2	2	3		3	1	2	3	1	2	3	6	8	15
Total	81	81	162	20	19	39	80	87	167	77	46	123	27	15	42	285	248	534

Disclosure Patterns of Victims

Majority of the victims (26) reported experience of child sexual abuse to their friends/peer, followed by parents (6) and siblings (4) (Table 5). Extremely low number of victims disclosed experience of sexual abuse to a doctor, police or a social worker.

Table 5.

Frequency of Disclosure to Someone About Sexual Abuse (N = 274).

Person	Gender		Total
Person	Male	Female	Total
Parents	4	2	6
Other relatives		1	1
Sibling	1	3	4
Teacher	3		3
Friend/peer	18	8	26
Neighbor	1		1
Doctor / health professional	1	1	2
Police		1	1
Counselor / social worker		1	1
Religious leader	1	1	2
Other	3	1	4
Total	32	19	51

Social Support on Disclosure of Sexual Victimization

Regarding disclosure about experience of child sexual abuse 16 respondents reported that they were believed and supported, 14 were believed but no action was taken, four were blamed for causing it and five were not believed at all (Table 6).

Table 6.

Frequency of Social Support on Disclosure of Sexual Abuse.

Response after disclosure	Gender		Total
Response after disclosure	Male	Female	Total
They believed me and supported	10	6	16
They believed me but didn’t act	10	4	14
They blamed for causing it	2	2	4
They didn’t believe me at all	3	2	5
Total	25	14	39

Discussion of Findings in Social Ecological Perspective of Pakistan

Ecological model provides a framework to understand an issue at individual, family, social, cultural, institutional and state levels. Ecological Model provides holistic explanation of the factors in play regarding child sexual abuse because of its comprehensiveness to explain the abuse at every level in society where the child mostly interacts with inner and outer environment, situation, people, institutions or culture.

Characteristics of Victims (Micro System)

As shown in Table 4 and evident in the findings of this study, children within specific age span 6–18 years reported more frequent sexual abuse. Age span about sexual abuse is closer to the one mentioned in INSPIRE, Seven Strategies for Ending Violence against Children.²⁸ Year 12 and 13 of age are the highest reported years of abuse in the case of ‘looking at private parts’ and ‘touching private parts’ respectively. In this age span a child becomes more interactive with outdoor environment, school, neighborhood, institutions, peer and people which might increase the exposure to abuse especially when there is no or lack of supervision. In current study the type of abuse ‘touching of private parts’ was reported more by female than male respondents, which might be due to unfriendly public spaces in Pakistan for females as strangers are highest reported perpetrator by female victims (Table 3). In the sub-forms ‘looking at private parts’, ‘touching private parts’ and ‘speaking in sexual way’ strangers are the more frequent reported perpetrator by female than male victims but in the case of ‘sexual intercourse’ male victims reported stranger as perpetrator more frequently. Peer or friends are the highest reported perpetrators by male victims (Table 2). In gender perspective, according to the findings of this study (Table 1) overall male respondents reported more frequent abuse. Similarly, according to findings of another study²⁹ conducted in a South Asian country (India) boys reported more sexual abuse than girls. Due to social factors such as concept of female virginity, over protection of girls to avoid pregnancy and strictly sanctioned pre-marital sex might be the reasons of female children’s decreased exposure to sexual abuse³⁰ or it might be due to low reporting by female victims of child sexual abuse. The situation further worsens for male children because the boys are involved in prostitution in Pakistan and unlike male female relationship outside marriage the physical and social attachment with boys is socially accepted in some parts of Pakistan.³¹

Gender and age are the important factors regarding exposure of children to sexual abuse and according to the findings of this study, frequency of abuse changes with change in age and gender.

