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James A. Mercy, PhD
Division of Violence PreventionNational Center for Injury Prevention and Control
Centers for Disease Control and Prevention
MOBILIZING GLOBAL ACTION TO END VIOLENCE AGAINST CHILDREN:
LESSONS FROM AROUND THE WORLD
Violence Across the Lifespan
EARLYCHILDHOOD ADOLESCENCE ADULTHOOD
Bullying Youth Violence
Child Maltreatment: physical, sexual, emotional, neglect
Dating Violence
Sexual Violence
Intimate Partner Violence
ElderMaltreatment
Violence Against Children is Common in the U. S., NatSCEV, 2008
Finkelhor, D., Turner, H., Ormrod, R., Hamby, S., and Kracke, K. 2009. Children’sExposure to Violence: A Comprehensive National Survey. Washington, DC: U.S.DOJ, OJP, OJJDP, CDC.
HIV/AIDS
Chronic LungDisease
Fractures
PregnancyComplications
Cancer
Burns
Unintendedand Adolescent
Pregnancy
FetalDeath
Internal Injury
Diabetes
Heart Disease
HIV
STDs
ViolenceAgainstChildren
AlcoholAnd Drugs Unsafe
Sexual Practices
Violence Against Children Is Costly and Destructive
Maternal andChild Health
Injury Non-Communicable Disease
Communicable Diseaseand Risk Behaviors
Stroke
Alcohol
Smoking
Obesity
PhysicalInactivity
Multiple Partners
Head Injury
Mental HealthProblems
Suicide
Depression and Anxiety
PTSD
Assault
Paths From Violence to HIV and Back Again
Direct transmissionCompromised negotiation
Reduced self efficacyForcing children out of homes
HIV Risk Behaviors
Risk for violence post-diagnosis
Social isolation & vulnerabilityStigmaStress
Violence Against Children
HIVInfection
Violence Damages Body Via Impact on the Brain
ViolenceAgainst
Children/Youth
Mental and Physical Health and CognitiveDevelopment
Infancy Adulthood
RiskBehaviors
And Conditions
Premature Aging
ToxicStress
Together for Girls: A Global Partnership
Generate data to guide actionSupport governments in evidence-based prevention and response
Mobilize action through communication strategies
Centers for Disease Control and Prevention United Nations Children’s Fund President’s Emergency Plan for AIDS Relief The Joint United Nations Programme on HIV/AIDS World Health Organization United Nations Development Fund for Women United Nations Population Fund Becton, Dickinson and Company CDC Foundation Nduna Foundation Grupo ABC
VACS Addresses Key Issues
MEASURES violence and its’ IMPACT on children’s lives with a strong gender lens
Uses data to foster POLITICAL ENGAGEMENT AND PROGRAMMING to prevent and respond to violence against children
Photo by Nadia Todres
Completed, Planned, and PotentialViolence Against Children Surveys (VACS)
Swaziland
Cote D’Ivoire
MozambiqueMalawiIndonesia
Cambodia
KenyaTanzania
Zimbabwe
Haiti Nigeria
Zambia
UgandaRwanda
Botswana
Laos PDR? Thailand
? Malaysia? Vietnam
? Guatemala
? Colombia
? Mexico
? Papua New Guinea
? Nepal? India
? Philippines
? China
VACS Methods
National household survey Three-stage cluster sample
survey design Randomly select one eligible
female or male aged 13-24
years in each household
Swaziland – girls only; All subsequent surveys both girls and boys
Surveys carried out by in-country institutions Extensive efforts to protect child respondents
+ Please do not share these data because data for some of these countries have not been officially released.
* Only girls interviewed in Swaziland
Prevalence of Sexual Violence Prior to Age 18 Reported by Females and Males 18-24 Years of Age
in Seven VACS Country Sites+
Swazi-land*
Zimbabwe Kenya Tanzania Haiti Malawi Cambodia0
5
10
15
20
25
30
35
40
45
50
38
33 32
27 26
22
4
9
18
12
21
15
6
Females
Males
Seven Country Comparison
Prevalence of Physical Violence Prior to Age 18 Reported by Females and Males 18-24 Years of Age by Parents, Adult
Caregivers, and Authority Figures in Six VACS Country Sites+
Kenya Zimbabwe Haiti Tanzania Cambodia Malawi0
10
20
30
40
50
60
70
80
90
100
66 6461
55 53
42
7376
5753 54 54
Females
Males
Six Country Comparison
+ Please do not share these data because data for some of these countries have not been officially released.
