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How many children have been abused in England and Wales and how does that compare to other countries? The frequency of child abuse in a country is usually derived from prevalence or incidence studies.
Measuring the prevalence or incidence of child abuse in a country requires an understanding of what child abuse is, how it is recognised and how it is recorded.
Child abuse is a culturally defined phenomenon. As Kempe (1978) wrote: " the rights of a child to be protected from parents unable to cope at a level assumed to be reasonable by the society in which they reside" (p.263, italics added). What is regarded as "reasonable" changes within and between societies? In a country where a large proportion of the child population is afflicted by malnutrition, a parent's inability to provide sufficient food to their child would not be categorised as neglect on the parent's part. In more affluent countries there have been changes in the recognition of the potentially abusive nature of some behaviours, which were previously accepted as "reasonable". A survey of the childhood experiences of a national UK sample of adults, aged 18-45 (Creighton & Russell, 1995), found that some 35% said they had been hit with an implement. Only 7% felt that it was acceptable to do that to a child now. Parental behaviours towards children, that are deemed to be unacceptable, are continually evolving within societies.
The most popular analogy used for child abuse is that of an iceberg, where only a portion of the whole is visible. Dividing the iceberg into layers you get:
Figures can be provided for Layers 1 to 3:
Countries vary in the number and size of the layers of the child abuse iceberg that are recognised and reported. According to Kempe (1978), there are six stages to recognising the full extent of child abuse in a country, and addressing the problem. The first stage involves denial that it exists outside a small minority of grossly deviant families, or foreign guest workers with different styles of child rearing, "people not like us". This stage is followed by the recognition of more widespread physical abuse, neglect, emotional abuse and sexual abuse to stage six, that of guaranteeing each child that he or she is truly wanted and provided for, by parents, community and state. Whilst most developed countries have passed through the stages of recognising and responding to the different forms of child abuse, few, if any, would claim to have reached stage six.
It is vitally important when looking at international comparisons to be sure that you are comparing the same things, hence the importance of definitions. Finkelhor (1994), in his overview of child sexual abuse surveys in 21 countries, concluded that the different ways in which child sexual abuse was defined in each country made cross-country comparisons largely impossible. This point has been vividly illustrated by Kelly et al's (1991) survey of the prevalence of sexual abuse among college students, where a number of different definitions of sexual abuse were used. The most rigorous "cases involving some form of penetration or coerced/forced masturbation where the abuser was at least 5 years older" yielded a prevalence figure for child sexual abuse of 4% for women and 2% for men. The broadest definition "any event/interaction that the young person reported as unwanted/abusive before they were 18" gave prevalence figures of 59% for women and 27% for men.
In addition to the difficulties of comparing prevalence figures across countries using different definitions, Gorey & Leslie (1997) have drawn attention to the variations caused by response rates to surveys. The higher the response rate was the lower the prevalence figure. They argued that this was due to responders being more interested, or experienced, in the condition being surveyed than non-responders. Martin et al (1993) demonstrated how the type of interview; postal or face to face, influenced answers to questions on child sexual abuse. These, and other, methodological considerations when comparing child maltreatment prevalence and incidence figures are explored more fully in Creighton (2002a) and Fergusson and Mullen (1999).
Prevalence studies of child abuse have largely been confined to child sexual abuse. This is partly due to the interests of the researchers and partly due to the nature of the abuse itself. In the UK, the earliest national prevalence studies (e.g. Baker and Duncan, 1985: BBC Childwatch, 1987) were funded by the media, to provide data for television programmes on child sexual abuse. Sexually abused children tend to be older than children who are physically abused or neglected. This means that they are more likely to remember their abuse if approached as an adult, than those who were physically abused or neglected at younger ages.
Table 1 details some of the most methodologically rigorous prevalence studies of child sexual abuse (CSA) conducted on representative populations of adults or teenagers in different countries.
A range of other CSA prevalence studies can be found in Pilkington and Kremer (1995), Fergusson and Mullen (1999) and Tonmyr (1998). Child sexual abuse prevalence figures are most affected by whether the definition of CSA used includes non-contact experiences such as exposure, in addition to contact experiences. Table 1 breaks the figures down into 'any CSA' and 'contact CSA' to allow for these differences. The data in Table 1 is drawn from western countries where most studies have been conducted. Recent studies on college students in non-English speaking eastern countries such as Hong Kong (Tang, 2002); Palestine (Haj-Yahia and Tamish, 2001) and South Africa (Madu and Peltzer, 2000) have found either lower prevalence figures than those in Table 1 or similar rates for men and women. It will be interesting to see if these potential cultural differences between western and eastern countries are maintained in representative population surveys.
Table 2 details the latest incidence figures for cases of child maltreatment reported to official agencies in different countries.