Characteristics of Perpetrators and Other Factors at the Level of Family and Immediate Environment (Meso System)

According to the findings of this study (Table 3) at the level of meso system the most frequently reported perpetrators are the ones immediately interacting with the child e.g peer or friends in four sub-forms of sexual abuse except in ‘sexual intercourse’ in which neighbors were the highest reported perpetrators. Perpetrators of sexual abuse are mostly known to the children who interact with children mostly at home, in the community or in school.³² Peer are not only the most reported perpetrators but also most reported regarding disclosure (Table 5) of sexual abuse (26 out of 51 reported disclosure of sexual abuse to peer or friends). This might be due to the trust with peers. Out of 51 disclosures of sexual abuse, only six were disclosed to parents. This could be due to stigma around the issue of child sexual abuse and lack of social support to victims.³³ Moreover, in South Asian culture the concepts of ‘izzat’ (honor), ‘sharam’ shame and haya (inhibition) prevent the people from disclosure of sexual abuse.³⁴ Most of the victims of child sexual abuse delay the disclosure of abuse for years or even until adulthood. Child’s developmental stage, gender, support by non-offending guardian’s support, relationship of the perpetrator to child influence the patterns and rate of disclosure.³⁵

Incest and sexual abuse by parents, siblings and close family relatives is also reported by some respondents of this study (Table 1). Close relatives are reported as the third highest reported perpetrators in the sub-forms of abuse ‘touching of private parts’. Re-victimization (Table 2) reveals repeated exposure to abusive conditions which might be due to poor or no supervision by the guardians. According to the findings of a study³⁶ conducted in Pakistan 24% respondents reported supervisory neglect and revealed that no adult or guardian was supervising them when they were injured. Among the respondents of the same study, 9% revealed that they were not provided safe place to live by their guardians. Parents, siblings and close relatives are expected to protect the children and sexual abuse by them is abuse of trust and dependence.³⁷ Majority of the perpetrators reported are the people known to the victim and highest reported perpetrator overall and by male victims are the peers or friends. Female respondents reported strangers as the highest reported perpetrator overall but did not report strangers as perpetrator in the sub-forms of abuse ‘making sex videos’ and ‘sexual intercourse’.

Sexual Abuse Related Factors at Neighborhood, Community and Institutions Level (Exo System)

At the meso-system and exo-system level in environment around the child such as at workplace, school or neighborhood children are at risk of sexual abuse. Rapid urbanization has eroded the traditional social structures of society and increased the risk factors. Lalor³⁸ maintained that change in traditional social structure of society also increases the risk factors of child sexual abuse. At the level of exo-system relatives and neighbors are the second and third most frequently reported perpetrators. Across the range of socioeconomic backgrounds and cultures boys and girls are sexually abused by male and female perpetrators, familiar faces, friends, close relatives, strangers and people from different walks of life.³⁹ Re-victimization (Table 2) of sexual abuse reveals that exposure of children to the unsafe conditions and perpetrator is repetitive.

Other factors in play at exo-system level include child protection as the less prioritized area and the institutions (health, education, police and social services) providing services to the children are not child friendly and professionals interacting there are not sensitized, trained and monitored regarding child rights and child protection issues. Even children are sexually abused by police while in custody.⁴⁰ This makes less likely reporting of incidents related to child abuse due to lack of trust by guardians in the institutions and few children reporting the incident are also at further risk of adverse experience and abuse by these institutions. These institutions where professionals closely interact with children include but not limited to health system, education system, child protection, police, justice system, welfare system and other institutions interacting with children. It is evident in the findings of this study that there is extremely low level of reporting of sexual abuse to any service providing institution by the children or their guardians (Table 5) which could be due to trust deficit and capacity issue of the institution, poor implementation of laws related to children and absence of abuse reporting mechanism for reporting by the responsible professionals e.g teachers and doctors.

Social Conditions, Norms and Cultural Values Related to Sexual Abuse of Children (Macro System)

A study⁴⁰ on reported cases of child sexual abuse in Pakistan revealed that children with poor and lower middle socio economic backgrounds are more vulnerable to sexual abuse. Poverty and unemployment undermine parents’ capacity to protect children from sexual abuse.⁴¹ Poverty, eroded social fabric, weak civil authority, lack of empowerment and being with disadvantage ethnic identity are also factors associated with child sexual abuse in South Asian community.³⁷ Tolerance of child sexual abuse is established on the basis of norms and culture of society. One third adult respondents of a study conducted in Khyber Pakhtunkhwah province of Pakistan did not consider sexual abuse of children unethical or bad because sexually abusing children by keeping a beardless boy as ‘companion’ is considered a symbol of power and status.⁴² In Pakistani culture there is strong silence around topic of sexuality which makes it difficult for researchers to study the factors related to child sexual abuse.³⁷ At macro level of ecology there is a role of attitudes and ideologies of the culture in society. According to the findings of this study (Table 6) on disclosure of sexual abuse majority of victim were not supported and even blamed for causing it. Similar trend of victim blaming in sexual abuse of children and women was reported in other developing countries such as South Africa and Namibia.⁴³

