Child Safety, Welfare and Well-being: Issues and Challenges 9811698198, 9789811698194

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Sibnath Deb   Editor

Child Safety, Welfare and Well-being Issues and Challenges Second Edition

Child Safety, Welfare and Well-being

Sibnath Deb Editor

Child Safety, Welfare and Well-being Issues and Challenges Second Edition

Editor Sibnath Deb Rajiv Gandhi National Institute of Youth Development Chennai, Tamil Nadu, India

ISBN 978-981-16-9819-4 ISBN 978-981-16-9820-0 (eBook) https://doi.org/10.1007/978-981-16-9820-0 1st edition: © Springer India 2016 2nd edition: © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd. The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore

The book is dedicated to all disadvantaged children.

Foreword

In my introduction to the first edition of this book, published in 2016, I wrote: Sometimes I despair when I hear influential people, such as politicians, business, or community leaders say: “Our children are our most precious resource.” Why do I despair? Because very often, nothing happens. Some seem to think that by making this statement, a statement we all agree with, their responsibility to children has been met. They have uttered a socially acceptable phrase and they then move on to a new topic. I hasten to add that there are others in positions of influence who do take children’s rights seriously. I applaud such people. They are the group that says children are important and do something about it.

I continue to hold that view, but am also very encouraged by the increasing number of influential scholars and practitioners from a wide range of disciplines who really are working to make a difference. The origins of the first edition go back to a remarkable conference organized in Pondicherry, India, by the editor of this book Prof. Sibnath Deb. That conference was remarkable because of the diversity of speakers and attendees. We all learned so much from each other. We often tend to confine ourselves to our own areas of specialty, be it psychology, education, therapy, medicine, or sociology, to name a few. But children in need do not recognize these distinctions. Their rights cross all of these arbitrary boundaries. The first edition was so widely read that it has resulted in this second edition, with former contributors updating their chapters as well as much new material, including chapters on nomadic children, street and working children, children living in institutions adopted children, abandoned children and the very current topic of child safety and well-being during the COVID-19 pandemic. In the not too distant future, child protection and children’s rights may be able to be helped by some of the new discoveries in science, particularly molecular genetics, that will be increasingly useful to our field such as understanding of how our childhood experiences can influence the way our genes function, leading to specific treatments and new pharmaceuticals that may one day be tailored for an individual’s genetic make-up. But while waiting for these exciting developments, we have here a volume that is relevant right now to all who work with children, whatever their profession. With vii

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its strong focus on the rights of vulnerable children in difficult circumstances, along with examples of practical strategies that have been found helpful in counteracting some of these problems, this book will broaden your knowledge beyond your own area. It is my strongly held belief that a good way to make progress in our particular professional area is to look beyond our own area and learn from others in different professional fields who work to improve the lot of children. There is so much more we can learn from others whose insights and experiences can sometimes be usefully applied to our own area. That is one of the reasons why I believe this book will be of value to a range of professionals. You will find that this book is about the rights of children and the protection of children in its broadest aspects. It is about the right of children to be free from abuse, neglect and exploitation, their right to education, their right to food and shelter, their right to be loved and to feel safe, their right to enjoy childhood, and their right to be heard. So, the next time someone in a position of influence or authority says “Children are our most precious resource,” it is our job as child advocates to hold them accountable and to say: “Actually, there is a lot that can be done.” And to ask: “What are some ways that you may be able to help?” And then to say: “How can I help? Can we combine our skills to make a difference?” Kim Oates Emeritus Professor University of Sydney Sydney, Australia

Preface

Quality upbringing of children is essential for their healthy growth and development. If a child does not receive proper care in terms of adequate nutrition, education, health care, safety as well as parents’ love and affection, a child’s potentials remain unutilized and they become vulnerable to various forms of risks. That is why the issue of child safety, welfare, and well-being has drawn the attention of international policy makers, necessitating several legislative and social welfare measures for the protection and safety of children across the world. As evidence highlights, research concerning the best practices related to quality upbringing of children in different countries also demonstrates another side of the coin, i.e., abuse and maltreatment of children in different countries, despite several legislative and welfare measures. Even in high-income countries, child safety is a serious concern for the policy makers. Reasons for violence against children are many, and it varies from country to country and child to child. Given this background, an edited book titled Child Safety, Welfare and Well-being: Issues and Concerns, edited by Sibnath Deb—a professor of Applied Psychology of Pondicherry University, was published by Springer in 2016, to disseminate the knowledge about the status of children across the society, with special reference to emerging features and measures of child safety, welfare, and their overall well-being. The book consists of 26 chapters on various dimensions of child welfare and wellbeing. In this book, highly experienced academics, researchers, child rights activities, and policy makers from both developed and developing countries have contributed chapters, and the book is well received by the readers globally, as disclosed by data. As of today, more than 34000 copies have been downloaded commercially across the world. The impressive downloads of soft copies of the book encouraged the editor to think of bringing out the second volume of the book with 30% to 40% new contents in the respective fields of child safety and welfare. In order to make it more informative, an effort was made to incorporate a few new chapters on newer dimensions of child safety and well-being. Accordingly, a group of 13 young scholars, academics, researchers, and service providers were invited to contribute chapters in the second volume based on their long field experience. Interestingly, all of them

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contributed a chapter in this volume. Again, it shows the interest of the contributors and the importance of the subject in our society. Broadly, the new areas which are going to be part of the second volume of the Child Safety book include status of children living under institutional care, untold stories of sexual abuse of tribal children challenges faced by children living in conflict zones, child living on the streets, COVID-19 and its impact on education of children, and so on. Finally, this volume comprises 32 chapters, 19 from the previous volume after necessary revision based on latest development in the field and 13 new chapters. The status of marginalized children got special importance in the second volume to draw the attention of policy makers, child rights activists, academics, and researchers, so that their issues and concerns are recognized and appropriate measures are taken to give them a platform to live in the society with self-respect and dignity and for the optimum utilization of their potentials through quality care. In turn, they can join hands with other children for making the society healthy, prosperous, progressive, and discrimination free. The broad objective of the second volume of the book is to present a comprehensive picture of child safety and welfare across the society. A number of new issues are covered in this book, which were not addressed by the previous competitive literature. The issues covered fall under four broad parts as follows:

Part I: Nature and Extent of Child Abuse and Neglect This part is comprises eleven chapters focusing on the nature of child abuse and neglect in different contexts, for example cyberbullying, problems of corporal punishment, child sexual abuse in trusted relationships, conflict and its psychosocial consequences, male circumcision, impact of work–life interface, consumerism and adult lifestyles choice on well-being of children, family violence and its impact on children and untold stories of tribal adolescent girls and (Chaps. 2–11). In Chap. 1, Sibnath Deb provides an overview of child safety, welfare, and well-being, while in Chap. 2, Kim Oates traces how various developments of understanding child protection have taken place in the past 59 years after the publication of the Battered Child Syndrome article by Kempe and his colleagues in 1962 and discusses changes in our perspective to see abuse as a children’s rights issue. Rebecca P. Ang highlights an emerging issue in Chap. 3 and describes how children and adolescents get attracted to the virtual world and indulge in the high risk behavior of cyberbullying. In Chap. 4, Sibnath Deb and Mrinalkanti Ray present the nature and extent of child abuse and neglect in India, its impact, the risk factors involved and finally discuss the poor implementation of appropriate legislations. Practice of corporal punishment in Pakistan and related legislations are the focus of Chap. 5 by Rose Ashraf and George W. Holden. In Chap. 6, Roopesh B. N. explains the impact of child sexual abuse in general and considers the children who experience the same problem from a trusted relationship and their responses to the assault. Waheeda Khan, in Chap. 7, holds out the disastrous effects of the Kashmir conflict on the lives of innocent children and calls for the need

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for immediate attention of the government to resolve this conflict. In Chap. 8, Ester I. J. Erlings speaks about the variations in legislations of different countries about the ritual of male circumcision, raises concern for the protection of child rights in terms of physical integrity and suggests the reforms of legislations. Tusharika Mukherjee discusses impact of work–life interface, consumerism, and adult lifestyles choices on child well-being in Chap. 9. In Chap. 10, Rituparna Chakraborty and Aneesh Kumar P. highlight negative influences of family violence and propose a number of preventive measures for the interest of children, while in the last chapter of Part I of the volume (Chap. 11), Saranya S., David Paul, Shayana Deb, and Sibnath Deb discuss about untold stories of sexual abuse of Paniya Tribal adolescent girls of Kerala.

Part II: Status of Children Under Difficult Circumstances In the second part, six chapters are provided (Chaps. 12–17), and these chapters focus on the status of children under difficult circumstances. For example, in Chap. 12, Aishwarya Gautam and Subhasis Bhadra discuss the challenges faced by the children of stigmatized parents. In Chap. 13, K. Bhuvaneshwari, Shayana Deb, David Paul, and Sibnath Deb present the status of children under institutional care in Puducherry based on primary data. In Chap. 14, Bishakha Majumdar discusses the challenges faced by the children during COVID-19 lockdown phase. Virgil D. Swamy, in Chap. 15, presents the status of street and working children of India and their issues and concerns based on her first-hand field experience, while in Chap. 16 Raveena Kousar and Subhasis Bhadra narrate the agony and stress of children living in conflict zones. P. Swathisha and Sibnath Deb, in Chap. 17, through light on a sensitive issue like male child sexual abuse to draw attention of the policy makers for needful intervention programs.

Part III: Child Rights, School Drop-Outs and Emerging Challenges There are four chapters in this part (Chaps. 18–21), which emphasize on adoption of disadvantaged children, impact of Internet usages by the children, school drop-out scenario, and impact of online classes. Jagannath Pati, in Chap. 18, deals with the subject of right to information versus right to confidentiality with respect to child adoption and discusses issues and concerns in case of root search of adopted children and the challenges involved in adoption. K. Jayasankara Reddy and Balasubramanian G., in Chap. 19, present the risk factors involved in prolonged usages of the Internet by the school children, whereas in Chap. 20, Vimala Veeraraghavan discusses the impact of the Right to Education Act 2009 and explains the role of teachers in imparting quality education to bring out the talents of the children. In Chap. 21, K. Jayasankara

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Reddy and Bhuvana Manohari Nataraj highlight the challenges of online classes for children in crisis and its impact on their mental health.

Part IV: Rights of Vulnerable Children The specialty of this part consists in the presentation of issues and perspectives of some categories of vulnerable children, for example children diagnosed with HIV/AIDS, the rights of children with disability, adoption of children with disability, the problems of children in precarious circumstances like disaster and adoption. There are five chapters in this part (Chaps. 22–26). In Chap. 22, Seema Sahay emphasizes the need for protection of rights of children affected by HIV/AIDS and recommends children’s rights to preventive health care, education, and life. In Chap. 23, Nilanjana Sanyal throws light on the challenges that arise after the adoption of a child, raises her concerns for vulnerabilities of adopted children to abuse and neglect, and appeals to adopted parents to be resilient enough to bring up adopted children well. In Chap. 24, Prerna Sharma critically discusses the rights of children with disability and the violation of their rights, also pointing out the barriers encountered in ensuring their rights. Chitra Shah, a social activist working with disabled children, recounts her first-hand experience, in Chap. 25, with regard to the status of disabled children, the stigma attached to disability, and emphasizes the need for community-based intervention programs to prevent the abandonment of children with special needs. In Chap. 26, Subhasis Bhadra brings to our notice the challenges faced by children in the wake of natural disasters like Tsunami and suggests a range of psychosocial measures based on his working experience with the survivors.

Part V: Protective Measures This part contains six chapters that describe field-based experiences of the researchers on the protection of child rights in different circumstances, for example mandatory reporting, sexual abuse, governance, and preventive measures (Chaps. 27–32). Child abuse and neglect differ in nature from case to case, a point addressed by Ben Mathews in Chap. 27. In his view, legal and policy response should be based on the gravity and nature of abuse and needs. Lucia C. A. Williams and Sabrina M. D’Affonseca, in Chap. 28, agree with the latest legal provisions in Brazil concerning child sexual abuse and discuss the crucial role of the media in bringing to light the incidences of sexual abuse. In Chap. 29, Lina Acca Mathew speaks in favor of a multidisciplinary approach for protection of children from sexual abuse in India. According to her, the NGOs and CBOs need to engage with the issue in order to ensure effective pre-trial and trial procedure in the interest of the child. Jenny Gray, in Chap. 30, emphasizes the need for setting up an effective system for child protection by the state government following multidisciplinary approaches.

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In Chap. 31, Akila Radhakrishnan discusses the governance and social spaces for children based on her field experience. Finally, in Chap. 32, K. Jayasankara Reddy, Sneha Vinay Haritsa, and Aeiman Rafiq discuss preventive and intervention strategies for psychogenic non-epileptic seizures in children. Although this document covers a wide range of issues related to child safety and welfare, it is very important to do further research on those issues about which we do not have much evidence. Evidence would help us to better understand the issues and to adopt corrective measures. The issues which call for particular attention of the researchers include: • Evaluation of various government social welfare and legislative measures like The Right to Education Act 2009 (The Right of Child to Free and Compulsory Education, 2009), Juvenile Justice (Care and Protection) Act 2000, Protection of Children from Sexual Offences Act, 2012, The Prohibition of Child Marriage Act, 2006, The Child Labor (Prohibition and Regulation) Amendment Bill, 2012, Integrated Child Development Scheme (ICDS), Integrated Child Protection Scheme (ICPS), and Panchayati Raj Institutions for child protection, in addition to various vocational trainings and rehabilitation programs for street children, trafficked children, and child laborers. • Follow-up study on school drop-out across the country, girl child marriage, and child trafficking in order to understand the kind of adversities they experience. • Challenges in the recovery of trafficked children and integrating them into mainstream society. • Benefits and challenges of disadvantaged children under institutional care and their mental health. • Knowledge and perception of the community about corporal punishment, sexual abuse of children, and its impact. It is hoped that this book will prove useful for psychology, law, social sciences (e.g., sociology, anthropology, social work, education, and women studies), and medical sciences (e.g., nursing, community medicine, psychiatry, pediatric, forensic medicine). It is also hoped that the book will be greatly useful to NGOs, policy makers, researchers, and law enforcement agencies working with children. The editor is grateful to all resource persons for their contributions to a good cause. Chennai, India

Sibnath Deb

Acknowledgements

The editor is grateful to all the contributors for their kind cooperation to submit the revised chapters with latest information in their respective fields. The editor is also grateful to 13 contributors who submitted a new chapter within a short notice. Special thank goes to Shayana Deb—a Master Degree Student of Behaviural Science of CHRIST (Deemed to be University), Bengaluru, India, for her assistance in bringing out this volume. The editor has chosen to refrain from making stylistic or linguistic changes in the various articles so as to retain their individualistic flavor. Efforts have been made to check the facts and thus to produce an unbiased document. Yet, if there occurs any factual or typographical errors, or errors in the citation of references, these are sincerely regretted. Sibnath Deb

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Contents

1

Introduction—Child Safety, Welfare, and Well-Being: Need of the Hour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sibnath Deb

Part I 2

1

Nature and Extent of Child Abuse and Neglect

Sixty Years of Child Abuse Awareness: Achievements, Errors and Opportunities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Kim Oates

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Bullying Among Children and Youth in the Digital Age . . . . . . . . . . . Rebecca P. Ang

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Child Abuse and Neglect in India, Risk Factors and Protective Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sibnath Deb and Mrinalkanti Ray

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The Need to Protect Children: Increasing Evidence of the Problem of Corporal Punishment in Pakistan . . . . . . . . . . . . . . Rose Ashraf and George W. Holden

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Child Sexual Abuse in a Trusted Relationship: Trauma or Confusion? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B. N. Roopesh

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Conflict in Kashmir: Psychosocial Consequences on Children . . . . . 103 Waheeda Khan

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Ritual Male Circumcision: Quo Vadis? . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Esther I. J. Erlings

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Child Well-being at the Crossroads: The Impact of Parental Work and Lifestyle Choices from a Socio-ecological Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Tusharika Mukherjee xvii

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Contents

10 Children Witnessing Violence in India: Nature, Risk Factors, Impact and Prevention Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Rituparna Chakraborty and Aneesh Kumar 11 Untold and Painful Stories of Survival: The Life of Adolescent Girls of the Paniya Tribes of Kerala, India . . . . . . . . . . . . . . . . . . . . . . . 185 T. S. Saranya, Shayana Deb, David Paul, and Sibnath Deb Part II

Status of Children Under Difficult Circumstances

12 Children of Stigmatized Parents: Concerns and Fostering Holistic Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 Aishwarya Gautam and Subhasis Bhadra 13 Safety and Welfare of Children Under Institutional Care in India: A Situation Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 K. Bhuvaneswari, Shayana Deb, David Paul, and Sibnath Deb 14 Child Safety and Well-Being During the COVID-19 Pandemic . . . . . 233 Bishakha Majumdar 15 Unfolding Children’s Agency in Ensuring Child Protection . . . . . . . . 253 Virgil Mary D. Sami 16 Children in Armed Conflict: Concerns for Safety and Measures Towards Well-Being . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269 Raveena Kousar and Subhasis Bhadra 17 Sexual Abuse of Male Children: Current Status and Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287 P. Swathisha and Sibnath Deb Part III Child Rights, School Drop-Outs and Emerging Challenges 18 Adoption: Right to Information Versus Right to Confidentiality . . . 305 Jagannath Pati 19 Misuse of Internet Among School Children: Risk Factors and Preventative Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321 K. Jayasankara Reddy and G. Balasubramanian 20 School-dropout Scenario in India and Impact of the Right of Children to Free and Compulsory Education Act, 2009 . . . . . . . . . 335 Vimala Veeraraghavan 21 Child Mental Health in the Milieu of Online Education . . . . . . . . . . . 353 K. Jayasankara Reddy, Bhuvana Manohari Nataraj, and Sukriti Pant

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Part IV Rights of Vulnerable Children 22 Child Rights in the Era of HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . 369 Seema Sahay 23 Evolving Trend of Adoption Against the Pedestal of Maltreatment and Child Rights Violation . . . . . . . . . . . . . . . . . . . . . 387 Nilanjana Sanyal 24 Rights of Children with Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407 Prerna Sharma 25 Prevention of Abandonment of Children with Special Needs Through Community-Based Programmes and Intervention . . . . . . . 429 Chitra Shah 26 Psychosocial Support for Protection of Children in Disasters . . . . . . 453 Subhasis Bhadra Part V

Protective Measures

27 Developing Countries and the Potential of Mandatory Reporting Laws to Identify Severe Child Abuse and Neglects . . . . . . 485 Ben Mathews 28 Child Sexual Abuse in Brazil: Awareness, Legal Aspects, and Examples of Prevention Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . 523 Lucia C. A. Williams and Sabrina M. D’Affonseca 29 A Multidisciplinary Approach to Child Protection for Sexual Abuse in India: The Law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 533 Lina Acca Mathew 30 Protecting Children: Building Effective Systems . . . . . . . . . . . . . . . . . 551 Jenny Gray 31 ‘I Need My Space’: Governance of Social Spaces from Child Lens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 565 Akila Radhakrishnan 32 Psychogenic Non-epileptic Seizures in Children: Prevention and Intervention Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 577 K. Jayasankara Reddy, Sneha Vinay Haritsa, and Aeiman Rafiq

Editor and Contributors

About the Editor Sibnath Deb Ph.D. and D.Sc., is Director of Rajiv Gandhi National Institute of Youth Development (RGNIYD) , Sriperumbudur, Tamil Nadu, India. Prior to joining RGNIYD, he taught at the Department of Applied Psychology, Pondicherry University (A Central University), and at the University of Calcutta. In 1994, he completed an intensive course on ‘HIV/AIDS and Qualitative Research’ from the University of Western Australia. During April 2009 to August 2009, he visited the School of Public Health, Queensland University of Technology (QUT), Brisbane, Australia, as Visiting Faculty. Currently, he is also Adjunct Professor of the School of Public Health and Social Work, QUT, Australia. He has 29 years of teaching, research, and administrative experience and has published a large number of research articles in leading national and international journals as well as in edited books. He has written six books and edited five books. His latest book titled Disadvantaged Children in India: Empirical Evidence, Policies and Actions Being has been published by Springer in 2020. His other books include Social Psychology in Everyday Life (SAGE, 2019); Childhood to Adolescence: Issues and Concerns (Pearson, 2019); Positive Schooling and Child Development: International Perspectives (Springer, 2018); Child Safety, Welfare and Well-being (Springer, 2016), and Distance Education: Prospects, Challenges and Way Forward (Pearson, 2018). His research interests include child safety, students’ mental health, adolescent reproductive health, family relationships, child care, happiness, and applied social psychology. He has got three international and five national awards for his contribution in academics and research including an award from the Asiatic Society, Kolkata (an institute of national importance under the Ministry of Culture, Government of India) in 2018 and “Visitor’s Award 2019” for his contribution in the field of child protection, students’ mental health and HIV/AIDS.

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Contributors Rebecca P. Ang Associate Professor, Psychological Studies Academic Group, National Institute of Education, Nanyang Technological University, Singapore, has long research and teaching experience. After completion of Master of Communication Studies from the Nanyang Technological University, Singapore in 1996, she did Ph.D. from the Texas A&M University, USA, in 2000. She is Registered Psychologist of the Singapore Psychological Society and Nationally Certified School Psychologist (NCSP), USA. Internationally, she is known for her significant contribution to the field of students’ mental health, especially on academic stress and anxiety of students. She has published more than 90 research papers in referred journals, written five books, and 11 book chapters in addition to producing a number of Ph.Ds successfully. For significant contribution to the academic and research field, she has received five awards like (i) International Council of Psychologists Seisoh Sukemune/Bruce Bain Early Career Research Award 2006. This award was given in recognition of outstanding early career contributions to scholarly endeavors addressing psychological issues of multinational significance, (ii) NTU Research Outcome Award and Recognition (ROAR) 2006. This award was given in recognition of research productivity and impact, (iii) School Psychology Review Outstanding Article of the Year Award 2002. Rose Ashraf is a graduate student in clinical psychology in the Department of Psychology at Southern Methodist University. She received her BS in Psychology from The University of Texas at Dallas. While obtaining her undergraduate degree, she worked with Dr. Marion Underwood studying adolescents’ relationships with their peers. As a student at The University of Texas at Dallas, she received several awards including the Buhrmester Research Award, Santrock Travel Award, Dean’s Scholar Award, and the Mary McDermott Cook Outstanding Student Award. She worked with Prof. Holden George in a project on parent–child relationship under the direction. Her thesis involves an examination of verbal negatives (e.g., yelling, threats, verbal hostility) directed at children by their parents based on audio recordings in the home. Currently, she is working as Instructor in Psychology, Harvard Medical School, Department of Psychiatry and Behavioral Sciences. G. Balasubramanian is Founder and MD of Aadya Tathva®. He is Senior Counseling Psychologist, Lead Trainer, Asian Healing Practitioner, Interdependent Researcher, Certified International Gatekeeper Professional from QPR Institute, Certified Seizure First Aid Professional from Epilepsy Foundation, USA, and Certified Mental Health First Aid Professional from National Council for Mental Wellbeing, USA. He is also General Council Member at Indian Epilepsy Association (IEA), Bangalore Chapter, and a professional member at International Association of Applied Psychology (IAAP). He has rich experience as Counseling Psychologist, Lead Trainer and Holistic Wellness Practitioner and has worked across different mental health settings. Also, he had delivered corporate training programs in different

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verticals of retail industries. He has been a guest speaker at various educational institutions across India, where he has presented on topics such as digital addiction, substance abuse, skills for early career psychologists, and holistic education. He has written articles on harmful Internet use and digital addiction for prominent newspapers and a health magazine. He also contributes to a scientific blog dedicated to bringing science to the general public (ORCID ID: https://orcid.org/0000-00029535-4674). Subhasis Bhadra MSW, M.Phil., Ph.D., Assistant Professor, and Head of the Department of Social Work, Gautam Buddha University, Greater Noida, Uttar Pradesh, India, began his career working with those affected by the Gujarat earthquake (2001) and subsequently worked in areas affected by riots (Gujarat, 2002), tsunamis (Southern India and Southeast Asia, 2004), earthquakes (Kashmir, 2005), terrorist attacks (Mumbai serial Train Blast, 2006), Japanese tsunami (2011) creating and implementing psychosocial programs with organizations, like Care India, American Red Cross, Oxfam India, Action Aid, International Medical Corps. K. Bhuvaneswari is working as Assistant Professor and Head, Dept. of Psychology in Kasthurba College for Women, Pondicherry. She did her Master of Rehabilitation Science and has specialized in child psychology and worked as Program Coordinator in special schools for children with Mental Retardation. She has served as Member, Child Welfare Committee, Government of Pondicherry, for two terms lasting six years. She completed her doctoral degree in Psychology, (Mental Health of Children under Institutional Care-An Empirical Investigation) from Pondicherry University. Rituparna Chakraborty currently works as Assistant Professor in the Department of Psychology, CHRIST (Deemed to be University), Bengaluru, India. She has previously worked as a faculty member at AIMS Institute of Higher Education, Bangalore. She has been part of research projects of Indian Council for Social Science Research ((ICSSR). She completed her graduate, postgraduate, and doctoral studies from University of Calcutta. Her teaching specializations are developmental, social, and media psychology. She has presented multiple scientific papers and symposium presentations in national and international conferences. She is a regular reviewer of scientific papers in international journals, like—Polish Psychological Bulletin and SAGE journals. She is a member of National Academy of Psychology (NAOP). She has multiple publications in SCOPUS indexed journals. Her research interest lies in the areas of—social and systemic oppression and violence, qualitative research methodology, gender studies, body and subjectivity, Foucauldian power politics, existentialism, interpersonal relations and identity, life space and positive psychology. Sabrina M. D’Affonseca is Postdoctoral Researcher at the Universidade Federal de São Carlos (Federal University of São Carlos), UFSCar, in Brazil, conducting a national research on Special Education. She is Associate Researcher of LAPREV (The Laboratory of Analysis and Prevention of Violence) supervising research in domestic violence, especially in mother–child interaction. She has a Ph.D. in Psychology from the University of São Carlos, Brazil, an M.A. in Special Education

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also from the University of São Carlos, Brazil, and a B.A. Degree from the University of São Carlos, Brazil. She made an internship in the Department of Psychology at Southern Methodist University (SMU), in Dallas (2011–2012) with Prof. George W. Holden. She is author of eight papers in peer-reviewed scientific journals and wrote six chapters of books. She was Professor at University of São Carlos for 4 years and at Centro Universitário Central Paulista—Unicep (Central University Center Paulista) for 2 years, teaching graduate courses. She has made presentations at national and international conferences. Shayana Deb is a student of triple major with biotechnology, chemistry, and botany at the undergraduate level, currently pursuing Master Degree in Behavioral Science in the CHRIST (Deemed to be University), Bengaluru, Karnataka, India. She has a special interest in child protection and student mental health. On a voluntary basis, she worked in two research projects which created interest in her on child welfare and well-being issues and positive development of adolescent and youth. ORCID ID: https://orcid.org/0000-0002-7073-7185 Esther I. J. Erlings is Lecturer in Law at Flinders University, Australia. She holds degrees from Utrecht University (LL.B.), Maastricht University (LL.M.) and The Chinese University of Hong Kong (Ph.D.). Her research focuses on ways in which the law and dispute resolution empower—or disempower—traditionally disadvantaged groups in society, such as children and minorities. She works mainly within the broader areas of family law (especially parental responsibility and parent–child mediation), law and religion and health law. She is, inter alia, the author of Freedom of Religion within the Family: From Coerced Manifestation to Dispute Resolution in France, England and Hong Kong, Book Review Editor for the International Journal of Law, Religion and State, and Member of the Management Committee of the Law and Society Association of Australia and New Zealand (LSAANZ). Aishwarya Gautam is a doctoral student in the Department of Social work, Central University of Rajasthan. She did her Master’s in Social Work (MSW) from the Udaipur School of Social Work, Rajasthan. She worked for 3 years with a grassroots level organization, Unnati Sansthan, on a UNICEF-based project which focused on enhancing early childhood development in rural areas of Udaipur by promoting the involvement of caregivers and building the capacities of frontline workers. She believed in the inevitable benefits of working with children in early childhood which ignited her desire to dig deeper to explore the domain. Her research is titled “Development in Early Childhood among Children of Stigmatized Parents.” She has conducted a study with stigmatized groups of rag-pickers and their children and has presented a paper on the same. Jenny Gray is a trained social worker in New Zealand and has worked in child welfare settings there and in the UK. She joined the British Government in 1990 and has held a number of roles, including working on the development of methodologies to inspect children’s services and developing policies, including on assessment, and related materials to support their national implementation. Her current responsibility