Sources:
The table distinguishes between those cases that were initially reported to the various child protection agencies in the country and those that were substantiated or registered (and thus provided with services) after various investigations (see Creighton, 2002b). In Australia, Canada and the USA there were approximately five times as many cases reported as were finally substantiated. The rate per thousand child population was considerably higher in these countries than that in England, though the breakdown by the different types of abuse was similar. Cases of neglect have always been the largest category in the USA but only became so in England in the late 1990s. This is probably due to the different ways the child protection management and reporting systems developed in each country, rather than to intrinsic differences in the maltreated populations. Registers in England were initially 'Non-accidental injury' registers and focussed entirely on physical abuse.
There have been three major studies looking at the incidence of child maltreatment in the USA. Table 3 shows the changes in the rates of maltreatment reported in the three National Incidence studies (NIS1, NIS2, and NIS3) conducted in the USA in 1980, 1986 and 1993 (US Department of Health and Human Services, 1988, 1996; Sedlak, 1990). The surveys were attempting to measure incidence down to Level 3 by recruiting agencies not in the child protective system, in addition to those within it, to act as "sentinels" for cases which came to light during the study period.
The Table shows that the rate of neglect cases increased most dramatically over the thirteen year period.
The Family Violence Research Program at the University of New Hampshire has attempted to measure the incidence of physical abuse in the USA at Layer 4 (Straus, 1979; Straus and Gelles, 1986; Straus et al., 1998). They conducted three nationally representative surveys of American families in 1975, 1985 and 1995 to find out the levels of physical violence used in them. Severe violence to a child was when a parent acknowledged that they, or their spouse, had 'hit with an object, punched, bitten, kicked, beaten up or used a knife or gun' on their child in the last year. The incidence rates for severe violence by parents towards their children fell from 140 per 1000 children in 1975 to 107 per 1000 in 1985 and 49 per 1000 in 1995. These rates are considerably higher than those reported in the three NIS studies. Using the same measures Bardi and Borgogni-Tarli (2001) found a rate of severe violence by Italian parents to their children of 83 per 1000 children. Ghate et al. (2003) expanded the definition of severe violence to include 'smacking/slapping of the head or face' in their national survey of parental discipline in Britain and found a rate of 90 per 1000 children.
The majority of child maltreatment prevalence studies have been carried out in Western countries and on child sexual abuse. There is a need for more studies on the prevalence of other forms of child maltreatment (e.g. Cawson et al., 2000) in different countries. Official reports of child maltreatment are now collected annually in a number of countries. Readers should be cautious in comparing these given the different systems, including definitions, employed in collating the data.
Australian Institute of Health and Welfare (AIHW) (2004) Child Protection Australia 2002-03. AIHW cat. No. CWS 22. Canberra: AIHW (Child Welfare Series no. 34).
Badgley, R. F., Allard, H. A., McCormick, N. et al. (1984) Sexual Offences against Children. Volume 1. Report of the Committee on Sexual Offences against Children and Youths. Ottawa, Canada: Minister of Supply and Services.
Baker, A. W. and Duncan, S. P. (1985) Child sexual abuse: a study of prevalence in Great Britain. Child Abuse and Neglect, 9: 453-467.
Bardi, M. and Borgogni-Tarli, S. M. (2001) A survey on parent-child conflict resolution: intrafamily violence in Italy. Child Abuse and Neglect, 25(6): 839-853.
BBC Childwatch (1987) National survey on child abuse. BBC Press Briefing, 9 July.
Cawson, P., Wattam, C., Brooker, S. and Kelly, G. (2000) Child maltreatment in the United Kingdom: a study of the prevalence of child abuse and neglect. London: NSPCC.
Creighton, S. J. (2002a) Patterns and outcomes. In: Wilson, K. and James, A. (eds) The child protection handbook. Second edition. Edinburgh: Balliere Tindall.
Creighton, S. J. (2002b). Recognising changes in incidence and prevalence. In: Browne, K. D., Hanks, H., Stratton, P. and Hamilton, C. (eds) Early prediction and prevention of child abuse. A handbook. Chichester: Wiley.
Creighton, S. J. and Russell, N. (1995) Voices from childhood. A survey of childhood experiences and attitudes to child rearing among adults in the United Kingdom. London: NSPCC.
Department for Education and Skills (2004) Referrals, Assessments and Children and Young People on Child Protection Registers: Year Ending 31 March 2003. London: TSO.
Fergusson, D. M., Horwood, L. J. and Lynskey, M. T. (1996) Childhood sexual abuse and psychiatric disorders in young adulthood. Part II. Psychiatric outcomes of sexual abuse. Journal of the American Academy of Child and Adolescent Psychiatry, 35: 1365-1374.
Fergusson, D. M. and Mullen, P. E. (1999) Childhood sexual abuse: An evidence based perspective. Developmental clinical psychology and psychiatry series; v.40. California: Sage Publications, Inc.
Finkelhor, D. (1994) The international epidemiology of child sexual abuse. Child Abuse and Neglect, 18(5): 409-417.
Finkelhor, D. and Dziuba-Leatherman, J. (1994) Children as victims of violence: A national survey. Pediatrics, 94: 413-420.
Creighton, S. J., Ghate, D., Hazel, N, Finch, S. and Field, J. (2003) The national study of parents, children and discipline in Britain: key findings (PDF, 47KB) Economic and Social Research Council (ESRC).
