ccih 2015 susan hillis plenary 4
TRANSCRIPT
Susan D. Hillis, PhD, MS
Senior Advisor for Global Health
National Center for Injury Prevention and Control Centers for Disease Control and Prevention
VIOLENCE AGAINST CHILDREN SURVEYS: PREVENTION WORKS
IMAGINE IF…
Past Year Exposure to Selected Categories of Violence, NatSCEV, United States, 2008
Finkelhor, D., Turner, H., Ormrod, R., Hamby, S., and Kracke, K. 2009. Children’s Exposure to Violence: A Comprehensive National Survey. Washington, DC: U.S. DOJ, OJP, OJJDP, CDC.
Estimaciones regionales de exposiciones a violencia contra los niños durante el año anterior, 2014
HIV/AIDS
Chronic Lung Disease
Fractures
Pregnancy Complications
Cancer
Burns
Unintended and Adolescent
Pregnancy
Fetal Death
Internal Injury
Diabetes
Heart Disease
HIV
STDs
Violence Against Children
Alcohol And Drugs Unsafe
Sexual Practices
Violence Against Children Is Costly and Destructive
Maternal and Child Health
Injury Non-Communicable Disease
Communicable Disease and Risk Behaviors
Stroke
Alcohol
Smoking
Obesity
Physical Inactivity
Multiple Partners
Head Injury
Mental Health Problems
Suicide
Depression and Anxiety
PTSD
Assault
Exposure to violence in childhood damages the brain
On the left is a cross section of the brain of a child growing up in a stable family
On the right is the cross section of the brain of a child growing up in an institution
Multiple studies from multiple
countries document this impact.
Completed
In Progress Botswana Laos Mozambique Rwanda Uganda Zambia
Benin China Cote d’Ivoire Colombia Guatemala El Salvador Honduras India Malaysia
Mexico Namibia Nepal Puerto Rico Thailand Vietnam
Cambodia Haiti Indonesia Kenya Malawi Nigeria Swaziland Tanzania Zimbabwe
Potential
Completed, Planned, and Potential Violence Against Children Surveys (VACS)
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
Together for Girls A Unique Public-Private Partnership
*Reports by professionals including social services and teachers
Global Prevalence of Child Sexual Abuse: Informant vs. Self-Report
0
2
4
6
8
10
12
14
Informant*Self-Report
0.4
12.7
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+
38
33 32
27 26 22
4
9
18
12
21
15
6
0
5
10
15
20
25
30
35
40
45
50
Swaziland* Zimbabwe Kenya Tanzania Haiti Malawi Cambodia
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+
66 64 61 55 53
42
73 76
57 53 54 54
0
10
20
30
40
50
60
70
80
90
100
Kenya Zimbabwe Haiti Tanzania Cambodia Malawi
Females
Males
Six Country Comparison
+ Please do not share these data because data for some of these countries have not been officially released.
Childhood Sexual, Physical, and Emotional Violence by Orphan Status - As Reported by 13 to 24 Year Old
Females, Tanzania , 2009
36.2
69.5
30.5 24.8
74.8
21.2 0
10
20
30
40
50
60
70
80
90
100
Experiences of ChildhoodSexual Violence
Experiences of ChildhoodPhysical Violence
Experiences of ChildhoodEmotional Violence
Perc
enta
ge (%
)
Orphaned Not Orphaned
Association Between Childhood Sexual Violence and Selected Health Conditions, Females 13 to 24
Years of Age, Swaziland, 2007
3.7 3.5
3.0 2.9 2.3 2.3
2.0 1.8 1.2
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Adju
sted
odd
s ra
tio*
*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 status STDs, Sexually transmitted diseases
Received services for
sexual violence
Sought services for sexual violence
Told someone about sexual violence
Girls Boys 0.4%* 3.4%
24.0% 18.0%
45.9% 35.8%
Source: UNICEF, CDC, KNBS. (2012). Violence Against Children In Tanzania: Findings from a National Survey 2010.