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is to provide professional advice on child protection in the Department for Education. She has lead responsibility for a number of policy areas including reviewing child deaths. She has been a member of ISPCAN since 1992 and the Council since 2004. Since joining ISPCAN, she has been involved in the Working Group on Child Maltreatment Data. She chaired the External Relations and Consultancy Committee during 2008–2010, edited the LINK for six years and World Perspectives in 2010. She has been a member of the Organizing Committee for a number of ISPCAN conferences and congresses and will assume the Presidency of ISPCAN in September 2012. Currently, she is acting as Honorary Lecturer, Great Ormond Street Institute of Child Health, University College London, UK, and as Director of Child and Family Training, UK. She was the Past President of the International Society for the Prevention of Child Abuse and Neglect. George W. Holden is Professor of Psychology at Southern Methodist University in Dallas, TX. His research interests are in the area of social development, with a focus on parent–child relationships. His work, into the determinants of parental behavior, parental social cognition, and the causes and consequences of family violence, has been supported by grants from the National Institute of Child Health and Human Development, National Institutes of Justice, Department of Health and Human Services, the Guggenheim Foundation, the Hogg Foundation for Mental Health, and most recently, the U.S. State Department. He is the author of numerous scientific articles and chapters, as well as two books. Parenting: A Dynamic Perspective (2010) and Parents and the Dynamics of Child Rearing (1997). In addition, he co-edited Children Exposed to Marital Violence (1998) and the Handbook of Family Measurement Techniques (2001). He is a fellow of the American Psychological Society and a member of the Society for Research in Child Development, the American Professional Society on the Abuse of Children, and the Society for Research in Human Development, where he served as president. He has been or is on the editorial boards of Child Development, Developmental Psychology, Journal of Emotional Abuse, Journal of Family Psychology, and Parenting: Science and Practice. K. Jayasankara Reddy has an M.Sc. and Ph.D. in Psychology in the area of neuropsychology, also has a degree in Clinical Neurophysiology. He has been an active teacher, researcher, and practitioner in the field of health, cognitive neuropsychology, and neuroscience since then. Presently, he is working as Professor, Department of Psychology, and Coordinator for Centre for Research at Christ University, Bangalore, India. He has guided and graduated 12 Ph.Ds. and 15 M.Phils. by research and more than 90 postgraduate research project students in the area of health, neuropsychology, and cognitive neuroscience. He has published more than 100 research articles in peer-reviewed journals, presented his research at more than 60 national and international conferences, and has also organized many conferences of national and international significance. He is the recipient of Indian School Psychology Association (InSPA)—P. K. Subaraja Trust Best Performance Award—2017 for his valuable services and contributions to the promotion of school psychology in India. Also, he received National Stress Management Research Award 2017 in recognition of positive contribution to the subject of stress management from

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the International Stress Management Association (ISMA). All through his career, he is identified for successful contribution as a teacher in the field of cognitive neuropsychology and neuroscience and as academic administrator at various capacities while maintaining a very high level of research output in terms of quality as well as quantity (ORCID ID: https://orcid.org/0000-0002-6071-0472). Waheeda Khan is currently working as Professor of Faculty of Behaviural Sciences and Advisor to SGT University, Haryana, India. Prior to that she worked as Head of the Department of Psychology and as Director of the University Counseling & Guidance Centre, Jamia Millia Islamia (A Central University), Delhi, India. She has more than 23 years of teaching, research, and administrative experience. She has supervised/supervising 27 doctoral students and published more than 50 research papers. Her research areas are related to environment, terrorism/violence, counseling, mental health, stress, emotion and coping in adolescents, youth, and women. She has been awarded JRF/SRF and Post-Doctoral Research Associate awards by the Government of India and Fellowship of the Year Award by NESA. She has been the recipient of ARTS program twice, which is organized by International Union of Psychological Sciences. She has been recently appointed Adjunct Faculty, Co-guide, and Member of Ph.D. Advisory Committee, Texila American University (Distance & Online Program), Georgetown, South America. e-mail: [email protected] Raveena Kousar MSW is a doctoral student in the Department of Social Work, Central University of Rajasthan. She completed her Master’s in Social Work from the Central University of Jammu. She worked with few civil society organizations working in the areas of Jammu and Kashmir for the social welfare and development of the marginalized communities. Currently, she is working on the research topic “Impact of border conflict on the development of the children in the frontier areas of Jammu region.” She has presented her research work in international conferences and published the chapters in the book on Indigenising Social Work Practices in India and Governance and Security Issues in South Asia. Her research article titled “Border Conflict: Understanding the impact on education of the children in Jammu Region” was published in 2021 in Journal of Peace Education, from Routledge (Taylor & Francis). P. Aneesh Kumar Ph.D. is Assistant Professor of Psychology in the Department of Psychology, CHRIST (Deemed to be University), Bengaluru, India. He serves as the coordinator for pre-doctoral (M.Phil.) and undergraduate programs in Psychology. He is involved in major research project on student mental health through positive schooling program, school mental health and the United States-India Education Foundation Project with Miami University to develop a training model for culturally competent and evidence-based mental health care for diverse societies. His research interests include child and adolescent development, childhood experiences and student mental health. He teaches papers in child and adolescent counseling, counseling interventions for special population, development psychology, and qualitative research methods. He has published and presented papers in various

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national and international forums in the areas of public health, child and adolescent psychology ([email protected]). Bishakha Majumdar Assistant Professor, Indian Institute of Management (IIM), Vishakhapatnam, has been in teaching and research for the last five years. She has 12 national and international publications, and her works have been recognized with, among others, an Honourable Mention (ISB-Ivey Global Case Competition 2015), the Best Management Research Award 2013 (National Academy of Psychology), Best Publication Award 2012 (Journal of Indian Academy of Applied Psychology), and the Young Scientist Award, 2011 (Indian Academy of Applied Psychology). She has also conducted several management development programs with organizations such as Coal India and Oriental Insurance, in the areas of communication, leadership, and employee motivation. She has also been Master Trainer for HIV/AIDS counselors under the World Bank GFATM Program. Organizational behavior, psychology, and human resource management are the areas of her teaching interest. She co-authored a book titled Disadvantaged Children in India: Empirical Evidence, Policies and Actions, 2020, (Springer Nature Singapore). Lina Acca Mathew Assistant Professor, Government Law College, Ernakulam (former name—His Highness Maharajas Law College), Kerala, has been carrying out her doctoral research on child sexual abuse-related legislations. She has a special interest for protection of children from sexual abuse. She has attended several national and international conferences on child abuse and neglect and presented papers. Ben Mathews Ph.D., LLB, BA is Director of Research in the School of Law at Queensland University of Technology in Brisbane, Australia. He conducts interdisciplinary research at the forefront of international scholarship in child abuse and neglect, public policy, and law. He has published over 50 scholarly works on children and the law, with a key focus on mandatory reporting law, theory and practice, and civil claims for child abuse. He has an international reputation, holds adjunct positions at two overseas institutions, and is a member of the editorial board of the leading journal in the child abuse field. He is now co-editing a major new book on mandatory reporting laws, which will be published in 2014. In recent years, he has undertaken major studies of the law, theory, and practice of mandatory reporting laws. He has been involved in the two largest empirical studies of mandatory reporting in Australia: a study of Queensland nurses’ reporting of all types of child abuse and neglect and leadership of a three year Australian Research Council-funded study of teachers reporting child sexual abuse in Queensland, New South Wales, and Western Australia. Results of the ARC study led to: significant reform of Queensland legislation (2012 amendments to the Education (General Provisions) Act 2006); improvements to reporting policies and teacher training (in Queensland and Western Australia, and elsewhere); and delivery of innovative teacher training methods. Tusharika Mukherjee is an industrial and organizational psychologist working in the areas of diversity, performance, and personality relationship and creating sustainable work organizations. She obtained her Ph.D. in Applied Psychology from the University of Calcutta and pursued her postdoctoral research in the area of situation

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contingent performance variability in the Department of Work and Organizational Psychology, Justus Liebig University Giessen, Germany. At present, she is associated with the Centre for International Development and Environmental Research at Justus Liebig University Giessen, Germany, as an independent lecturer and trainer. She has over thirteen years of experience in university teaching, research, conducting skill development workshops, and consultation. Her other academic and research experiences include intercultural communication competence, work-life integration, team and leadership development, and didactics (ORCID ID: https://orcid.org/0000-00025837-0990). Bhuvana Manohari Nataraj is a Ph.D. scholar pursuing her doctorate in Psychology at CHRIST (Deemed to be University), Bengaluru, India. After completing her M. Sc. in Applied Psychology and M.Phil. in Psychology, she worked with corporate clients and non-governmental agencies in the areas of psychological assessment, counseling and psychotherapy, and training and development. Her areas of interest include counseling and psychotherapy, positive psychology, mindfulness-based programs, school psychology, and psychosocial well-being. In the long run, she seeks to work toward enhancing well-being in schools and educational institutions (ORCID ID: https:// orcid.org/0000-0002-8868-1220). Emeritus Professor Kim Oates M.D., D.Sc., MHP, FRACP, FRCP, FAFPHM, FRACMA, DCH is a pediatrician who trained in the Sydney, London, and Boston. Most of his professional work has been associated with the Royal Alexandra Hospital for Children (now The Children’s Hospital at Westmead) and the University of Sydney, Australia. He has a long-standing interest in child development, child behavior, and the problems of child abuse, neglect and advocacy on behalf of children. In 2000, he received the Kempe award from the USA for “Outstanding contributions to the community on behalf of children,” the first time this has been awarded outside the USA. He has been on Council of the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) for two periods, each of 12 years, including 2 years as president and 6 years as treasurer. He has written 13 books and has over 300 publications. He is currently Emeritus Professor of Pediatrics at the University of Sydney and Director of Undergraduate Quality and Safety at the Clinical Excellence Commission where he has a focus on teaching about how errors in hospital can be reduced. Sukriti Pant is Postgraduate student at Azim Premji University, Bengaluru, while also holding the position of Director of Programs at Empowered, an education management solutions company. Prior to this she has worked with Teach for India as a Teaching Fellow at a Government Higher Primary School in Bengaluru, Karnataka. Her areas of interest include social studies curriculum and pedagogy, teacher professional development, child development and learning, and inclusive education. Jagannath Pati is an India-based rehabilitation specialist with over 30 years’ experience working across national and international platforms. He has substantive experience working in multicultural environments with diverse population groups, with

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experience spanning on-ground field work and communications research and policy issues related to children in need of care and protection. He has extensive experience with central government and autonomous bodies and has demonstrated competence in initiating and maintaining close, cross-cultural partnerships at the national, state and regional levels of stakeholders including children homes, non-government organizations, and civil societies. He has been actively involved in capacity building and promoting national resource mobilization in India particularly for service providers of children in need of care and protection. He is Senior Fulbright Awardee and has published a number of books and volume of literature on development issues. He has contributed several papers in national and international conferences. David Paul has 21 years of experience as Research Associate at National Institute of the Visually Handicapped-Regional Centre (Govt. of India) and served as Training and Placement Officer where he undertook research studies pertaining to jobs identification for the visually impaired and their performance evaluation. He previously taught Career Counseling and Counseling Psychology at RGNIYD, an apex organization of the Union Ministry of Youth Affairs and Sports. He is currently Training Officer at RGNIYD. His passion areas include training, teaching, research, documentation, and dissemination on youth issues and specialize in applied psychology, career counseling and disability rehabilitation. Akila Radhakrishnan is Social Policy Specialist at UNICEF Chennai office for Tamil Nadu and Kerala. Her current work is on public policy for education to promote holistic development of adolescents and to meet the country’s expectations from its young population. She has a doctorate in Sociology and had a postdoctoral ford foundation fellowship for exploring educational inequalities. She is UK Government’s Chevening Gurukul Fellow for leadership and excellence, 2020. At UNICEF since 2011, she has led programs related to reducing poverty, vulnerability, and social inequality. She has leveraged successful partnerships that have improved child nutrition, health, education, and social protection, especially among the poor and marginalized population. Her innovative pilots in child-friendly local governance, child-sensitive social protection, and localizing the global sustainable development goals have influenced policy makers and planners. In COVID context, she serves in high-level government committees. Earlier, she worked with academic institutions such as Madras Institute of Development Studies and Madras School of Economics. She offered research- and evaluation-based consultancies for ILO, UNDP, DFID, and other national and international human rights-based organizations. She loves to travel, meet people, and philosophize about life in her unpublished writings. She wrote this paper as an outside activity from her regular job with UNICEF. Aeiman Rafiq has completed her M.Sc. in Clinical Psychology from CHRIST (Deemed to be University). She is an active researcher who aspires to work in the field of clinical psychology. Her areas of interest include neuropsychology, addiction, metal health, and psychological disorders. Mrinalkanti Ray a child right activist received a master’s degree in English Literature from the University of Calcutta and an M.Phil. degree in English Literature from

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Rabindra Bharati University in the City of Calcutta. Later, he earned a Ph.D. degree in English Literature from the University of Laval (Université Laval), Canada. The subject of his doctoral dissertation is William Wordsworth, exploring his debt to the French Enlightenment and original reworking of French Enlightenment ideas. He wrote this dissertation under the joint supervision of Dr. Kathryn Ready (now Associate Professor in the Department of English at the University of Winnipeg) and Dr. Thierry Belleguic (a full professor in the Department of Literatures at the Université Laval). He completed the Diplôme supérieur in French at the Alliance Française de Calcutta. Among his areas of research interest are eighteenth-century and British Romantic literature. He has presented papers at several conferences, including one at the University of Oxford. He has taught several undergraduate courses of English literature at the Université Laval. B. N. Roopesh has been teaching in the Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India. After obtaining Ph.D. from the NIMHANS, he did Postdoctoral Research in the Downstate Medical Center, New York, USA. He has published 14 research papers and presented papers in 16 conferences. Till date, he has completed six research projects successfully. Seema Sahay is an anthropologist and has completed her Master’s and Doctorate from Department of Anthropology, University of Delhi (Delhi). Currently, she is working as Scientist at National AIDS Research Institute, Pune (India). She has successfully led clinic- and field-based qualitative, quantitative, and descriptive epidemiological research studies. She has completed over 15 national and international collaborative projects as Principal Investigator and Co-investigator. Major areas of her research are HIV prevention, care and support, mental health, pediatric and adolescent HIV/AIDS, and clinical trials. Currently, she is leading studies on new prevention technologies, pediatric and adolescents HIV/AIDS, mental health and HIV prevention and care in rural India. Her other academic affiliations are: Faculty for Ph.D., Department of Anthropology, University of Pune (Pune); Faculty for Ph.D. in Health science, Symbiosis International University (Pune); Faculty for MPH program at KLE University (Belgaum). She is Member of Ethics Committee at National Institute of Virology (Pune) and Bharti Hospital and Medical College, Bharti Vidyapeeth (Pune). She is in the editorial board of several peer-reviewed journals. She has published over 42 papers in national and international journals and has authored book chapters and coauthored a book. Virgil Mary D. Sami a professional social worker has nearly four decades of experience in working on Child rights. She is the founder and executive director of Arunodhaya Centre for street and working children, started in 1992. Elimination of child labor practice, ensuring education rights for the underprivileged children, creating awareness and initiating preventive and protective action against child abuse, child sexual abuse, drug abuse and prevention of child marriage are major areas of actions by him to protect and promote child rights. A child-centric approach is adopted

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enabling children to exercise their right to participation through child-led organization and creating spaces for children to voice their opinion on issues concerning them. Nilanjana Sanyal Department of Psychology, University of Calcutta, has 30 years of work experience as teacher, psychoanalyst, and psychotherapist. She has imparted training in counseling in various governmental institutions and NGOs, both nationally and internationally. She has to her credit a number of national and international publications and is also a columnist in different national dailies and magazines. She has edited a book and is a co-author of a Test Manual. She has 19 book chapters to her credit till date. Her research interests include personality and clinical psychology, interpersonal relationships, and psychodynamic psychotherapy. She is Co-Researcher for the creation of registered assessment methodologies, namely the Fairy Tale Test (FTT) with Dr. Carina Coulacouglou, University of Athens, Greece, and State Trait Anxiety Inventory—2 Children and Adolescents (STAXI—2 C/A) with Dr. Thomas Bruner and Dr. Charles D. Spielberger, University of South Florida, Tampa, USA. She is Gold Medalist of Calcutta University. She received Jubilee Merit Prize and Jawaharlal Nehru Award from Government of India along with the Subhashini Basu Memorial Prize from Indian Psychoanalytic Society for excellence of a research paper. She is the recipient of Bharat Jyoti Award, 2012 for meritorious achievement and life time contribution to social works, and Prof. Maya Deb Memorial Award from Asiatic Society, Kolkata, 2012 apart from other awards. T. S. Saranya is working as an assistant professor in the Department of Psychology Sree Narayana College, Vadakara. Her areas of interest are adolescent mental health, major neurocognitive disorder and developmental psychology. She pursued her Doctoral Degree from Pondicherry University under the supervision of Prof. Sibnath Deb. She published around 15 articles in both national and international journals and published a book on Mental Health of Adolescents Significant Predictors and Risk Factors with Lulu Publishers USA. She is highly passionate about qualitative and mixed method research among cultural minorities. Chitra Shah Director of Satya Special School, Puducherry—a Centre for Children with Special Needs has been working with disabled children for the last 25 years. She has a special interest in delivering services to the children with special needs at the community level in addition to delivering institution-based support services. Under her dynamic leadership, a group of multidisciplinary professionals are able to deliver quality services to the children with special needs which really made the differences in an isolated Union Territory like Puducherry. Prerna Sharma is presently Assistant Professor in the Department of Social Work, SNDT Women’s University, Mumbai, since 2007. She has also worked with Tata Institute of Social Sciences as a lecturer for four years prior to that from 2002, when she moved from social work practice in field to education. She has worked with several organizations like the United Nations High Commissioner for Refugees, Spastics Society of India, Mumbai (now known as ADAPT) and SHARE,

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a community-based organization working to empower women by building leadership and social action skills in them. She is a member of board of trustees, SHARE and member of the Advisory Board of Sanskar India Foundation in Mumbai. She has presented papers in national and international conferences and published articles in journals. She successfully completed international training program linking Development and Human Rights conducted by Dignity International. Her work and research interests lie in the areas of child rights, disability and inclusion, human rights and the concerns and issues of senior citizens. P. Swathisha a Ph.D. scholar of the Department of Applied Psychology, Pondicherry University, has been carrying out her research on issues and challenges of commercial sex workers in Puducherry. She has published one book chapter and one article and attended a number of workshops and conferences. Vimala Veeraraghavan Ph.D. (Psychology) from Delhi University has 40 years of teaching, administrative, and research experience in the field social sciences, which includes psychology, educational psychology, clinical psychology, mental health, forensic psychology and related subjects in central universities like Delhi University and Jawaharlal Nehru University, Indira Gandhi National Open University, and the only private university Amity University. She has received several awards for her academic achievements. Important positions held include (i) Emeritus Professor, Psychology, Indira Gandhi National Open University, New Delhi; (ii) Professor of Psychology and Director General, Amity Institute of Behavioural Health and Allied Sciences, Amity University Uttar Pradesh; (iii) served as Professor and Head, Department of Applied Psychology University of Delhi South Campus, New Delhi, and (iv) Professor and Head, Department of Psychology, Delhi University. She has been Visiting professor to Thammasat University, Bangkok, Thailand. She served as an expert consultant to various national-level bodies in government and private organizations. Sneha Vinay Haritsa is currently pursuing Ph.D. at CHRIST (Deemed to be University). She has graduated with a M.Sc. Clinical Psychology from CHRIST (Deemed to be University). She has also worked as a research scholar and an adjunct faculty before starting her doctoral education specializing in the areas of neuropsychology and family therapy. Her areas of interest include neuropsychology, family interventions, and biopsychosocial approaches. Being a budding researcher in the field, she has written chapters for two edited books and an article in the field on neuropsychology. She aspires to practice as a family therapist and continue research in the fields of neuropsychology and family therapy (ORCID ID: https://orcid.org/00000002-6169-5884). Lucia C. A. Williams is Retired Faculty of the Department of Psychology at the Universidade Federal de São Carlos (Federal University of São Carlos), UFSCar, in Brazil, where she coordinated The Laboratory of Analysis and Prevention of Violence (LAPREV), doing research, teaching, and community outreach efforts in addressing and preventing violence, particularly family and school violence. She is the author of 14 books and over 80 papers in peer-reviewed scientific journals. She

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has received many awards, such as her work as considered “Exemplary Practices in the Perspective of Gender and Ethnicity in Health” by the Pan American Health Organization, PAHO/WHO, and Third Prize in Prevention of Child Abuse by the Women’s World Summit Foundation (WWSF), in Geneva, both in 2009. She was a visiting professor twice in Argentina, teaching graduate courses at University of Mar Del Plata (2010), and National University of Cordoba (2012). She has several international research partnerships, such as with the American Psychological Association (APA) for validation in Brazil of the ACT parental training program, the University of California at Davis for a mutual research project on Parental Alienation, and the Children’s Hospital at Westmead/Sydney, Australia, for validating to Brazil Shaken Baby Syndrome prevention materials. She was twice the Vice-President of the Brazilian Psychological Association (2009–2013).

Chapter 1

Introduction—Child Safety, Welfare, and Well-Being: Need of the Hour Sibnath Deb

Introduction Child safety and protection has become a concern for global public health policy makers resulting in various initiatives in terms of policies and programs for protection of child rights. In order to address the issue, meaningful and well-planned partnership between various agencies is required (Raman et al., 2021). Human civilization made substantial progress in terms of technological advancements, infrastructure, and economic growth. But when it comes to protection of child rights, the reality is very disturbing, especially in the countries where continuous fighting is going on between various groups for capturing power and the entire global community is watching the situation expressing helplessness. In that situation, hardly anybody thinks for the welfare and well-being of children in conflict zones. Mother is the first social agent for a child, and mother’s care and concern for healthy child upbringing make a big difference for overall child growth and development. Biological parents or immediate caregivers are generally responsible for the safety and protection of children. If biological parents or immediate caregivers fail in their duties, the concerned local government is then obligated to take care of children, as per the verdict of the United Nations Convention on the Rights of the Child (1989). That being said, to ensure the safety and protection of child rights is everybody’s responsibility, and this responsibility has been recognized by the international community in 1989 through the United Nations Convention on the Rights of the Child (CRC). Violence against children in any form constitutes a violation of the basic rights of children. During childhood, young people deserve unconditional love from their parents, as well as all the necessities for proper physical, mental, and social development (Deb, 2010). A fundamental assumption of the United Nation Convention is that family should be the natural environment for the growth and well-being of all S. Deb (B) Rajiv Gandhi National Institute of Youth Development, Sriperumbudur, Tamil Nadu, India © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_1

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its members, particularly its children. Yet, very regrettably, it is in the family where child abuse occurs most often.

Phenomenon of Child Safety, Welfare, and Well-Being in Different Social Strata A large number of children irrespective of age, gender, caste, religion, and socioeconomic background are not safe in today’s society, whether at home or in educational institution or in the community (Deb & Mukherjee, 2011; Deb & Walsh, 2012; Deb et al., 2020; Pinheiro, 2006). They are treated as minor and unimportant by elderly people. Although children constitute a substantial percentage of the global population, they form a minority in matters of legal protection, government policy, and benefits as citizens. Almost always, they find themselves at the mercy of their immediate caregivers for their safety and welfare (Deb, 2009). As in other Asian countries, violation of child rights is quite common in India owing to the insensitivity of the communities to child rights (Chiang et al., 2012; Chou et al., 2010; Nguyen et al., 2010). Although reliable national-level data and international-level data are not available, there exists data based on regional studies, which indicate that the problem is serious and deep-rooted (Deb & Modak, 2010; Deb & Walsh, 2012: The Report of MWCD, GOI, 2007). Similarities are observed in the developing countries regarding child safety and welfare issues. Violence against children in Asian countries is directly linked to socioeconomic and demographic variables of a given society. Developing countries can generally be divided into three groups in terms of income, namely low-, middle-, and high-income groups. Each group has its own set of beliefs and practices when it comes to parenting. The nature of child abuse and neglect varies in keeping with different socioeconomic strata. In low-income families, child abuse and neglect result from illiteracy and poverty (Deb, 2009). The highest rates of school dropout, petty crimes, juvenile delinquency (Deb & Mitra, 2001), and child mortality and morbidity are found among the children of lower social strata. These children become vulnerable to sexual abuse, exploitation, and trafficking (Deb, 2005; Deb et al., 2005). The gender discrimination is caused by multiple social and cultural factors. Girl children are considered as burdens to the family and are discriminated against with respect to nutrition, education, and medical care. Issues of girl child marriage and adolescent pregnancy are recurrent in this class of society, putting at risk the lives of both the mother and the child (Deb, 2009). Since parents of low-income families remain busy earning wages for their livelihood, they can hardly look after the child’s safety and well-being. Poor income is one of the main causes of family disturbances which children witness. As a result, they tend to become emotionally disturbed. Family disturbances and lack of supervision for studies lead to a high number of school dropouts, lowering the literacy rate and increasing the crime rate. There are many similarities in child rearing practices and disciplining methods of the people of upper-

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and middle-income groups. Issues of abuse relate mostly to the parenting styles and unrealistic expectations of the parents regarding the child’s education and career (Deb & Chatterjee, 2008). Parents psychologically put pressure on children and do not hesitate to inflict corporal punishment in the hope of better academic performance, which often leads to depression and anxiety among the children (Deb, 2004). Many studies reported the detrimental effects of child abuse and neglect on their physical and mental health (Azi & Saluhu, 2016; Deb & Madrid, 2014; Pinheiro, 2006; Toth & Manly, 2019; WHO, 2010). UNICEF (2009) Multiple Indicator Cluster Surveys covering 37 low-income countries revealed that almost 86% of children aged 2–14 years suffered both physical and psychological aggressions.

COVID-19 and Its Impact on Education and Mental Health of Children The outbreak of COVID-19 in the beginning of 2020 compelled all the educational institutions to close down for safety of the children, and thereafter, the lockdown phase continued for more than 18 months. Confinement at home caused a lot of stress for children, especially the children living in 2 or 3 bedroomed flats (Phelps & Sperry, 2020). All examinations were canceled. However, classes were continued through virtual mode, especially in the urban or semi-urban schools. Attending continuous classes from morning to evening was highly stressful for children. Internet connectivity and fluctuation of power in some localities caused serious problems for some children in attending the online classes. COVID-19 did not affect children emotionally only (Pierce et al., 2020); it adversely impacted their learning process and created a big division between urban and rural children. Unfortunately, children living in semi-urban and rural areas were deprived from education because of poverty and lack of Internet and computer facilities.

International Efforts for Child Safety and Prevention of Child Abuse Considering the gravity of the problem, the United Nations (UN) declared November 19 as the World Day for Prevention of Child Abuse and Violence against Children. The UN thus seeks to raise awareness about children’s rights so that they are treated with love and respect. Certainly, it is a laudable move, as it contributed to increase awareness among the common people about child rights. As a result of the efforts of different international and professional organizations like UNICEF, SCF, Oak Foundation, ECPAT, OXPAM, ILO, Plan International, ISPCAN and research works

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of academics, direct activities in the field by the social activists and communitybased organizations, new legislations, policies, and programs are being drafted and enforced to ensure the safety of the children worldwide. Recognizing children’s rights to safety and protection from all forms of physical and mental violence, as many as 37 countries have already put a ban on corporal punishment in all venues. This project is monitored by the Global Initiative to End all Corporal Punishment of Children (www.endcorporalpunishment.org). It is salutary that more and more developing countries are bringing in legislation to entirely ban corporal punishments.