Prevalence of 12-month Sexual Violence for Females by Age Group,
Tanzania, 2009
13-14 15-16 17-18 19-20 21-22 23-240
5
10
15
20
25
Age Group
Prev
alen
ce (%
)
* Statistically significant, p<0.05
Unwanted Sexual Touch-
ing
Attempted Sex Pressured Sex Forced Sex0%
10%
20%
30%
19%
13%
5%6%
26% 26%
8%6%
Female Non-RestavèkFemale Restavèk
Type of Sexual Violence
Pre
va
len
ce
(%
)
*
*
Prevalence of Childhood Sexual Violence inFemale Restavèks Compared to Non-Restavèks
*
* Statistically significant, p<0.05
Household Authority Figure EV0%
10%
20%
30%
40%
50%
60%
33%
* 55%
Female Non-RestavèkFemale Restavèk
Type of Emotional Violence (EV))
Pre
va
len
ce
(%
)
*
Prevalence of Childhood Emotional Violence in Female Restavèks Compared to Non-Restavèks,
Haiti, 2012+
+ Please do not share these data because data for this country has not been officially released.
* Statistically significant, p<0.05
Household Authority Figure EV0%
10%
20%
30%
40%
50%
60%
26%
*50%Male Non-RestavèkMale Restavèk
Type of Emotional Violence (EV)
Pre
va
len
ce
(%
)
*
Prevalence of Childhood Emotional Violence in Male Restavèks Compared to Non-Restavèks,
Haiti, 2012+
+ Please do not share these data because data for this country has not been officially released.
Prevalence of Sexual Violence Prior to Age 18 Reported by Females and Males 13-24
by Camp Status, Haiti, 2012+
Females Males0
5
10
15
20
25
30
35
40
45
50
34.7
24.321.6 19.6
Camp
Non-Camp
Any Sexual Violence Post Quake in Haiti
+ Please do not share these data because data for this country has not been officially released.
Top Three Types of Perpetrators of Childhood Sexual Violence Reported by Females 13 to 24 Years of Age,
Swaziland – 2007 and Tanzania, 2009
SwazilandPrimary perpetrators: Male neighbors- 32.3% Boyfriends - 26.2% Relatives - 14.0% (excludes parents)
Age Difference: 60% 5 or more years
older
TanzaniaPrimary perpetrators: Male neighbors- 32.2% Strangers - 32.0% Boyfriends - 24.7%
Age Difference: 40% 10 or more years
older
Cambodia Haiti Malawi Kenya Zimbabwe0
10
20
30
40
50
60
70
80
90
23.928.9
33.4
47.3
77.7
Sources: UNICEF. CDC, and KNBS. Violence Against Children in Kenya: Findings from a National Survey, 2010. Nairobi: UNICEF- Kenya Country Office; 2012; ZIMSTAT, UNICEF, and CCORE. National Baseline Survey on Life Experiences of Adolescents, 2011. Harare: ZIMSTAT. 2013. + Please do not share these data because data for some of these countries have not been officially released.
Percentage of Females in Five VACS Sites Reporting First Sexual Violence Incident Prior to Age 18 was
Perpetrated by a Boyfriend/Partner+
Per
cen
tag
e (%
)
Association Between Childhood Sexual Violence and Selected Health Conditions, Females 13 to 24 Years
of Age, Swaziland, 2007
STDs
Pregn
ancy
Com
plica
tions
Alcoho
l Use
Unwan
ted
Pregn
ancy
Suicid
al Id
eatio
n
Feelin
g Dep
ress
ed
Attem
pted
Sui
cide
Difficu
lty S
leep
ing
Cigar
ette
Use
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
3.73.5
3.0 2.9
2.3 2.32.0 1.8 1.2
Ad
jus
ted
od
ds
ra
tio
*
HIV /
*Adjusted for age, community setting, SES, and orphan status
Source: Reza A, et al. Sexual violence and its health consequences for female children in Swaziland: a cluster survey study. Lancet 2009;373(9679):1966-72 .SES, Socioeconomic statusSTDs, Sexually transmitted diseases
None or Infrequent Condom Use in the Previous 12 Months by Experiences of Childhood Sexual Violence - As Reported by
19-24 Year Olds Who Ever Had Sex, Tanzania 2009
0
10
20
30
40
50
60
70
80
90
100
46.156.9
24.4 30.2
Experienced Childhood Sexual Violence
Per
cen
tag
e (%
)
MaleFemale
Source: United Republic of Tanzania, UNICEF, CDC, Muhimbili University. (2011). Violence Against Children In Tanzania: Findings from a National Survey 2009.