Beliefs, attitudes, economic and socio-cultural factors such as effects of poverty, patriarchal control over the society and cultural acceptance of sexual violence with children and women can cause or increase the child sexual abuse in a society.²³ Another study⁴³ conducted in South Africa explored the involvement of cultural factors in sexual abuse of female children due to accepted interaction patterns with children and women. It is a norm in South Asian culture that girl victims of sexual abuse are blamed for causing abuse and such incidents decrease their chance of marriage.^44,45 In case of an incident of sexual abuse attempts are made in South Asia by guardians to hide the matter and maintain the silence to protect family ‘honor’ and avoid public humiliation⁴⁵ which benefits the perpetrator and puts child at further risk of abuse. Societal norms of obeying adults and their unquestioned authority over the children further exacerbate these factors associated with child sexual abuse.⁴⁶ Harmful societal norms, victim blaming, sexual exploitation of children, taboo, patriarchy, tolerance of child sexual abuse, vulnerability due to poverty, lack of supervision by guardians, unsafe neighborhoods, unsafe public spaces are factors exacerbating the child sexual abuse in Pakistan.

Conclusion and Recommendations

In sum, Child sexual abuse occurs at multiple level of society in Pakistan, and patterns of sexual abuse of children at micro, meso, exo and macro levels can be identified for devising the solution. At individual or child related factors level, it is evident in the analysis above that three main factors are age, gender and other family related factors which can increase vulnerability of child to sexual abuse. Highest reported age span of child sexual abuse is 6–18 years according to findings of this study and 12th year of age as single highest reported year of age. According to compiled data of reported cases of child sexual abuse in Pakistan 6–15 is the highest reported age span of victims.² At micro level incest is reported by the children. Close relatives are also reported for sexually abusing the children. Peers are the highest reported perpetrators of sexual abuse and also reported as highest reported person to whom the sexual abuse is disclosed. At meso and exo system levels neighbors and relatives are reported as the third and fourth highest reported perpetrators of sexual abuse. Very few incidents (3 out of 51 cases) were reported to social, health or police services which might be due to trust deficit or capacity issue of these institution. Findings of this study in Pakistan and reviewed literature from South Asian countries reveal that majority of children do not reveal sexual abuse to caregiver, social services institutions, health services and law enforcement agencies. Moreover, on disclosure of sexual abuse, children are not believed and even blamed for causing it.

These findings suggest that instead of response only driven by punitive attitudes or increasing the severity of sentence towards issue of child sexual abuse it is extremely important to implement the holistic and preventive strategies based on broader social scenario. Policies and institutional responses for addressing the issue of child sexual abuse in Pakistan are mostly populist and reactive, rather than holistic, rational or focused on prevention of abuse. For improving the criminal justice system response towards incidents of child sexual there is a need to raise awareness and improve structures, institutional responses, police performance, conviction rates and effective reporting mechanism related to the issue of child sexual abuse. The most important role criminal justice system can play in cases of child sexual abuse is to increase detection, disclosure of abuse and prosecution of offender.¹⁴ Moreover, all the process related to cases should be managed under one roof to protect the child from recalling the traumatic events due to repeated interviews by medical examiner, police and court. It should be understood by all stakeholders and society that sexual abuse of children is not just a matter of law and order. Child sexual abuse prevention programs about education of children for their protection as reviewed in meta-analysis studies are effective for protection of children.^47,48 Data suggests that such programs are useful for reducing incidence of child sexual abuse.⁴⁹ Preventive interventions of awareness and education aimed at personal, family and social norms may prove effective for reducing the incidence of child sexual abuse.^50,51 There is evidence that education and awareness of children, parents, community and professionals are effective for protection of children from sexual abuse.⁵² However, it is important that child sexual abuse programs should address the diversity of population, and children with special needs should also be protected. A review⁵³ of 87 child sexual abuse prevention programs revealed that only 17% programs addressed the diversity of population and 33% programs addressed the children with special needs.

