Child sexual abuse (CSA) is a widespread problem, estimated to affect nearly 1 out 5 girls and 1 out of 20 boys prior to the age of 18. Due to its prevalence and potentially serious consequences for individuals’ health, CSA is considered a global health issue. For the last two decades, CSA has received growing attention both within research and in ongoing debates. Yet little is known about sexual abuse of children with immigrant background and help-seeking, prevalence and characteristics of sexual children abuse.
The aims of this study are to gain more knowledge about the prevalence of CSA among children with immigrant background, and to identify whether they experience challenges or helping-needs that differ from those experienced by children without immigrant background. To gain more insight into this, we have mapped and analyzed cases of CSA reported to the health care system and/or judiciary, and analyzed data from respondents with immigrant background from the prevalence study “Violence and rape in Norway” (NKVTS, 2013). Also, qualitative in-depth interviews with 15 professionals who work with sexual abuse cases have been conducted. These are professionals who have detailed knowledge of the challenges and support needs victims of child sexual abuse might have.
This report is based on three methodological approaches:
- Analysis of registry data from the Child Advocacy Centre in Oslo (Statens Barnehus Oslo, SBO), the Section for Social Pediatrics at Oslo University Hospital (OUH), and the Sexual Assault Centre, The Emergency Medical Agency, City of Oslo (Overgrepsmottaket på Legevakten i Oslo).
- Analysis of data from the prevalence study “Violence and rape in Norway” (NKVTS, 2013)
- Qualitative in-depth interviews of 15 professionals working at the Child Advocacy Centre in Oslo and the section for Social Pediatrics at Oslo University Hospital.
The analysis of the registry data shows that the percentage of children with immigrant background in the figures from SBO, OUH and the Sexual Assault Centre was on average 24 %. This is somewhat less than the share of the total population in Oslo with immigrant background at the beginning of 2015 (32%). Regardless of immigrant background, we found several similarities between children exposed to sexual abuse, including:
- The age of the child during medical examination and interrogation.
- The type of abuse and other characteristics of the abuse.
- A majority of girls seeking and/or being referred to medical examination and interrogation.
- The suspected perpetrator most often being a person the child already knows.
- A lack of medical evidence in the majority of medical examinations.
- The mother most commonly being the first person to suspect CSA.
Registry data from the Sexual Assault Centre show that nearly half of the youth in both groups reported voluntarily use of alcohol or other intoxicants prior to the abuse. This differs from results from other studies, where youth with immigrant background less often than those without report use of intoxicants in relation to sexual abuse.
Analyses of cases of referrals to medical examinations at SBO and OUH showed that the proportion of boys was twice as large in the group of children with immigrant background compared to the non-immigrant group. Other possible differences between groups are mainly related to which agencies that are involved in each case, and to what kind of health-care and follow up the child/youth use. Compared to other youth, fever of those with immigrant background came to the Sexual Assault Centre within the deadline for forensic examination (1 week) or chose to use further medical follow-up. Furthermore, fewer immigrant youth had other forms of known follow-up.
Registry data from SBO and OUH may indicate that children with immigrant background to a lesser extent than other children were referred to child and adolescent psychiatry and child welfare services. The child welfare services, health personnel, kindergarten and school were to a larger extent reported as the referral 15 agency, as well as the first to suspect sexual abuse in cases that included children with immigrant background. Children without immigrant background were more often referred and followed to examination and interrogation by the police, while school and kindergarten less often were the first to suspect CSA and refer the child in these cases. This might suggest that schools and kindergartens have a lower threshold for suspecting sexual abuse among children with immigrant background; however, the data analyzed in this study is not large enough as to draw any firm conclusions.
The analysis of the data from the prevalence study «Violence and rape in Norway» show that respondents with non-Western background somewhat more often than those with Western background report experiences of sexual abuse prior to the age of 13, otherwise there were no differences between the groups. This was surprising, considering that several other studies have shown a lower prevalence of child sexual abuse among minority youth. Furthermore, a somewhat smaller share of the non-Western than Western group had talked to someone about the abuse, or been to any form of medical examination. The experience of sexual abuse was related to feelings of shame and guilt for the sample as a whole; however, participants with non-Western background reported significantly more shame and guilt than those with Western background.
The analysis of the qualitative interviews of professionals working at SBO and OUH show that certain themes were emphasized as particularly apparent in child sexual abuses cases in general. In these cases there are often many agencies involved, issues with co-ordination and numerous considerations to make. Employees emphasize that there is a need for clearer guidelines for responsibilities and cooperation between the agencies involved. Furthermore, many CSA cases are characterized by uncertainty about the range of events, as well as lack of forensic evidence that may support children’s descriptions. Children’s explanations during interrogations are often the only proof available to the agencies and the judiciary, as CSA seldom leaves physical traces. It is therefore crucial that adults trust and have knowledge about children’s credibility and ways of communicating, and that interrogators working with these cases are trained in forensic interviewing of children.
