Sexual Abuse of Young Children in Southern Africa ppt

FCS Family Violence, Child Protection and Sexual Offences UnitHPCSA Health Professions Council of South Africa ICFD Institute for Child and Family Development IDASA The Institute for Dem

Edited by Linda Richter, Andrew Dawes and Craig Higson-Smith

Compiled by the Child, Youth and Family Development Research Programme, Human Sciences Research Council

Published by HSRC Press

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© 2004 Human Sciences Research Council

Funded by the Ford Foundation

First published 2004

Second impression 2005

All rights reserved No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers.

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Andrew Dawes, Linda Richter and Craig Higson-Smith

Section I: Talking about child sexual abuse 19

Linda Richter and Craig Higson-Smith

William Bird and Nicola Spurr

Section II: Understanding child sexual abuse 53

of children under 12: a review of recent literature 55

Loraine Townsend and Andrew Dawes

Mthobeli Guma and Nomvo Henda

Heather Brookes and Craig Higson-Smith

7 Child sexual abuse and HIV infection 130

Rachel Jewkes

8 Commercial sexual exploitation and trafficking of children 143

Craig Higson-Smith and Linda Richter

9 Measurement and monitoring 176

Andrew Dawes, Jacqueline Borel-Saladin and Zareena Parker

Section III: Legal and policy responses 207

10 Legal definitions and practices in child sexual abuse 209

13 At the coalface: the Childline experience 263

Joan van Niekerk

14 Advocacy on behalf of sexually abused children: research and policy issues arising from a case study 276

16 Access to specialist services and the criminal justice system:

data from the Teddy Bear Clinic 335

Craig Higson-Smith, Luke Lamprecht and Lorna Jacklin

17 Doing something: the initiation of sexual abuse services in Soweto 356

Chrissie Mkhasibe with René Brandt

18 Therapeutic approaches to sexually abused children 367

Beverley Killian and Jonathan Brakarsh

19 Case studies of child sexual abuse in Zimbabwe 395

Clare Rudd

20 Armed conflict and the sexual abuse of children in Mozambique 411

Boia Efraime Junior

Section V: Reflections 427

21 Research on child sexual abuse: some problems and comments

(Nog ’n klip in die bos) 429

Ann Levett

22 Are we any closer to solutions? 452

Linda Richter, Andrew Dawes and Craig Higson-Smith

Free download from www.hsrcpress.ac.za

Recently the horror of child sexual abuse in southern Africa has been pushed

to the forefront of public consciousness

It is impossible to describe the physical and emotional wounds that childrenwho have been violated are left to deal with Sexual abuse causes terrible pain

at the time of the assault and can leave scars that linger on in children’s lives

in a multitude of ways, threatening their physical and emotional well-beingand development, their sense of self, their right to health and happiness

Some say that the incidence of this horrendous crime is increasing; others saythat there is a higher rate of reporting of such abuse; yet others say that suchcrimes have been exploited by sensationalists Whatever the strengths orweaknesses of such arguments, surely it must be clear to us as adults, as par-ents, as human beings – that while even one child suffers from this horror, that

is one child too many And we all know that we are not dealing with only onechild or one isolated case Our estimates may not always be accurate, but thoseworking in communities know the enormity of the problem The incidence ofchild sexual abuse in southern Africa is high enough to be seen as an assault,

a war upon our children And in the African tradition that I have been a part

of, any assault on our children is an assault on ourselves – our integrity, ourfamilies, our communities, indeed the very essence of our humanity

The ratification of the United Nations Convention on the Rights of the Childmarked an important step toward developing and implementing policies thatwould protect children’s rights Sexual abuse clearly constitutes a violation ofsuch rights, resulting in an obligation on the part of the state to ensure thateffective and appropriate steps are taken to address the problem Yet thisresponsibility of the state for action must encompass and be supported by ourindividual responsibility and actions as well

As adults, I believe we have a responsibility towards children This sibility should motivate and mobilise us all – individuals, civil society, and

government – to obliterate the scourge of child sexual abuse from our regionand beyond Let us act together to show our love for our children – and let us

Note from the Ford Foundation

The high prevalence of sexual abuse among young children in southern Africa

is well established In part due to the recent high profile publicity given to rific cases of infant rape, sexual abuse has become a major focus of public con-cern Given the scale of the problem, we face nothing less than a crisis Clearly,the phenomenon poses significant challenges to our commitment to advanc-ing the rights of children, and to ensuring their well-being

hor-Child sexual abuse touches on many critical issues However, the questionsthat are perhaps foremost in people’s minds when they confront the problemare: how on earth do we explain what is going on and what do we do about it? The Ford Foundation is concerned about household viability and regardsthe problem of child sexual abuse as a feature of this systemic threat To thisend, the Foundation has provided financial support for the publication of the present volume We endorse the view of the editors that the problem requires

a coordinated, considered and integrated response that is informed by soundresearch and policy formulation

We believe that The sexual abuse of young children in southern Africa makes an

important and much needed contribution to the field The book will serve as

a resource for researchers, advocates and service providers to better stand the phenomenon of child sexual abuse in the region and to translate thisunderstanding into an integrated response

under-The Ford Foundation is proud to have been part of the process that led to theconceptualisation of this book The idea for this volume was born out of ameeting of researchers, practitioners, child rights activists and policy analyststhat was hosted by the Foundation in August 2002 Given the excellent discussions at the meeting, it was a natural step to take the debate into thewider public domain through the production of this volume It was clear fromdeliberations at the meeting that our understanding of child sexual abuse insouthern Africa is very limited We trust that the publication will be of

assistance to those working in the field of child sexual abuse, that it will act as

a stimulus to research, and that it will lead to improved policies and services

The Ford Foundation

The editors are most grateful to the Ford Foundation for their generous support for this project The Foundation, through the Program Officer forSexuality and Reproductive Health, Dr William Okedi, funded the researchmeeting convened by the Child, Youth and Family Development ResearchProgramme of the Human Sciences Research Council at which the idea of abook of this nature was first raised The Foundation has gone on to fund themajor portion of the publication costs for this volume It should be noted thatthe views expressed in this volume are those of the individual contributorsand do not reflect the official views of the Ford Foundation