Disclosure and Service Usage by Victims of Child Sexual Violence as Reported by 18-24 Year Olds, Kenya, 2009
* Estimate is unstable
VACS Catalyzes Action
Advocacy tool
Breaks the silence
Creates a new
conversation Guides action
Multi-Sector Task
Force
USG In-Country
Multi-Lateral And Bi-lateral
Agencies
Civil Society & NGOs
Universities
UNICEF In-Country
Other Government
Ministries
Government Ministry Lead
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
Child-Friendliness Index Rankings in 2013 and 2008
Source: The African Child Policy Forum (ACPF)
2008 Ranking 1) 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
Source: National Child Abuse and Neglect Data System
8
13
18
23
U.S. SEXUAL ABUSE 1990-2012
62% Decline (1992-2012)
Rat
e pe
r 10
,000
Chi
ldre
n (<
18)
THRIVES: A Global Technical Package to Prevent Violence Against Children
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 urveillance to monitor trends and progress
20
THRIVES Technical Package Compared to Other Agencies’ Core Packages/Guidance
CDC 2015
PEPFAR OVC 2012
PEPFAR DREAMS
2015
Gender Strategy
2012
UNICEF 2014
WHO 2014
Training in Parenting + + + + + +
Household Economic Strengthening
+ + + + -
-
Reduce violence by egal protections
+ + - + + + (alcohol)
mproved Services + + + + + +
Values and Norms + + + + + +
Education /life skills + + + + + +
Surveillance + + + + + + 21
Component Implementation Programs Implementation Resources
T Training for Parents
- Home Visitation - Training in comprehensive programs - Training in small groups
http://cwbsa.org/sinovuyo/kids, http://cwbsa.org/sinovuyo/teens Nurse Family Partnerships, Philani Plus, Positive Action, KiVa , Families for Safe Dates, ACT Raising Safe Kids, www.irh.org/projects/real-fathers-initiative/ Families Matter! [email protected]
H Household Economic Strengthening
- Microfinance with gender equity training - Group savings & loans associations with gender equity training - Cash transfer with or without conditions
Intervention with Microfinance for Aids and Gender Equity (IMAGE)
R Reduced Violence Through Legal Protection
- Laws banning violent punishment - Laws regulating alcohol sale, outlets - Laws prohibiting child sexual abuse - Laws establishing equal rights for females and males
UN Women, Child Abuse legislation, Alcohol policies, Corporal Punishment legislation
I Improved Services
- Counseling/therapeutic approaches - IPV screening with interventions - Support groups, Shelters, Case management
Hawaii Healthy Start Program Community Advocacy Project
V Values and Norms that Protect Children
- Small group programs - Bystander interventions - Community mobilization programs - Campaigns
Yaari-Dosti, Coaching Boys into Men, Bringing in the Bystander, Green Dot, SASA!, Soul City
E Education and Life Skills
- School enrollment and attendance - Life skills violence-prevention programs
Child-Parent Center Education Program, Positive Action, Safe Dates, Real Consent, IMpower
G i i d t i t i d t
22
Changing the Paradigm
Moving from a Vision of Surviving
to
a Vision of Surviving and Thriving
23
24
CASH + CARE: HALVED HIV-RISK BEHAVIOR INCIDENCE
GIRLS: Cash alone: OR .63 Cash plus care: OR .55
41%
25%
15%
0
10
20
30
40
50
60
nosupport
cash cashpluscare
Controlling for: family HIV/AIDS, informal/formal housing, age of child, poverty levels, number of moves of home, baseline HIV risk behaviour
Cluver, Orkin, Boyes, Sherr (2014). AIDS.
42%
28%
17%
no support cashcash plus care
BOYS: Cash alone: no effect Cash plus care: OR .50
Las Consecuencias de la Violencia contra las Ninos Pueden Ser Eliminadas
30.1
0.0
43.7
23.3
05
101520253035404550
2006 2012
>18 yrs
15-17 yr
Survey Drives Action: HIV Seroprevalence Drops after 6-Year Multi-sector Response
Top 5 Causes of Years of Life Lost – Guatemala
1990 1 Diarrheal diseases
2 Lower respiratory infections
3 Preterm birth complications
4 Protein-calorie malnutrition
5 Interpersonal violence
27
2010 1 Lower respiratory infections
2 Interpersonal violence
3 Diarrheal diseases
4 Preterm birth complications
5 Ischemic heart disease
Top 5 Causes of Years of Life Lost – El Salvador
1990 1 Diarrheal diseases
2 Interpersonal violence
3 Preterm birth complications
4 Lower respiratory infections
5 Road injury
28
2010 1 Interpersonal violence
2 Ischemic heart disease
3 Road injury
4 Lower respiratory infections
5 Congenital anomalies
“One of the most powerful ways to change the world
is to make it better for kids.”
Jack P. Shonkoff National Scientific Council for the Developing Child