Latest Efforts by the Government of India for Child Safety and for Their Welfare The Government of India (GOI) acceded to the UN Convention on the Rights of the Child on December 11, 1992. It reflects the commitment of the government to address the issue of child abuse and neglect. In an attempt to fight this problem, the “Ministry of Women and Child Development” has been set up with independent charges. Furthermore, the GOI has recently taken up a number of legal and social measures for child safety and protection of their rights, which include the Protection of Children from Sexual Offences Act, 2012 (POCSO Act, 2012), The Rights of Children to Free and Compulsory Education Act 2009, The National Commission for Protection of Child Rights Act 2005, Integrated Child Protection Scheme (ICPS), and so on. Section 3 (VI) of the Rules under the Juvenile Justice (Care and Protection of Children) Act 2000 (56 of 2000), amended by the Amendment Act 33 of 2006, talks about the “Principle of Safety” in the following manner: (a)

(b)

At all stages, from the initial contact till such time, he remains in contact with the care and protection system, and thereafter, the juvenile or child or juvenile in conflict with law shall not be subjected to any harm, abuse, neglect, maltreatment, corporal punishment or solitary, or otherwise any confinement in jails and extreme care shall be taken to avoid any harm to the sensitivity of the juvenile or the child. The state has a greater responsibility for ensuring safety of every child in its care and protection, without resorting to restrictive measures and processes in the name of care and protection.

Gradually, a good number of educational institutions in the developing countries are trying to come up with a Child Protection Policy and form a Child Protection Team with a representative from teachers, guardians, psychologists, and students. At the same time, some NGOs have adapted Child Protection Policy for rendering effective services to children. It is relevant to mention here that, from 2003 to 2007, a series of multidisciplinary training programs was organized on child protection in India by the editor of the book. These programs were organized as part of the International

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Society for Prevention of Child Abuse and Neglect’s (ISPCAN) regular training program. These training programs were funded by the OAK foundation, Switzerland, and attended by police officers, doctors, NGO personnel, judges from the Juvenile and Family courts and personnel from the Observation Homes. These programs were aimed at making them aware about the seriousness of the issues, legislations, policies, and programs related to child safety. In the programs, it was discussed how to respond to the problems as professionals by deploying their characteristic skills in identification and remedy.

Need for Reporting of Abuse The first step in prevention of any form of violence against children is to bring the issue to light through reporting. Reporting of any offense is very important as it could help to render justice to the victim and to punish the perpetrators. In addition, it would help to understand the nature and magnitude of the problem and to plan need-based intervention programs. Unfortunately, the reporting of child sexual abuse is very low across the world both in urban and in rural areas for many reasons, such as humiliation, disclosure of identity, social stigma, lack of trust on the system and social support, laxity of juvenile justice system, lack of knowledge about legal procedures, apprehension of further victimization, and so on (Deb & Modak, 2010; Deb & Mukherjee, 2011). And to speak of giving corporal punishment, it is as tardy as the legal system and it is hardly pronounced. Traditionally, psychological abuse is not recognized as an abusive activity against children in developing countries. Of course, defining psychological abuse and assessment of the same is difficult. Scolding children for minor mistakes and unrealistic expectations of parents is perceived to be their rights in developing countries like India. This issue requires more attention from the academics and other professionals for defining the boundary of psychological abuse.

Need for New Legislations for Prevention of Child Sexual Abuse and Child Trafficking There have been a number of incidents in the recent past where children were raped and then killed in order to suppress the evidence. This sort of heinous crime necessitates strict legislation. Similarly, it is imperative to amend existing laws in consideration of the present scenario of child sexual abuse and child trafficking (Deb, 2014). With regard to mandatory reporting of child sexual abuse, the USA, Canada, and Australia have made effective legislations specifying the category of social agents and professions for mandatory reporting. The Trafficking Act of Ghana (2005) for mandatory reporting of child trafficking is a good example in this context.

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Need for Systematic Development of Documentation System, Monitoring, Research, and Evaluation of Existing Program Compared to developed countries, most of the developing countries have very poor or little documentation systems. Without proper documentation, it is difficult to assess any situation and to design a need-based intervention program. In India, there is no system of assessment and documentation of child abuse and neglect cases in the hospitals, both in government and in non-government sectors. Policy makers have to be aware of the great importance of documenting child abuse and neglect in hospitals. It is very important that the hospitals send the data every month to the Central Documentation System. For the assessment of child sexual abuse and intentional physical injury, there should be a uniform procedure. In default of a uniform policy, doctors follow different procedures in different set-ups as the situations demand. Research on different issues related to child abuse such as cyberbullying, child custody issues, child trafficking, and efficacy of community-based and institutions based intervention programs is required for generating more evidence. Developing countries still need population-based data for understanding the magnitude of the problem and taking corrective measures. In some developing countries like India, policies are not made on the basis of systematically generated evidence. However, a study tool developed by the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) for assessing the nature and magnitude of child abuse and neglect could be used in the developing countries for generating latest evidence which will be helpful for the policy makers to design the need-based intervention program (Meinck et al., 2020). Monitoring and evaluation are also essential when it comes to checking the quality of implementation of any program and its effectiveness, for example how mid-day meal is benefiting the target groups, what the perception of the parents of the beneficiaries of mid-day meals has about their quality, what about the effectiveness of childline, and so on. In developing countries, monitoring and evaluation are not given adequate importance probably because of the drawbacks inherent in the system.

Prevention Prevention of child abuse and neglect and ensuring their safety are possible through education, awareness, advocacy, and effective implementation of child rights legislations and programs. As with other countries, the Government of India has contrived various legislations and policies for protection of child rights as mentioned earlier. For effective implementation of the legalizations and programs, political will is needed for the allocation of more funds. More funds are required for the infrastructure development for the construction and renovation of children/observation homes. The conditions of children/observation homes in different states under the Social Welfare Department are in a sorry state with poor infrastructure for accommodating

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a large number of children. Safety of the children in the Observation Homes should be ensured in addition to making arrangements of skill building training programs and counseling facilities by trained counselors. The performance of the Observation Homes should also be monitored periodically by experienced professionals for ensuring the safety and well-being of the disadvantaged and victimized children. For generation of resources and funds, corporate sectors could be approached by the local government as part of their social responsibility. Arguably, there cannot be a better investment of resources than for the welfare and well-being of the children. Media should be utilized for the spread of information about socio-legal measures for child protection among community members. Awareness of social measures will encourage needy people to come forward to avail themselves of the facilities, while awareness about legal measures will serve to discourage the perpetrators from committing offenses against children. Likewise, awareness about legal measures will encourage victims to report the crime and to seek justice. Prioritization of the issue of the protection of child rights in the national agenda will bring about change in the national policy. In addition, there is a need for improvement of documentation system and for encouraging people to report child abuse (whether physical or sexual) and child trafficking to the respective agencies for protection and justice.

Strengthening the System with Trained Human Resources There is an urgent need to recruit Child Protection Officers in every district as per the Integrated Child Protection Scheme (ICPS, 2015) and also to recruit female Juvenile Officer in every police station (or at least one female Juvenile Officer for 2/3 police stations) as mentioned in the Juvenile Justice (Care and Protection) Act (2000) (amended in 2006). Simultaneously, arrangement of periodic training programs for the law enforcement agencies, Child Protection Officers, NGO personnel, and authorities of educational institutions will help them to manage or to implement better social and legal measures. Hardly, any university in India offers courses on child rights and/or protection. Therefore, there is a necessity to introduce postgraduate diploma and master degree program on child rights and protection to professionally train students on the subject so that in turn they act as Child Protection Officer and train grassroot-level workers dealing with children in the field level, Juvenile Officers, Police Officers, Doctors, Nurses, School Teachers, and Personnel working in different shelter and Observation Homes. The Rajiv Gandhi National Institute of Youth Development under the Ministry of Youth Affairs and Sports, Government of India, proposes to introduce a master degree course on child rights and protection from the 2022 to 2023 academic session.

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Intervention: Assessment and Treatment Evidence-based intervention programs should be adopted for redressing psychological trauma of sexually abused and trafficked children. There is also a need to develop school-based intervention program for the children to address some of the issues which torment them, such as academic stress, corporal punishment, sexual abuse, and discrimination based on caste and intellectual ability. School-based intervention programs are needed for life skill development, as well as for sensitizing the students about issues like good touch and bad touch which will help them to deal with unwanted situations more effectively. Very few schools in India have intervention programs on any of these issues on a regular basis. Sometimes, they organize a workshop or seminar when the school authority receives a circular from the education department. However, some of the NGOs are doing commendable jobs in the educational institute in India and other developing countries in sensitizing the students about sexual abuse issues and about the way to deal with them. From the first-hand experience of the editor, a school-based intervention program on adolescent reproductive and sexual health is beneficial in providing them with correct knowledge and information about the issue and thus in making them psychologically stronger to cope with various challenging issues in everyday life. The first step of the intervention program is assessment of the nature of abuse experienced by a child after doing the reporting, followed by mental state examination for need-based psychological support services. Unfortunately, very few educational institutions in India have such facilities. The goal of the clinical assessment is to determine the child’s and the caregiver’s overall functioning, adaptation, and level of symptomatology. To begin, a thorough assessment of the family’s strength and problems should be ascertained, including the problems that need to be addressed at the parental, child, family, and social systems levels. Procedures for assessments are interviews, paper-and-pencil measures, or structured observations with the child, siblings, and caregivers. Periodic school-based sensitization programs for the teachers and parents about child rights are indispensable for changing their mindset about the issue and about the friendly disciplining methods. These two social agents who are primarily responsible for the growth and development of the child often lack adequate knowledge; they have wrong perceptions about child rights as revealed by an Indian study (Deb & Mathews, 2012). It is worth mentioning here three evidence-based intervention programs: abusefocused cognitive behavioral therapy (AF-CBT), parent–child interaction therapy (PCIT), and trauma-focused cognitive behavioral therapy (TF-CBT). They all were found to be beneficial to victimized children and to their family members. AF-CBT targets individual child’s and parent’s characteristics related to the abusive experience, as well as the family context in which coercion or aggression exists. PCIT is a treatment approach originally developed to treat children ages 2–7 with serious behavioral problems. PCIT utilizes live coaching and focuses on improving the behaviors of both the parent and the child. Parents learn to model

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positive behaviors and are trained to act as “agents of change” for their children’s behavioral or emotional difficulties. TF-CBT is an evidence-based treatment approach that addresses the negative effects of sexual abuse and other traumatic events by combining elements drawn from cognitive, behavioral, and family therapies. In addition to legal measures, there is a need to bring all the perpetrators indulging in severe child abuse and neglect under the mental health intervention program to change their attitude and behavior toward children. Although this is a difficult task, this approach will save thousands of children from abuse and maltreatment. Abusing children in different forms is nothing but also an indication of an impulsive and hostile behavior of elderly people, and in case of sexual abuse, it is a sign of perversion. This type of behavior of elderly people requires psychological and even in some cases psychiatric intervention. Increasing rate of mental health problems is another issue which concerns the public health and other professionals since mental health problem has a direct link with child abuse and neglect (Deb, 2010). Parents with mental health problems often fail to provide quality care to their children, and these children become the victim of neglect and maltreatment. Therefore, it is very important for close family members to seek mental health support services for the person who is suffering from minor or major mental health problems before or after marriage instead of keeping the information secret. There is also a myth among the general population in India that a person’s mental health problems will be solved automatically after marriage. This wrong notion affects the life partner and the next generation adversely. This issue requires debate and discussion for bringing appropriate legislation and policies to protect the rights of innocent people. Child neglect is a very common phenomenon in developing countries like India, Bangladesh, Pakistan, Nepal, Myanmar, and so on. About one-fourth of the families in India live below the poverty line, and they are unable to provide adequate nutrition, medical care, and education to their children. Respective local government also fails to provide the basic facilities to these poor children, although it was instructed in the UNCRC (1989). Officially, there might be some programs, but the benefits of the programs do not reach these poor children. There is no effective mechanism for monitoring the implementation of the programs. However, in the developed countries, intervention programs for some forms of neglect have indicated promising results that include home visitation as a primary approach. In developing countries, it is a big challenge to implement similar programs because of lack of resources and population size. A large number of children live in disturbed family environments and hardly get any support to overcome the family challenges. Therefore, school-based family counseling should be introduced in every school to reach out to parents so that challenges faced by the children at home could be addressed sensitively by trained psychologists.

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Challenges Despite a range of socio-legal measures, children in society experience neglect, abuse, and maltreatment. For ensuring their safety, welfare, and well-being, federal and provincial governments should work in concert with each other, review the present legislations and policies and programs, and come up with comprehensive policies for addressing challenges, which are almost similar across the developing countries. These challenges include: (i) ensuring primary education for all the children as mentioned in The Rights of Children to Free and Compulsory Education Act (2009) (India); (ii) the implementation of school-based intervention programs across the country, both in rural and in urban areas, for sensitizing the parents and teachers about child rights and negative consequences of corporal punishment; (iii) ensuring nutrition and safe drinking water for all the children through mid-day meal program and Integrated Child Development Scheme (ICDS); (iv) rehabilitation of thousands and thousands of children living on the street through NGOs; (v) eradication of child labor and child marriage and ensuring their socioeconomic rehabilitation; (vi) the prevention of child trafficking for commercial sexual abuse and ensuring rehabilitation of trafficked children after recovery and connecting them with the family members; (vii) addressing gender discrimination, social stigma, cultural belief and practices with regard to education, nutrition, health care, HIV/AIDS, disability through culturally sensitive programs using electronic media and involving community-based organizations; (viii) ensuring that the orphan and destitute children as well as children from poor families are adopted by genuine adopters following proper procedures for their better future; (ix) the prevention of child pornography and cyberbullying through effective legislations; (x) prevention of marriage of elderly people with major mental health problem; (xi) addressing psychological stress of school students because of social distancing; (xii) continuing education through virtual mode for rural students; (xiii) keeping school students away from mobiles and engaging them in extracurricular activities and games and sports on account of lack of open playground facilities.

Immediate Need of the Hour The formation of the State Commission for Protection of Child Rights in all the states in India should speed up, since the State Commission has a greater role to play in every state in the implementation of the legislations and social welfare programs for the children. The State Commission also plays a pivotal role in developing better coordination among the government and the NGOs. Counseling facilities by trained psychologists for students in the educational institutions should be arranged. The government should also have a policy for the recruitment of trained counselors. It is relevant to mention here that the New Education Policy 2020 of the Government of India has emphasized on mental health of students and hopefully there might be

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a circular from the Ministry of Education, Government of India, for recruitment of trained mental health professionals in every educational institution in near future to address the mental health-related challenges of the students like academic stress, interpersonal relationship problems, general stress, psychological trauma of students caused by abuse and maltreatment, anxiety, examination phobia, suicidal ideation, and so on. Community-based intervention programs should be strengthened with help from the NGOs to house a large number of orphan and destitute children with basic facilities. In addition, every higher learning institute should adopt villages in and around their institute and create awareness about child rights and sensitize the parents for treating children of both genders equally and supporting them for continuation of their education as education can ensure safety of the children and help them to become a skilled person. It is important to look into some of the core issues like rapid population growth, poverty, illiteracy, unemployment, and primary health issues at the national program of the Government of India, which are directly linked with child abuse and neglect. Otherwise, whatever efforts are being made, they may not have desired results (Deb, 2009). In order to address all the issues as stated earlier, there is a need to closely monitor the implementation of various policies and programs at the ground level for taking corrective measures. Evidence clearly highlights the adverse impact of COVID-10 on mental health of children which requires immediate attention of mental health professionals of every school (de Miranda et al., 2020; Imran et al., 2020; Liu et al., 2020; Ravens-Sieberer et al., 2021). In this regard, the role of School-Based Family Counseling is extremely helpful to guide parents to deal with the emotions of the children.

References Azi, A. S., & Saluhu, A. I. (2016). The effect of child abuse on the academic performance of school children: Implication on the Nigerian Economy. Asia Pacific Journal of Education, Arts and Sciences, 3(3), 23–27. Chiang, W. L., Huang, Y. T., Feng, J. Y., & Lu, T. H. (2012). Incidence of hospitalization due to child maltreatment in Taiwan, 1996–2007: A nationwide population-based study. Child Abuse and Neglect, 36(2), 135–141. https://doi.org/10.1016/j.chiabu.2011.09.013 Chou, C. Y., Su, Y. J., Wu, H. M., & Chen, S. H. (2010). Child physical abuse and the related PTSD in Taiwan: The role of Chinese cultural background and victims’ subjective reactions. Child Abuse and Neglect, 35(1), 58–68. https://doi.org/10.1016/j.chiabu.2010.08.005 Deb, S. (2005). Child trafficking in South Asia: Dimensions, roots, facets and interventions. Social Change, 35(2), 143–155. https://doi.org/10.1177/004908570503500211 Deb, S. (2009). Child protection: Scenario in India. International Journal of Child Health and Human Development, 2(3), 339–348. Deb, S. (2010). Child protection: Scenario in India. International Journal of Child Health and Human Development, 2(3), 339–348. Deb, S., & Chatterjee, P. (2008). Styles of parenting adolescents: The Indian scenario. Akansha Publ House.

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Deb, S., & Mathews, B. (2012). Children’s rights in India: Parents’ and teachers’ attitudes, knowledge and perception. International Journal of Children’s Rights, 20, 1–24. https://doi.org/10. 1163/157181811X616022 Deb, S., & Mitra, K. (2001). Deviance among disadvantaged children in Kolkata and reasons thereof. Indian Journal of Criminology and Criminalistics, 22(1), 41–53. Deb, S., & Modak, S. (2010). Prevalence of violence against children in families in Tripura and its relationship with socio-economic, cultural and other factors. Journal of Injury and Violence Research, 2(1), 5–18. https://doi.org/10.5249/jivr.v2i1.31 Deb, S., & Mukherjee, A. (2011). Background and adjustment capacity of sexually abused girls and their perceptions of intervention. Child Abuse Review, 20, 213–230. https://doi.org/10.1002/ car.1153 Deb, S., & Walsh, K. (2012). Impact of physical, psychological, and sexual violence on social adjustment of school children in India. School Psychology International, 33(4), 391–415. https:// doi.org/10.1177/0143034311425225 Deb, S., Srivastava, N., Chatterjee, P., & Chakraborty, T. (2005). Processes of child trafficking in West Bengal: A qualitative study. Social Change, 35(2), 112–123. https://doi.org/10.1177/004 908570503500208 Deb, S., & Madrid, B. (2014). Burden of child abuse and neglect with special reference to sociolegal measures: A comparative picture of India, Philippines and Japan. In J. Conte (Ed.), Child abuse and neglect worldwide (Vol. 2, pp. 77–106). PRAEGER. Deb, S., Sunny, A. M., & Majumdar, B. (2020). Children under institutional care: Ensuring quality care and safety. In Disadvantaged children in India (pp. 175–215). Springer. Deb, S. (2004). Corporal punishment of children at home and in the school: A comparative study of attitude, perception and practice of parents and teachers. Paper presented in the 15th International Congress on Child Abuse and Neglect, held during September 19–22, 2004 in Brisbane, Australia. Deb, S. (2014). Legislation concerning reporting of child sexual abuse and child trafficking in India: A closer look. In B. Mathews, & B. C. Donald (Eds.), Mandatory reporting laws and the identification of severe child abuse and neglect. Springer. Imran, N., Zeshan, M., & Pervaiz, Z. (2020). Mental health considerations for children & adolescents in COVID-19 pandemic. Pakistan Journal of Medical Sciences, 36(COVID19-S4), S67. Liu, J. J., Bao, Y., Huang, X., Shi, J., & Lu, L. (2020). Mental health considerations for children quarantined because of COVID-19. The Lancet Child & Adolescent Health, 4(5), 347–349. Meinck, F., Murray, A. L., Dunne, M. P., Schmidt, P., Nikolaidis, G., Petroulaki, K., Zarokosta, F., Tsirigoti, A., Hazizaj, A., Cenko, E., Brikc-Smigoc, J., Vajzovic, E., Stancheva, V., Chincheva, S., Ajdukovic, M., Rajte, M., Raleva, M., Trpcevska, L., Roth, M., Antal, I., et al. (2020). Measuring violence against children: The adequacy of the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) child abuse screening tool—Child version in 9 Balkan countries. Child Abuse & Neglect, 108, 104636. de Miranda, D. M., da Silva Athanasio, B., de Sena Oliveira, A. C., & Silva, A. C. S. (2020). How is COVID-19 pandemic impacting mental health of children and adolescents? International Journal of Disaster Risk Reduction, 101845. Nguyen, H. T., Dunne, M. P., & Le, A. V. (2010). Multiple types of child maltreatment and adolescent mental health in Viet Nam. Bulletin of the World Health Organization, 88(1), 22–30. https://doi. org/10.2471/BLT.08.060061 Phelps, C., & Sperry, L. L. (2020). Children and the COVID-19 pandemic. Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S73. Pierce, M., Hope, H., Ford, T., Hatch, S., Hotopf, M., John, A., Kontopantelis, E., Webb, R., Wessely, S., McManus, S., & Abel, K. M. (2020). Mental health before and during the COVID-19 pandemic: A longitudinal probability sample survey of the UK population. The Lancet Psychiatry, 7(10), 883–892. Pinheiro, P. S. (2006). World report on violence against children. United Nations Secretary-General’s Study on Violence against Children.

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Raman, S., Muhammad, T., Goldhagen, J., Seth, R., Kadir, A., Bennett, S., D’Annunzio, D., Spencer, N. J., Bhutta, Z. A., & Gerbaka, B. (2021). Ending violence against children: What can global agencies do in partnership? Child Abuse & Neglect, 119, 104733. Ravens-Sieberer, U., Kaman, A., Erhart, M., Devine, J., Schlack, R., & Otto, C. (2021). Impact of the COVID-19 pandemic on quality of life and mental health in children and adolescents in Germany. European Child & Adolescent Psychiatry, 1–11. Report on Child Abuse and Neglect. (2007). Min Women Child Dev, Government of India. The Commissions for the Protection of the Child Rights Act. (2005). The Integrated Child Protection Scheme (ICPS). (2015). A centrally sponsored scheme of Government of India—Civil society partnership with the Ministry of Women & Child Development. Government of India. The Juvenile Justice (Care and Protection of Children) Act. (2000) (amended in 2006, India). The Rules of the Juvenile Justice (Care and Protection of Children) Act. (2000) (amended in 2006, India). The Protection of Children from Sexual Offences Act. (2012). The Rights of Children to Free and Compulsory Education Act. (2009). The Trafficking Act of Ghana. (2005). The U.N. Convention on the Rights of the Child (CRC). (1989). Toth, S. L., & Manly, J. T. (2019). Developmental consequences of child abuse and neglect: Implications for intervention. Child Development Perspectives, 13(1), 59–64. UNICEF. (2009). Progress for children: A report card on child protection: Innocenti Report Card Number 8. UNICEF Division of Communication.

Part I

Nature and Extent of Child Abuse and Neglect

Chapter 2

Sixty Years of Child Abuse Awareness: Achievements, Errors and Opportunities Kim Oates

Introduction In the 60 years, since Henry Kemp and colleagues coined the phrase “The Battered Child Syndrome” (Kempe et al., 1962), there has been considerable progress as well as a few misconceptions that led to errors. There are still considerable opportunities, particularly by taking an ecological view, by learning from other organizations beyond the health and welfare professions and by learning from more recent genetic research. Looking back at achievements as well as errors can be helpful on those occasions when we become despondent and feel that we are making little progress in child protection. Looking back helps us to see how far we have come as well how to avoid some of the errors of the past. Looking forward helps us to see how much still we have to do and where the opportunities are. Child abuse is a spectrum covering neglect, failure to thrive, physical abuse, sexual abuse and emotional abuse. These different aspects of child abuse have similarities as well as differences. Some children experience several types of abuse either over the course of their childhood. This makes it difficult to interpret research studies that group each type of abuse together, treating them as if they are the same thing in the analysis and then drawing conclusions. This is something we need to be aware of when reading the research literature in this area. Everyone realizes that child abuse is important because of the immediate effects on the child. Just as important should be the awareness that many abused children suffer long-lasting effects which can impair their ability to function effectively in their adult lives and in their role as parents (Child Welfare Information Gateway, 2019; Herrenkohl et al., 2017).

K. Oates (B) University of Sydney, Sydney, Australia e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_2

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Achievements While there had been some early descriptions of child abuse as far back as the 1880s, by West in London and Tardieu in Paris, the modern era is generally regarded as starting in 1946 when Caffey, an American radiologist, described multiple fractures in the long bones of children who also had chronic subdural hematoma (Caffey, 1946). If you read Caffey’s paper with the knowledge we have today, the diagnosis of child abuse seems obvious. These children had subdural hematomas, retinal haemorrhages and multiple fractures. Yet, Caffey could give no clear explanation in this paper. He often receives the credit for being one of the first to document child abuse. But he did not really recognize it as such. He described it. When Caffey wrote this description in 1946, society and the professional groups were not yet ready to hear this type of information. It was not until 9 year later that Woolley and Evans talked about the significance of these injuries and the fact that they although they resembled accidental trauma, they were really inflicted by the parents (Woolley & Evans, 1955). The connection became clear. Henry Kempe had been concerned about child abuse since the 1950s but could not muster interest from his colleagues. He got his chance when he became Chair of the 1961 Program Committee of the American Academy of Pediatrics and used his position to organize a session on “The Battered Child”, a phrase he coined. The next year the classic paper “The Battered Child Syndrome” (Kempe et al., 1962) was published in the Journal of the American Medical Association. It was the turning point in the recognition of the extent of the problem. In a survey to find the ten most influential papers published on child abuse (Oates & Cohn-Donnelly, 1997), the paper by Kempe and colleagues was the clear winner. By 1972, Caffey now recognized an important aspect of child abuse, about abuse, publishing a landmark paper on the shaking of babies, “On the theory and practice of shaking infants” in the American Journal of Diseases of Children (Caffey, 1972). He was not the first to describe the damage caused by shaking, but this important paper popularized the notion. We learnt that what paediatricians used to call the “spontaneous subdural hematoma of infancy” was not that spontaneous after all and that it was usually caused by inflicted trauma. Another advance occurred in 1972 when we learnt about Munchausen Syndrome by Proxy in a paper from the UK (Meadow, 1977). When we read this paper, we realized that we too had seen similar cases. It alerted us to a further dimension of abuse which had been right before our eyes, but often missed. In 1978, Kempe’s paper “Sexual abuse, another hidden pediatric problem” was published (Kempe, 1978). It was not the first paper on child sexual abuse, but it was probably the most important. This was because of Kempe’s stature in the field. By 1978, Kemp was so well known in this field that when he spoke or wrote he could not be ignored. This was the paper that brought child sexual abuse out of the closet. Then, in 1978, we were reminded about the importance of emotional abuse. “The elusive crime of emotional abuse” (Garbarino, 1978) paper brought a variety of

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concepts about emotional abuse into a clear framework which greatly improved our understanding in this area. A valuable paper appeared in 2010 when Sidebotham described an ecological approach to child abuse. The ecological framework comes from research that shows no single factor can explain why some children are at higher risk of abuse while others are more protected. It explores the various interacting contributions of the family, the community and the values of the society in which that community exists. As well as offering some practical suggestions, the ecological model has helped us to see child abuse not just as a family problem or a society problem but to understand how all of these factors can interact for good or for bad outcomes.