Editorial assistance

The editors of this volume are all very busy people, and René Brandt wasrequested to act as our editorial assistant and copy editor René did an out-standing job She went the extra mile to make sure the project and all theauthors stayed on track We are most grateful for her contribution

ACDP African Christian Democratic Party

ACESS Alliance for Children’s Entitlement to Social Security ADHD Attention Deficit Hyperactivity Disorder

AHCP Accredited Health Care Person

CADRE Centre for AIDS Development, Research and EvaluationCAP Churches’ Agricultural Project

CAPFSA Child Accident Prevention Foundation of South Africa CERPIJ Centro Reabilitacao Psicologica Infantil e Juvenil

(Psychological Rehabilitation Centre for Children andTeenagers)

CIET Community Information and Epidemiological Technologies

CRC (United Nations) Convention on the Rights of the Child

DoCS Department of Correctional Services

DoJ Department of Justice and Constitutional Development

DoSS Department of Safety and Security

FCS Family Violence, Child Protection and Sexual Offences Unit

HPCSA Health Professions Council of South Africa

ICFD Institute for Child and Family Development

IDASA The Institute for Democracy in South Africa

ILO International Labor Organization

IOM International Organization for Migration

ISP Internet service providers

NCCAN National Committee on Child Abuse and Neglect

NDPP National Directorate of Public Prosecutions

NPASA National Prosecuting Authority of South Africa

PTSD Posttraumatic Stress Disorder

RAPCAN Resources aimed at the Prevention of Child Abuse and NeglectRPTG Report of the Parliamentary Task Group

SABC South African Broadcasting Commission

SACSSP South African Council for Social Service Professions

SADC Southern African Development Community

SAHRC South African Human Rights Commission

SANCA South African National Council on Alcohol and Drug

Dependence SAPS South African Police Services

SASPCAN South African Society for the Prevention of Child Abuse

and NeglectSOC Sexual Offences Court

SOCA Sexual Offences and Community Affairs Units

SPARC Support Programme for Abuse Reactive Children STD Sexually transmitted disease

STI Sexually transmitted infection

SWEAT Sex Worker Education and Advocacy Taskforce UCT University of Cape Town

UDM United Democratic Movement

UNICEF United Nations Children’s Fund

UNISA University of South Africa

US United States (of America)

VCTR Voluntary counselling, testing and referral

VFC Victim-Friendly Courts

WHO World Health Organisation

WITS University of the Witwatersrand

ZNA Zimbabwe National Army

1 Confronting the problem

Andrew Dawes, Linda Richter and Craig Higson-Smith

How does one begin to understand and respond to the high level and brutalnature of sexual abuse of young children in South Africa and elsewhere in theregion? What is it about our societies that render so many children vulnerable

to abuse? What is it that induces perpetrators from all walks of life to

sexual-ly abuse pre-pubertal children, even infants, often with appalling violence? These are very challenging questions As will become apparent in the course

of this book, they are easy to ask, but much more difficult to answer In part,this is because the issues that attend child sexual abuse in all its manifesta-tions are very complex An added complication is our inevitable emotionalreaction to the abuse of young children, which inevitably influences ourintellectual engagement with the problem Particularly when infants andyoung children are raped, our shock and disgust cry out not for reflection,but for action

While our emotional response is understandable, if we do not take time topause, reflect and undertake the research that can help us address the challenges

of child sexual abuse, our actions will be ill-informed and will do little to turnthe tide of this very distressing and highly challenging problem

This volume seeks to provide a space for such reflection It was conceived during a time of increasing public outrage at the sexual assault of very youngchildren (see Chapter 3) In August 2002, the Ford Foundation SouthernAfrica Office commissioned the Child, Youth and Family Developmentresearch programme in the Human Sciences Research Council to convene asmall meeting of researchers, advocates and service providers to discuss anagenda for furthering our understanding of sexual abuse of pre-pubertal children, that is, children younger than 12 years of age The initial intentionwas to publish a short policy brief on current knowledge of the problem, and

Following the meeting, it was agreed that a more substantial product wasrequired and the idea of a book began to take shape We soon recognised thatthere were many gaps in our knowledge, and that it would be profitable towiden the range of perspectives by inviting a number of additional contribu-tions from experts who were not at the original meeting The volume there-fore contains contributions from a range of service providers, children’sadvocates, and members of the research community While a guide for prac-titioners dealing with child sexual abuse in South Africa was published in 1989(Robertson, 1989), this volume is the first attempt to synthesise the southernAfrican research, treatment and policy literature.

In this introductory chapter, our primary task is to signal the principal pointsthat are raised by our contributors Before we proceed to that task, however,

we believe it is necessary to outline a set of issues that emerge at various points

in the volume They include the cultural construction of gender relations andchildren’s sexuality in the context of, or in relation to, sexual abuse Both arecomplex and controversial issues Some might claim that to discuss culturalmatters in the context of child sexual abuse invites the charge that we arechampioning cultural relativism, and that we thereby reinforce the arguments

of those who use ‘culture’ to explain away their abusive actions This is not ourintention Raising the issue of children’s sexuality is even more difficult To do

so can provide ammunition for perpetrators of abuse who seek to legitimatetheir behaviour with appeals to children’s rights to sexual pleasure, as has hap-pened, for example, with some paedophile groups in the United Kingdom.Again, this is obviously not our intention As difficult as these matters might

be, it is important that we confront them, not least because they are part of thecomplexity that attends our understanding of sexual abuse, and part of thecomplexity that needs to be incorporated into the range of our responses