Gorey, K. M. and Leslie, D. R. (1997) The prevalence of child sexual abuse: Integrative review adjustment for potential response and measurement biases. Child Abuse and Neglect, 21(4): 391-398.
Haj-Yahia, M. M. and Tamish, S. (2001) The rates of child sexual abuse and its psychological consequences as revealed by a study among Palestinian university students. Child Abuse and Neglect, 25: 1303-1327.
Halperin, D. S., Bouvier, P., Jaffe, P. D., Mounoud, R-L, Pawlak, C. H., Laederach, J., Wicky, H. R. and Astie, F. (1996) Prevalence of child sexual abuse among adolescents in Geneva: results of a cross sectional survey. British Medical Journal, 312: 1326-1329.
Home Office (2003) Crime in England and Wales 2002/2003.
Simmons, J. and Dodd, T. (eds). Home Office Statistical Bulletin. London: Research, Development and Statistics Directorate.
Kelly, L., Regan, L. and Burton, S. (1991) An exploratory study of the prevalence of sexual abuse in a sample of 16-21 year olds. Child Abuse Studies Unit. London: PNL.
Kempe, C. H. (1978) Recent developments in the field of child abuse. Child Abuse and Neglect, 2(4): 261-267.
McGee, H., Garavan, R., de Barra, M., Byrne, J. and Conroy, R. (2003) The SAVI Report: Sexual Abuse and Violence in Ireland. Dublin Rape Crisis Centre; Liffey Press.
Madu, S. N. and Peltzer, K. (2000) Risk factors and child sexual abuse among secondary school students in the northern province (South Africa). Child Abuse and Neglect, 24: 259-268.
MacMillan, H. L., Fleming, J. E., Trocme, N., Boyle, M. H., Wong, M., Racine, Y. A., Beardslee, W. R. and Offord, D. R. (1997) Prevalence of child physical and sexual abuse in the community. Results from the Ontario Health Supplement. Journal of the American Medical Association, 278(2): 131-135.
Martin, J. Anderson, J., Romans, S., Mullen, P. and O'Shea, M. (1993) Asking about child sexual abuse: methodological implications of a two stage survey. Child Abuse and Neglect, 17: 383-392.
National Assembly for Wales (2003) Local Authority Child Protection Registers 2003. Cardiff: Statistical Directorate.
Pilkington, B. and Kremer, J. (1995) A review of the epidemiological research on child sexual abuse: community and college student samples. Child Abuse Review, 4(2): 84-98.
Sariola, H., and Uutela, A. (1994) The prevalence of child sexual abuse in Finland. Child Abuse and Neglect, 18: 827-835.
Sedlak, A. J. (1990) Technical amendment to the study findings : National incidence and prevalence of child abuse and neglect: 1988 (NIS-2). Westat, Inc.
Siegal, J. M., Sorenson, S. B., Golding, J. M., Burnam, M. A. and Stein, J. A. (1987) The prevalence of childhood sexual assault: the Los Angeles epidemiologic catchment area project. American Journal of Epidemiology, 126: 1141-1153.
Straus, M. A. (1979) Family patterns and child abuse in a nationally representative American sample. Child Abuse and Neglect, 3(1): 213-225.
Straus, M. A. and Gelles, R. J. (1986) Societal change and change in family violence from 1975 to 1985 as revealed in two national surveys. Journal of Marriage and the Family, 48: 465-479.
Straus, M. A., Hamby, S. L., Finkelhor, D., Moore, D. W. and Runyan, D. (1998) Identification of child maltreatment with the parent-child conflict tactics scales: development and psychometric data for a national sample of American parents. Child Abuse and Neglect, 22(4): 249-270.
Tang, C. (2002) Childhood experience of sexual abuse among Hong Kong Chinese college students. Child Abuse and Neglect, 26: 23-37.
Tonmyr, L. (1998) International studies on the incidence and prevalence of child maltreatment: Selected bibliography. Child Maltreatment Division, Health Protection Board, Health Canada. Ottawa: Minister of Public Works and Government Services, Canada.
Trocme, N. and Wolfe, D. (2001) Child Maltreatment in Canada: Selected Results from the Canadian Incidence Study of Reported Child Abuse and Neglect. Ottawa, Ontario: Minister of Public Works and Government Services Canada.
U.S. Department of Health and Human Services, Administration on Children, Youth and Families (2003) Child Maltreatment 2001. Washington, DC: U.S. Government Printing Office.
U.S. Department of Health and Human Services (1988) Study findings. Study of national incidence and prevalence of child abuse and neglect (NIS-1). Washington DC: National Center on Child Abuse and Neglect.
U.S. Department of Health and Human Services (1996) The Third National Incidence Study of child abuse and neglect (NIS-3). Washington DC: National Center on Child Abuse and Neglect.
This research briefing is based on a review of research and literature. It reports the findings and views of a range of authors. These views are not necessarily the views of the NSPCC.
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