Errors There have also been errors; mistakes we have made in getting to where we are now but that have helped us to learn. Once the misconceptions of the past were when we insisted that “children never lie”. Is this true? In the 1970s and 1980s, we confused the fact that children can give accurate stories of their abuse with the assertion that children never lie. Anyone who has had anything to do with a child knows that they do not always speak with what we would regard as the truth. They make up stories and can happily garnish the truth to avoid getting into trouble. This is not surprising as adults do this as well. However, this insistence in court that children “never” lie about anything did not add credibility to our cause when we were asked to give evidence in court. However, it is true that that child rarely lie about abuse. False accusations of child sexual abuse do occur, but the incidence is less than 2% (Oates et al., 2000). A more recent review of the literature about children’s sexual abuse disclosure showed that while they often delay revealing that they have been abused, denial and recantation are uncommon (London et al., 2008). As far as the reliability of children to remember things goes, of the most robust findings of memory research is that children from as young as 6 years of age are just as accurate as adults in recalling events and are no more suggestible than adults (Davis, 1998; Goodman et al., 2001). Children do make good witnesses. These peer-reviewed studies about the reliability and truthfulness of abused children remain at odds with views of the general public. Yarmey and Jones (1983) found that when members of the public were asked how an 8-year-old child would respond to questions by police in court, less than 50% believed that the child could give an accurate account. As well as being at odds with the research, this view held by many members of the public make it difficult for abused children to be believed by a jury in some cases. Although we know that children only rarely make up stories of abuse, the blanket assertion that “children never lie” dented our credibility. Another past mistake was to be dogmatic about the diameter of the hymen in cases of child sexual abuse. This view probably led to wrongful diagnosis in some cases. The basis for this view was a paper by Cantwell (1983), stating that a hymen opening

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greater than 4 mm was indicative of sexual abuse. However, we know a lot more now. The correct data about the hymen are that there is a wide normal variation in shape and size. It depends on the age of the child, the position in which the child is examined and the method used for examination (Finkel, 2009). There is a wide range of normal. The vaginal or hymen diameter cannot be relied on as the sole diagnostic criteria of penetration. A comprehensive review by Mishori et al. (2019) concluded that an examination of the hymen is not an accurate or reliable test of a previous history of sexual activity, including sexual assault and that clinicians performing forensic sexual assault examinations should avoid descriptions such as “intact hymen” or “broken hymen” instead, describing specific findings using international standards and terminology of morphological features. A further pitfall has been the view that mandatory reporting was a panacea which would help to solve many of our problems. But is it a help or hindrance? Some countries who do not have mandatory reporting want it. Others who do have it want to abandon it. Although over 60 countries have some form of mandatory reporting, there is no real consensus (Dubowitz, 2012). Mandatory reporting legislation makes a clear statement that the governments takes child abuse seriously. It raises public awareness. It encourages early identification which may prevent further abuse and death. It provides a database so that the size of the problem can be measured and monitored. It results in services being provided, and its introduction is often accompanied by public and professional training and education. These advantages of mandatory reporting have to be weighed up with some of the disadvantages. On the other hand, mandatory reporting may not distinguish between serious and less serious reports. It can be discriminatory as poor and vulnerable groups are more likely to be those reported. Many cases cannot be substantiated. The large numbers being reported result in child protection services becoming overloaded. There is a danger that with so many resources going into investigating reported cases that there are few resources left for adequate meaningful intervention on the scale required. When caregivers and children are asked their views on mandatory reporting, the insights are valuable. McTavish et al. (2019) in a meta-analysis of studies linking the views of children and caregivers revealed findings suggesting that children and caregivers fear being reported, as well as the responses that result from being reported. They identified a need for improvement in communication from healthcare providers about mandatory reporting and the need to consider child-driven and caregiver-driven strategies to reduce potential harms associated with reporting processes. In summary, mandatory reporting can be a useful tool when applied thoughtfully, but it is not a panacea. Another early error was thinking that domestic violence and child abuse were unrelated. However, we now know that children exposed to family, domestic and sexual violence can experience long-term effects on their development and have increased risk of mental health issues and behavioural and learning difficulties. Children can experience family violence as a witness and/or a victim. More than two-thirds (68%) of mothers who had children in their care when they experienced violence from their previous partner reported that their children had seen or heard the violence. Family

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and domestic violence can have far-reaching consequences. It is a leading cause of homelessness for women with children. In Australia, in 2016–17, about 72,000 women, 34,000 children and 9000 men seeking homelessness services reported that family and domestic violence caused or contributed to their homelessness (Australian Institute of Health and Welfare, 2018). Domestic violence and child maltreatment have a 30–60% overlap (Jaffe et al., 2012). This is useful knowledge as when we see domestic violence we should also consider the question as to whether there is concurrent child abuse. Similarly, there was a time when it was believed that alcohol was not a significant factor in precipitating or abuse. However, the current evidence is that alcohol can be an influencing factor in 77% of child maltreatment cases (Meredith & PriceRobertson, 2011). In addition, a link has been found between child abuse and areas with a greater concentration of on-premises alcohol outlets, such as bars. These areas had higher rates of child neglect, while those with better access to substance abuse facilities had lower rates of neglect after controlling for other demographic factors (Morton et al., 2014). This finding suggests that the built environment and socioeconomic structure of neighbourhoods have important consequences for child well-being, another example of the value of looking at child abuse through the lens of the ecological model. A further misconception was that sexual abuse was thought to be an isolated crime in otherwise law-abiding people. This may be so in many cases, but certainly not all. A review of police and court records of 180 child sexual abuse offenders 10 years after initial offence found that 60% had a criminal conviction for offences other than sexual abuse, including violence and robbery (Parkinson et al., 2004). So, while some abusers may be otherwise normal, we need to be aware that others offend in many other ways as well, with sexual abuse being just part of a broad spectrum of their criminal behaviour. Domestic violence, alcohol abuse and other criminal activity are just three examples of our former inability to look at the bigger picture in the early years of child protection work. A pitfall still prevalent is to blame individuals, when it is the system that needs fixing. Child protection systems are complex. They involve a variety of staff and procedures. Lessons from the mining and aircraft industries have shown that a significant proportion of errors are due to problems in the system, including work practices that lead to fatigue from the high workload, cognitive overload, poor interpersonal communications, imperfect information processing, flawed decision making and fear of punishment for making a mistake (Helmreich, 2000). The message is clear. We need to build safer systems to protect children and in particular to support people who work in the area and not to discipline them as a first reaction when things go wrong.

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Where We Are at Present There is some evidence that the incidence of child abuse is falling. Finkelhor and Jones (2006) have shown that neglect, physical abuse, sexual abuse and juvenile homicide have all fallen significantly in recent years. Neglect has not fallen by as much, but the other three have fallen sharply. This evidence comes from the USA where the National Child Abuse and Neglect Data System (NCANDS) which provides the longest-running data set to analyse trends. Finkelhor et al. (2015) have noted that rates of child sexual abuse fell by 64% and child physical maltreatment fell by 55% since the early 1990s. This trend in agency reported cases of child sexual abuse has been corroborated by a concurring decrease shown in prevalence studies (Finkelhor et al., 2010). However, the decline has been smaller in child neglect, the most prevalent form of child maltreatment. In contrast to these findings, hospital data show no decline in maltreatment-related injuries or fatalities (Leventhal & Gaither, 2012). What is the reason for this fall? Finkelhor has suggested several possibilities: Perhaps increased public awareness; more prevention programs, and the use of pharmacotherapy, particularly anti-depressants are some of the possibilities. He also speculates that it may also be due to incarceration, where in the United States long prison sentences for abuse are common, so that perhaps many of the offenders are not able to offend again.

But is it really falling in countries other than the USA? Gilbert and colleagues (2012) showed no consistent evidence for a decrease in all forms of child maltreatment in Sweden, England, New Zealand and Western Australia. However, this information is difficult to interpret as child abuse rates vary considerably between countries. What the paper did point out was that the lower level of child maltreatment in Sweden compared with the USA was consistent with lower rates of child poverty between the two countries and with Swedish government policies which provide high levels of universal support for parenting. It seems clear from this study that high levels of support for parenting, at all levels of society, can play a crucial role in reducing child abuse. The detection and management of child abuse and neglect is expensive. In Australia, where I am based, the cost of child abuse and neglect to our society was $A5.2 billion in 2016/17 for a country of just under 26 million people. The lifetime costs and burden of disease adds another $A14 billion, stressing that child abuse has long-term costs in many cases (Australian Institute of Family Studies, 2018). On a global level, the economic cost of child abuse has been estimated at $US3.7 trillion or 4.3% of the global GDP (United Nations, 2015). A study for the World Health Organization on global GDP impact of disease found that child sexual abuse alone contributed to between 4 and 5% of the total burden of disease in men and 7–8% of the burden of disease in females (Andrews, 2004). This study also found that for some disorders, the percentage attributed to child sexual abuse is even higher, particularly panic disorders, suicide attempts and post-traumatic stress disorder. One of the reasons for the adverse effects comes from the cumulative effect of adverse childhood experiences. Felitti et al. (1998) looked at the relationship between

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adverse childhood experiences and adult mental and physical health in a cohort of over 13,000 adults. They used 8–10 categories of adverse childhood experiences (ACE), including abuse and neglect, and found that a third had an ACE score of zero, (no adverse childhood experiences), but 16% had four adverse childhood experiences and 10% had five or more adverse childhood experiences. When these researchers looked at the relationship between physical and mental health problems and adverse childhood experiences, they found a linear relation between the number of adverse childhood experiences and a range of health problems. The more adverse childhood experiences, the greater the likelihood of suicide attempts, being prescribed anti-depressants, having memory gaps for large periods of their childhood, being smokers, alcoholics, intravenous drug users, being promiscuous and more likely to have teenage pregnancy. Even physical problems such as liver disease and coronary artery disease were more likely with a greater number of adverse childhood experiences. The experiences of childhood can be long-lasting. They are not like footprints in the sand, where the effects disappear fairly quickly. The experiences of childhood are like footprints in cement explaining why early childhood is so important.

Opportunities What about the opportunities? It has been shown that adolescents who have a history of abuse have reduced grey matter with the location of grey matter reduction depending on the type of abuse (Edmiston et al., 2011). Future advances in understanding brain function are going to tell us much more about abuse, and this knowledge may one day be able to lead to more effective, targeted treatments. Can child abuse change the way our genes function? This is the exciting new field of epigenetics, broadly defined as outside conventional genetics. Does our genetic make-up protect some of us and make others of us more vulnerable? Binder et al. (2008) looked at the FKBP5 gene and abuse. These researchers studied 762 adults and looked at two things. The first was whether they had been abused as children. Seventy percentage had not been abused as children and 30% had been abused. The second thing they looked at was whether the FKBP5 gene had a normal expression (was functioning normally) or a low expression. They found that adults who had a low expression of the gene and who had also been abused as children had twice the incidence of post-traumatic stress disorder. It seems that here is a gene which may give some protection against the adverse effects of child abuse because, when it is not well-expressed, the adverse effects of childhood abuse may be more likely to appear. A similar finding appeared in Nature Neuroscience (McGowan et al., 2009) about the NR3C1 gene, which is thought to modulate stress. The researchers analysed 36 brains. Twelve of the brains were from people who had suicide but where there was no history of abuse. Twelve were from people who had committed suicide and where there was also a history of abuse and 12 were from people who had died accidently.

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It was found that in those who had suicide and who also had a history of abuse, there was less expression of the gene. There is also emerging evidence that, as well as future mental health problems, epigenetic mechanisms may be associated with increased risk for future physical health problems in children who have been abused (Yang et al., 2013). What might findings like these mean? They suggest that childhood abuse seems to reduce the ability of some genes to be expressed (to function fully), an example of how life events may alter our biology, by altering how our genes are expressed. Some recent genetic research (Van Wert et al., 2019) suggests that there can be intergenerational transmission of child abuse and neglect. We have known for some time that parents who experienced maltreatment in childhood may be at increased risk of being abusive or neglectful parents. Van Wert and colleagues (2019) suggest there may be epigenetic embedding of maltreatment that could be intergenerational. There is some evidence that the mechanism of any such transmission may be through DNA methylation of sperm as shown in a longitudinal study of 34 adult males who had been exposed to childhood abuse (Roberts et al., 2018). Although these and similar findings add to the complexity of our understanding of long-term effects of abuse, it is necessary to stress the importance of considering social and environmental factors as well as the importance of early intervention to disrupt possible harmful intergenerational patterns. As we continue to learn more in this area, conflicting results will inevitably appear. For example, Ramo-Fernandez and colleagues (2019) in a sample of 113 newborns where there had been a history of maltreatment in their mothers were unable to find any evidence of intergenerational transmission of child maltreatment-related methylation profiles for any of the specific epigenetic sites, suggesting that these specific epigenetic patterns might not be directly transmitted to the next generation. The area is simultaneously expanding, exciting with the possibilities it brings and also potentially confusing until the research becomes consistently clear and indicates pathways for prevention and better treatment. There is much to learn in this exciting area. What is clear is that there is a complex interplay between environmental factors and gene expression. We look forward to practical ways that this new knowledge may be able to prevent and ameliorate the effects of child abuse. In our enthusiasm about these new discoveries, it is essential never to forget these are vulnerable children, and this is where our focus should be. In practical terms, with genetic advances proceeding so rapidly, it may become possible to detect these genes through genetic testing, so that in people with low levels of expression of these genes there might be the opportunity to improve their environment or to provide help to them early on. It may even be possible at the same stage to deliver genetic therapy to boost the expression of particular genes to protect against abuse or to counteract the adverse effects of abuse. A further avenue is that with this new information it may become possible for drugs to be designed to treat people with particular genetic profiles. This concept may also have a role in the prevention and treatment of abuse. While the possibilities are exciting, there is a long way to go.

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What Other Disciplines Can Teach Us We can also learn much from other disciplines. In Australia, there has been a 35% reduction in motor traffic deaths between 2006 and 2014 with an additional 20% drop between 2014 and 2020, even though there are far more cars on the roads than previously. The reason for this success has been due to a combination of legislation, surveillance, safer roads and safer cars as well as public education about road safety. It is a similar story with coronary artery disease, with an 85% reduction in deaths over the last 30 years. This is a spectacular success story, even though life is more stressful now than 30 years ago. It occurred because of a combination of public education (less smoking, better diet and exercise), much more effective emergency treatment and on-going medical support. The lessons for child protection from these good results in reducing road deaths and deaths from heart disease are that a combined approach is needed, a combination of legislation, public education, reducing risk factors, early intervention and better treatment. The success also occurred because governments and the public realized that these were serious problems and that something needed to be done. The child protection field can also learn from the quality and safety movement. For example, airlines and mining industries have reduced error markedly and saved lives by a combination of: simplifying systems; having a skilled and knowledgeable workforce; providing a supportive working environment; having reasonable work schedules for staff; seeing errors as opportunities for improving the system rather than blaming the individual; having clear guidelines for performance appraisal, having a culture where errors are reported without fear of retribution and robust systems to collect data on errors with a view to improving the systems. The health industry, which learnt from the mining and aircraft industries, now knows the value of clear, unambiguous communication, using “time out” to ensure the whole team understands what is about to be done, clear handover at the end of shifts and learning from error. It took the health industry 20 years to start to catch up with the airline and mining industries in developing safer systems and blame-free reporting. These lessons are also important for child protection systems. How long will it take the child protection system to catch up and produce safer systems to care for those who work in the area and to protect children? So, the future holds some very exciting possibilities: in new knowledge from epigenetics, in psychopharmacology, in learning from successes in other areas such as reducing traffic accidents and heart disease and in designing safer systems.

A Future Challenge One of the next big challenges for us is to make the future safe from corporal punishment for the next generation of children. If we really take a stand, right now, we may be able to protect the current generation of children. This is an international issue.

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The argument against corporal punishment becomes side-tracked when people disagree by saying “Children need discipline”. Of course, they need discipline. But hitting is just one form of discipline, and research shows it to be one of the least effective. And, it can have adverse longer term consequences for later mental health problems and in increasing the likelihood of aggressive behaviour (Gershoff, 2002; Simons & Wurtele, 2010; Taylor et al., 2010). A recent analysis of the links between physical punishment and detrimental child outcomes leads the authors to recommend that parents should avoid physical punishment, psychologists should advise and advocate against it, and policymakers should develop means of educating the public about the harms of and alternatives to physical punishment (Gershoff et al., 2018). Why do parents hit their children? Because we learnt most of our parenting skills when we were children, from the way our parents treated us. Hitting children is intergenerational. But we now know that this teaches children that violence is an acceptable way to resolve conflict. It is the experience of many parents that physical punishment does work. But we now know that the change in behaviour is often short lived and what the child really learns is to avoid the behaviour in front of the adult. Hitting a child contravenes the United Nations Convention on the Rights of the Child (UNCRC). Article 19 of the Convention (United Nations, 1989) states that: “… Children are to be protected from all forms of physical violence while in the care of their parents…”. Continuing international concern about violence towards children resulted in the UN Secretary General commissioning a report on violence against children in which stated (United Nations, 2006). “No violence against children is justifiable. This study marks the end of adults’ justification of violence against children, whether accepted as traditional or disguised as discipline…”. The rights of children in this area is now recognized by legislation against corporal punishment of children. Momentum is growing with the 46 countries having appropriate legislation in 2015 now growing to 62 in 2021 with an additional 27 countries committing to reform their legislation to achieve a complete legal ban. But legislation alone is not enough. It needs to be combined with major investment in helping parents to learn about more effective, less harmful methods of discipline which are known to work, complemented by government policies which support parenting. In 2011 in New Delhi, at an ISPCAN conference, a declaration was made, the Delhi Declaration (Seth & van Niekerk, 2012). A declaration which aimed to make the Asia Pacific area a safer place for children by declaring a commitment and pledging a resolve to stand against the neglect and abuse of children and to strive for achievement of child rights and the building of a caring community for every child, free of violence and discrimination. It is our challenge to implement this. The future is preventing child abuse has much to offer. We have come a long way in the last 60 years in understanding child abuse, initially as something seen mainly as an individual family problem, later expanded to an ecological view involving the broader community and society and now acknowledged in many countries to be a key issue in the protection of children’s rights.

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References Andrews, G. (2004). Comparative quantification of health risk, global and regional burden of disorders attributable to selected major risk factors. In: Ezzati et al. (Eds.), Chapter 23 in global health risk. WHO. Australian Institute for Family Studies. (2018). https://aifs.gov.au/cfca/publications/economiccosts-child-abuse-and-neglect. Accessed June 21, 2021 Australian Institute of Health and Welfare. (2018). https://www.aihw.gov.au/reports/domestic-vio lence/family-domestic-sexual-violence-in-australia-2018. Accessed June 19, 2021 Binder, E. B., Bradley, R. G., Liu, W., Epstein, M. P., Deveau, T. C., Mercer, K. B., et al. (2008). Association of FKBP5 polymorphisms and childhood abuse with risk of posttraumatic stress disorder symptoms in adults. JAMA, 299, 1–1510. https://doi.org/10.1001/jama.299.11.1291 Caffey, J. (1946). Multiple fractures in the long bones of infants suffering from subdural hematoma. American Journal of Roentgenology, 56, 163–173. Caffey, J. (1972). On the theory and practice of shaking infants. American Journal of Diseases of Children, 124, 161–169. https://doi.org/10.1001/archpedi.1972.02110140011001 Cantwell, H. (1983). Vaginal inspection as it relates to child sexual abuse in girls under thirteen. Child Abuse and Neglect, 7, 171–176. https://doi.org/10.1016/0145-2134(83)90069-8 Child Welfare Information Gateway. (2019). Long-term consequences of child abuse and neglect. U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau. Davis, S. (1998). Social and scientific influences on the study of children’s suggestibility: A historical perspective. Child Maltreatment, 3, 186–194. https://doi.org/10.1177/1077559598003002011 Dubowitz, H. (Ed.). (2012). World perspectives on child abuse, international society for prevention of child abuse and neglect. Denver Co. Edmiston, E. E., Wang, F., Mazure, C. M., Guiney, J., Sinha, R., Mayes, L. C., & Blumberg, H. P. (2011). Corticostriatal–limbic gray matter morphology in adolescents with self-reported exposure to childhood maltreatment. Archives of Pediatrics and Adolescent Medicine, 165, 1069–1077. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., & Marks, J. S. (1998). The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine, 14(4), 245–258. Finkel, M. (2009). Medical evaluation of child sexual abuse (p. 63). American Academy of Pediatrics. Finkelhor, D., & Jones, L. (2006). Why have child maltreatment and child victimization declined? Journal of Social Issues, 62, 685–716. https://doi.org/10.1111/j.1540-4560.2006.00483.x Finkelhor, D., Saito, K., & Jones, L. (2015). Updated trends in child maltreatment, 2013. Crimes against Children Research Center. Finkelhor, D., Turner, H., Ormrod, R., & Hamby, S. L. (2010). Trends in childhood violence and abuse exposure. Evidence from 2 national surveys. Archives of Pediatrics & Adolescent Medicine, 164, 238–242. Garbarino, J. (1978). The elusive crime of emotional abuse. Child Abuse and Neglect, 2, 89–99. https://doi.org/10.1016/0145-2134(78)90011-X Gershoff, E. T. (2002). Corporal punishment by parents and associated child behavior experiences: A meta-analytic and theoretical review. Psychological Bulletin, 128, 539–579. https://doi.org/10. 1037//0033-2909.128.4.539 Gesrhoff, E. T., Goodman, G. S., Miller-Perrin, C. I., et al. (2018). The strength of the causal evidence against physical punishment of children and its implications for parents, psychologists and policymakers. American Psychologist, 73, 626–638. Gilbert, R., Fluke, J., O’Donnell, M., Gonzalez-Izquierdo, A., Brownell, M., Gulliver, P., & Sidebotham, P. (2012). Child maltreatment: Variation in trends and policies in six developed countries. Lancet, 379, 758–772. https://doi.org/10.1111/j.1365-2214.2012.01375_4.x. Goodman, G. S., Bottoms, B. L., Rudy, L., Davis, S. L., & Schwartz-Kenney, B. M. (2001). Effect of past abuse experiences on children’s eyewitness memory. Law and Human Behavior, 25, 269–298.

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Helmreich, R. L. (2000). On error management: Lessons from aviation. BMJ (Clinical Research Edition), 320(7237), 781–785. https://doi.org/10.1136/bmj.320.7237.781 Herrenkohl, T. I., Jung, H., Lee, J. O., & Kim, M.-H. (2017). Effects of child maltreatment, cumulative victimization experiences, and proximal life stress on adult crime and antisocial behavior. https://www.ncjrs.gov/pdffiles1/nij/grants/250506.pdf Jaffe, P. G., Campbell, M., Hamilton, L. H., & Juodis, M. (2012). Children in danger of domestic homicide. Child Abuse and Neglect, 36(1), 71–74. Kempe, C. H. (1978). Sexual abuse, another hidden problem. Pediatrics, 62, 382–389. Kempe, C. H., Silverman, F. N., Steele, B. F., Droegemueller, W., & Silver, H. K. (1962). The battered child syndrome. JAMA, 1962(181), 17–24. Leventhal, J. M., & Gaither, J. R. (2012). Incidence of serious injuries due to physical abuse in the United States, 1997 to 2009. Pediatrics, 130, e847–e852. London, K., Bruck, M., Wright, D. B., & Ceci, S. J. (2008). Review of the contemporary literature on how children report sexual abuse to others: Findings, methodological issues, and implications for forensic interviewers. Memory, 16(1), 29–47. https://doi.org/10.1080/09658210701725732 PMID: 18158687. McGowan, P. O., Sasaki, A., D’Alessio, A. C., Dymov, S., Labonté, B., Szyf, M., & Meaney, M. J. (2009). Epigenetic regulation of the glucocorticoid receptor in human brain associates with childhood abuse. Nature Neuroscience, 12(3), 342–348. McTavish, J. R., Kimber, M., Devries, K., Colombini, M., MacGregor, J., Wathen, N., & MacMillan, H. L. (2019). Children’s and caregivers’ perspectives about mandatory reporting of child maltreatment: A meta-synthesis of qualitative studies. British Medical Journal Open, 9(4), e025741. https://doi.org/10.1136/bmjopen-2018-025741 Meadow, R. (1977). Munchausen syndrome by proxy: The hinterland of child abuse. Lancet, 2, 343–345. Meredith, V., & Price-Robertson, R. (2011). Alcohol misuse and child maltreatment. Australian Institute for Family Studies. Mishori, R., Ferdowsian, H., Naimer, K., Volpellier, M., & McHale, T. (2019). The little tissue that couldn’t—Dispelling myths about the Hymen’s role in determining sexual history and assault. Reproductive Health, 16(1), 74. https://doi.org/10.1186/s12978-019-0731-8 Morton, C. M., Simmel, C., & Peterson, N. A. (2014). Neighborhood alcohol outlet density and rates of child abuse and neglect: Moderating effects of access to substance abuse services. Child Abuse & Neglect, 38(5), 952–961. https://doi.org/10.1016/j.chiabu.2014.01.002 Oates, R. K., & Cohn-Donnelly, A. (1997). Influential papers in child abuse. Child Abuse and Neglect, 21, 319–326. https://doi.org/10.1016/S0145-2134(96)00169-X Oates, R. K., Jones, D. P. H., Denson, D., Sirotnak, A., Gary, N., & Krugman, D. (2000). Erroneous concerns about child sexual abuse. Child Abuse and Neglect, 24, 140–157. https://doi.org/10. 1016/S0145-2134(99)00108-8 Parkinson, P., Shrimpton, S., Oates, R. K., Swanston, H., & O’Toole, B. (2004). Non-sex offences committed by child molesters. International Journal of Offender Therapy and Comparative Criminology, 48, 28–39. https://doi.org/10.1177/0306624X03257246 Ramo-Fernandez, L., Boeck, C., Koenig, A. M., et al. (2019). The effects of childhood maltreatment on epigenetic regulation of stress-response associated genes: an intergenerational approach. Science and Reports, 9, 983. https://doi.org/10.1038/s41598-018-36689-2 Roberts, A. L., Gladish, N., Gatev, E., et al. (2018). Exposure to childhood abuse is associated with human sperm DNA methylation. Translational Psychiatry, 8, 194. https://doi.org/10.1038/s41 398-018-0252-1 Seth, R., & van Niekerk, J. (2012). Delhi declaration, E10 Green Park Main. Sidebotham, P. (2011). An ecological approach to child abuse: A creative use of scientific models in research and practice. Child Abuse Review, 10, 97–112. Simons, D. A., & Wurtele, S. K. (2010). Relationships between parents’ use of corporal punishment and their children’s endorsement of spanking and hitting other children. Child Abuse and Neglect, 34(9), 639–646. https://doi.org/10.1016/j.chiabu.2010.01.012

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Taylor, C. A., Mangarella, J. A., Lee, S. J., & Rice, J. C. (2010). Mothers’ spanking of 3 year old children and subsequent risk of children’s aggressive behavior. Pediatrics, 125, 1057–1065. https://doi.org/10.1542/peds.2009-2678 United Nations. (1989). Convention on the rights of the child. High Commissioner for Human Rights. United Nations. (2006). World report on violence against children. United Nations Publishing Services. United Nations, UN Special Representative of the Secretary-General on Violence Against Children. (2015). https://violenceagainstchildren.un.org/economic_costs_of_vac_viewpoint. Accessed June 21, 2021 Van Wert, M., Anreiter, I., Fallon, B. A., & Skolowski, M. B. (2019). Intergenerational transmission of child abuse and neglect: A transdisciplinary analysis. Gender and the Genome, 3, 1–21. Woolley, P. V., & Evans, W. A. (1955). Significance of skeletal lesions in infants resembling those of traumatic origin. Journal of the American Medical Association, 158, 539–543. https://doi.org/ 10.1001/jama.1955.02960070015005 Yang, B.-Z., Zhang, H., Wenjing, G., et al. (2013). Child abuse and epigenetic mechanisms of disease risk. American Journal of Preventive Medicine, 44, 101–107. Yarmey, A. D., & Jones, H. P. (1983). Is the psychology of eyewitness identification a matter of common sense? In S. M. A. Lloyd-Bostock & B. R. Clifford (Eds.), Evaluating eyewitness evidence (pp. 13–40). Wiley.

Chapter 3

Bullying Among Children and Youth in the Digital Age Rebecca P. Ang

Introduction Given the increased and almost ubiquitous use of technology in the academic and social lives of children and adolescents today, bullying occurs in different forms and through different means. Bullying is no longer confined to the physical realm; the Internet has become a new arena for social interactions, permitting children and adolescents to say and do things with some anonymity and limited oversight by adult monitors. Bullying is defined as an intentional aggressive behavior that is carried out by a group or an individual repeatedly and over time, against a victim who cannot easily defend himself or herself (Olweus, 1993). This definition which contains the three key criteria for bullying (intention of harm, repetition, imbalance of power) is widely accepted, although it is not without controversy. Cyberbullying has been defined as the use of electronic communication technology as a means to deliberately threaten, harm, embarrass, or socially exclude another (e.g., Patchin & Hinduja, 2006). Whether it is appropriate to carry over the same definition we have for bullying into the online realm is a fundamental question that has been debated (Kowalski et al., 2014; Olweus & Limber, 2018). The intention of harm generally applies similarly across traditional bullying and cyberbullying, though intent can be difficult to establish in certain situations. Regarding the issue of repetition, a single perpetrator act could be seen as cyberbullying because text messages or images can be passed on multiple times, and these can remain in cyberspace for a significant amount of time or indefinitely. In cyberbullying, imbalance of power can be seen in how anonymity and technical know-how confer power in cyberspace, whereas power in traditional bullying is conveyed through size and strength for example. Hence, the consensus is

R. P. Ang (B) National Institute of Education, Nanyang Technological University, Singapore, Singapore e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_3

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that the criteria used to define traditional bullying can generally be used for cyberbullying, but researchers recognize that in particular, “repetition” and “imbalance of power” are to be understood and interpreted differently (Olweus & Limber, 2018).