It is worth noting that, as far as we know, sexual abuse constitutes a limitedproportion of all types of child abuse (Leventhal, 1990) Under-reportingnotwithstanding, the evidence suggests that significantly more young childrenexperience other forms of neglect and violence than those who are subjected

to sexual abuse by more powerful adults and older children Many more dren in the southern African region, for example, are subjected to the chron-

chil-ic hardships caused by deep and long-lasting poverty

If this is the case, why is it that sexual abuse, in particular, commands such

abuse of young children is unequivocally associated with high levels of distressand commonly profound disturbance of the child’s physical, emotional,social, moral and intellectual development The effects of abuse are often feltinto a person’s adulthood and indeed throughout life Why, as Linda Richterand Craig Higson-Smith write in Chapter 2, do we skirt around the details

of child sexual abuse? What is it about sex and children that makes us souncomfortable? These are obviously substantial questions, each requiringmore extensive analysis than is possible here However, a few comments are in order

Clearly the shocking violence that has accompanied recent, highly publicisedcases of infant and toddler abuse provides a partial answer to reasons for thisfocus of attention (see Chapters 2 and 3) The physical injury and psycho-logical trauma experienced by the surviving children is, of course, anothercompelling reason for our concern No child should endure these abuses ofpower, the pain that ensues, and the potential loss of love and sexual pleasure

in adulthood

Media reports tend to suggest that child sexual abuse is a relatively recent phenomenon However, as many of the chapters in this volume attest, childsexual abuse is not a new crime Nor is the rape of babies These phenomenaare not particular to southern Africa, and neither are they specific to particu-lar cultural communities in the region Of course, it is individuals who perpetrate abuse, and while we need to comprehend their particular motiva-tions, we also need to understand the role of wider socio-cultural forces Therole of cultural beliefs in child sexual abuse in southern Africa is explored inseveral chapters (5, 7, 19 and 20 in particular)

Sexuality and sexual abuse are profoundly cultural matters Cultural nities create norms for sexual relations and for their violation While having anumber of commonalities, the meaning of sexual abuse is variable across cul-tures (Korbin, 1990) The rape of infants is proscribed in all cultures, and inthe case of incest, Korbin notes ‘virtually all societies have proscriptions… onsexual behaviour among related individuals’ (p 47)

commu-Contemporary definitions of abuse cover a wide range of acts, includingtouching a child’s genitals (see for example Chapter 9) In all cultures though,

it is the meaning of the contact that is important to seeing it as abusive As

Finkelhor (1994) has noted, an important element of the definition of child

sexual abuse is that it is intended primarily for the sexual stimulation of the perpetrator, even if it involves attempts to sexually stimulate the child Of

course, the precise intention of perpetrators is not always easy to establish andthe ‘meaning’ of the act is therefore always open to interpretation

Nonetheless, cultural guidelines assist us to distinguish between behaviour

involving a child’s sexual organs that has a sexual meaning and that which

does not Also, they aid in providing rules concerning who may touch whom,how and when Caregivers frequently touch children’s genitals in the course ofthe routine care of young children In addition, Korbin points out that in anumber of societies, adults touch the sexual organs of children as part ofritual practices For example, a Turkish practice of kissing and praising ababy’s genitals recognises the promise of future fertility (Olson, 1981 inKorbin, 1990) In New Guinea highland communities, ‘grasping the testicles

of an adult male was…a form of non-sexual greeting’ (Korbin, p 43) In neither case is the contact seen as a sexual act, but other communities ignor-

ant of local practice might label these behaviours as sexual abuse In cultural communities such as those in southern Africa, possibilities formisinterpretations abound

multi-In common with Finkelhor’s point about the defining nature of intended ual arousal, Korbin comments that where the purpose of the act is the sexualarousal of the initiator, then one is speaking of a sexual act When a child is

sex-the object of such attention, and if sex-the act is deemed culturally inappropriate,

it is fitting to speak of the act as sexual abuse As Korbin puts it: ‘Child sexual abuse is best conceptualised as the disruption of expected roles, relationships and behaviours’ (Korbin, 1990, p 44; italics ours) However, as she points out,

there are contexts within which sexualised contact with children is accepted –for example in the practice of marrying child brides in some parts ofthe Indian subcontinent and in West Africa Such practices violate inter-national child rights as well as local law, but are still accepted by some sectors

of the population

Adult behaviour towards children is embedded in local beliefs about what isgood, what is bad, and what is necessary for children It is useful to understandthat the cluster of beliefs and behaviours that are associated with child sexu-ality and abuse are embedded in ‘cultural practices’ Miller and Goodnowdefine cultural practices as ‘actions that are repeated, shared with others in a

social group, and invested with normative expectations and with meanings orsignificances which go beyond the immediate goals of the action’ Theyinclude ideas about what is natural and moral, as well as activities that ‘mayeasily become part of a group’s identity’ (1995, p 6).

What is important for the present purposes is that the idea of a cultural practice helps us to appreciate that ‘the way things are ordinarily done’ in aparticular community is deeply embedded The adults who take these prac-tices for granted will not easily give them up, and their children also come tosee the practices as part and parcel of life

The development of contemporary Western ideas and policies with respect tochild sexual abuse over the last 30 years, itself reflects a process of construct-ing norms and practices – a form of cultural construction (Levett, 1994;Chapter 21) Gradually we have come to understand sexual abuse in particu-lar ways, and to formulate sanctions for those who disrupt the codes of sexu-

al conduct and adult–child relations we have evolved

This process is rendered no less cultural by being informed by a deep concernfor child rights and by scientific research attesting to the negative effects ofsexual abuse on children Let it also be clear that our observations are not

a call to relativism in matters pertaining to child sexual abuse Rather, we have pointed to the cultural ground on which our approach to child sexualabuse rests