Percentage of Males 18-24 Years of Age Who Reported Sexually Transmitted Disease or Transactional Sex by Experience of Sexual
Violence as a Child: Kenya, Haiti and Cambodia
Penile discharge or sore Transactional sex0.0%
4.0%
8.0%
12.0%
16.0%
13.5%
3.8%
6.7%
0.9%
Experienced Sexual Violence Never Experienced Sexual Violence
Adjusted OR = 1.9P-value < 0.01
Adjusted OR = 3.8P-value < 0.01
Percentage of Females 18-24 Who Reported a Pregnancy Resulting from Forced and/or Coerced Sex Prior to Age 18
in Four VACS Country Sites+
24.5
30.3
16.0
34.3
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
Haiti
Tanzania
Kenya
Zimbabwe
+ Please do not share these data because data for some of these countries have not been officially released.
Received services for
sexual violence
Sought services for sexual violence
Told someone aboutsexual violence
Girls Boys0.4% - 6.6%2.7% - 10.0%
4.3% - 38.9% 2.1% - 5.9%
38.3% - 61.2% 20.6% - 64.7%
Source: Violence Against Children Surveys in Tanzania
Disclosure and Service Usage by 18-24 year old Victims of Sexual Violence Prior to Age 18, VACS
+ Please do not share these data because data for some of these countries have not been officially released.
Percentage of 13-17 Year Old Girls and Boys Tested for HIVAmong Those Who Experienced Sexual Violence
in the Past 12 Months+
Zimbabwe Kenya Haiti0
5
10
15
20
25
30
35
40
45
50
37.5
44.6
23.8
9.2
39.2
5
Females
Males
Per
cen
tag
e
VACS Catalyzes Action
Advocacy tool
Breaks the silence
Creates a new
conversation
Guides action
Multi-Sector Task Force
USGIn-Country
Multi-LateralAnd Bi-lateral
Agencies
Civil Society & NGOs
Universities
UNICEF In-Country
Other Government
Ministries
GovernmentMinistry Lead
HEALTH• Child abuse
screening • Access to
services, including comprehensive post-rape care
JUSTICE & POLICE• Child-
and women-friendly policies and laws
• Police stations and courts
• Legal aid
SOCIAL SERVICES• Child
helplines• Child
protection centers
• Increase social welfare officers
COMMUNITY• Parenting
support• Safe
spaces• Helping
children manage risks
• Social norm change
EDUCATION• Teacher
codes of conduct
• Early childhood education
• End corporal punishment
• Keep girls in school
Multi-sector Interventions
IndividualRelationshipCommunitySocietal
Examples • National education campaign• Weekly children’s radio program
Examples• Every police station has trained officers• First shelter established for survivors• First counselling center established • First child-friendly court established
Examples • Sexual Offenses Bill• Child Welfare Bill • Gender, children’s and
education policiesstrengthened
Scope of Policy and Programs Influenced by the Violence Against Children Survey in Swaziland
1) Mauritius
2) Namibia
3) Tunisia
4) Libya
5) Morocco
6) Kenya
7) South Africa
8) Malawi
9) Algeria
10) Cape Verde
11) Rwanda
12) Burkina Faso
13) Madagascar
14) Botswana
15) Senegal
16) Seychelles
17) Egypt
18) Mali
African Child-Friendliness IndexRankings in 2013 and 2008
Source: The African Child Policy Forum (ACPF)
2008 Ranking1) Mauritius
2) South Africa
3) Tunisia
4) Egypt
5) Cape Verde
6) Rwanda
7) Lesotho
8) Algeria
9) Swaziland
10) Morocco
11) Seychelles
12) Libya
13) Togo
14) Malawi
15) Senegal
16) Botswana
17) Nigeria
18) Ghana
19) Burkina Faso
20) Gambia
2013 Ranking
…45) Swaziland
Tanzanian Multi-Sector Task Force:A National Response to Violence Against Children
Comprehensive child protection response Education Social Welfare Legal and Justice Public Health Community State and Civil Society
Partnerships Local Government Service
Delivery Public Awareness Campaign
• T raining in parenting for caretakers
• H ousehold economic strengthening
• R educe violence by legislative protection
• I mprove services for victims of violence
• V alue norms that protect children
• E ducate and build life skills
• S urveys to monitor trends and progress
Key Actions Needed to Prevent and Respond to Violence Against Children - THRIVES
The Strategic Importance of Preventing Violence Against Children
Big Human Rights, Public Health, and Social Problem Influences many different health and
social outcomes Economic costs are substantial
Viable Prevention Programs and Policies Exist
Scientifically Grounded
Politically Feasible
“One of the most powerful waysto change the world
is to make it better for kids.”
Jack P. ShonkoffNational Scientific Council for the Developing Child
For more information
Visit CDC’s National Center forInjury Prevention and Control web site:
www.cdc.gov/ncipc