Cyberbullying, Traditional Bullying, and Outcomes Most researchers acknowledge that cyberbullying and traditional bullying are related phenomenon; they are not entirely distinct with victims of traditional bullying also being more vulnerable to being victimized online (Hase et al., 2015; Khong et al., 2020; Kowalski et al., 2014; Olweus & Limber, 2018). There is substantial overlap between cyberbullying and traditional bullying, and between cyberbullying victims and traditional bullying victims with traditional bullying being about twice as common as cyberbullying (Modecki et al., 2014). Therefore, cyberbullying should not be seen in isolation; rather, it should be viewed as an extension of traditional bullying. Cyberbullying, like traditional bullying, is recognized to be a global phenomenon cutting across cultural groups and contexts (Ang et al., 2011, 2014; Sittichai & Smith, 2015). Even though this phenomenon has been mostly researched in Western societies, there is a substantial body of research in Japan and South Korea for example, and this has suggested that bullying and cyberbullying can exhibit different characteristics in other cultural contexts. Compared to Western countries, South Korea and Japan can be considered societies that are more collectivist, and in such societies, there is a greater likelihood of whole-class or whole-group aggressive norms emerging resulting in an entire class shunning a victim or aggressing against a victim (Sittichai & Smith, 2015). Bullying including cyberbullying has extensive and potentially severe consequences such as school refusal, depressive symptoms, and suicide (Raskauskas & Stoltz, 2007). In part, cyberbullying has been facilitated by the speed with which children and adolescents are using the Internet and social networking sites. According to the Pew Internet and American Life Project research, 66% of Internet users are social networking site users (Rainie et al., 2012). This rate is even higher among adolescent Internet users between the ages of 12 and 17 (80%), which suggests that having a presence on a SNS is almost synonymous with being online for adolescents (Lenhart et al., 2011). The rise in the number of children and adolescents online may also suggest an increase in the number of children and adolescents at risk for engaging in unhealthy, dangerous, and aggressive online social interactions even though a majority of children and adolescents report positive online experiences (Ybarra & Mitchell, 2004). In a recent study by Khong and colleagues (2020) from Singapore, they found victimization in adolescents (whether from bullying or cyberbullying) to be associated with poorer mental health outcomes in the form of more internalizing and externalizing problems compared to those with no victimization. These findings are in line with the international literature. Research also suggests that bullying

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and victimization are related. Kowalski et al. (2012) found that frequent perpetrators of traditional bullying also bully electronically, and they too become victims of cyberbullying themselves as their frequency of electronic perpetration increases. Taken together, it is timely and important to review child and parent variables associated with bullying and cyberbullying and to examine prevention and intervention strategies targeting multiple levels and contexts/systems in order to more effectively address cyberbullying and traditional bullying in an integrated manner.

Child and Parent Variables Associated with Cyberbullying Internet Use In a large, nationally representative survey of adolescents who use the Internet regularly, Ybarra and Mitchell (2004) found that specific usage characteristics were related to online harassment. Three of these characteristics will be highlighted here. First, adolescents who used the Internet most often for chat rooms were 3.5 times more likely than adolescents who used the Internet most often for all other activities (except email or Instant Messaging) to harass or cyberbully others online. Second, 54% of online harassers rated themselves as an Internet expert versus 6% who rated themselves as novices, compared to 29% of non-harassers who rated themselves as an Internet expert versus 25% who rated themselves as novices. Third, self-rated importance of the Internet was associated with a twofold increase in the odds of reporting Internet harassment behavior. These associations remained statistically significant even after controlling for all other significant factors. More recently, Pew Research Center found that adolescents who were very often online reported being more likely to face online harassment (Anderson, 2018). In related research, in a sample of 780 adolescent Facebook users from Singapore, Liu et al. (2013) found privacy concerns to directly and significantly decrease adolescents’ risky disclosure of personally identifiable information. Put differently, adolescents who were less concerned about the security of their online personal information tended to disclose more personally identifiable information on Facebook. Many types of content that Facebook users generate meet the definition of personally identifiable information such as one’s full name, date of birth, home address, mobile phone numbers, and personal photographic images (especially face and other distinguishing characteristics). Generally, individuals who have a greater willingness to disclose personal information online have a higher possibility of cyber-victimization and a higher possibility of engaging in other potentially risky behaviors such as meeting people face to face who were first encountered online (Lenhart et al., 2011; Liau et al., 2005; Mesch, 2009). Collectively, these results suggest that children and adolescents, who find themselves online frequently, especially if they actively engage in social networking and are not concerned about personal privacy, are particularly vulnerable.

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Psychosocial Difficulties Children and adolescents who face various types of psychosocial problems and difficulties are also vulnerable online. In Ybarra and Mitchell’s (2004) study, they found that indications of psychosocial challenge were associated with significantly elevated odds of harassing others online. For example, 32% of online harassers compared to 10% of non-harassers reported frequent substance use and that represented a fourfold increase in odds of Internet aggression against others. Also, 6% of online harassers versus 1% of non-harassers reported physical or sexual victimization by an adult in the previous year. Additionally, adolescent-reported delinquency, depressive symptomatology, and receiving a failing grade at school were also related to elevated odds of harassing others online. Psychosocial difficulties have also been linked to excessive and problematic Internet use. As reviewed earlier, Internet use has robust links with cyberbullying and harassment. Problematic Internet use can be specific or generalized in nature (Davis, 2001); specific problematic Internet use is the excessive or overuse of specific Internet functions such as gambling or viewing sexual material, and generalized problematic Internet use covers multidimensional overuse of the Internet resulting in negative consequences for the individual. Both theoretical and empirical studies have linked psychopathological, psychosocial difficulties such anxiety, depression, loneliness, and shyness with problematic Internet usage (Caplan, 2002; Davis, 2001; Morahan-Martin & Schumacher, 2000).

Proactive Aggression The proactive–reactive aggression distinction was first introduced by Dodge and Coie (1987), and this typology focuses on the function as opposed to the form of aggressive behavior. Proactive aggression is defined as instrumental aggressive behavior that occurs without apparent provocation or instigation and is motivated by anticipated rewards and outcomes resulting from aggressive acts. In contrast, reactive aggression is defined as a hostile, impulsive, and angry response that functions as retaliation to a real or perceived threat, provocation or frustration. Instrumental aggression is thought of as a premeditated means of obtaining a particular goal, while hostile/expressive aggression is thought of as unplanned, thoughtless, and primarily perpetrated in reaction to anger-inducing situations. Taken together, it is important to note that reactive/hostile/expressive aggression is performed in response to external social stimuli that are perceived to be aversive and proactive/instrumental aggression is motivated by internal desires and goals (e.g., domination) that are perceived to be attractive. Previous research has shown differential correlates for both proactive and reactive aggression (e.g., Seah & Ang, 2008). In particular, there is sufficient empirical evidence to posit a link between proactive aggression and traditional face-to-face

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bullying (e.g., Dodge & Coie, 1987; Dodge et al., 1997; Hubbard et al., 2001). There has also been emerging empirical evidence showing the association between proactive aggression and cyberbullying. For example, in a large sample of 1431 schoolgoing adolescents (682 boys and 726 girls) from 12 to 17 years of age from Spain, Calvete and colleagues (2010) examined cyberbullying in relation to other indicators of aggressive behavior such as proactive, reactive, direct, and indirect behaviors as well as the justification of violence. The authors used multiple regression analysis, and this model tested explained 13% of the variance in cyberbullying behavior. Of the various indicators of aggressive behavior, Calvete et al. found that proactive aggression and belief justifying violence were the only two correlates associated with cyberbullying. In a study using a cross-cultural sample of adolescents from the USA and Singapore, Ang et al. (2014) found that both proactive and reactive aggression were correlated with cyberbullying across cultures, and that percentages of adolescents involved in cyberbullying across the two countries were relatively comparable. These rates of 17.9 and 16.4% for the USA and Singapore, respectively, fell within the range of prevalence rates obtained across multiple studies as reported by Calvete et al. (2010). Of note were the findings indicating that nationality did not moderate the relationship between proactive aggression and cyberbullying and between reactive aggression and cyberbullying. As expected, Ang et al. found proactive aggression to be positively associated with cyberbullying, after controlling for reactive aggression, in both the USA and Singapore samples, and the combined sample. Conversely, as expected, the relation between reactive aggression and cyberbullying was not found to be statistically significant after controlling for proactive aggression across the USA, Singapore, and combined samples. This means that while proactive aggression could uniquely contribute additional variance in predicting the scores in cyberbullying across both USA and Singapore adolescents, reactive aggression could not.

Normative Beliefs About Aggression Normative beliefs are individuals’ own cognitions about the acceptability or unacceptability of a behavior and serve to regulate actions by prescribing the range of permitted and prohibited behaviors, and these beliefs are expected to be universal across cultures (Huesmann & Guerra, 1997). Individuals who endorse normative beliefs about aggression view bullying and use of aggressive behavior as acceptable. The dearth of social and contextual cues available in cyberspace might lead to an activation of these normative beliefs supportive of aggression in adolescents, particularly those with narcissistic traits such as exploitativeness which are closely aligned to correlates of proactive aggression such as lack of empathy and a blatant disregard for others (e.g., Werner et al., 2010). Anonymity on the Internet can operate to reduce self-awareness resulting in deindividuation, and a de-individuated person has a weakened ability to regulate his or her behavior and a lower likelihood of caring about what others think of his or her behavior (Zimbardo, 1970). McKenna and Bargh’s (2000)

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review suggests that scholars are in agreement that higher levels of interpersonal misunderstandings and aggression are more likely to occur in computer-mediated interactions compared to face-to-face interactions. Williams and Guerra (2007) found that adolescents’ normative beliefs endorsing aggression were associated with all forms of bullying including cyberbullying. With specific reference to cyberbullying, the authors found that an increase in one unit of the normative beliefs about aggression scale led to a 24% increase in odds of cyberbullying (Williams & Guerra, 2007). Similarly, in a longitudinal study involving middle school adolescents, Werner et al. (2010) found that greater acceptance and approval of both overt and relational aggression were associated with increases in cyberbullying. Additionally, this association has empirical support cross-culturally. Ang et al. (2011) investigated the role of normative beliefs about aggression in relation to cyberbullying across two adolescent samples—one from Singapore and another from Malaysia. Ang et al.’s findings demonstrated that normative beliefs about aggression partially mediated the relationship between narcissistic exploitativeness and cyberbullying in both Singapore and Malaysia adolescent samples. Normative beliefs about aggression have been shown to be one mechanism of action by which narcissistic exploitativeness could exert its influence on cyberbullying. These findings extended previous work (e.g., Williams & Guerra, 2007) and showed that such beliefs could be the mechanism of action in both offline and online contexts. In a recent study, Peled et al. (2019) examined normative beliefs about cyberbullying in Israeli and US youth. Findings showed that normative beliefs about cyberbullying were predictive of cyberbullying even after taking into account country, grade level, gender, access to electronic devices, and face-to-face relational aggression. Furthermore, cyberbullying strategies were more likely to be present at the highest level of normative beliefs. Contextual cues serve regulatory functions, and reduced contextual cues in online social interactions could lead to deregulated online behavior (Kiesler et al., 1984). For narcissistic individuals with a tendency for exploitativeness in particular, the anonymity of the Internet could exacerbate their sense of disregard for others and their belief that aggression is acceptable and justifiable (Rigby & Slee, 1991). Especially in a cyber context where cues are absent or ambiguous, when these children and adolescents are confronted with a potentially conflictual social situation, these beliefs about legitimacy of aggression are likely to be activated. Gradually, more empirical evidence is emerging that normative beliefs of aggression not only act as a mediator facilitating bullying behavior in traditional contexts but these findings can similarly be extended to online contexts, across cultures.

Parent–Child Relationship Several aspects of poor parent–child relationships have been shown by research to be closely related to cyberbullying and harassment. Ybarra and Mitchell’s (2004) work showed that 44% of online harassers reported having a very poor emotional bond with

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their caregivers versus only 16% who reported a strong emotional bond. Conversely, 19% of non-harassers reported having a very poor emotional bond with their caregivers compared to 32% who reported a strong emotional bond. Infrequent caregiver monitoring was also associated with an 84% increase in the odds of reporting Internet harassment behavior. What appears to be particularly noteworthy about these findings is that despite adjusting for significant personal characteristics and all other aspects of the caregiver–child relationship, a poor emotional bond remained significantly related to online harassment, and an adolescent with a poor emotional bond with his/her caregiver was still more than two times as likely to engage in online harassment compared with an adolescent with a strong emotional bond with his/her caregiver. Grunin et al. (2020) examined the relationship between adolescent cyberbullying behaviors and their perceptions of parental emotional support in a large representative sample of 14,627 adolescents in the USA between 11 and 15.5 years of age. Of particular interest is the finding that if an adolescent “almost never” perceived their parent/guardian as loving, their odds ratio increased dramatically to more than six times as likely of falling into the high cyberbullying class compared to the reference group of participants who report their parents as “almost always” loving. Related research has also shown that parents’ knowledge and awareness of children’s and adolescents’ online activities have been associated with lower levels of problematic Internet use among adolescents in the USA (Sun et al., 2005), China (Huang et al., 2010), Italy (Milani et al., 2009), South Korea (Park et al., 2008), and Singapore (Liau et al., 2008). In line with previous research, Ang and colleagues (2012) found that parents who were perceived to have greater knowledge and awareness of adolescents’ online activities had adolescents who reported a lower level of problematic Internet usage, and conversely, lower perceived parental knowledge and awareness were associated with higher levels of problematic Internet usage. Ang et al. extended previous research by demonstrating that perceived parental knowledge and awareness acted not just as a main effect but as a moderator to modify the already empirically established link between loneliness and generalized problematic Internet use in an adolescent sample. Therefore, collectively, these research findings suggest that parental knowledge of their children’s and adolescents’ online activities and having a communicative and open parent–child relationship are important factors in contributing to children’s and adolescents’ positive adjustment in the use of the Internet across various domains. Research studies in the social media domain also report consistent and similar results providing further support that a poor parent–child relationship is a risk factor for cyberbullying. Parents have consistently been identified to be the major source of social influence with respect to children’s media consumption (Buijzen & Valkenburg, 2005; Moscardelli & Divine, 2007). Researchers defined the strategies parents use to supervise children’s media use or help children interpret media content as parental mediation (Warren, 2001). In the Internet era, two main types of parental mediation have been found: active mediation and restrictive mediation. In active mediation, parents discuss with children the positive and negative aspects of Internet

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content and teach children how to protect themselves from uncomfortable experiences online. In restrictive mediation, parents also use restrictions to limit children’s Internet use, for instance, they limit the number of hours the child can surf the Internet, or prohibit the viewing of certain websites (Miyazaki et al., 2009). Generally, parental mediation has been described as one of the most effective methods to protect children from negative media influence (Buijzen & Valkenburg, 2005). In Liu et al. (2013) study, the authors found that active mediation decreases adolescents’ disclosure of personal information both directly and indirectly by increasing privacy concern, while restrictive mediation only indirectly decreases such disclosure through privacy concern. Therefore, adolescents whose parents discuss the consequences of engaging in risky Internet behaviors and teach them methods to protect themselves may perform much better in protecting their personal information compared to adolescents whose parents mainly utilize rule setting to limit their Internet behaviors without explanation. That said, it is important to underscore the fact that these results do not completely negate the use of restrictive mediation strategies; while active mediation is more helpful, both types of mediation can be used effectively and appropriately to protect children and adolescents. These results are consistent with findings in a majority of previous studies (Fujioka & Austin, 2002; Nathanson, 1999; Youn, 2008).

Prevention and Intervention Strategies Bullying behaviors whether online or offline often occur in a bullying context, and this context is in turn embedded in a larger ecosystem. Cyberbullying and traditional bullying are closely interconnected and have extensive and potentially serious consequences (Modecki et al., 2014; Olweus & Limber, 2018). Bullying (traditional bullying and cyberbullying) and victimization are also related (Kowalski et al., 2012); frequent traditional bullies engage in cyberbullying, and these individuals also become victims of cyberbullying themselves in due course. Regardless of form, victimization in youths has been found to be associated with poorer mental health outcomes (Khong et al., 2020). Therefore, as we analyze cyberbullying and online harassment with reference to prevention and intervention strategies, we do so with this understanding in mind. These strategies should target and address specific child and adolescent issues and variables. Additionally, parent-related and parent–child relationship variables should also be specifically targeted and addressed because parents continue to play a crucial and critical role in the lives of children and adolescents. Ultimately, prevention and intervention strategies need to target multiple levels and contexts/systems in order to more effectively address cyberbullying and traditional bullying in an integrated fashion.

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Empathy Training and Changing Beliefs Supporting Aggression As both forms of bullying are related, victims of one form may have an increased likelihood of becoming a victim of the other form of bullying. Kowalski et al. (2012) have shown that the more visible signs displayed through traditional bullying behaviors may serve as a warning signal for potential cyber-victimization and pave the way for early detection of bullying behavior (traditional bullying or cyberbullying) and hence prevention and intervention efforts. Hence, with respect to empathy training and education, this can be part of a broader bullying prevention and intervention program. Such training has been successful in reducing offline aggressive, bullying behavior (e.g., Bjorkqvist et al., 2000). The effect sizes vary across studies, but on average, the magnitude is of a small to medium range (Derzon et al., 1999; Ttofi et al., 2008). For example, children and adolescents could be taught to view issues and grievances from the victim’s perspective and to learn to vicariously experience the emotions of the victim as opposed to engaging in typical responses of victim blaming (Chibbaro, 2007). Generalizing these empathy skills from an offline to an online context with reduced social–contextual cues can be a challenge. Therefore, it is important in the context of providing empathy training and education, to personalize the serious and real consequences of cyberbullying, sending the message that if these consequences can happen to a fellow peer, it could happen to anyone including themselves. Previous research studies have also shown that proactive aggressive children and adolescents, and those having normative beliefs of aggression view aggression as a legitimate response, they construe cyberbullying as an acceptable way to attain instrumental goals, expecting positive outcomes from their actions for example (e.g., Dodge et al., 1997; Hubbard et al., 2001; Werner et al., 2010). Prevention and intervention programs need to target changing mindsets. Changing mindsets about the acceptability of aggression is not easy, but research has shown that such beliefs and cognitions can be modified (Guerra & Slaby, 1990). In such programs, children and adolescents learn that cyberbullying and bullying behaviors are not legitimate responses, that such actions hurt the victims, and victims do not deserve to be hurt.

Develop Positive Parent–Child Relationships Early The need to establish and develop positive parent–child relationships cannot be overemphasized. This is central to all prevention and intervention strategies targeted at parents. Ybarra and Mitchell’s (2004) research study reminds us of the importance of a positive and strong parent–child emotional bond; a positive and healthy parent– child relationship can help to reduce the likelihood of cyberbullying and traditional bullying. Additionally, poor caregiver monitoring is also implicated in increased odds

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of being an Internet harasser (Ybarra & Mitchell, 2004). These results and implications are consistent with social media research findings that parental mediation strategies are crucial in helping children and adolescents recognize the risks and consequences of personal information disclosure along with learning methods of protecting personal information and making discerning choices about what information they can reveal (Liu et al., 2013). Not only is it important to establish and develop a positive parent–child emotional bond, it is critical to establish this as early as possible. In Ang et al.’s (2012) study, she and her colleagues found that parents who had knowledge about their adolescents’ online activities and parents who did not were more differentiated at low levels of adolescent-reported loneliness than at high levels of adolescent-reported loneliness. At low levels of loneliness, parents who were reported to be aware of their adolescents’ online activities had adolescents who indicated a much lower level of problematic Internet use. In comparison, parents who were reported to be unaware of their adolescents’ online activities had adolescents who indicated a much higher level of problematic Internet use. In contrast, at high levels of loneliness, both groups of parents were associated with adolescents who reported similarly high levels of problematic Internet use. What this means is that in a non-clinical, school-going sample of adolescents, these results suggest that parents’ perceived knowledge and awareness of their adolescents’ online activities are likely to be associated with a lower level of problematic Internet use if this occurs at low levels of loneliness. These results have implications for prevention and early intervention work. This implies that for the parent–adolescent interaction to be effective, it may be best to cultivate a positive relationship early and to intervene at an earlier stage where loneliness has not reached a higher, more maladaptive level. Therefore, establishing and cultivating a positive parent–child relationship early has numerous advantages and goes a long way in helping to protect vulnerable children and adolescents in the online and offline environments.

Adopting a Multilevel and Multisystemic Approach While targeting child-related and parent-related variables are important, prevention and intervention efforts for bullying and cyberbullying are incomplete without situating these in a larger framework and simultaneously addressing multiple levels such as the individual, relationship, the community, and societal levels. Within each of these levels, it is equally crucial to address the contextual systems within which the child/adolescent is embedded as that constitutes the child’s ecology (Espelage & Swearer, 2004). At the individual level, strengthening children’s and adolescents’ social– emotional skills would be a staple for prevention and intervention work. Such social–emotional skills could include but are not limited to understanding and expressing feelings, emotional awareness, emotional regulation, anger coping, and problem-solving (Ong et al., 2019; Tan et al., 2013). Targeting and specifically

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addressing normative beliefs about aggression as a legitimate response has already been discussed earlier, and this would be crucial as well. At the relationship level, three sets of relationships are particularly central in the lives of children and adolescents—the parent–child, parent–adolescent relationship, the teacher–student relationship, and the peer–peer relationship. The parent–child, parent–adolescent relationship has been addressed in earlier sections. Alongside the parent–child, parent– adolescent relationship, the other two sets of relationships also affect children and adolescents in significant ways (Ang et al., 2020; Cheong et al., 2017). Across relationships, interactions are shaped by various factors such as age, gender, and culture, among other factors. At the community level, schools and classrooms ought to be safe spaces for children’s and adolescents’ optimal development. Researchers have advocated for a whole-school approach when addressing bullying and cyberbullying behaviors where interventions target the entire school context instead of only the students involved and such approaches have been shown to be effective (Ttofi & Farrington, 2011). Given how quickly technology is advancing, many parents do not have sufficient knowledge to educate their children on how to protect their online security. Schools as a social agent that is tightly linked to children and adolescents as well as their parents may be the best platform to provide support to parents. O’Neill et al. (2011) suggested that schools could organize workshops for parents on digital literacy and safety skills. Additionally, if industry could concurrently play their part in self-regulation, this could work hand in hand with parents’ supervision, and it will make children’s online security issues much easier to handle and manage. The community level is very much connected to interventions at the societal level as well. The importance of cross-sector coordination and integration cannot be overemphasized. Overall, adopting a multilevel and multisystemic approach when considering the phenomenon of bullying (including cyberbullying) in relation to prevention and intervention would likely result in the most effective outcomes.

Conclusion and Recommendations Cyberbullying is a global phenomenon and a universal concern with potentially serious consequences. With the anonymity provided by the Internet and the reduced social and contextual cues available in cyberspace, children and adolescents tend to become less conscious of what others think concerning their behavior resulting in a higher chance of interpersonal conflict. Children and adolescents also tend to engage in more high-risk behaviors online. At the same time, we recognize that bullying behaviors are situated in a larger ecosystem. Cyberbullying is not a phenomenon completely distinct from traditional bullying; being a victim of one form of bullying also increases the chances of becoming a victim of the other forms of bullying. Child variables associated with cyberbullying were reviewed, and these include Internet usage patterns and characteristics, psychosocial difficulties and challenges, proactive aggression features, and normative beliefs about the acceptability of aggression.

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Likewise, parent–child relationship variables such as a poor emotional bond, a lack of knowledge about the child/adolescent’s online activities, and lack of adequate parental monitoring and parental mediation have been reviewed to be related to cyberbullying. Based on these variables reviewed, and based on the understanding that cyberbullying should not be viewed in isolation, strategies targeting child/adolescent issues, parent-related, and parent–child relationship variables were highlighted as suitable targets for prevention and intervention work. Specifically, there is a need for empathy training and to modify the belief that aggression is a legitimate and acceptable response. As parents play a very important role in the lives of children and adolescents, it is crucial to nurture and develop a positive parent–child emotional bond and to establish that as early as feasibly possible. Finally, for prevention and intervention strategies to be effective, it should be addressed within a framework that takes into account multiple levels and multiple systemic contexts.

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Chapter 4

Child Abuse and Neglect in India, Risk Factors and Protective Measures Sibnath Deb and Mrinalkanti Ray

Introduction Abuse of children in any form is a criminal offence. This act does not affect the children mentally, physically, sexually and morally, it also affects their personality, social adjustment and career, and thereby, the country loses huge potential human resource. In other words, it is a national loss in economic terms. One of the evils that cripple India like other developing countries and hinder her growth is child abuse and neglect. Figuring as she does among the nations with the largest child populations, India could amply take advantage of this human resource if it is provided with basic facilities and support services. Otherwise, this resource would threaten to be a considerable national burden. India is extraordinarily rich in cultural diversity, suggesting that every culture has its typical beliefs and practices about child-raising. Not that all these measures are beneficial or always beneficial; some of them prove detrimental and even destructive at times. For normal physical, psychological, and social development, children require basic facilities like nutrition, education, entertainment, security, medical care and parental love. They can consequently arrive at their full potential and flower into ideal citizens. According to Worldometer elaboration of the latest United Nations data, the total population of India as on September 23, 2021, is 1,396,605,602 (Source: India Population (2021)—Worldometer; https:// www.worldometers.info). As per Census of India 2011, the literacy rate at all India level is 72.98%, and the literacy rate for females and males is 64.63% and 80.9%, respectively. Even 72 years after independence, poverty is widespread, mostly in the rural regions. Like anywhere else in the world, it is poverty which is the root cause of child abuse and neglect in India. According to the 2010 World Bank Report, 32.7% of people in India live below the international poverty line of US$1.25 a day, while S. Deb (B) Rajiv Gandhi National Institute of Youth Development, Sriperumbudur, Tamil Nadu, India M. Ray University of Laval (Université Laval), Quebec City, Canada © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_4

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68.7% subsist on less than US$2 a day (PPP). Similarly, the 2010 United Nations Development Programme estimated that 29.8% of Indians live below the country’s national poverty line (Mandal, 2010). The children of these families are easy preys of human trafficking and sexual abuse (Census of India, 2011). Children make up about 44.4% of the total population regardless of their socioeconomic background, and one in every two children is deprived of primary education, adequate nutrition and medical care (Indian National Family Health Survey, 2005–2006). Girls of especially rural areas are grossly discriminated against with respect to education, nutrition, and health care, the reason being that they, unlike boys, are regarded as burdens of the family.