Cultural practices also include normative understandings of power relations

between men and women The term abuse is clearly linked to the notion of

power Those who are more powerful have the potential to abuse it, and thosewith less power have the potential to be abused More importantly, abusiveacts may become so intertwined with the exercise of power that those whowield power cease to recognise their acts as abusive Indeed, this is frequentlythe case in relationships between males and females in patriarchal societies.Men may see their (abusive) behaviour as within their (culturally given) malerights Women may unwittingly collude in this assumption and come toexpect their male counterparts to act in ways that are actually abusive (seeChapter 5) After all, men have difficulty controlling their sexuality, do theynot? Is this not a ‘natural condition’ of being male? Of course, this not thecase, but many men and women, in countries all around the world, continue

to believe these assertions

When it comes to sexuality – regardless of culture – the defining power ofpatriarchy, and the necessarily subordinate position of women and children,

is clear In spite of law, and in spite of norms that proscribe sexual acts withchildren, it is men, with or without the connivance of women, who have thestructural and physical power to define sexual relations (Campbell, 1992).Indeed, across the world, it is predominantly men who sexually abuse chil-dren, and it is clear from this volume that southern African men from all

backgrounds are no exception This fact must be an integral part of our quest

to understand child sexual abuse It is crucial that we understand the way inwhich our various cultures construct expectations and norms for men The

risk of abuse is likely to rise where these cultural constructions expect men to

exercise power over women and children (see Chapter 4) Unfortunately, as is

noted by several colleagues in this volume, the role of masculine identity in

sexual assaults on children is not commonly considered in a research ture that is dominated by a search for individual causes in the personality profile of the child sex abuser (see Chapters 4 and 21)

litera-A final point to be made in this discussion concerns children’s sexuality Theidea that children might be sexual beings has long been disturbing to adults,certainly in Western society (De Mause, 1976) Children are able to experiencesensory and tactile arousal (even if they do not interpret it as ‘sexual’ in theadult sense), and it is probable that all children engage in sexual self-stimula-tion at some point (see Chapter 2) As part of our enquiry, we need to ask howour understanding of child sexual abuse is affected by our anxiety concerningchild sexuality This is not a trivial matter

As we have suggested in the discussion of cultural practices, the period we callchildhood is culturally constructed, and the appropriateness or otherwise ofchildren’s sexual activity follows from our notions of what childhood is orshould be The fact that the Convention on the Rights of the Child (CRC)defines a child as anyone younger than 18 years of age is a very modernnotion, and there is no doubt that in many parts of the world, includingsouthern Africa, childhood ends for many well before or well after this magi-cal cut-off point This fact poses challenges for policy and statutory provisions

in a region that is culturally diverse It is important for us to understand,though not necessarily accept, locally distinct approaches to these issues

We need to be mindful that cultures are characterised by change more than by

one another Indeed, the very policies and laws we have today are a reflection

of cultural change They are cultural products of an emerging consensus inmany parts of the world that sexual acts between children and more powerfulothers is harmful and abusive to all children, and particularly to those who arepre-pubescent

An outline of the volume

This volume is divided into five sections The first section discusses the ner in which child sexual abuse presents as a phenomenon, and the way inwhich it is represented in the press The second section consists of six chaptersthat seek to unpack some of the main theoretical and empirical findings in thefield Section III covers legal and policy responses to the problem of abuse,while the fourth section presents a series of accounts of interventions onbehalf of abused children drawn from South Africa, Mozambique andZimbabwe The book concludes with a critical reflection An outline of eachsection follows

man-The book commences with two contributions that explore the experiences

of individuals exposed to the frequently shocking sequelae of abuse InChapter 2, Linda Richter and Craig Higson-Smith confront us with some

of the appalling realities of violent sexual abuse and the rape of young children Their contribution presents material we do not want to see orknow about, but need to if we are going to begin to understand what isinvolved in the sexual abuse of young children The accounts included in thechapter are those that commonly defy comprehension and produce fiercecounter-reactions

In Chapter 3, William Bird and Nicola Spurr tackle the manner in which the South African media have reported and shaped infant rape They con-ducted an extensive examination of news reports of the infamous ‘BabyTshepang’ rape case On 26 October 2001, this nine-month-old child wasraped at her home in Louisvaleweg, Upington, South Africa Bird and Spurranalyse the way in which key actors in the case were represented by the pressand identify the themes that emerge Among other points, they note that thefact that the child was allegedly gang-raped was exploited for its horror Theauthors note that there was little evidence of a human rights discourse in thereports No links were made between the rape of children and women, and

there was no exploration of the ideological contexts within which the abuse ofwomen and children occurs Bird and Spurr show that media representations

of abuse are extremely powerful in constructing the nature of abuse as well asthe nature of our response These reports play a positive role in drawing ourattention to abuse, but the sensationalism that often accompanies thesereports is deeply problematic, perhaps obscuring the everyday, almost banalnature of most child sexual abuse

The second section of the volume presents research findings on child sexualabuse that address several issues The opening chapter by Loraine Townsendand Andrew Dawes (Chapter 4) reviews findings on the correlates of sexualabuse, ranging from those at the socio-cultural level to characteristics of indi-vidual perpetrators The authors also point to some of the major method-ological problems that are associated with research in this field, and thatcontribute in their own way to the limits of our current understanding Theynote too that it is essential to go beyond the individual level of explanationand examine the role of cultural factors in particular Most studies in this fieldare located within the discipline of psychology and, as a result, there is a focus

on individual dynamics Our search has therefore neglected key social forceslikely to be involved in the abuse of children and women, particularly gen-dered power relations and patriarchy Townsend and Dawes make it clear that, despite the predominance of psychological explanations, on the availableresearch evidence it is very difficult to construct profiles of those who abuse children sexually In part this is because child sexual abuse is not one phenomenon, but takes many forms It is often poorly defined and data arenot systematically collected This theme is picked up at a later point byAndrew Dawes, Jacqui Borel-Saladin and Zareena Parker in their work on themonitoring of child sexual abuse (Chapter 9) These writers stress the need forimproved national data collection systems through the use of common defi-nitions and reporting mechanisms Without this we will always have a hap-hazard idea of the incidence of child abuse, and of the nature andcharacteristics of the act, the victims and the abusers

The relationship between socio-cultural practices, child abuse and ment in the southern African context is explored in Chapter 5 by MthobeliGuma and Nomvo Henda They point to the manner in which gender roles,values, perceptions and coercive practices may provide the setting withinwhich violence against children and women emerges The chapter examines

the various ways in which child abuse is understood in the region and proceeds to highlight the way language usage brings forth ambiguities thattend to negate the ‘good’ intentions embodied in cultural practices.