Desired goal of curbing child sexual abuse at national level can be achieved by implementing a sound policy based on a valid causal theory explaining the associated factors and causes of this issue in Pakistan. So, the government should invest in research about understanding and prevention of child sexual abuse in Pakistan and should review its legislation and policies in the light of findings explaining this complex issue. Instead of sensationalizing, creating approaches based on isolated cases, discussing only criminal justice system response and provoking punitive sentiments among the masses about child sexual abuse, media should highlight the broader social context of child sexual abuse in Pakistan by collaborating with experts of the field having technical knowledge of causes and preventive measures of this complex issue. It will also generate a genuine debate in society about this issue and break the taboo around this topic. Similarly, social legislation on this issue should be evidence-informed and assistance should be sought from the researchers and practitioners from the field of child protection during the process of legislation.

This cross sectional study was based on retrospective sexual abuse disclosure of a sample of 274 respondents from a public sector university in Lahore. A study of child sexual abuse using social ecological framework with bigger representative sample from all provinces of Pakistan with different populations groups can provide more comprehensive explanation of issue for laying the foundation of an effective preventive strategy on the issue of child sexual abuse. Analysis of the problem of child sexual abuse on the basis of ecological framework provides a sound approach for addressing the issue at every level in society and state.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Syed Saleem Abbas

Notes

Author Biographies

Syed Saleem Abbas is working as Health Education Officer in Health Department, Government of Punjab, Pakistan. He is published researcher and did research projects on child abuse and child protection in Pakistan. He did M.Phil in Social Work from University of the Punjab, Pakistan with research focus on child abuse. He is working with children, parents, community, healthcare staff, government officials and teachers on child protection and child abuse prevention.

Tahira Jabeen has joined the Social Work Department, University of the Punjab, Lahore, Pakistan in 1996 as lecturer, now working as associate professor and head of the department. Prof Jabeen is PhD in Child protection policy in Pakistan’ (2008–2012) from the Australian National University (ANU), Canberra, Australia. She teaches master, M Phil and PhD courses with a focus on child protection, social policy, qualitative research methods and public policy and administration. She has published scholarly articles in reputed/impact factor national and international journals. She has worked as research consultant and trainer with international organizations including DFID, UNICEF, GTZ and UNDP. Currently, she is a member of the Oxford Policy Management, UK project team providing consultancy to UNICEF, Pakistan, developing Child Protection Case Management System in Balochistan, Gilgat-Baltistan, Sindh and Khyber Pakhtunkhwa provinces. She is also member Board of Governors, Child Protection & Welfare Bureau, Punjab, Pakistan.

References

Sahil. Cruel numbers 2018: a compilation of statistics on child sexual abuse cases. Islamabad: Sahil, 2018.

Sahil. Cruel numbers 2019: a compilation of statistics on child sexual abuse cases. Islamabad: Sahil, 2019.

Jabeen

Pakistan’s child protection legislative and policy frameworks: a critical review. Pak J Criminol 2013; 5: 159.

Bilal

Man handed 3 death sentences in Chunia rape, murder case. Dawn, 17 December 2019, www.dawn.com/news/1522798 (accessed 15 April 2021).

Abbasi

Senate body sets the stage for public hanging of Zainab’s killer. The News, 24 January 2018, www.thenews.com.pk/print/272228-senate-body-sets-the-stage-for-public-hanging-of-zainab-s-killer (accessed 15 April 2021).

Hafeez

Bakhsh

Violent protests against Zainab’s rape, murder continue in Kasur on second day, www.geo.tv/latest/176309-kasur-in-mourning (11 January 2018, accessed 17 January 2020).

Chaudhry

Staged encounter’ police reopens case of rape suspect’s killing. The News, 1 January 2018, https://epaper.dawn.com/DetailImage.php?StoryImage=28_01_2018_177_004 (accessed 15 April 2021).

