With the dawn of the New Year and the sound of merry making still echoing in our ears, to thousands of children around the world including Sri Lanka , the new year brings little joy and hope. Living in poverty, suffering from malnutrition and the constant fear of being abused by their own family members, forced into drugs by their own parents, physically and emotionally assaulted by their school teachers, these children need priority attention.
Dr Saraji Wijesekera, Senior Lecturer in Paediatrics - University of Sri Jayewardenepura, and Consultant Paediatric Neurologist, Teaching Hospital Colombo South has closely moved with such children in the past several years shares some of her sentiments on the subject with the Sunday Observer.
Excerpts
Q. Data from Police sources indicate that child abuse cases have been increasing since 2012 in Sri Lanka. Since the range of child abuse is wide what exactly does the term child abuse constitute?
A.The term child abuse is a physical, sexual, and/or psychological maltreatment or neglect of a child or children, especially, by a parent or a caregiver.
Child abuse may include any act or failure to act by a parent or a caregiver that results in actual or potential harm to a child, and can occur in a child’s home, or in the organizations, schools or communities the child interacts with.
Q. Have there been any national studies to find out what types of child abuse are most common in our country? If so what are the results? How much of this abuse is verbal, physical and sexual?
A. According to sources of the National Child Protection Authority (NCPA), over 10,000 child abuse cases were reported in 2017 and 1,532 cases reported within the first two months of 2018. This includes both physical and sexual.
Q. What are the most serious forms of abuse? Rape? Physical Violence? Incest? Why?
A. Any kind of abuse is serious with regard to the child concerned as this may have major repercussions in his/her later life. Rape is a type of sexual assault usually involving sexual intercourse or other forms of sexual penetration carried out without that person’s consent. Incest is human sexual activity between family members or close relatives. The perpetrator could be blood relatives of the victmised child.
Physical violence which results in injury, death or psychologicl harm is unacceptable. The forms of physical violence in children are: hitting, shaking, burning, throwing, kicking, pinching and scraping, in schools they are subjected to corporal punishments by teachers and at home their own parents or caregivers could cause physical harm.
Marital disharmony, change of schools and homes could also cause emotional and psychological disturbance in children
Q. What about parental neglect? Many mothers work abroad to send back money for their families, without finding proper care givers to look after their children, especially, girls who are often left at the mercy of their fathers and abused by them in the absence of the mother..
A.Yes . It is the socio economic background of the families that leads to these decisions by parents. As you are aware the female labour force as domestic help in other countries provide an attractive salary for the women who are burdened with poverty, and thinking of the future of their children, they leave them unwillingly at home while the fathers get addicted to alcohol and other illicit drugs and abuse their own children physically and sexually hindering their chances of education, etc.
Q. What are the immediate health effects on abused children? Does it depend on the kind of abuse inflicted on them?
A. When a child is physically abused the immediate effects can vary from a minor scratch to taking the life of a child.The injuries include bruises, abrasions, fractures and burns with bleeding into internal organs causing the death of a child.
In sexual abuse they get injuries to external and internal genitalia and mainly psychological harm, which can manifest as depression, aggression, lack of social interaction, school refusal and self harm.
Whatever the mode of abuse the child ultimately would suffer from low self esteem, psychological stress and poor social interactions leading to developmental and learning problems later in life.
Q Long term abuse? What are the negative effects?
A. Most children suffer continuously with long term abuse. They are unable to divulge the information due to pressure from the perpetrator who is mostly a close relative or a person known to them.
As they are stressed and suffer alone the psychological impact to these children are immense in the form of psychiatric illnesses or poor school performance, school refusal and negative peer relationships.
Q. In a girl child can rape have a negative effect on her reproductive health? How?
A. Yes. Rape can cause physical and psychological impact to the victim. It could end up with teenage pregnancies which could be a risk for life for these young girls. Also, negative psychological stress occurring at a younger age could pose major problems in later life in their sexual relationships with their partners.
Q. What are the signs and symptoms to look for in a child who has been abused? Explain in detail.
A. When a child is brought with a suspected abuse they look very disturbed and depressed.
Externally look for injuries in the skin like cuts, abrasions and burn marks. In babies look for tears of the lips and injuries in mouth due to forceful bottle feeding. Check for injuries causing fracture to legs and arms.
Boggy masses in the tummy and injuries to external genitalia should be checked.
An unusually drowsy child or presenting with fits may raise the suspicion of head injuries and bleeding into the brain.
Q. Can an abused child have suicidal thoughts?
A. Yes.
Q. What about early pregnancy? Children as young as nine and ten have been found to be pregnant mostly by their own family members and end up as mothers while they themselves are still children. What is the effect of this traumatic experience on a child with no coping skills to deal with motherhood.
A. Firstly they may be unaware of the physical changes due to pregnancy, especially, morning sickness and other physical difficulties. Her body may not be ready to carry the fetus. Delivery itself is painful and following delivery in a hospital among other females of child bearing age, feeding and carrying the baby may cause extra stress to these little girls who should be playing with dolls.
The baby on the one hand suffers and the young mother who does not understand the situation would suffer from physical and psychological stress which ultimately lead to a traumatic experience lasting a whole life.
Q. Malnutrition and lack of balanced diets are still prevalent among children in certain parts of the country. Since all children are entitled to lead healthy lives isn’t this too a form of child abuse?
A. If it is intentional it is.
Q. But in most families poor economy hinder these children from getting a balanced diet.
A. Yes. As the families have a poor income they use their kids as a source of generating income. Child labour, pornography and drug trafficking are various forms of child abuse, and as a result these kids lose their chance of education and end up in courts.
Q. Social discrimination and prejudice are often cited as obstacles to children seeking fair justice in courts. Do you agree?
A. Mostly yes. There are courts dedicated to children that provide some justice to them.
Q. Rights of the disabled child has been a neglected area. Children with disabilities are vulnerable to abuse, especially sexual, as they are unaware of the consequences. Your comments.
A. Yes. This is a grossly neglected area. Their rights are hidden due to certain legislations that prohibit their expressions. Disabled kids get abused at home, school and the community both physically and sexually due to their ignorance.
It is imperative as a community that everyone should be aware of their rights and respect and protect others’ rights. This should be included in the school curriculum so that they are aware of this.
Q. What are the gaps you see in ensuring that all Lankan children live happy lives free of violence or any form of abuse? Do you think more attention should be paid to research and in depth studies?
A. Yes, especially vulnerable groups in the previously war affected areas, children with disability, inmates of Children’s Homes, parents in prison and dealing in illicit drugs. An island wide data is needed to overcome the menace of child abuse with the collaboration of state and private sector institutions, i.e. the National Child Protection Authority, Women in Need, Women and Children officers in Sri Lanka Police, etc.
Q. Any recent interventions by the Ministry of Health in place?
A. In child protection, strengthening the enabling environment to protect children from violence, abuse and exploitation remained the priority. As one of 13 ‘pathfinder’ countries of the global partnership to end violence against children, the Sri Lankan Government launched a ‘national partnership to end violence against children’ (NPEVAC) in June 2017. UNICEF Sri Lanka played a critical role in it, including the development of a country discussion paper to identify the current situation regarding children’s experiences of maltreatment and to recommend solutions.
Q. Your message to parents, teachers and adults with reference to minimising risks of child abuse?
A. Children are pure and innocent. As responsible adults we should protect them from abuse.