Taking the role of cultural practices and child abuse in a rather different tion, Rachel Jewkes (Chapter 7) examines an issue that has generated a lot ofheat but very little light – the story that sex with a young virgin can cureHIV/AIDS The notion that such beliefs are widespread has been fuelled byreports of cases such as that of ‘Baby Tshepang’ and other accounts of the rape

direc-of pre-pubescent children Indeed, concern is developing that the media itselfmay play a role in perpetuating and extending these beliefs, thereby uninten-tionally contributing to the rape of children by HIV-infected men who come

to believe that there must be something in the story Jewkes also investigatesother ways in which HIV infection may influence the prevalence of child sex-ual abuse The results of her analyses lead to the conclusion that although thevirgin-cleansing myth has received considerable publicity, it is probably not asignificant cause of child sexual abuse She argues that the prevalence of HIVinfection among children is most likely to be a function of sexual abuse, butnot because the abusers believe virgin-cleansing myths Most men who per-petrate child sexual abuse probably do not even know their HIV status

Other chapters in Section II report on empirical findings in particular areas ofconcern Schools are supposed to be places of support for children and theirdevelopment However, as Craig Higson-Smith and Heather Brookes report intheir contribution on school-based sexual violence (Chapter 6), sexual abuseand harassment are major problems in South African schools They note too

that the response of schools to sexual abuse is ad hoc Echoing some of the

points raised in our earlier discussion of patriarchy and cultural practices,Higson-Smith and Brookes attribute at least part of the responsibility for boththe problem and the response to the gendered power relations that are sowidespread in the region, and which are enacted in the social relationships ofthe school and surrounding community They note that one of the key factors

in reducing sexual violence in schools is the instillation of a culture of respectfor students, clear rules and clear consequences for perpetrators

Chapter 8 presents a discussion of the commercial sexual exploitation of dren and child trafficking This is a problem about which we have relatively little information, but which is likely to command our attention to

a significant extent in future Craig Higson-Smith and Linda Richter arguethat both the commercial sexual exploitation of children and trafficking inchildren are significant and growing problems in southern Africa Althoughsex tourism is one aspect of this problem, the underlying causes of the sexualexploitation of children are firmly embedded in social inequalities, corrup-tion, gender discrimination, cheap labour practices and poor educationalopportunities Worsening poverty among especially vulnerable families andcommunities affected by HIV/AIDS, and increasing rates of adult mortalityassociated with AIDS-illness, is creating a very dangerous situation for affect-

ed children who become easy targets for sexual exploitation and trafficking.These authors conclude that a co-ordinated strategy for southern Africa isurgently needed to protect vulnerable children Important international

instruments are in place However, it is clear that they are not being

rigorous-ly applied

What is it that prevents the institutionalisation of a comprehensive range ofgood policies and practices to deal with child sexual abuse? Why do we nothave a solid system of accountability for those who have the duty to carrythem out? Are we serious about our obligations to children under the CRC,the African Children’s Charter, and our various country constitutions? Or do

we just pay lip service to them? The chapters in Section III suggest answers tothese questions These contributions are specific to the South African context.However, discussions at the original Ford Foundation-sponsored meetingindicate that the analyses included in this section are broadly applicable in thesouthern African region

Some of the chapters lay out the policy and legal foundations for the manner

in which abused children should be managed by those who are responsible forthem in the police, justice and welfare sectors (Chapters 10, 12 and 15) Othersinclude critical examinations based on work at the coalface, of how the systemfails, in many instances, to serve vulnerable children (Chapters 11, 13 and 14).Jacqui Gallinetti opens this section (Chapter 10) She notes that South Africaand the other countries in the Southern African Development Communityhave signed and ratified the CRC as well as the African Charter on the Rightsand Welfare of the Child In consequence, the nations in the region are obliged

to uphold the provisions of these instruments as legal requirements The CRChas particular force given its reporting mechanisms Articles 19, 34 and 36

oblige all State parties to protect children from sexual abuse and exploitation.

The African Charter has very similar provisions (Articles 16 and 27) and, inthe South African case, the Constitution is the legal foundation for the protection of children, who are identified as a vulnerable group in need ofspecific attention It is the view of most contributors to this section that,notwithstanding the framework of international and local law and despite thebest efforts of policy-makers, social welfare officers, court officials and thepolice, the system is not functioning well

Deborah Ewing makes this very clear in her harrowing account of two childrape survivors from a rural community and their journey towards redressthrough the police and justice systems (Chapter 14) Rather than supportingthese girls and providing care and protection, the failings of the system sub-jected them to further abuse Joan van Niekerk (Chapter 13) adds her criticalvoice from the perspective of Childline, an organisation that deals with thousands of calls from children every month and which provides care andsupport to abused children as well as to child sexual abuse perpetrators Shepoints out how poor services on the part of the South African Police Services(SAPS) and court personnel (there are of course many exceptions), andthreats to victims by perpetrators, contribute to low reporting levels andinaccurate incidence figures In essence, she maintains that the Childlineexperience is that the justice system generally fails in its constitutional obli-gations to protect children

Part of the problem is that a number of different sectors are involved, themain players being the Departments of Safety and Security, Justice, and SocialDevelopment Historically, co-ordination between these authorities has beenvery difficult to achieve As Mastoera Sadan and Jackie Loffell (Chapters 11and 12 respectively) point out, a further problem is that despite the scale ofchild abuse, responses remain hampered by a lack of resources The establish-ment of specialised sexual offences courts has been welcomed as a move toreduce the trauma for children who have to give testimony The system is newand finding its feet The limited evidence available shows that these servicesare making advances where they are well supported However, many are underconsiderable strain

A number of important policy initiatives have sought to improve child protection and services to abused children As noted by Rose September