BBC News. Death for Pakistan serial killer, http://news.bbc.co.uk/2/hi/south_asia/678553.stm (16 March 2000, accessed 15 April 2021).

Hussain

NA passes contentious resolution calling for public hanging of child sexual abusers. Dawn, 7 February 2020, www.dawn.com/news/1533010 (accessed 15 April 2021).

10.

Mustafa

Mehmood

The Kasur incident of child abuse: a fact funding report for analyzing state of child protection in Pakistan. Lahore: University of the Punjab, 2015.

11.

Stubbs

Sexual assault, criminal justice and law and order. Criminal justice and law and order. Women Against Viol 2008; 14: 14–26.

12.

Roberts

Loretta

David

, et al. Penal populism and public opinion: lessons from five countries. Oxford: Oxford University Press, 2003.

13.

Kubik

Moran

JR.

Lethal elections: gubernatorial politics and the timing of executions. J Law Econ 2003; 46: 1–25.

14.

Finkelhor

The prevention of childhood sexual abuse. Future Child 2009; 19: 169–194.

15.

Dorfman

Mejia

Gonzalez

, et al. Breaking news on child sexual abuse: early coverage of Penn state. Berkeley, CA: Berkeley Media Studies Group, 2012.

16.

Meloy

ML.

The sex offender next door: an analysis of recidivism, risk factors, and deterrence of sex offenders on probation. Crim Just Policy Rev 2005; 16: 211–236.

17.

Kitzinger

Skidmore

Playing safe: media coverage of child sexual abuse prevention strategies. Child Abuse Rev 1995; 4: 47–56.

18.

Post

Smith

Meyer

Media frames of intimate partner homicide. In: Stark

Schlesinger Buzawa

E (

eds) Violence against women in families and relationships. New York: Praeger/Greenwood, 2009, pp. 59–79.

19.

Sabatier

Mazmanian

The implementation of public policy: a framework of analysis. Policy Stud J 1980; 8: 538–560.

20.

Alaggia

Collin-Vézina

Lateef

Facilitators and barriers to child sexual abuse (CSA) disclosures: a research update (2000–2016). Trauma Viol Abuse 2019; 20: 260–283.

21.

Casey

Lindhorst

TP.

Toward a multi-level, ecological approach to the primary prevention of sexual assault. Trauma Viol Abuse 2009; 10: 91–114.

22.

Davis

Parks

Cohen

2006. Sexual violence and the spectrum of prevention: towards a community solution. Enola, PA: National Sexual Violence Resource Center.

23.

Townsend

Dawes

Individual and contextual factors associated with the sexual abuse of children under 12: a review of recent literature. In: Richter

Dawes

Higson-Smith

(eds) Sexual abuse of young children in Southern Africa. Cape Town: HSRC Press, 2004, pp. 55–94.

24.

Bronfenbrenner

The ecology of human development: experiments by nature and design. Cambridge, MA: Harvard University Press, 1979.

25.

Townsend

SM.

Primary prevention of sexual violence: a technical assistance guide for planning and evaluation. Enola, PA: Pennsylvania Coalition against Rape, 2008.

26.

Wandersman

Florin

Community interventions and effective prevention. Am Psychol 2003; 58: 441–448.

27.

Kelly

Ryan

Altman

, et al. Understanding and changing social systems: an ecological view. In: Rappaport

Seidman

(eds) Handbook of community psychology. New York: Plenum Press, 2000, pp. 133–160.

28.

UN World Health Organization. INSPIRE: seven strategies for ending violence against children, www.refworld.org/docid/57878f5e4.html (July 2016, accessed 29 November 2019).

29.

Kumar

Kar

Kumar

Prevalence of child abuse in Kerala, India: an ICAST-CH based survey. Child Abuse Negl 2019; 89: 87–98.

30.

De Silva

DH.

Children needing protection: experience from South Asia. Arch Dis Child 2007; 92: 931–934.

31.

ECPAT International and Pakistan Pediatric Association. Situational analysis report on prostitution of boys in Pakistan. Lahore: ECPAT International and Pakistan Pediatric Association, 2006.