Corporal Punishment, Psychological and Sexual Abuse and Neglect Child abuse and neglect is a major social problem of India (Deb, 2018; Deb et al., 2016, 2020; Seth, 2015; Sunny & Deb, 2020). Public health professionals are justified in giving a special importance to this issue (Theodore et al., 2000). But the solution to the problem sounds difficult especially for the lack of documentation system, because without documentation, it is hard to conceive of the magnitude of the problem and to plan out intervention programs. Reliable data about child abuse that comes in such forms as sexual exploitation and corporal punishment could be garnered by trained personnel of hospitals, police stations and educational institutions. Several cases of sordid child sexual abuse were brought to light by the media, allowing the public and the policy-makers alike to perceive the gravity of the problem and to contemplate new legislations. Let us now take a glance at the findings of some local studies available to us. Leaving aside its methodological limitations, the Study of the Ministry of Women and Child Development, Government of India, on child abuse covering 13 states provides a glimpse of the nature of the problem. According to this study, children in the age group of 5–12 years have experienced the worst of abuses. Boys are as much at risk of being abused as girls, and the abusers are generally those placed in position of trust and authority (MWCD Report on Child Abuse & Neglect, 2007). When protectors turn into perpetrators or predators, the assumption that home is the safest place for a child simply dwindles into a myth (Virani, 2000). The negative image of the protectors pushes the children to choose bad companions and unhealthy lifestyles. Consequences of this problem are many, but one consequence that towers over all the rest is the ailing health of these children. “The Child is father of the Man” proclaims the English poet William Wordsworth in the epigraph of his celebrated poem “The Immortality Ode.” If it is so, a dysfunctional childhood predicts a dysfunctional adulthood, which implies that the health of an individual is of paramount importance. According to the 2012 Report of the Indian National Commission for Protection of Child Rights based on the survey of 2009–2010 covering seven states of India,

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99.7% of the children reported one or more types of punishment. As many as 81.2% children were subjected to outward rejection when told that they were incapable of learning. Three-forth (75%) children testified that they used to be caned, and 69% children testified that they were slapped in the cheek (Report of the National Commission for Protection of Child Rights, 2012). It is relevant to mention here that Section 17(l) of the Rights of Children to Free and Compulsory Education Act, 2009, ruled against physical punishment or mental harassment to students in schools. In a Kolkata-based study, 52.4, 25.1 and 12.7% adolescents reported about psychological, physical and sexual abuse (Bhattacharyya, 2011). One study in Tripura revealed that about 20.9, 21.9 and 18.1% of children suffered psychological, physical and sexual violence, respectively (Deb & Modak, 2010). Speaking of corporal punishment, 33.3% of male and 40% of female teachers confessed that they were in the habit of physically punishing students, as the Kolkata-based study reveals. And those who are unaccustomed to exercising physical punishment did not bother to speak against this practice, apparently because they saw nothing wrong with it, or because they did not wish to offend or alienate their abusive colleagues. Findings also revealed that 60% of male teachers and 53.4% of female teachers used to be physically punished in their childhood (Deb & Adak, 2006). One recent incident as reported by a local newspaper proves that the practice of child sacrifice out of superstitious beliefs is still prevalent in India. In January 2011, a 5-year-old Dalit girl child named Rajalakshmi, the daughter of a poor agricultural laborer, was decapitated in the midst of pomp and ceremony in the belief that the sprinkling of the victim’s blood on a construction site is propitious for its success. This barbaric crime was perpetrated in a village in Madurai district of the state of Tamil Nadu. Surprisingly enough, a member of an active political party masterminded it (DMK Functionary, 2012; Helpless Dalit Girl, 2012). A study that covered a group of 120 migrant child laborers working in households, tea stalls, garages and shops in South Kolkata has shown that an overwhelming number of children got abused (Deb, 2005a, 2005b). A study of 35 trafficked children and young women found that trafficking is usually done with offers of false marriages and jobs, or through abduction and sale (Deb et al., 2005). In another study, the authors (Chatterjee et al., 2006) observed that six of 41 trafficked children contracted HIV/AIDS. Child marriage was legally banned in India as early as 1929. Today, even 85 years after independence, this outrageous custom prevails in many regions of India. Nearly 45% of women in India are married off before they reach 18 years of age, a fact corroborated by a joint Indo-American study in the Lancet. The report adds that more than 40% of the world’s child marriages take place in India (Eighty Years, 2009). The states which are in the forefront of girl child marriages are Rajasthan, Bihar, Uttar Pradesh (UP), Chattisgarh and Madhya Pradesh. Customs reign over reason and common sense in these states. In the rural areas of Rajasthan, the situation is worse, as exemplified by the assault of enraged villagers of Jhalawar District on 12 government officials when the latter attempted to thwart the child marriage of about 42 couples. Later, these villagers stormed into the Churiliya Police check-post and did incalculable damage to it (Villagers Attack, 2012).

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Another bane of India is malnutrition which particularly affects her child population. According to the National Family Health Survey–3 (2006), more than 56% of the teenage girls in India are anemic with a hemoglobin count of less than the standard 12 g/dL. The incarceration of child-domestic-servants is a common occurrence, while their masters go out on travels. In 2012 in New Delhi, a family allegedly practicing the medical profession locked up their 13-year-old maidservant in the house without food or provisions before setting out for a vacation in Thailand (Doctors in the Dock, 2012). Child sexual abuse is as rampant in India as ever. By way of example, we may refer to the two cases that happened in Uttar Pradesh in May (2012) and to one case that happened in the Coimbatore district of Tamil Nadu on June 11, 2013. The Coimbatore case is particularly disturbing, for it happened in a children’s home run by a church, where one or two men managed to infiltrate and raped two little girls, aged 10 and 11, at knifepoint, and then fled. A more shocking case is, however, the brutal gang rape and murder of two cousin sisters, aged 14 and 15, in Badaun, UP. Their abductors snatched them as they went out of home in the evening into the fields to answer nature’s call (as they had no toilets at home). Their corpses were spotted hanging from a mango tree the next day. Those entrusted with maintaining law and order are occasionally found to be negligent about their duties. A compelling proof is the refusal of the local police to file the case when reported by the distraught parents of the missing girls. The cops did so only hours later when faced with angry villagers crowding the compound of the police station. A week later, a similar crime was repeated in Sitapur. A minor girl stepped out of her house to relieve herself in the fields and fell on the clutch of six hyenas of men. Her body was later discovered suspended from a tree (NDTV, 2014). Child trafficking for commercial sexual exploitation is on the rise in India, and the hub of this notorious trade is West Bengal or, more precisely, Kolkata (Sen, 2005). The trade operates by way of recruitment, transport and transfer of children picked through abduction, deception or force. Since girls for commercial sex are in great demand in other countries, the trade has become increasingly transnational (International Labor Organization, 2005; UNICEF, 2005). Cases were that children simply disappeared overnight, at an average rate of one in every 8 min, according to the National Crime Records Bureau (Ministry of Home Affairs, Government of India, 2010).

Reported Cases of Crime Against Children in India During 2018–2020 Apart from abuse, children experience other forms of criminal offences like rape, murder, trafficking, kidnapping and infanticide. The offences committed against children or the crimes in which they are victims are usually labeled as crime against children. Indian penal code and the various protective and preventive “Special and

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Local Laws” specifically mention the offences wherein children are the victims. The age of child varies as per definition given in the concerned Acts and Sections, but the age of child has been specified to be below 18 years as per the Juvenile Justice Act 2000. The cases in which children get victimized and abused fall into two broad sections (i) Crimes committed against children are punishable under Indian Penal Code (1860) (IPC) and (ii) Crimes committed against children are punishable under Special and Local Laws (SLL). In this section, information about various forms of crime against children is provided. According to the Crime in India Reports published by the National Crime Records Bureau, in 2018, a total of 141,764 children experienced various forms of crime across the country, 132,426 incidents happened in the 28 states, while 9398 happened in the eight Union Territories. The number of cases of various forms of crime against children went up to 148,090 in 2019. However, there is a sharp decline in incidents of crime against children in 2020. In 2020, the total reported cases was 128,531 across the country. It might be because of continuous lockdown in India owing to COVID-19 resulting in less mobility of children. Among the states, the highest number of cases reported was Uttar Pradesh (19,936) in 2018, followed by Madhya Pradesh (18,992), Maharashtra (18,892), Bihar (7340) and Chhattisgarh (6924). In 2019, Maharashtra (19,592) was in the top position in terms of highest number of reported cases of crime against children, followed by Madhya Pradesh (19,028), Uttar Pradesh (18,943), Rajasthan (7385) and Odisha (7012). In 2020, the total incidents of crime against children has come down to 1,28,531. Madhya Pradesh (17,009) recorded the highest number of reported cases of crime against children in 2020, while Uttar Pradesh occupied the second position (15,271). The other three states with the highest number of cases of crime against children include Maharashtra (14,371), West Bengal (10,248) and Bihar (6591). Nagaland is the state where the least number of children experienced crime during the last three years. In 2018, 2019 and 2020, only 70, 59 and 31 cases were reported. Among the Union Territories, Delhi recorded the highest number of crimes against children in the last three years (2018–2020), i.e., 8246, 7783 and 5362, respectively, with a declining trend. After Delhi, Jammu & Kashmir, Chandigarh and Andaman & Nicobar Islands are the other Union Territories that recorded more cases of crime against children. There was no incident of crime against children in Ladakh in 2018 and 2019. Only two incidents reported in 2020 in Ladakh. After Ladakh, Lakshadweep is one of the Union Territories where incidents of crime against children were low, i.e., 8, 26 and 9 cases in 2018, 2019 and 2020, respectively. The rate of total crime against children with respect to one lakh population in the states and Union Territories in 2020 was 28.2 and 56.0. If we look at the incidents of crime against children across the Metropolitan cities in India, Delhi is on the top in the last three years, followed by Mumbai and Bengaluru.

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Nature of Crime Against Children in 2020 Ninety-seven (97) cases of murder of children were reported in 2020 in different cities in India. In a number of cases, children were murdered after sexual abuse to suppress the evidence. A total of 332 cases of child trafficking in different cities in India were reported to the Police under Sec.370 and 370A of Indian Penal Code (IPC) in 2020 signifying the seriousness of the issue. Altogether 10,229 IPC-related crimes against children have been registered in 2020.

Child Abuse Cases Booked Under POCSO Act During 2019–2020 A total of 26,497 sexual abuse cases (268 boys and 26,229 girls) under the Protection of Children from Sexual Offences Act 2019 were reported in 2019 as per Crime in India Report. Data clearly demonstrates an association of higher age with the incidents of sexual abuse, i.e., more number of children aged between 16 and 18 years experienced sexual abuse during this reporting period (i.e., 13,746), while the figure was 9415, 2627 and 709 for children aged between 12 and 16, 6–12 and below 6 years age groups, respectively. In 2020, a total of 4881 cases of various forms of child sexual abuse were booked under different sections of Protection of Children from Sexual Offences Act 2019 in different cities of India. Delhi is the most vulnerable city for sexual abuse of children as per Crime in India Report 2020 with 1151 cases of abuse, followed by Mumbai (964), Ahmedabad (325), Hyderabad (318) and Bengaluru (278).

Perpetrators of Sexual Abuse As per Crime in India Report 2020, 96% of the perpetrators are known to children. They mostly include family members, family friends, neighbors, employers, friends, online-friends or live-in partners on pretext of marriage.

Kidnapping and Abduction of Children in 2020 in India A total of 8501 cases of kidnapping and abduction of children were reported during the year 2020 across the country. These children were kidnapped and abducted with intention to abuse them for various purposes like murder, ransom, marriage, using for

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commercial sexual exploitation and other purposes (Source: Crime in India Report, 2020).

Cyber Crime Against Children in 2020 in India A total of 1102 children were victims of cybercrime in India in 2020. Most common form of cybercrime against children (66.96%, 738/1102) includes cyber pornography, hosting or publishing obscene sexual materials depicting children which is coming under sec.67B of IT Act and other IPC and SLL Acts. Cyber stalking and/bullying is another form of cybercrime children experienced in 2020 (12.7%, 140/1102). A group of 220 children experienced other forms of cybercrime. Uttar Pradesh, Maharashtra, Karnataka and Kerala are the most vulnerable states for cybercrimes against children as per Crime in India Report 2020.

Report of Child Abuse and Neglect Cases in India Compared to the industrialized countries of the West, the reporting of child sexual abuse and of corporal punishment is done tardily in India, as local studies demonstrate (Modak, 2009; Mukherjee, 2006). Csorba et al. (2006) tell us that cases of sexual abuse are rarely reported across the geographical boundaries for a variety of reasons, such as the fear of social stigma, the perceived harassment, the reluctance of parents or their disbelief and of course the threats from the perpetrators. According to a study in Kolkata, only 1.7% of sexually abused cases were reported to the police (Deb & Mukherjee, 2011). And according to another study in Agartala (Tripura), 15.5% of sexually abused cases were reported (Modak, 2009). A primary reason why reporting is rarely done is that the victims do not wish to incur the grudge of the perpetrators. If the cases are reported to the police, the victims or their families run the risk of being pursued by the perpetrators for retaliation. Another reason is the fear of social stigma which many victims cannot afford to bear with (Mukherjee, 2006). There also lies the problem of shortage of professionals to administer psychological and medical services to sexually abused children. As a result, the majority of the children get to live with the grim experience of sexual abuse for the rest of their lives, and this materially impacts on their personalities, their interpersonal relationships and their career developments (Deb & Sen, 2005).

Child Abuse and Neglect: Scenario of Asian Countries The incidents of child abuse cases of India are similar to other Asian counties with little variation. One secondary study based on a review of nine articles of four South

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Asian countries disclosed the high prevalence of physical maltreatment against child laborers, and it varied from 2.3 to 73.27%. As usual like other studies, the prevalence of emotional maltreatment was more than three times that of physical abuse. A good number of child laborers also experienced sexual abuse (16.82%) followed by neglect (12.9%). The study also highlights that a large number of child laborers witnessed victimization, experienced financial exploitation and worked as slaves. Further the study reported that the victims and caregivers’ characteristics and sociocultural practices were strong predictors of maltreatment. About one-third child laborers were psychologically traumatized and were suffering from social phobia, conduct disorder and obsessions (Ahad et al., 2021). One Singapore study reported lifetime prevalence of adverse childhood experience to be 63.9% (Subramaniam et al., 2020). One systematic review study on epidemiology of child sexual abuse in Japan revealed that “the range of contact CSA for females was 10.4%–60.7%, and the prevalence of this type of CSA for males was 4.1%. The range of penetrative CSA for females was 1.3%–8.3% and that for males was 0.5%–1.3%.” One of the main limitations of the study was lack of uniformity in methodology. Another big challenge for estimating prevalence of sexual abuse is poor reporting of incidences. One recent qualitative study in Indonesia reported high incidence of girl child marriage during the COVID-19 lockdown phase owing to a number of factors like escape from schoolwork, house chores and the stress and boredom of studying and staying at home during the pandemic, social permissibility, poor understanding about adverse impact of early marriage, poor financial condition of parents and social pressure (Rahiem, 2021). A number of steps suggested by the author for prevention of early marriage include sensitization of larger society, engaging children and adolescents in productive and creative activities including study and so on. There is an association between impact of child abuse and internalizing as well as externalizing behavior of children. Some abused children suffer from depression and anxiety, while some become violent and aggressive in later life. In this regard, one study in Hong Kong reported statistically significant associations between experience of physical and emotional abuse in childhood and behavior problems in later life. Further the study observed that social support played a role of moderator to minimize the impact of child abuse in later life (Oh et al., 2019). Tran et al. (2021) examined the association between family-related factors and child maltreatment and observed that the grown up children experience multiple abuse as compared to minor children. Contrary to other studies, the findings of the study of Tran et al. (2021) revealed that boys were more likely to experience lifetime sexual abuse more in Vietnam especially living in a single family than that of girls. Interestingly, children from poor families and parents with unemployment status were less likely to become victims of abuse as compared to children from upper socioeconomic strata. A study in Bangladesh by Atiqul Haque et al. (2020) examined the newspaper reports related to child maltreatment (CM). Review of 790 new articles demonstrates that “almost half of the CM cases concerned alleged physical abuse (26%) and sexual abuse (22%). Neglect and emotional or psychological abuse received less coverage. Female children were to a high degree (90%) victim of sexual abuse. The main

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perpetrators were males, and they were often known to the victims. Approximately 32 per cent of the reported abuse cases resulted in death and were related to rape, family violence, administrative negligence, abduction and ransom demand.”

Risk Factors to Child Abuse Risk factors for child abuse vary in accordance with the type of abuse, socioeconomic background, and demographic characteristics of the nation in question. But underlying the variables of risk factors are some common denominators, such as poverty, gender, parental educational background, parental mental health and substance dependence, family and social environment. Doctors from their first-hand clinical experiences indicated that there are numerous caregiver risk factors which put children at risk of emotional abuse (Glasser et al., 2001). Caregiver risk factors include the mental health difficulties of the caregivers, their alcohol or drug abuse, parental conflict or domestic violence and caregiver childhood maltreatment (often responsible for discontinuities of caregiving to their own children). The child risk factors are usually identified as follows: (i)

Child-Related Factors • Birth History of a Child Premature birth, birth anomalies, low-birth weight and exposure to toxins can act as risk factors for children, in that they are likely to predispose children to neglect and abuse (Cederbaum et al., 2013). Child’s temperament is another important factor. If children are difficult or slow to warm up, or if they have aggressive temperament or behavioral problems or attention deficit problems, they are at risk of abuse. Similarly, childhood trauma and negative childhood experiences not only impair their early development, but also render them vulnerable in later stages. Vulnerable are also those children who are neglected or who hang out with antisocial peer groups. The same is true of those who get into wrong companionship, and later try sex and drugs out of curiosity or for making money. • Age and Gender of the Child Risk factor depends on age as well. Children of younger age are evidently at high risk of abuse—the younger the age, the higher the risk. The abuse of children between birth and 3 years of age has been reported to be at its worst. The risk diminishes as the age advances. Children during infancy and early childhood stage requiring close supervision are prone to certain forms of maltreatment such as battered child syndrome and physical neglect (Kempe et al., 1962). Boys and girls are equally at risk of abuse. To put it in short, a child’s vulnerability to abuse is proportionate to his (her) age, as well as to his (her) physical, mental, emotional or social development.

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• Girl Child Generally speaking, the health or the living condition of a girl child is far from agreeable. The reason is traced back to the age-old prejudice that male child is superior to a female child. The 2011 Census has shown that there is a significant decline in the female population of India (Ministry of Statistics & Programme Implementation, 2012). Each phase of life of a female is blighted by gender discrimination which results in an unbalanced ratio between male and female population (Fikree & Pasha, 2004). An unwanted girl child is systematically eliminated through abortion. And those who are lucky to escape infanticide often find themselves extremely neglected. This is another reason for a higher girl-child mortality rate. Chances of her dying between her first and fifth birthday are 40% higher than those of a boy (Filmer et al., 2004). It is worth noting that India has the world’s largest gender survival gap (Save the Children, 2008). • Vulnerable Children are at Risk While a vast number of children are predictably vulnerable in India, most vulnerable are those who are orphaned or living outside of parental care or born into poor families. And greatly vulnerable are those discriminated as sex workers or the children of sex workers, street children, children with disabilities, children of lower castes and, of course, children of the Dalits (the so-called untouchables). They all are at risk of falling victims to abuse and neglect by caregivers and society alike. • Children with Physical, Cognitive and Emotional Disabilities Children with physical, cognitive and emotional disabilities are more likely to be maltreated than children without disabilities. The maltreatment may even become repeated. It is because the abusers know that they can get away with it, since these children do not have the ability to understand that abusive treatment is inappropriate and unacceptable. It is also because the abusers know that such children are unable to escape or to defend themselves. Children with intellectual disability or those having chronic illnesses are at high risk of maltreatment (Jaudes & Mackey-Bilaver, 2008). Such children become very dependent and are generally considered as burdens even by their parents. If children are stolid or unresponsive to affection, or if they live apart from their parents on account of frequent hospitalizations, chances of poor care and further abuse are high. Vulnerable to abuse and neglect are also the children who are affected with HIV. They may be affected with this deadly virus directly, meaning that they live with it. They may be affected with it indirectly, meaning that they live with a family member who has it. Similarly, vulnerable are the children who are orphaned following the death of their parent(s) from AIDS or AIDS-related diseases. Children living in institutional lodgings or with extended family members are also vulnerable to neglect with respect to care and support. • Child Laborers and Domestic Assistants

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Children are employed as child laborers in numerous sectors such as domestic chores, agriculture, construction works, factories and roadside business, to name a few. These children are often exploited and maltreated not just physically or psychologically, but also sexually. As anticipated, some of them sustain injuries, some are left with permanent disabilities, some meet death, and some get infected with HIV/AIDS (MWCD Report on Child Abuse & Neglect, 2007). Their basic needs of food, health and education are scarcely attended to. • Street Children A large number of children live on the street either with their parents or on their own. Child begging on the street is a common scene in Indian cities. According to UNICEF (1986), street children fall into three categories: (a) “children at risk,” those who live in families but work on the streets to supplement the family income; (b) “children on the street,” those who have some family support but work on the streets; and (c) “children of the street,” those who live and work on the streets without any family support. Since these children live on the street, they become more vulnerable to all forms of abuse, exploitation and maltreatment (Mathur et al., 2009). • Orphans and Children in Institutional Care It is customary to put disadvantaged or orphaned children in institutional care for their safety and well-being. Paradoxically enough, the seemingly safe havens usually turn out to be veritable hells. The kind of environment in which these institutions are wrapped up is favorable to different kinds of corruption and malpractices. In other words, these institutions present high risks, since the environment itself is risky (Keeshin & Campbell, 2011). Children living in different institutions are at risk of emotional, physical and sexual abuse by inmates, peers, caregivers and others in default of any viable system to protect them. Despite the dreadful nature of tyranny and humiliation endured, there is no escape, for the abuses go unreported all the same. To make matters worse, they come to be known as problem children and are compelled to live at the mercy of the authorities of the institution. All this plunges them into the depths of despair. • Sex Tourism Sex tourism is another serious problem in some parts of India. Sex tourists indulge in sex and abuse children of both sexes. A prominent example of Indian sex tourism is Goa (ECPAT, 2009). Children (even from well-to-do families) are brought in through pimps or mediators who make hefty profits which come not only from the supply of children to clients, but also from the sale of children. These children are either kidnapped or by making false promise they are indulged in sex tourism (Bandyopadhyay, 2012). They are sexually abused, very often repeatedly. Sooner or later, they end up being prostitutes. • Cultural Beliefs and Misconceptions as Risk Factors

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Colostrums are believed to be beneficial to a newborn child for increasing their immune capacity. Unfortunately, a large number of Indian mothers, especially those from rural areas, abstain from providing colostrums to their newborn children, apprehending that it is injurious to children’s health, just because it looks dirty. Their children are left vulnerable as a result. There is a misconception among semi-literate or illiterate people in rural India that a person with HIV/AIDS will be cured from that disease if they have sexual intercourse with a minor girl. Driven by this notion, many adults sexually abuse innocent girl children and transmit the disease to them. Indeed, child prostitution has assumed such a proportion that it has taken root in cultural belief, as exemplified in the consignment of female children as devadasis (temple prostitutes). Fear of diseases, curses and superstitious beliefs induce parents to consign their daughters to the goddess. Child marriage is a cultural practice in some communities in India (Raj et al., 2009). Girl children married off to adult men are vulnerable to different health-related problems including sexually transmitted diseases (ICRW, 2007). Gender discrimination with respect to nutrition and education is a very common phenomenon in rural India. (ii)

Family-related Factors Specific life situations of some families, such as single parenting, domestic violence and stressful life, augment the possibility of maltreatment. • Family Size, Family Income and Family Dynamics Both the parents are indispensable for the proper upbringing of children. Children living with single parents, or living with a large or joint family, are much more at risk of physical and sexual abuse or neglect than children living with biological parents (Stith et al., 2009). Poor economic condition of the family also accounts for child neglect and maltreatment. Finally, the family functioning, communication and conflict resolution methods all play determining roles in the development of children (Whitaker et al., 2008). • Family Violence Research indicates that in the families in which spouse abuse takes place, child maltreatment also occurs there (Rumm et al., 2000). They themselves become victims of physical or emotional abuse and are neglected by parents due to disturbed family environment. Their witnessing of parental violence takes a heavy toll on their mental and emotional life. Elder and partner violence also contributes to child abuse. • Stressful Life Events in the Family Stress of adult or elderly people plays a negative role in a family as far as the well-being of children is concerned. Evidence indicates a connection of physical abuse with stressful life events, parenting stress and emotional

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distress. Evidence also demonstrates that neglectful families report more day-to-day stress than non-neglectful families (Stith et al., 2009). Losing a job, physical illness, marital problems like divorce or interpersonal relationship problems among family members may trigger negative emotions like hostility, anxiety or depression which may aggravate family conflict, maltreatment and bad childhood experiences. (iii)

Parental Factors A number of parents-related factors are responsible for child abuse and neglect. As per the United Nations Convention on the Rights of Child, it is parents’ responsibility to ensure basic facilities for child development. If parents fail to provide the same, it is the nation’s responsibility to look after a child by providing him or her with basic facilities and a roof. • Personality and Mental Health of Parents Research shows that no specific characteristic or personality trait can be associated with maltreating parents or caregivers. But they were invariably found to have low self-esteem, poor impulse control, aggressive tendency, depressive mood, anxiety problem and antisocial behavior. Parents with dominating and hostile personality with major mental health problems and with very high expectations of their children tend to abuse them more than their counterparts (Cancian et al., 2010; Hien et al., 2010; Wallio, 2009). • History of Childhood Abuse Research shows that abused parents are particularly abusive (Afifi et al., 2011). Research also shows that about one-third of all individuals who have been maltreated as children are likely to subject their children to maltreatment, thus keeping in motion the cycle of abuse (Dixon et al., 2007). It is also likely that children who either experience maltreatment or witness violence between their parents or caregivers learn violent behavior and also learn to justify that behavior. • Substance Abuse and Violent Behaviors Parents who are dependent on substance are unable to provide quality care and supervision to their children and therefore these children. Having thus experienced neglect, such children gradually become dependent on peer group members. As a result, their education gets affected. Alcoholic fathers and absence of female caregivers increase the risk of children to be abused within the family (Carter & Myers, 2007). • Child Rearing Practices Lack of knowledge about child rearing practices and absence of elderly people (e.g., grandparents) in a family is often a contributing factor in child maltreatment. Poor parenting skills, unrealistic expectations of the children and inappropriate punishment are also identified as forms of child abuse (Stith et al., 2009).

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• Adolescents as Parents Children of young parents are at high risk of neglect because of their inexperience and lack of mental maturity (Rumm et al., 2000). Several studies of physical abuse have demonstrated that teenage mothers with low levels of education tend to do child abuse more than older mothers (Afifi, 2007; Sidebotham & Heron, 2006). • Neglect Neglect of children is a global phenomenon whether intentional or unintentional. In the developing countries it is mostly unintentional because of poor economic conditions and illiteracy among parents while it is a negligent behaviour of parents in the developed countries mostly because of their dependence on substance, family violence or parental separation. However, most of the countries have taken appropriate measures for child protection following the UN Convention on the Rights of the Child (1989). The main challenge lies in its implementation. According to Kobulsky, Dubowitz and Xu (2020), economic and other barriers inhibit progress to address the neglect of children. (iv)

Community and Environmental Factors Child safety in the community is a big challenge, since people with different backgrounds and mentalities live in the same community or neighborhood. A family is highly susceptible to its community and neighborhood, for the simple reason that there are constant interactions between them. In any community, people with poor economic background and low social network experience discrimination, social isolation and different challenges (Carter & Myers, 2007). Evidence clearly indicates that poor economic conditions and mental health problems of parents have high correlation with child maltreatment (Cancian et al., 2010; Carter & Myers, 2007). Children living in underdeveloped and hostile environments with low social support and especially those who are out of school are at high risk of neglect and all types of abuse (Wikström & Loeber, 2000; Zolotor & Runyan, 2006).

Living Environment and Child Abuse and Neglect Child abuse and neglect has high correlation with living environment of a child in terms of rural areas and underdeveloped areas in urban belt like slum and pavements (Balaji et al., 2011; Pillai et al., 2009). In general, the socioeconomic background of a child living in rural and interior rural areas is very poor in addition to poor health care and educational facilities. Therefore, children born in poor families in rural areas, slums and/or underdeveloped areas are mostly derived from healthy hygienic living conditions, adequate nutrition, health care and educational facilities resulting

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in suffering from common health problems, malnutrition and deprivation from education and/or quality education. One study disclosed that children in urban areas are living in drainage pipes, under tarpaulins, flyovers and in the road side open areas) (Save The Children, 2020). Therefore, it might be stated that child maltreatment is a result of poor living and economic conditions, absence of parents and lack of social and institutional support facilities (Strochlic, 2018). One meta-analysis study reported that geographical and economic factors contribute significantly in child neglect and maltreatment (Viola et al., 2016).