(Chapter 15) and other authors, the draft National Strategy on Child Abuseand Neglect was written in 1996 It remains a draft that still needs to be fullyimplemented Every now and then we see high-level responses to dramaticcases of child sexual abuse The establishment of a parliamentary Task Group

on Child Sexual Abuse in November 2001 is a case in point Responding tocases of ‘baby rape’, public hearings were held in March 2002 Submissions onthe causes of child rape and abuse were presented to inform the parliamen-tary structures as to the causes and possible solutions to the problem The taskteam concluded its deliberations in 2002, and elements of their recommenda-tions are being taken forward in the new Children’s Bill Among other ele-ments, the envisaged Bill includes mandatory reporting requirements forteachers, medical practitioners, nurses and persons dealing with children in aprofessional capacity

Mandatory reporting of suspected abusers is, however, a controversial area.Jackie Loffell takes this up in Chapter 12 She argues that while mandatoryreporting is sound in principle as a way of bringing the problem into the openand preventing collusion with abusers, the practice may give rise to unintend-

ed consequences, particularly if available resources are not up to the task Shenotes that experience elsewhere shows the mandatory systems are very expen-sive both in financial and human resource terms, because they require highquality investigations Where the investigatory resources are limited, fundsavailable for preventive services are diverted into a system that may not be

cost-efficient For example, she reports that in the United States two-thirds of

all reports of child sexual abuse that are investigated are unsubstantiated.Apart from the waste of resources in pursuing these cases, significant traumaensues for individuals (and their families) who are initially reported and sub-sequently cleared She argues that resources detoured to reporting may bemore effectively used for prevention, for supporting abused children and theirfamilies, and to bring perpetrators to book

Having considered the broader policy issues, the fourth section of the bookturns to a discussion of clinical and therapeutic responses to child sexual abuse.While there are far too few facilities to assist abused children and their families,those that do exist make a very significant contribution

What is to be done where there are no facilities? Well, you need a person withextraordinary energy, faith and commitment to get things going No doubt

most, if not all, service providers in this difficult field have these tics In Chapter 17, Chrissie Mkhasibe and René Brandt tell the story of acommunity-based initiative to tackle child sexual abuse in Soweto ‘Mama’Chrissie, as she is known, remains a key person in the initiative Togetherwith staff at Chris Hani-Baragwanath Hospital, she established the SowetoChild Abuse Liaison Group Mama Chrissie has maintained a deep commit-ment to the plight of sexually abused children and to the belief that a com-munity cannot simply sit back and complain about the lack of resourcesavailable to them In addition to addressing child abuse itself, the group sawthemselves as working together for the protection of children, in the interests

characteris-of family and community well-being This story demonstrates what can bedone with few resources and high levels of commitment by people withleadership capacity

The remaining chapters in the section discuss centre-based initiatives andtherapeutic services Craig Higson-Smith and Luke Lamprecht (Chapter 16)describe the services rendered by the Teddy Bear Clinic in Gauteng, SouthAfrica With three sites in different parts of the province, the clinic providesservices to clients from a broad section of the general population This chap-ter draws attention to a sizable and especially vulnerable subgroup of childrenfor whom access to the criminal justice system is particularly challenging,namely physically and mentally disabled children A series of case studies isused to illustrate the problems faced by this group of children, particularlywhen presenting evidence in court

It is safe to say that the vast majority of abused children and perpetrators inthe region receive no professional services following the abuse In their con-tribution, Beverley Killian and Jonathan Brakarsh (Chapter 18) discuss theimpact of abuse on the child, as well as models of therapeutic interventionand clinical assessment They point to the difficulties that accompany the mix

of legal and therapeutic elements that commonly coincide in this field Whiletherapeutic services to children are insufficient, there is no doubt that servic-

es for perpetrators are even less adequate Importantly, the authors note thatunder certain conditions, and with some perpetrators (particularly adoles-cents), therapeutic change is indeed possible However, remediation requiresboth intensive and extensive treatment

A further contribution on therapeutic services for abused children is

provid-ed by Clare Rudd (Chapter 19) She presents a series of case studies basprovid-ed onthe work of the Family Support Trust and the Ministry of Health and ChildWelfare in Zimbabwe Combined medical and psychosocial treatment servic-

es are provided to victims of child sexual abuse in three hospital-based clinics

in different parts of the country Case studies of children who were seen at theclinics are presented Similar to other countries, a high proportion of Zimbab-wean perpetrators are known to the child Relatives account for about one-quarter of perpetrators in reported cases Rudd’s account of the Zimbabweansituation suggests similar patterns of abuse to those observed in South Africa.The final chapter in this section takes us to Mozambique Many regions on thecontinent of Africa have been wracked by civil war in the past 30 years Thesouthern African region has been no exception The victimisation of womenand children, including sexual assault, is a common feature of all these conflicts (Machel, 2001) The conflict in the Balkans showed that rape as aninstrument of war is not particular to Africa

Boia Efraime Junior (Chapter 20) explores the consequences of sexual violation in the context of the Mozambican civil war, a conflict that tore at thesocial fabric of the country for 20 years, disrupting and distorting traditionalpractices He points to the way cultural practices and repertoires were used bythe military on both sides to legitimate the subjugation and sexual violation

of young girls during the war He shows how the consequences for the victims

of being ‘damaged goods’ on return to their communities was devastating forthese young women Despite the fact that they had little or no power to resistcapture and rape, these girls were positioned as ‘spoiled’ on their return home,marginalised, and held responsible for their own violation Boia’s chapter pro-ceeds to outline some of the challenges of a rural village reintegration andtherapeutic programme for these women

The volume closes with a final section that invites reflection on where we havebeen and how we might proceed The key conclusions of the various chapters are brought together in the final chapter, and we shall not reiteratethem here

The author of the penultimate chapter is Ann Levett Levett produced some ofthe first South African work in this field during the 1980s In many ways she

is the mother of South African research on child sexual abuse She has never

been afraid to ‘push the envelope’, ask the difficult questions, and test the

lim-its of the conceptualisation of child sexual abuse The title of her piece, ‘Nog

’n klip in die bos’, is an Afrikaans idiom that does not translate well into

English (Translation: another stone [thrown into] the bush) It refers to thedisruption of what is taken for granted – perhaps ‘setting the cat among thepigeons’ would be an equivalent expression