Employees at the Child Advocacy Centre in Oslo often experience that the Child welfare services withdraw from the case if it is dismissed by the police. This is a major concern, as although many cases are dismissed due to a lack of evidence, this does not automatically mean that the child do not need follow-up from the Child welfare services. A reoccurring theme in the interviews is a concern that criminal prosecution receives more attention than follow-up of the child and the family. As the main task of the services is to conduct interrogations and medical examinations for the purpose of collecting evidence, the employees are concerned that there are insufficient resources and guidelines for further medical care and follow-up of sexually abused children.
In regards to distinctive needs related victims of CSA with an immigrant background, the employees emphasize that the characteristics of the sexual abuse, as well as the reactions to the assault essentially are the same regardless of country- or immigrant background. Particular challenges and service or helping-needs employees see more of in cases where people with immigrant background are involved, revolve to a large extent around the following:
- Children with immigrant background may seem to experience more shame, guilt and taboo associated with sexual abuse.
- Challenges associated with limited language knowledge and the need for an interpreter. If there is a need for an interpreter, there is more to coordinate for the agencies. The presence of an interpreter can complicate communication and building of trust, and lead to uncertainty regarding whether necessary information is communicated correctly and clearly enough.
- Limited knowledge of the health and welfare system can make it difficult for people with immigrant background to know which support agencies to contact with concerns and suspicions of sexual abuse. Fear and suspicion from caregivers and children to police and child welfare services may result in reluctance toward reporting abuse, or insufficient follow-up of a suspicion.
Summary of results and further recommendations
Taboo, guilt and shame are more pronounced, and professionals who work with CSA cases report that this may act as barriers to help seeking. Further research should look closer at how emotions such as guilt and shame can become obstacles that prevent children and families from seeking help.
Limited language and lack of system knowledge can complicate help seeking, and information on sexual abuse and welfare services targeting both caregivers and children should be made available in various arenas and formats. Development of information materials and websites in several languages should be a priority for public institutions.
To prevent that limited language skills reduce access to health care, it is important that children and families have access to skilled interpreters. Professional interpreters are particularly important in sexual abuse cases, and it is vital that interpreters have knowledge of sexual abuse and relevant terminology so that medical concepts are translated properly and nuances of children’s explanations are communicated accurately.
Coordination between agencies is time- and resource intensive, which may implicate a risk of vulnerable children not getting help as soon as needed. It may therefore be useful that one agency has overarching responsibility; this to ensure that agencies involved receive relevant information and that children and families receive tailored assistance and support.
The Child welfare services should observe forensic interviews of children, as many cases are dismissed due to lack of evidence. It is then the child protection services who are responsible and mandated to suggest suitable actions and implement interventions to support the child and the family, independent of legal processes.
Access to a clinic for children exposed to violence and abuse, where doctors with skills in abuse pediatrics, and child psychologists- or psychiatrists are available at all times. This will ensure that children of any age receive rapid expert help and examination in emergency situations, as well as assessment of both physical and mental health needs.
There is a need for more focus on treatment and follow-up services for children that do not meet the criteria for psychiatric treatment in the child and youth psychiatry. There is also a need for counseling and follow-up services for caregivers and other family members. The less knowledge and openness there is about sexual abuse in the society, the greater the need for such follow-up of parents.
Upgrading of school health services and other low-threshold services are an important part of efforts to identify children at risk and help children to disclose sexual abuse. The results from this study suggest that children with immigrant background may experience greater barriers to seeking help, which makes the need for tailored low-threshold services particularly crucial.
Questions about exposure to violence and sexual abuse should to a larger extent be a theme in consultations with general practitioners, psychologists, psychiatrists, school nurses and at health clinics. Furthermore, children who are victims of one type of abuse should always be asked whether they have experienced other forms of abuse, due to the overlap between different forms of violence and abuse.
Teaching about child sexual abuse should be a compulsory part of all educations that involve contact with children. Those working with children must have sufficient knowledge about the topic so that they can recognize signs and signals of CSA, as well as knowing how to talk about and teach the topic. It is of great importance that children are taught about sexual abuse in school and kindergarten. This promotes openness about sexual abuse, and might thereby work preventive.
Because children’s explanations are of such great importance in CSA cases, it is crucial that adults have knowledge about children’s credibility and ways of communicating. Furthermore, it is necessary to act quickly on suspicions of a child being victim of CSA and report such concerns as soon as possible, both in order to stop the abuse and because potential medical evidence quickly disappear.