Effects of Child Abuse and Neglect Abuse and neglect jeopardize the development of the brain, not to mention its harmful effect on mental, social and physical health and career development of a child (Deb & Walsh, 2012; Johnson & James, 2016; Kendall-Tackett, 2002). Physical or sexual abuse often predisposes a child to an increased risk of depression, borderline personality disorder (BPD), post-traumatic stress disorder (PTSD) and other psychiatric disorders. Depression is ubiquitous in abused survivors (Zuravin & Fontanella, 1999). Abused children often suffer from lifelong psychological consequences like low selfesteem and relationship difficulties which are detrimental to health. A stable and strong social support is predictive of sound health (Deb & Mukherjee, 2011). Juvenile delinquents are steadily on the rise in India. Studies show that most of them are actually victims of abuse, neglect, family violence, social discrimination and prolonged deprivation from basic care and support facilities. As a result, they get involved in anti-social activities knowingly or unknowingly under the influence of peer group members and are termed juvenile delinquents as per Juvenile Justice Act (JJ Act) (2020). Over 33,000 juveniles, mostly in the age group from 16 to 18 years, were arrested for crimes like rape and murder across the country in 2011, the highest being in the last decade (Juvenile Delinquency 2013). The news of the Delhi gang rape that occurred on December 16, 2012, caught international attention. The National Crime Records Bureau (NCRB) study reveals that the number of juveniles raping girls and women in the state has shot up in the last 3 years (Mishra, 2013). Psychiatrists and women rights activists claim that easy access to pornography and rapidly changing food habits are primarily responsible for the dramatic rise in rape cases (Mishra, 2013).

Legislative Measures for Protection of Child Rights in India India is a signatory to the United Nations Convention on the Rights of the Child (1989), which is a significant development. It means that the Government of India endorses all the rights as outlined in the UN Convention on the Rights of the Child. Now, it is the obligation of the government to ensure its implementation through

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appropriate legislations and social policies or programmers. It is encouraging that the government has already adopted a number of legislations and social measures in this direction. The latest initiative the government has taken is to bring new legislation. As such, The Protection of Children from Sexual Offences Act 2012 (POCSO Act 2012) was passed by the Indian Parliament, which mandated the reporting of offences against children without specifying the category of person or profession. For example, Section 19 of POCSO Act, 2012 defines the reporting of offences in the following manner: Any person (including the child), who has apprehension that an offence under this Act is likely to be committed or has knowledge that such an offence has been committed, shall provide such information to (a) the Special Juvenile Police Unit; or (b) the local police. The Section 19 has given sufficient importance to proper recording of complaint and insists that the recording is checked by the informant in order to avoid errors or discrepancy. Furthermore, Section 19 has mandated the Special Juvenile Police Unit or local police to make immediate arrangements for care and protection of the child informant for a safe shelter within 24 h and to report the matter to the Child Welfare Committee and/or the Special Court within 24 h. The POCSO Act, 2012, also mandated the media, studio and photographic profession-related persons to report sexual exploitation of the child to the police. For example, Section 20 of POCSO Act, 2012, states the obligation of media and photographic facilities to report cases, as we see below: Any personnel of the media or hotel or lodge or hospital or club or studio or photographic facilities, by whatever name called, irrespective of the number of persons employed therein, shall, on coming across any material or object which is sexually exploitative of the child (including pornographic, sexually related or making obscene representation of a child or children) through the use of any medium, shall provide such information to the Special Juvenile Police Unit, or to the local police, as the case may be. Section 21 of POCSO Act, 2012, clearly states the punishment for failure to report or record a case. As per sub-Section (2) of Section 19, a person shall be punished with imprisonment of either description which may extend to 6 months or with fine or with both.

The Protection of Children from Sexual Offences (Amendment) Act, 2019 The Protection of Children from Sexual Offences (Amendment) Bill, 2019 amended the Protection of Children from Sexual Offences Act, 2012 and makes a number of special provisions to protect children from offences such as sexual assault, sexual

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harassment and pornography. It clearly defines the penetrative sexual assault stating that “if he: (i) penetrates his penis into the vagina, mouth, urethra or anus of a child, or (ii) makes a child do the same, or (iii) inserts any other object into the child’s body, or (iv) applies his mouth to a child’s body parts.” For such acts, the Bill enhances the minimum punishment from seven years to ten years. The Bill also says that if a person commits penetrative sexual assault on a child below the age of 16 years, he will be punishable with imprisonment between 20 years to life, along with a fine. The sexual act like aggravated penetrative sexual assault is also elaborated in the Bill, and it says that if any police officer, a member of the armed forces, or a public servant commits and even family members are involved in penetrative sexual assault on a child and injure sexual organs of the child or the child becomes pregnant will be booked under this Bill. Further the definition of aggravated penetrative sexual assault adds two more aspects, and they include (i) assault resulting in the death of child, and (ii) assault committed during a natural calamity. The minimum punishment for aggravated penetrative sexual assault has increased from 10 to 20 years, and death penalty is the maximum punishment. The punishment for use of a child for pornographic purposes is increased from maximum five years to minimum five years in the Bill 2019. Similarly, the punishment for use of child for pornographic purposes resulting in aggravated penetrative sexual assault has increased from life imprisonment to minimum 20 years and maximum life imprisonment, or death. Storage of pornographic material is a punishable offence as per the law. The Bill increases the punishment from three years imprisonment to three to five years, or a fine or both. The Rights of Children to Free and Compulsory Education Act 2009 was passed by the Indian Parliament for ensuring free and compulsory education to all children from the age of 6–14 years. At the same time, this Act prohibits physical punishment and mental harassment of children in schools. As per the Sect. 17(I) of the Rights of Children to Free and Compulsory Education Act, 2009, No child shall be subjected to physical punishment or mental harassment.” Section 17(2) states that “Whoever contravenes the provisions of sub-Section (I) shall be liable to disciplinary action under the service rules applicable to such person.

In this Act also, there is no provision for mandatory reporting of corporal punishment to the appropriate authority. The Commissions for Protection of Child Rights Act, 2005, ensures the establishment of the State Commission for Protection of Child Rights in every state, and in due course, child protection officers will be appointed in every district of the country. The National Commission for Protection of Child Rights was established in 2006, and all the states and the Union Territories are in the process of setting up State Commissions for Protection of Child Rights. The objective of these National and State Commissions is to guarantee the proper enforcement of children’s rights and the effective implementation of laws and programmers relating to children. Despite the legislation, the State Commission for Protection of Child Rights is yet to be formed in many states. The singularity of this Act is its coverage of a wide range

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of issues relating to Child Protection. To give an example, every district should appoint a Child Protection Officer to closely monitor and work with grass-root level organizations. The juvenile Justice (Care and Protection of Children) Act (2000) (amended in 2006, India) is primarily aimed at consolidating the law relating to juveniles in conflict with the law and to children in need of protection by addressing their problems, that is, by catering to their respective needs and by adopting a child friendly approach within the limits of jurisdiction. With that aim in view, various institutions were established for offering services to the troubled juveniles and the endangered children for their eventual rehabilitation. Two committees (namely the Juvenile Justice Board and Child Welfare Committee) are also supposed to be formed in each district or for a group of districts in order to facilitate the task. This Act also dictates the recruitment of a female juvenile officer for every police station or for every two/three police stations as feasible, for this would encourage a female victim of sexual assault to visit the police station for reporting the case. So far, very few police stations have put this recommendation into effect. The amended Juvenile Justice (Care and Protection) Act 2020 (JJ Act, 2020) has clarified a number of issues and introduced new provision for trial of juveniles, aged between 16 and 18 years who are involved in heinous crimes. As per JJ Act 2020, juveniles of this age group will be treated as adults and processed through the adult justice system. The punishment for engagement of juveniles of upper age group (i.e., 16–18 years) in heinous crime like rape and murder will be seven years of imprisonment (i.e., minimum). In earlier Act, it was seven years or more (maximum sentence). Second major change in the new Act is giving more responsibilities to the District Magistrates and Additional District Magistrates for close monitoring of functioning of various committees and institutions engaged in child welfare activities like Child Welfare Committees, the Juvenile Justice Boards, the District Child Protection Units and the Special juvenile Protection Units. Third, the new amendment ensures that every child welfare home should function following the broad guidelines of JJ Act and will operate with the permission from the District Magistrate. In addition, the legal measures taken for addressing different types of abuse and neglect include (i) The Child Marriage Restraint Act (1929); (ii) The Prohibition of Child Marriage Act (2006) (January 10, 2007); (iii) The Child Labor (Prohibition and Regulation) Act (1986); The Immoral Traffic (Prevention) Act (1956); and The Indian Penal Code (1860). Numerous other statutes that promote commitments to child health, prevent gender discrimination and ensure safety are (i) The Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act (1992) (56); (ii) The Pre-conception and Pre-natal Diagnostic Technique (Prohibition of Sex Selection) Act (1994) (57); (iii) The Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act (1995) (58); (iv) The Guardian and Wards Act (1890) (59); and (v) The Young Persons (Harmful Publications) Act (1956) (60).

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Some of the constitutional provisions for protection of child rights are (i) offering free and compulsory education for children aged 6–14 years (Article 21A); (ii) prohibiting human trafficking and bonded labor (Article 23); prohibiting child labor (Article 24); offering early childhood care and education for children until they complete the age of 6 years (Article 45) and so on. Though provisions are there in the Indian Constitution for the protection of children, they unfortunately lack in specificity and consequently give rise to ambiguities in interpretation. Hence, it is difficult to implement them in the practical world.

Social Welfare Measures for Children Apart from the constitutional provisions, legislative measures, and policies, there are different social welfare programmes and schemes intended to promote the welfare of children. Since health, nutrition and education are all interrelated and interdependent, the following policies, for example, are in the right direction as far as the welfare of children is concerned. • Integrated Child Development Scheme (ICDS): This scheme was initiated in 1975 with the aim of facilitating early childhood development comprising education and good health. It is one of the effective measures employed to ensure nutrition to the underprivileged and impoverished children of society (Kapil, 2002). It has its shortcomings, but with certain modifications, and it promises to be more effective (Kapil, 2002; Kapil & Pradhan, 2000). First-hand experience of the author about the evaluation of ICDS programmers in different states indicates that the success of this program is owing to the Anganwadi workers. A dynamic Anganwadi worker is capable of mobilizing his community for running the center efficiently. However, it is to be noted that in another block the center failed to mobilize or motivate the community people despite the same support facilities which are provided by the government. • Integrated Child Protection Scheme (ICPS): This scheme was initiated with the aim of governing all the child protection legislations and policies. As such, it is a comprehensive scheme, and it seeks to make sure that the best interests of the children are taken care of. Among other social welfare schemes are Rajiv Gandhi National Creche Scheme for the Children of Working Mothers, Rajiv Gandhi Scheme for Empowerment of Adolescent Girls (RGSEAG) or SABLA, Mid-Day Meal (MDM) and Total Sanitation Campaign (TSC). The benefits of the schemes are mixed. In some states, these programmers are successfully implemented, while in some others, it was partially successful in achieving long-term objectives. It is imperative to create awareness of the schemes among the target groups through block development offices and/or Panchayat. Periodic monitoring and evaluation should be carried out to optimize the benefits to the beneficiaries. It is worthwhile to mention that

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special girl child scheme named “Kanyashree Package” of Government of West Bengal for prevention of forced girl child marriage and child trafficking has been recognized by the Department of International Development (DFID), the United Kingdom, and the UNICEF. The scheme was launched in October 2013 with a view to awarding an annual scholarship of Rs 500 to girls between 12 and 18 years of age to continue with their studies, provided they are unmarried. A one-time grant of Rs 25,000 is also made to the girl, when she turns 18, to pursue higher studies. According to the Chief of Field Office, UNICEF, West Bengal, there has been visible changes at the ground level with regard to enrollment of girl students and child marriage (Singh, 2014). Similar or need-based innovative social schemes should be undertaken by all the states for child protection by taking into account the point of sustainability.

Conclusion Evidence demonstrates the nature and extent of child abuse and neglect in India and the risk factors involved in it. Besides physical, psychological and sexual abuse, the increasing rate of various forms of crime against children has become a serious concern for the law enforcement agencies especially in some of the states and union territories in India. For example, Uttar Pradesh was on the top of the lists in terms of maximum number of crimes against children in 2018, followed by Madhya Pradesh, Maharashtra, Bihar and Chhattisgarh, while in 2019, Maharashtra was in the top position, followed by Madhya Pradesh, Uttar Pradesh, Rajasthan and Odisha. Sexual abuse and murder of the victim girl for suppressing the evidence is another major another challenge for the law enforcement agencies. Kidnapping and abduction as well as cybercrime are other major forms of crime against children reported in India in the last few years. The most common forms of cybercrime against children include cyber pornography, hosting or publishing obscene sexual materials depicting children. A number of legal and social measures have been adopted by the Government of India for the safety and welfare of children, but the problem lies with their implementation. It rests with the state government to implement any socio-legal measures adopted by the federal government. Some states implement the schemes quite efficiently, while others, regrettably, do not attach much importance to them. More funds for child protection should be allocated, and the issue should be given top priority in the agenda of the government, for children are the most precious assets of a nation. The United Nations declared “World Day for Prevention of Child Abuse and Violence against Children, November 19” for raising awareness among the people about this issue with the celebration of the day. It is certainly a commendable step in terms of the child-friendly environment. Finally, we all have to bear in mind that child protection is the sacred responsibility of every conscientious citizen.

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Recommendations 1.

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6. 7.

8.

Sensitization of the larger society about child rights with the help of the media is urgently needed. Local NGOs should take initiatives to create awareness about child safety issues in the local community. Every school should have a Child Protection Committee involving representatives from teachers, parents, students, NGO representatives, one medical and legal professional to address issues and challenges of students. School-based sensitization programs on child rights should be organized periodically to create awareness among children about their rights. In addition, schoolbased family counseling facilities should be initiated to address challenges faced by the children at home. Every school should engage a professional psychologist or student counselor to address their issues and concerns. Ensuring nutrition, education, basic health care facilities and safety for all the children through community and institution-based approach; in this regard, local health officials should take help from the Panchayat (the village council) and school authorities. Corporate sectors should come forward with support as part of corporate social responsibility. Ensuring effective and timely intervention of government policies and programs for the needy children and periodic monitoring and evaluation of the same. Involvement of community members for effective implementation of government policies and programs like Right to Free and Compulsory Education Act 2009, midday meal program, Integrated Child Development Scheme (ICDS), Integrated Child Protection Scheme (ICPS) and so on. Given the seriousness of child sexual abuse and child trafficking for commercial sexual exploitation, there is an urgent need to amend existing legislation or bring new legislation for mandatory reporting of these two types of child abuse (Deb, 2014). As for the notification of child trafficking, Panchayat Members (elected by the villagers), village health workers and of course parents should step up to report the incident to local police, child protection officers and/ or child welfare committee members, since they have close contact with the village people. For sexual abuse cases, people/professionals like parents, doctors, nurses, teachers and personnel from the Non-Government Organizations (NGO) should be mandated for reporting. It is also necessary to state clearly about the range of activities which should be considered as sexual abuse as defined by the international legislation and/or the World Health Organization (WHO). In Indian societies, sexual intercourse with a minor is usually considered as sexual abuse, but such acts as stimulation, showing pornographic picture, touching private parts of a child and so on are not generally recognized as sexual abuse and ignored.

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Singh, S. S. (2014, June 22). Global pat for Bengal’s girl child scheme (p. 9). The Hindu. Stith, S. M., Liu, T., Davies, L. C., Boykin, E. L., Alder, M. C., Harris, J. M., & Dees, J. E. M. E. G. (2009). Risk factors in child maltreatment: A meta-analytic review of the literature. Aggression and Violent Behavior, 14(1), 13–29. https://doi.org/10.1016/j.avb.2006.03.006 Strochlic, N. (2018). India’s forgotten child brides, 2018. Available at: https://www.nationalgeograp hic.com/photography/proof/2018/04/child-brides-marriage-shravasti-india-culture/. Accessed March 05, 2020 Subramaniam, M., Abdin, E., Seow, E., Vaingankar, J. A., Shafie, S., Shahwan, S., Lim, M., Fung, D., James, L., Verma, S., & Chong, S. A. (2020). Prevalence, socio-demographic correlates and associations of adverse childhood experiences with mental illnesses: Results from the Singapore mental health study. Child Abuse & Neglect, 103, 104447. Sunny, A. M., & Deb, S. (2020). Protecting Children’s Rights: The paramount rule of law for a healthy and prosperous society. In Delivering justice (pp. 17–29). Routledge India. Theodore, A. D., Chang, J. J., Runyan, D. K., Hunter, W. M., Bangdiwala, S. I., & Agans, R. (2000). Epidemiologic features of the physical and sexual maltreatment of children in the Carolinas. Pediatrics, 115(3), e331–e337. https://doi.org/10.1542/peds.2004-1033 The National Crime Records Bureau. (2010). Accidental deaths and suicides in India: 2000. Ministry of Home Affairs, Government of India. The U.N. Convention on the Rights of the Child 1989 (CRC). The Protection of Children from Sexual Offences Act, 2012. The Juvenile Justice (Care and Protection of Children) Act, 2000 (amended in 2006, India). The Child Marriage Restraint Act, 1929. The Prohibition of Child Marriage Act, 2006 (2007, January 10). The Child Labour (Prohibition and Regulation) Act, 1986. The Immoral Traffic (Prevention) Act, 1956. The Indian Penal Code, 1860. The Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992. The Pre-Conception and Pre-natal Diagnostic Technique (Prohibition of Sex Selection) Act, 1994. The Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995. The Guardian and Wards Act, 1890. The Young Persons (Harmful Publications) Act, 1956. Tran, N. K., Van Berkel, S. R., van IJzendoorn, M. H., & Alink, L. R. (2021). Child and family factors associated with child maltreatment in Vietnam. Journal of Interpersonal Violence, 36(5–6), NP2931–NP2953. UNICEF. (1986). Children in especially difficult circumstances: Supporting annex, exploitation of working and street children. United Nations Children’s Fund. UNICEF. (2005). Multiple indicator cluster surveys (MICS). Strategic, Information Section, Division of Policy and Planning. Villagers attack Rajasthan Officials. (2012, April 23). The Hindu (p. 3). Viola, T. W., Salum, G. A., Kluwe-Schiavon, B., Sanvicente-Vieira, B., Levandowski, M. L., & Grassi-Oliveira, R. (2016). The influence of geographical and economic factors in estimates of childhood abuse and neglect using the Childhood Trauma Questionnaire: A worldwide metaregression analysis. Child Abuse & Neglect, 51, 1–11. Virani, P. (2000). Bitter chocolate: Child sexual abuse in India. Penguin Books India. Wallio, S. C. (2009). Caregiver physical health and protective factors against child abuse and neglect. Unpublished Thesis. Whitaker, D. J., Le, B., Karl Hanson, R., Baker, C. K., McMahon, P. M., Ryan, G., et al. (2008). Risk factors for the perpetration of child sexual abuse: A review and meta-analysis. Child Abuse and Neglect, 32(5), 529–548. https://doi.org/10.1016/j.chiabu.2007.08.005 Wikström, P. O. H., & Loeber, R. (2000). Do disadvantaged neighborhoods cause well-adjusted children to become adolescent delinquents? A study of male juvenile serious offending, individual

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risk and protective factors, and neighborhood context. Criminology, 38(4), 1109–1142. https:// doi.org/10.1111/j.1745-9125.2000.tb01416.x Zolotor, A. J., & Runyan, D. K. (2006). Social capital, family violence, and neglect. Pediatrics, 117(6), 1124–1131. https://doi.org/10.1542/peds.2005-1913 Zuravin, S. J., & Fontanella, C. (1999). The relationship between child sexual abuse and major depression among low-income women: A function of growing up experiences? Child Maltreatment, 4, 3–12. https://doi.org/10.1177/1077559599004001001

Chapter 5

The Need to Protect Children: Increasing Evidence of the Problem of Corporal Punishment in Pakistan Rose Ashraf and George W. Holden

Introduction There is widening recognition of the harm that corporal punishment (CP), a harsh and violent form of discipline, inflicts on children’s development. Corporal punishment, also called physical punishment, refers to causing bodily pain on a child in an effort to punish or correct their behavior. Most commonly, this form of punishment is manifested as hitting a child on the buttocks or hand either with a hand (i.e., spanking, smacking) or with an object (i.e., paddling). However, adults inflict pain on children in many ways, including slapping, pinching, “hot-saucing,” making a child stand for a long period of time, and/or pulling hair. These assaults by adults are described under the euphemistic language of “spanked,” “smacked,” “slapped,” or a dozen other similar terms (Brown et al., 2018). This chapter provides an overview of the problem of corporal punishment in general and in Pakistan specifically. The topic of CP has become a popular area of inquiry with well over two thousand studies and multiple books on the topic. By necessity, the overview below only touches on some of the main findings. We then examine CP in one South Asian country: Pakistan. We build on and update the chapter in the first edition of this book (Holden & Ashraf, 2016). We chose Pakistan to focus on because the topic has not received adequate attention in that country, as well as other parts of South Asia. We also focus on Pakistan because its population of more than 216 million people makes it the fifth most populous nation in the world (World Bank, 2021). Additionally, the fertility rate of 3.5 children per woman means R. Ashraf Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Boston, USA e-mail: [email protected] Department of Psychiatry, Harvard Medical School, Boston, USA G. W. Holden (B) Department of Psychology, Southern Methodist University in Dallas, Dallas, TX, USA e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_5

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that it has the highest population growth rate in the region after Afghanistan (World Bank, 2021). As demonstrated by these statistics, families are rapidly growing in Pakistan and it is an opportune and important country in which to examine parenting and discipline.

The Need to Protect Children from Corporal Punishment Corporal punishment is a widely used disciplinary practice among parents and teachers. As studies have repeatedly found, most children around the world are spanked, slapped, and hit. For example, one investigation used the Multiple Indicator Cluster Survey, a nationally representative study of households from 49 lowand middle-income countries (LMIC), to assess child-rearing violence. Based on reports from more than 30,000 caregivers, the majority of informants (63%) revealed that they or another caregiver in the household used physical punishment or some form of physical violence on their children in the past month (Cuartas et al., 2019). The use of harsh discipline is not limited to LMICs. There is ample evidence that CP of young children young children is prevalent in all five major regions of the world (Africa, North America, South America, Asia, and Europe) (e.g., Lansford et al., 2014; Lokot et al., 2020).

Children Need Protection from the Ill Effects of Corporal Punishment Typically, parents do not ever want to harm their children. They recognize their role in needing to correct their child’s behavior and may resort to the disciplinary practices that were used on them. The best predictor of a parent endorsing the use of spanking is whether their own parents spanked them (e.g., Gagné et al., 2007). Despite the continued cycle of corporal punishment, dozens of carefully designed studies indicate that parental use of CP is associated with a variety of negative, unintended consequences for children. We begin with an overview of some of the research into the associated effects of CP on children. The evidence is clear: corporally punishing children is a problematic behavior for multiple reasons. We will briefly discuss four. There is now ample evidence, replicated many times, that corporal punishment is linked to a variety of behavioral, emotional, and relationship problems. Reviews, both meta-analytic (e.g., Gershoff & Grogan-Kaylor, 2016) and narrative (Heilmann et al., 2021), provide detailed descriptions of the many problems that can result from parental use of CP. For example, children punished with CP are more likely to engage in aggression, have mental health problems (e.g., anxiety, depression), and experience worse quality of parent–child

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relations than children who are not hit. In Gershoff and Grogan-Kaylor’s (2016) metaanalysis, they found that recently published empirical studies continued to find negative effects that earlier, less well-designed studies had reported: CP use is correlated with adverse cognitive, behavior, and health problems. The most serious unintended consequence is corporal punishment escalating into physical child abuse. Parents who rely on CP are at higher risk for perpetrating physical child abuse (Zolotor et al., 2011). Other examples of child problems include aggression, depression, anxiety, stress, and poor academic performance. A recent narrative review examined 69 studies conducted over the past two decades (Heilmann et al., 2021) and concurred with the conclusion that CP is hazardous to children’s development. Parental use of CP consistently predicts child behavior problems, and the studies uniformly find a number of “robust” detrimental child outcomes. Similarly, Cuartas (2021) discovered that children exposed to CP across 49 countries were 24% less likely to meet developmental milestones compared to children who had not experienced CP. Evidence is also emerging on a new topic: Hitting young children can negatively impact their brain architecture. Gershoff (2016) outlined how CP as a toxic stressor can affect a brain development in several ways. Stressors activate the hypothalamic– pituitary–adrenal (HPA) axis. Specifically, being hit results in secretion of stress hormones (e.g., adrenaline and cortisol). If CP occurs frequently enough, then it is likely the excess of those stress hormones affect the developing structure and function of the brain. One study indicates that young adults who were frequently punished as children had reduced gray matter (Tomoda et al., 2009). A recent study found evidence for differential brain functioning as a consequence of a history of being spanked. On fMRI images, children who were spanked had greater activation of several brain regions in response to fearful faces (Cuartas et al., 2021). Complementing the evidence that CP is linked to a variety of child problems is the evidence that physically punishing a child is ineffective at promoting good behavior. Ironically, the single most common reason why parents use CP is because they believe it is an effective disciplinary technique to promote good behavior (Ateah & Durrant, 2005). In fact, mothers’ positive attitudes toward CP when their child is an infant predicts frequency of use four years later (Vittrup et al., 2006). It is likely parents observe their children immediately stop an undesired behavior after a spanking and therefore consider it effective. However, they fail to recognize that CP does not promote a desired alternative behavior or even stop an undesired behavior for very long. In an observational study, 73% of children who were subjected to CP were “misbehaving again” within 10 min (Holden et al., 2014b). When taking a broader lens, another problem with CP is that it contributes to a “culture of violence” (Straus, 1996). Where there is CP, there is more aggression and heterotypic continuity of the aggressive behavior. The violent acts may manifest differently as the child grows (e.g., bullying, dating violence, marital violence, approval of violence, harsh discipline, and child maltreatment), but the aggression continues (Straus et al., 2014). At a macrosystem level, countries that have more violent crimes are also the same countries where CP is widely practiced (Barry, 2007).

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We mention a final problem that, in our view, supersedes all others. The use of CP violates children’s human rights. Many countries have arrived at a ban on corporal punishment from a human rights perspective. The United Nations adopted the Convention on the Rights of the Child (CRC) in 1989. This document is the single most widely ratified human rights treaty (Britto & Ulkuer, 2012). As of 2021, only the United States has not ratified it. Article 19 of the CRC states: Parties shall take all appropriate legislative, administrative, social and educational measures to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse, while in the care of parent(s), legal guardian(s) or any other person who has the care of the child (italics added).

This directive has been interpreted as recognizing corporal punishment (CP) as a form of physical violence inflected on children (Bitensky, 2010). The stance of human rights activists is consistent: Children have the right to not be hit by anyone, including their caregivers (Durrant et al., 2019). Given this context of problems linked to CP and the increasing recognition of CP as a violation of children’s rights, where does Pakistan stand today?

Why Protection Is Needed in Pakistan Pakistan is a unique country in certain ways. Although its history dates to almost 2500 B.C., the country as it is known today is relatively new. The Islamic Republic of Pakistan was formed in 1947. Prior to that, it was a part of British India. In 1906, The All India Muslim League was formed to protect Muslim interests. The League became popular in the 1930s under the leadership of Muhammad Ali Jinnah and established the Lahore Resolution. Under this resolution, the League demanded that independent states be formed east and west of British India with a constitution modeled on Islamic ideology. The origins of Pakistan’s separation from India contribute to a key feature of its identity: Its culture and law is heavily informed by religion. The state religion is Islam, and 96.4% of the population are Muslims. Sunni Muslims comprise 85– 90% of Pakistanis with Shia’s making up another 10–15% (CIA, 2020). The small remaining percent of the population includes other Muslim sects, Hindus, and Christians. Despite its religious homogeneity, it is an ethnically diverse country. Almost 45% of the population is Punjabi (44.7%), but there are also Pashtun (15.4%), Sindhi (14%), and other ethnic groups. More than ten languages are spoken in the country, in addition to the national language of Urdu. This ethnic diversity calls for caution in making any generalizations about Pakistanis as a whole. Given Pakistan’s majority Islamic faith, and the role of religion in its separation from India, where does Islam stand regarding CP? Although CP is not mentioned in the Qu’ran, parenting and the transactional role of parents and children is clear in the Hadith, a collection of the teachings of the Prophet Muhammad. Parents are

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held responsible for raising their children to be Godly and moral beings and will ultimately be judged based upon their fulfillment of this responsibility (Thomas, 1988). Although the Hadith discusses the importance of being affectionate and kind toward children, it also discusses the use of CP: Order your sons to pray when they are seven, and spank them if they do not pray when they are ten. (Sabig, 1978 cited by Obeid, 1988)

In essence, parents are encouraged to use loving methods to teach their children, but when a strong punishment is called for, it is permissible to use CP. Note too that the age of the child is clearly stated. Spanking a child younger than 10 years is not prescribed. We next review the extent to which CP is used in Pakistani homes and schools. Due to the limited number of empirical studies, the data come from several types of sources including a book, journal articles, and reports from non-governmental organizations (NGOs).