32.

Raman

Kadir

Seth

, et al. Violence against children of the world: Burden, consequences and recommendations for action, www.pediatriasocial.es/HtmlRes/Files/issop_position_statement_9.pdf (2012, accessed 15 April 2021).

33.

Collin-Vézina

De La Sablonnière-Griffin

Palmer

, et al. A preliminary mapping of individual, relational, and social factors that impede disclosure of childhood sexual abuse. Child Abuse Neglect 2015; 43: 123–134.

34.

Gilligan

Akhtar

Cultural barriers to the disclosure of child sexual abuse in Asian communities: listening to what women say. Br J Soc Work 2005; 36: 1361–1377.

35.

Olafson

Lederman

JCS.

The state of the debate about children’s disclosure patterns in child sexual abuse cases. Juven Fam Court J 2006; 57: 27–40.

36.

Abbas

Jabeen

Prevalence of child abuse among the university students: a retrospective Cross-Sectional study in university of the Punjab, Pakistan. Int Q Community Health Educ 2020; 40: 125–134.

37.

Frederick

2010. Sexual abuse and exploitation of boys in South Asia: a review of research findings, legislation, policy and programme responses. Florence, Italy: UNICEF Innocenti Research Centre.

38.

Lalor

Child sexual abuse in Sub-Saharan Africa: a literature review. Child Abuse Negl 2004; 28: 439–460.

39.

Cromer

Goldsmith

RE.

Child sexual abuse myths: attitudes, beliefs, and individual differences. J Child Sex Abuse 2010; 19: 618–647.

40.

Jabeen

Child protection data: an analysis of newspapers coverage of child protection issues in Pakistan. South Asian Stud 2014; 29: 125–136.

41.

Finkelhor

Ormrod

Turner

HA.

Lifetime assessment of poly-victimization in a national sample of children and youth. Child Abuse Negl 2009; 33: 403–411.

42.

NGO’s Coalition on Child Rights. Community perceptions of male child sexual abuse in North Western frontier province, Pakistan, https://archive.crin.org/en/docs/resources/publications/SexAbuse1.pdf (1999, accessed 15 April 2021).

43.

Jewkes

Penn-K

Rose

JH.

If they rape me, I can’t blame them: reflections on the social context of child sexual abuse in South Africa and Namibia. Soc Sci Med 2005; 61: 1809–1820.

44.

Slugget

2003. Save the children Sweden-Denmark: mapping of psychosocial support for girls and boys affected by child sexual abuse in four countries in South and Central Asia. Sweden: Save the Children.

45.

Pinheiro

World report on violence against children, www.violencestudy.org (2008, accessed 16 December 2019).

46.

Madu

SN.

The relationship between perceived parental physical availability and child sexual, physical and emotional abuse among high school students in the Northern Province, South Africa. Soc Sci J 2002; 39: 639–645.

47.

Zwi

Woolfenden

Wheeler

, et al. School‐based education programmes for the prevention of child sexual abuse. Campbell Syst Rev 2007; 3: 1–40.

48.

Davis

Gidycz

CA.

Child sexual abuse prevention programs: a meta-analysis. J Clin Child Psychol 2000; 29: 257–265.

49.

Gibson

Leitenberg

Child sexual abuse prevention programs: do they decrease the occurrence of child sexual abuse?

Child Abuse Negl 2000; 24: 1115–1125.

50.

Wurtele

SK.

Preventing sexual abuse of children in the twenty-first century: preparing for challenges and opportunities. J Child Sexual Abuse 2009; 18: 1–18.

51.

Wurtele

SK.

School-based child sexual abuse prevention. In: Schewe

(ed.) Preventing violence in relationships: interventions across the life span. Washington, DC: American Psychological Association, 2002, pp. 9–25.

52.

Martin

Silverstone

PH.

An evidence-based education program for adults about child sexual abuse (“prevent it!”) that significantly improves attitudes, knowledge, and behavior. Front Psychol 2016; 7:1177.

53.

Plummer

CA.

Prevention of child sexual abuse: a survey of 87 programs. Violence Vict 2001; 16: 575–588.