She has thrown other ‘klippe in die bos’ before, and as a result she is no stranger

to controversy In earlier years it was her argument that child sexual abuse was

culturally constructed, and that the manner of its construction had a deep

influence on how acts of abuse were experienced by the survivors This

invit-ed controversy at the time (Russell, 1991, 1995) She arguinvit-ed that it was lematic to assume that sexual abuse always leads to psychological trauma, and

prob-that where gendered power relations normalise what we commonly refer to as

the abuse (of young girls), traumatic consequences cannot be assumed

On this occasion, Levett reiterates her long-held conviction that we must payattention to the definitions, methods and, most importantly, the paradigms

we employ when we try to understand sexual abuse She challenges us to think

why the research in this field keeps ‘running into cul de sacs’, and proceeds to

provide some preliminary answers, critiquing and disrupting currentapproaches to the conduct of research on child sexual abuse

She takes issue with the neo-positivist empiricism that underpins modern chology’s attempt to get to grips with explanations of human behaviour, and

psy-of child abusers In her chapter, Levett proceeds to psy-offer a more complexapproach Echoing some of the considerations with which we commenced thisintroduction, she stresses the importance of understanding the historically andculturally constituted nature of childhood and sexuality She points to the factthat we take for granted our contemporary notions of what child sexual abuse

is She ends by challenging us to consider a new research project that treats allsexual violence as united by a single phenomenon – gendered power

Levett’s views are, as is her wont, challenging, and they will not rest easy with

some readers That is the point Her new ‘klip in die bos’ invites us to debate,

to undo our common assumptions She is correct; we have become stuck

in cul de sacs Her invitation to look with different lenses on the phenomenon

of child abuse is a welcome stimulus to search for new approaches to an old problem

As we stated at the outset of this chapter, this book is an invitation to seriousreflection on the sexual abuse of young children There are no simple answerscontained here We trust, however, that the suggestions for improved researchand services that are raised by our contributors become the source of ideas forimproved research, policy and intervention Most importantly, we wish that intime our various endeavours will contribute to advances in our understand-ing of child sexual abuse, and to improved care and services for the manyaffected children on the subcontinent.

We trust too that readers will take note of one of the main underlying ics of the problem of child sexual abuse, rape and related violence againstwomen and children in southern Africa This is the inclination of men to

dynam-assume that women and children are naturally subordinate to them and are

bound to serve their needs A wider reflection is necessary on what needs to

be done to change this perspective, for it carries the inherent potential for lence and sexual abuse

vio-References

Campbell, C (1992) Learning to kill? Masculinity, the family and violence in Natal.

Journal of Southern African Studies, 18(3), pp 614–628.

De Mause, L (1976) The history of childhood London: Souvenir Press.

Finkelhor, D (1994) Current information on the scope and nature of child sexual abuse.

The Future of Children, 4(2), pp 31–53.

Korbin, J (1990) Child sexual abuse A cross-cultural view In R K Oates (Ed.),

Understanding and managing child sexual abuse (pp 42–58) Sydney: Harcourt Brace

Jovanovich.

Leventhal, J M (1990) Epidemiology of child sexual abuse In R K Oates (Ed.),

Understanding and managing child sexual abuse (pp 18–41) Sydney: Harcourt Brace

Jovanovich.

Levett, A (1994) Problems of cultural imperialism in the study of child sexual abuse.

In A Dawes, & D Donald (Eds.), Childhood and adversity Psychological perspectives from South African research (pp 240–260) Cape Town: David Philip.

Machel, G (2001) The impact of war on children Cape Town: David Philip.

Miller, P J., & Goodnow, J J (1995) Cultural practices: Toward an integration of culture

and development In J J Goodnow, P J Miller, & F S Kessel (Eds.), Cultural practices as contexts for development (pp 5–16) San Francisco: Josey-Bass.

Robertson, G (1989) Sexual abuse of children in South Africa: Understanding and dealing

with the problem Hammanskraal: Unibook Publishers.

Russell, D (1991) The damaging effects of discounting the damaging effects: a response

to Ann Levett’s theories on child sexual abuse Agenda, 11, pp 47–56.

Russell, D (1995) Towards justice for incest survivors Agenda, 27, pp 62–73.

Free download from www.hsrcpress.ac.za

Section I: Talking about

child sexual abuse

Free download from www.hsrcpress.ac.za

2 The many kinds of sexual abuse

of young children

Linda Richter and Craig Higson-Smith

One of the reasons why we understand relatively little about the sexual abuse

of pre-pubertal children is that we think and speak about child sexual abuse

as if it were one thing; as if all episodes of sexual abuse of a young child followed the same pattern, were prompted by the same motivations, and led

to the same consequences Rather, there are several distinct kinds of sexualabuse perpetrated against pre-pubertal children Child sexual abuse varies byfeatures of the event, the experience of the child, the duration of abuse, the age

of the child, the circumstances under which the abuse takes place, and theeffects of the abuse on the child and the family This more precisely specifiedknowledge about child sexual abuse resides in police files, in the notes of serv-ice organisations, in whispered disclosures between friends and family, and inthe memories of children and perpetrators Little of this knowledge has madeits way into formal scholarly discourse, and little of this knowledge currentlyinforms theory or recommended practice in South Africa

We are convinced that our lack of knowledge is, in part, defensive We suggestthis because we have experienced our own efforts to protect ourselves fromknowing more than the broad outline of sexual acts performed on and withsmall children In much of what we read about child sexual abuse, we findonly the outline and often a stereotypical one, stripped of the complexity, thecomplicity of others, the repetition of the acts, and the experience of the childand the perpetrator

Some 15 years ago, I was employed in the medical faculty of a

large teaching hospital A week after I started work I was asked, as

part of my combined teaching and clinical duties, to see a

four-month-old infant who had been raped I was also asked to try

to speak to her grandfather who was under suspicion as the

perpetrator He apparently had not left the child’s side since her

admission to hospital The file indicated that the child was veryseverely injured and that she would have to undergo progressivesurgery to repair the damage to her internal organs and to

reconstruct her anus and vagina As I pressed the lift button to goupstairs to the medical wards, I experienced a panic attack Myown son was not much older than the child I was going to see Mysympathetic identification with the child, my fury at the grand-father, regardless that the facts of the case were not yet known,made me turn around I sat in my office for the afternoon, crying

I was overtaken by an overwhelming desire to hold my child andwrap him in the primordial protection of my fantasy that whathad happened to the baby upstairs was contained among peopleother than myself I learned later that the little girl in the wardwas, like myself, white and middle class Her grandfather had beenleft to look after her while her mother went out.1

The motif of child sexual abuse in the minds of many of us is brutal enough

to evoke horror It also arouses an urgency for ‘something to be done’ The lawneeds to be revised, policy and procedures need to be improved, corruptionand inefficiency need to be rooted out, police and justice staff need to be bet-ter trained, and more services need to be put in place to treat and support thechild, the family and the perpetrator Without a doubt all this is true, as isillustrated by the tragic case of two-year-old Thendo Nenzhelele (‘Stop this

horror!’, Sunday Times, 17 November 2002) When admitted to hospital, an

hour before she died, the child was found to have septic buttocks, a severely damaged anus and rectum, and her abdominal cavity was visible through thegaping hole created by her injuries She had been vomiting and was dehy-drated The child reportedly told her family that the perpetrator had hit herwith a stone The chronic nature of the child’s injuries and her dehydration atthe time of her death indicated that, apart from her subjection to repetitivesexual penetration by a lodger in the house, her caregivers, for unknown rea-sons, did not observe or act on her distress and poor condition The policeexamination and investigation following her death were incorrect, incompleteand incompetent Thendo Nenzhelele was apparently one of close to 300 chil-dren treated at the Tshilidzini Hospital for rape or sexual abuse during 2002.Police statistics on child rape and sexual abuse are given in other chapters inthis volume There is a great deal of confusion about numbers because of

discrepancies in legal and clinical descriptions and definitions, accuracy ofrecord-keeping and so on However, the sexual abuse of pre-pubertal childrenoccurs with unacceptable frequency in South Africa Eighty-eight cases ofsuspected sexual abuse of children aged between 10 months and 13 years wereinvestigated at one tertiary hospital in a single year, more than 15 years ago(Jaffe, & Roux, 1988) Among the confirmed rape cases, the greatest majoritywere incestuous In South Africa and elsewhere, the younger the child, themore likely it is that the abuse is repeated over time and is perpetrated by arelated or familiar adult in the child’s home (De Jong, Hervada, & Emmett,1983; Mian, Wehrspann, Klajner-Diamond, LeBaron, & Winder, 1986; Van As,Withers, du Toit, Millar, & Rode, 2001).

Horrifying as it is, the sexual abuse of children is not new, nor is it peculiar toSouth Africa Historical accounts have been found of childhood molestation,including incest, among the ancient Greeks and Romans, in Renaissanceaccounts, and during the Victorian era (Kahr, 1991) In a frequently quotedobservation, Lloyd de Mause wrote that ‘the history of childhood is a night-mare from which we have only recently begun to awake The further back inhistory one goes, the lower the level of childcare and the more likely childrenare to be killed, abandoned, beaten, terrorised and abused’ (1974, p 1) Severalhistorians of childhood and of child sexual abuse have pointed out that manyforms of child sexual abuse have tended to be ignored or covered up Theseinclude defloration rites at puberty, pederasty, incest, murder and rape ofchild captives, and the masturbation of infants during pacification However,the sexual abuse of children cannot be separated from other abusive practicesagainst children, including infanticide and child labour (Radbill, 1980) Thesexual abuse of children is one type of abuse against children, among others(Lewit, & Baker, 1996)

The fact that child, and even infant, rape is not peculiar to South Africa isillustrated by an account from Perth in Australia, which was reported just afew months after the rape of Baby Tshepang:

A man who raped an eight-month-old baby has been sentenced to

18 years in jail [X]2pleaded guilty to sexually penetrating the baby

in a park in [Y] The attack ruptured the infant’s stomach and

nearly killed her… The judge said the baby received terrible

injuries in the savage attack… Surgeons operated on the baby to

save her life after the attack and she is now in foster care [X], ahomeless drifter, was described in court as suffering from severecognitive disorder that arose from brain damage and that wasaggravated by long-term substance abuse and a fall five years

ago… [X] was with a group of people drinking in a [Y] park whenthe baby’s mother left the child in a baby carriage with the groupand went off for a drinking session… [X]’s girlfriend called thepolice after he went off with the baby and officers later found himnext to the bloodied infant on a deserted block of land in [Y] (‘18

years jail for baby-rape in park’, Natal Witness, 17 August 2002)

The Australian case is reported here, not to exonerate the rape of babies inSouth Africa, but to illustrate the generalised nature of the abuse of children

As Rachel Jewkes and her colleagues assert, ‘cases of child rape are not exotic’(Jewkes, Martin, & Penn-Kekana, 2002, p 711)

All cases of the rape of young children, children under 12 years of age, involveforce If the child submits to penetration, then the penetration of the anus orthe vagina itself is forceful and, inevitably, painful for the child If the child isphysically precocious, the damage to the child’s sexual organs may not besevere However, considerable force has to be applied against the child if thechild is unwilling and the child has to be prevented from crying out Thismeans that the sexual act takes place while the perpetrator hits, hurts, smoth-ers or threatens the child at the same time as forcing penetration of thechild’s small mouth, anus or vagina The younger the child, the more brutalthe physical act becomes The rape of an infant is the most extreme ofsuch acts:

To penetrate the vagina of a small infant, the perpetrators firstneed to create a common channel between the vagina and the anal canal by forced insertion of an implement This action isanalogous to the most severe form of female genital mutilationpractised in parts of Africa, introcision, in which the perineum issplit with a finger, knife or similar object.3… Rape in this mannercan be immediately life-threatening The tearing of the perinealbody, rectovaginal septum, and anterior anal sphincter can causeinfants to die from haemorrhage or abdominal sepsis despitemedical care… (Pitcher, & Bowley, 2002, p 274)