The Widespread Need for Protection from CP in Pakistan From time to time, news outlets report egregious incidents of harsh punishment ending in a child’s death. In 2021, one such story detailed how an eight-year-old boy in Punjab was beaten to death by his teacher in a madrasa for not memorizing a lesson. A similar story and sad outcome occurred to a 17-year-old boy in Lahore who died from his injuries sustained after a beating by his teacher for not memorizing a lesson. The teacher allegedly had a history of physically disciplining students and was suspended and reinstated prior to this incident (Riaz, 2019). The prior year, an eight-year-old girl, employed as a maid in Islamabad, also lost her life because she had inadvertently let pet parrots escape (Baloch, 2021). There are numerous additional reports from Pakistan describing child injuries and deaths caused by CP (e.g., Society for the Protection of the Rights of the Child, 2012).

The Problem of CP in Pakistani Homes Few nationwide statistics concerning the prevalence of CP in Pakistani homes are available, but those that can be found indicate a widespread problem. The UNICEF Multiple Indicator Cluster Survey provides one such estimate. Of children aged 1– 14 years, 42% in Gilgit-Baltistan, 66% in Punjab, and 63% in Sindh experienced physical punishment at home (Global Initiative to End All Corporal Punishment of Children, 2021). Another estimate comes from 2013 data. Based on those selfreports, it has been estimated that 8.9 million 2- to 4-year-old children are hit in Pakistan (Cuartas et al., 2019). The researchers determined that the proportion of children exposed to the harsh punishment is somewhere from 0.71 to 0.77. In this

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particular study of LMICS, Pakistan ranked fourth out of 49 nations in terms of the estimated number of young children exposed to physical aggression, after India (54.3 million), China (30.2 million), and Nigeria (13.9 million). A carefully designed study of more than 1750 children aged 11 to 14 years old conducted in Hyderabad asked children directly to report their experiences with corporal punishment. Sixty per cent of the almost 500 boys and 37% of the 345 girls reported they were hit at home (Khuwaja et al., 2018). Earlier studies corroborate the finding that CP is commonly used by Pakistani parents. Among the 4200 children aged 5–16 years old living in KPK Province, all of the children and youth reported that they were physically punished at home (NCCR, 2001). The five most commonly reported punishments were being slapped on the face (54%), slapped on the back (29%), hit with a stick (16.6%), kicked (12.3%), and having hair pulled (11%). According to the children, the offenses preceding the CP included being naughty (47% boys, 41% girls), school problems (22% boys, 25% girls), playing (18% boys, 25% girls), disobeying adults (37% boys, 16% girls), making noise (12% boys, 12% girls), and forgetting an important task (8% boys, 4% girls). An investigation into parental attitudes about CP corroborates the children’s reports. A survey by the Society for the Protection of the Rights of the Child (2012) revealed that 76% of parents supported CP and considered it a necessary tool in correcting behavior. Similarly, 67.4% of 640 parents interviewed believed that CP was either “right,” or “wrong but unavoidable.” An interesting study involved interviews of Pakistani children. When asked if they believe CP is acceptable, 54.1% of children said it was not okay and approximately 70% of the children reported they would not physically punish their children when they became parents. Many students cited Islamic virtues as reasons they would not hit their own children (e.g., respecting others is obligatory, treating children with love and kindness). Given the high rate of parental use of CP summarized above, not surprisingly 92.9% of children reported that they were afraid of their parents (Profanter, 2007).

The Problem of CP in Pakistani Schools The use of CP in schools in Pakistan is also pervasive. In the large study by Khuwaja and colleagues (2017) mentioned above, 83.4% of boys reported that they had been “slapped, hit, or beaten” by a teacher in the past four weeks. Almost one fifth of the boys (17.8%) revealed that they had been hit “many times” in the past month. In comparison, girls fared better: 33% of the girls reported being slapped, hit, or beaten in the past month with only 1.8% reporting many times. School administrators readily admit that CP is commonly used in Pakistan. Plan International (2013) surveyed teachers in Punjab, the most populous province in Pakistan. They found that almost all (89%) of the public and private school administrators sampled reported they used CP. They also surveyed 300 students and 137

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teachers at 32 schools. Nearly half (47%) of the teachers “partially agreed” that physical punishment is necessary for disciplining children. The primary rationales included rudeness (75%) and rule violation (65%). Students reported that the forms of CP at school included hitting with a stick on the hand, slapping on the face or head, making a child stand in uncomfortable positions, hitting with a stick on another part of the child’s body, and kicking (Plan Pakistan, 2013). A more comprehensive approach was taken by Save the Children, UNICEF, and the Khyber Paktunkhwa provincial government, who teamed up to study school CP in three districts of the region (Global Initiative to End All Corporal Punishment of Children, 2012). Surveys were given to 3528 children aged 6 to 14 years, 1231 parents, and 486 teachers from public (government) and religious schools. Every single child reported having received CP at least once. The most common punishments reported were smacking, hitting with an object (e.g., shoe, brick, iron rod, and knife), hair-pulling, ear-twisting, and being placed in painful (and humiliating) positions. Another NGO used a different sampling method to assess the prevalence of CP in schools. They surveyed 600 school heads and 630 parents from various schools in the Khyber Paktunkhwa province (Coalition on Child Rights with UNICEF, 1998). Most headmasters (57%) said that CP was necessary for a variety of reasons. The most common rationales given were it was necessary for maintaining discipline (68.7%), facilitating learning (55.1%), and building character (50.7%). The educators reported 63 incidents of injury as a result of physical punishment, including children falling unconscious and severe injuries to the face and eyes. Interviews with parents revealed that most parents (78%) knew the punishments were occurring in the schools and 64% reported being aware their children were the recipients. Of the parents surveyed, 40% of parents agreed that the CP was appropriate, 27% believed it was inappropriate but necessary, and the remaining 30% believed it was inappropriate. A total of 74 parents reported injuries to their children due to CP, including fractures and permanent neurological damage (Profanter, 2007). Teachers’ attitudes, like parents’ can be difficult to change. In a recent qualitative interview study of 30 teachers working in Punjab, most teachers believed that CP was necessary to maintain order in the classroom (Abbas et al., 2020). Despite their awareness that the disciplinary behavior was outlawed in schools, they continued to report using it. A second study of teachers’ views about CP affirms the entrenched nature of views about punishment (Batool et al., 2017). In a study of 12 teachers from five schools in Rawalpindi and Rawat, it was found that the teachers readily admitted to using a variety of harsh physical punishments on their secondary school students. These included making them stand or hold up their hands for a long period of time, beating with a ruler or can on the hand, slapping on the face, hitting with a book, twisting the ears, or beating with a cane. In addition to these studies of prevalence, we located three empirical investigations that examined the impact of CP in schools on students’ academic performance, personality development, or psychological well-being. One of the studies involved interviewing 10- to 16-year-old youth to assess CP in schools (Naz et al., 2011). Based on their responses, three subgroups were formed: those who reported receiving

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no CP, mild CP (slapped or hit on the hand or leg, pushed, or pulled), and severe CP (hit on head, beat with a stick, ear, or hair-pulling). The researchers found that the experience of CP in the classroom adversely affected academic performance. Students who experienced mild or severe CP were more likely to miss classes, have poorer academic performance, and even to quit school compared to students who did not experience any CP. The study also found that experiencing physical punishment was correlated with negative psychological effects. Students in the mild and severe CP groups were more likely to report depression, lower self-esteem, pessimism, and apprehension. When interviewed, the students who had received mild or severe CP reported feeling hostile and vengeful of society, hatred, and frustration significantly more than the other students. A large school questionnaire study that assessed 1100 students aged 13- to 14-yearold compared punishment in three types of schools: Urdu-medium, English-medium, and madrassas (Nazar et al., 2019). Overall, students reported that CP was rampant. Most students (82%) reported being slapped by a teacher, 78% reported being beaten, being hit with a stick (72%), forced to stand in a corner (61%), or having books thrown at them (41%). Boys reported being victimized more. Students reported male teachers used more physical punishment than female teachers. Physical discipline occurred the least in English-medium schools, while boys attending madrassas were reportedly hit most frequently. A strong correlation (r = 0.63) was found between reports of being hit by a teacher and students’ feelings of emotional upset. Another group of researchers also found ill effects of CP in a sample of 400 secondary school students (Ali et al., 2019). They determined there was a dose– response relation between CP and psychological problems. Among the 126 students who reported being physically punished both in schools and at home (31.5% of the sample), those students experienced more anxiety, depression, and stress symptoms than the other students who received CP only at school (13.75%) or only at home (21.5%).

Cultural Considerations Pakistani parenting values are strongly influenced by several prominent cultural beliefs such as the importance of patriarchal orientations and child obedience. Those beliefs can perpetuate harsh, physical discipline (Maker et al., 2005; Malik, 2010; Stewart et al., 1999). The first study to indicate this was a focus group investigation about parent education in Pakistan (Brieland & Brieland, 1957), published only 10 years after the country was founded. In those discussions, discipline was one of seven topics a group of mothers from Peshawar wanted to discuss. Several Mothers reported they used spanking regularly as a discipline method but also commented that it didn’t improve their children’s behavior. More recently, evidence for the cultural importance of disciplining children was found in a study of British Pakistani mothers who were compared with British white mothers (Ali & Frederickson, 2011). Although there was no difference in the reported frequency of using CP, the authors

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found that the Pakistani mothers were more likely to report following through with discipline as well as “reminding” their children about discipline. Linguistically, the Urdu term used to describe child rearing, tarbiat, is associated with a connotation of training and supervision. Pakistani parents are likely to view child training—and correcting misbehavior—as an important aspect of their parenting role. A study of more than 300 Pakistani youth by Stewart and her colleagues (2000) suggests that like in Confucian cultures, the concept of “training” guides Pakistani parents in their child-rearing behaviors. In addition, respect for parents and collectivism are widely shared values in Pakistani culture. Eliciting proper child behavior through disciplining children is regarded as a parenting imperative. Each of these cultural constructs may contribute to a greater desire for immediate obedience, parental control, and the desire to use CP. Cultural differences are also reflected in the lexicon associated with discipline. In English, there are words like “spanking,” “slapping,” and “smacking” to describe the act of an adult striking a child (Brown et al., 2018). There are no equivalent words in Urdu for these terms. In contrast, the Urdu language uses direct and specific terms to describe physical punishment (e.g., thappar is slapping on the face, danda is hitting with a stick, and jhoota is hitting with a shoe). Unlike English, which utilizes different words when a child is hit (e.g., spank, smack, and paddle) versus when an adult is hit (e.g., hit, assault, and battery), Urdu uses the same terms across the lifespan. Urdu speakers use maar to describe CP, which directly translates to “hitting.” Similarly, maar peet or peetna, both mean “beating” and are commonly used to describe more severe physical punishments. At least since 2006, the Pakistani government has had a school campaign called “maar nahi pyaar” or “love instead of punishment” in an effort to change the attitudes of school personnel toward punishment (Mir, 2006). The campaign appears to have limited success. In a study of 111 primary teachers in Multan in Punjab, at least some teachers recognized the negative effects of CP on their students’ behavior and academic performance (Khurshid et al., 2020). The impact of CP on students included escalating the drop-out rate (27%), promoting bad relationships between teachers and pupils (14%), and increasing aggression among students (10%). On the other hand, 30% of the teachers believed that spanking maintains classroom discipline and 23% reported that students studied more as a consequence of CP.

Does Acculturation Affect the Need for Protection? Do Pakistanis and South Asians in general hold more punitive attitudes in child rearing than others? Studies of South Asian parents in western countries indicate that these parents are likely to have experienced CP as children and are likely to endorse CP use when disciplining their own children. Irfan and Cowburn (2004) found that 75% of British Pakistanis (aged 16–25) reported having experienced CP during childhood, with being slapped as the most common, followed by being punched (50%), and spanked (42%). Siblings were the perpetrators 35% of the time,

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followed by mothers (33%) and fathers (19%). Of this subgroup, 72% accepted it as an appropriate method of discipline (Irfan & Cowburn, 2004). Comparable results were found by Maker et al. (2005): 73% of South Asian American women reported having experienced at least one type of physical abuse, and this experience predicted the acceptance of physical abuse as a parental right. In contrast, a comparison of British Pakistani and White mothers found that the British Pakistani mothers were more likely to follow through on discipline with their sons, but there was not a difference between the two groups on their self- reported use of physical punishment (Ali & Frederickson, 2011). Similarly, South Asian parents living in Canada for 12 years did not differ from other populations on their attitude toward CP and were not significantly more supportive of punitive punishment than other populations (Maiter et al., 2004).

Legal Status of CP in Pakistan We next consider what is the legal status of CP in Pakistan. Corporal punishment conflicts with the Convention on the Rights of the Child, adopted by the United Nations General Assembly in 1989. Although Pakistan ratified the CRC in 1990, it cannot be invoked into court until legislation is passed that would enforce it. Perhaps prompted to action by the media attention and children’s rights movements, there have been periodic legislative efforts to ban corporal punishment in schools. Legal reform efforts are discussed in further detail below. There are three types of laws that pertain to the use of CP in Pakistan: federal, provincial, and Shariah.

Federal Law Under current Pakistani law, CP of children is legal. Article 89 of the Penal Code states 89. Act done in good faith for benefit of child or insane person, by or by consent of guardian: Nothing which is done in good faith for the benefit of a person under twelve years of age, or of unsound mind, or by consent, either expressed or implied, of the guardian or other person having lawful charge of that person, is an offence by reason of any harm which it may cause, or be intended by the doer to cause or be known by the doer to be likely to cause to that person: Provided First: That this exception shall not extend to the intentional causing of death, or to the attempting to cause death; Secondly: That this exception shall not extend to the doing of anything which the person doing it knows to be likely to cause death, for any purpose other than the preventing of death or grievous hurt; or the curing of any grievous disease or infirmity; Thirdly: That this exception shall not extend to the voluntary causing of grievous hurt, or to the attempting to cause grievous hurt, unless it be for the purpose of preventing death or grievous hurt, or the curing of any grievous disease or infirmity; Fourthly:

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That this exception shall not extend to the abetment of any offence, to the committing of which offence it would not extend. Pakistan Penal Code Act XLV of 1860 (italics added)

The Penal Code contains multiple sections that allow CP of children and confer significant discretion on parents or guardians. The phrase “done in good faith for the benefit of a person under twelve” is key. This clause confers considerable discretion to the parent or guardian. Both phrases “in good faith” and “for the benefit” allow for a punitive act to be rationalized and defensible in court. With this language, children lose their right of physical safety. Other provisions of the code grant further discretion to punishers. The phrase “other person having lawful charge of that person” allows any person in charge of a child, not just a legal guardian, to employ CP. The combination of this phrase with the provision that consent may be implied rather than explicit adds considerable ambiguity. For example, could a parent leaving their child in the care of another adult constitute implied consent for physical discipline? In addition to granting full discretion to parents, teachers, and other persons with legal charge of children, this article provides virtually no protection for children. What protection it provides is in its few exceptions: It does not include intentionally causing death, intentionally attempting to cause death, or intentionally causing grievous harm. However, even the severest cases of CP, resulting in child fatalities, may be excused by the alleged intention. If a person does not intend to cause harm or is unaware of the harm that their actions may cause, the behavior is not considered unlawful. An obvious limitation of the Penal Code is that it contains no mention of punishment of children older than twelve years of age. Overall, the ambiguity and broad application of this law can provide a convenient justification for CP in home, school, and alternative care settings. It can also provide a cover for physical child abuse. Even if a parent or teacher violated this law, it is unclear whether complaints to police would be investigated, and the law enforced. We were unable to discover any information about complaints, investigations, or enforcement of the law.

Provincial Laws Currently, laws in three of Pakistan’s four provinces mention corporal punishment of children. In Punjab, the most populous province, the Destitute and Neglected Children Act 2007-Amendment provides an allowance for the guardian (i.e., person with lawful control or custody) to inflict physical punishment on a child if there is “sufficient reason.” In contrast, in the other two provinces, some statutory restraints are imposed. In the province of Sindh, the Right of Children to Free & Compulsory Education Act 2013 makes CP unlawful in government schools for children aged 5–16. Prior to this, the Children Act of 1955 allowed for the use of physical punishment “for a proper reason.” In Khyber Pakhtunkhwa, the Child Protection and Welfare Act 2010 bans

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CP in the home and other settings. However, this act fails to ban CP completely, because the prohibition is only within the context of Section 89 of the Penal Code; it does not overwrite Section 89 of the Penal Code. To compensate for that loophole, in 2012, a Grievances Redressal Mechanism was established to address complaints related to CP in school settings. The goal of this system was to ensure thorough investigation of reported cases in both public and private schools. Additionally, the 2010 act was expanded in 2012 to include other areas under provincial control. The revised act now indicates that CP, as well as other forms of violence against children, is punishable by imprisonment and fines. Children living in the sparsely inhabited Federally Administered Tribal Areas, an area bordering Afghanistan that comprises just 2.3% of the Pakistani population, have the greatest legal protection from teacher violence. In 2012, the Free and Compulsory Education Bill was passed, which prohibits teachers in both government and private schools from administering CP.

Shariah Law Shariah law adds an additional layer of complexity to the legal status of CP in Pakistan. Although CP is not mentioned in the Qur’an, CP is mentioned in the Hadith (Obeid, 1988). Specifically, in the narrations by Dawud: “The Prophet said: Order your children to pray at the age of seven, and beat them [lightly] if they do not do so by the age of ten.” It is with this Hadith, and the Islamic construct of parents training children to be upstanding and religiously active adults that many Muslims interpret the use of CP to be encouraged by their belief system. However, there also exist sayings in the Hadith that speak against abuse and cruelty. For example, according to Bukhari and Muslim (cited in Thomas, 1988), Muhammad said “abusing a Muslim is a sin, and killing him is disbelief.” Thus, there is some ambiguity regarding the use of CP. Federal or provincial laws do not apply to hadd offenses. Hadd offenses are those that have predetermined punishments in Islamic law (i.e., theft, fornication, adultery, consumption of alcohol, or other intoxicants). These offenses continue to be punished by CP, including whipping, and apply to children from the onset of puberty. Thus, 9.4-year-old girls and 11.4-year-old boys, the average age of puberty found in one study in Peshawar (Rasool et al., 2011), may be subject to CP under Shariah law. Another type of CP allowed under the Pakistani Penal Code is the penalty of qisas. Qisas is a punishment causing similar pain at the same location of the perpetrator as he or she caused to the victim; it also has its roots in Islamic law. The Penal Code prohibits qisas for minors. However, a minor is defined as a male under 18 years old; females can be subjected to the punishment at any age.

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Promising Developments Regarding Legal Reform In recent years, CP of children, especially in schools, has garnered media attention and inspired efforts to ban CP, both provincially and federally. Bills have been introduced to the National Assembly since at least 2013. Some positive reforms have occurred beginning in 2016. The first recent legal development was the adoption of the Gilgit-Baltistan Prohibition of Corporal Punishment Act in 2016. It utilizes the CRC definition of CP and prohibits its use in home, work, school (public and private), childcare, and juvenile justice settings. Soon after, in 2017, a similar prohibition was enacted in Sindh (The Sindh Prohibition of Corporal Punishment). Bills dictating the prohibition of CP in schools are under consideration in Baluchistan and Punjab. The next two legal milestones occurred in Islamabad. In 2020, the Islamabad Capital Territory suspended Section 89 of the Penal Code, eliminating the loophole that permitted CP despite provincial bans. Then, in 2021, National Assembly passed the Islamabad Capital Territory Prohibition of Corporal Punishment Act 2021. It prohibits CP of a child (18 years and under) as well as non-physical punishments which humiliate or frighten a child. This prohibition applies to educational, workplace, and childcare settings. Those who violate this law are subject to dismissal from their position. Notably, this act does not include prohibitions or recommendations regarding the use of CP in the child’s home. Although this act applies only to Islamabad, it is hoped that other provinces will adopt it (Baloch, 2021). The above efforts are due in part to the efforts of many groups and individuals over many years. In particular, advocates include South Asia Initiative to End Violence Against Children and South Asia Coordinating Group on Action against Violence against Children, as well as celebrity activists (e.g., the Pakistani musician Shehzad Roy), and the voices of the Pakistani people.

Recommendations It is clear that corporal punishment of children is a significant problem in Pakistan, like most countries. Until nationwide legal reform is fully enacted, the children of Pakistan are not being protected, and their rights, as identified in the CRC, are being violated. Based on that observation, we can propose three types of recommendations with the goal of reducing and then ending the CP of Pakistani children. First, we consider the legal recourse. As a start, the CRC, ratified by Pakistan in 1990, needs to be implemented nationally. Impressive progress has been made in legal reform, but there remain issues with consistency and enforcement. Laws should be passed in all provinces and at the federal level to protect children from CP. In those provinces with recent CP laws, further work needs to be done in educating parents, teachers, and law enforcement, so the prohibitions are upheld. Additionally, the

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process of filing and reviewing CP complaints should be standardized and simplified to ensure it will be equitable and effective. To complement passage of new legislation, a public health educational campaign is needed. Such a campaign can inform the public as well as train healthcare providers, school administrators, and parents about the potential consequences of CP. A parallel campaign is needed to educate and promote the use of non-violent management approaches for parents and teachers. There are many books and curriculums available for schools that provide “positive discipline” techniques (e.g., Durrant, 2016; Kersey & Masterson, 2012). Parents need to be informed about alternatives and educated as to why this approach is beneficial for them and their children. Emphasizing religious and cultural values regarding compassion toward children should be emphasized in Islamic education courses. Religious leaders can be especially powerful advocates for non-violent parenting. Our third recommendation involves research. To further understand the issue of CP in Pakistan and arrive at sound recommendations for addressing the problem, there is a considerable need for empirical research. Without carefully documenting the prevalence and correlates of CP in Pakistan, as well as the key determinants of the behavior, it will be difficult to develop appropriate and well-targeted efforts at intervention and prevention. Thus, an initial effort would be to systematically document the prevalence of the problem in the schools and homes. Another important area to investigate is how best to modify Pakistani attitudes and behavior regarding CP. Ward and colleagues, in an analysis more than 613,000 households in 65 countries using the UNICEF MICS data (that included more than 58,000 Pakistani parents), assessed both microsystem (i.e., interactional) and macrosystem variables (e.g., unemployment & homicide rates, urban vs. rural). They found that the most powerful predictor of CP reported use, by far, was a positive attitude toward it. Consequently, working to modify attitudes and beliefs is essential. For example, to what extent can attitude change occur simply by providing information about the problems linked to CP (e.g., Holden et al., 2014a)? It may also be beneficial to empirically assess whether existing interventions (e.g., Parent Child Interaction Therapy, Incredible Years) are effective in changing CP attitudes and behaviors in Pakistan. There are now at least 15 evidence-based interventions that target CP (Gershoff & Lee, 2020), in addition to parent education programs that aim to eliminate its use.

Conclusion The evidence indicates that CP continues to be widely used both in Pakistani schools and homes, as well as most other parts of the world. The good news is that, as of the summer of 2021, 63 countries have banned all corporal punishment of children. Columbia and Korea are the most recent additions (Global Initiative to End all Corporal Punishment of Children). That is close to double the number of countries than banned CP in 2012 (www.endcorporalpunishment.org).

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Bans on CP are designed to protect children, while work is done to change adults’ attitudes and behavior (Durrant et al., 2019). Despite the widespread acceptance of CP, the research evidence is now very strong that it is a problematic behavior because of its ineffectiveness in promoting good behavior, its unintended consequences, as well as its violation of children’s right to safety. The fact that there have been several recent legislative efforts to ban the practice in Pakistan is promising and a model for other nations. Those efforts indicate there are many Pakistanis who are committed to ending the practice of CP and promoting the safety, physical integrity, and respect of the rights of children.

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Cuartas, J., Weissman, D. G., Sheridan, M. A., Lengua, L., & McLaughlin, K. A. (2021). Corporal punishment and elevated neural response to threat in children. Child Development. https://doi. org/10.1111/cdev.13565 Durrant, J. E. (2016). Positive discipline in everyday parenting (4th ed.). Save the Children Sweden. Durrant, J. E., Stewart-Tufescu, A., & Afifi, T. O. (2019). Recognizing the child’s right to protection from physical violence: An update on progress and a call to action. Child Abuse & Neglect, 104297. https://doi.org/10.1016/j.chiabu.2019.104297. Gagné, M. H., Tourigny, M., Joly, J., & Pouliot-Lapointe, J. (2007). Predictors of adult attitudes toward corporal punishment of children. Journal of Interpersonal Violence, 22, 1285–1304. https://doi.org/10.1177/0886260507304550 Gershoff, E. T. (2016). Should parents’ physical punishment of children be considered a source of toxic stress that affects brain development? Family Relations, 65, 151–162. https://doi.org/10. 1111/fare.12177 Gershoff, E. T., & Grogan-Kaylor, A. (2016). Spanking and child outcomes: Old controversies and new meta-analyses. Journal of Family Psychology, 30(4), 453–469. https://doi.org/10.1037/fam 0000191 Gershoff, E. T., & Lee, S. J. (2020). Ending the physical punishment of children: A guide for clinicians and practitioners. American Psychological Association. Global Initiative to End All Corporal Punishment of Children. (2021). Country Report for Pakistan. https://endcorporalpunishment.org/reports-on-every-state-and-territory/pakistan/ Heilmann, A., Mehay, A., Watt, R. G., Kelly, Y., Durrant, J. E., van Turnhout, J., & Gershoff, E. T. (2021). Physical punishment and child outcomes: A narrative review of prospective studies. The Lancet, 398, 24–30. https://doi.org/10.1016/S0140-6736(21)00582-1 Holden, G. W., & Ashraf, R. (2016). Children’s right to safety: The problem of corporal punishment in Pakistan. In S. Deb (Ed.), Child safety, welfare and well-being: Issues and challenges (pp. 59– 74). New Delhi, India: Springer Publishing. Holden, G. W., Brown, A. S., Baldwin, A. S., & Croft Caderao, K. (2014a). Research findings can change attitudes about corporal punishment. Child Abuse & Neglect, 38, 902–908. https://doi. org/10.1016/j.chiabu.2013.10.013 Holden, G. W., Williamson, P. A., & Holland, G. W. O. (2014b). Eavesdropping on the family: A pilot investigation of corporal punishment in the home. Journal of Family Psychology, 28, 401–406. https://doi.org/10.1037/a0036370 Irfan, S., & Cowburn, M. (2004). Disciplining, chastisement and physical child abuse: Perceptions and attitudes of the British Pakistani community. Journal of Muslim Affairs, 24, 89–98. https:// doi.org/10.1080/136020042000212151 Kersey, K., & Masterson, M. (2012). 101 principles of positive guidance with young children: Creating responsive teachers. Pearson Professional Development. Khurshid, K., Batool, U., & Hussain, B. (2020). Perceptions of teachers regarding corporal punishment and its effects on students’ achievement at primary school level. Journal of Elementary Education, 30, 27–38. Khuwaja, H. M. A., Karmaliani, R., McFarlane, J., Somani, R., Gulzar, S., Ali, T. S., & Jewkes, R. (2018). The intersection of school corporal punishment and associated factors: Baseline results from a randomized controlled trial in Pakistan. PLoS one, 13(10), e0206032. Lansford, J. E., Deater-Deckard, K., Bornstein, M. H., Putnick, D. L., & Bradley, R. H. (2014). Attitudes justifying domestic violence predict endorsement of corporal punishment and physical and psychological aggression towards children: A study in 25 low- and middle-income countries. The Journal of Pediatrics, 164(5), 1208–1213.

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Lokot, M., Bhatia, A., Kenny, L., & Cislaghi, B. (2020). Corporal punishment, discipline and social norms: A systematic review in low- and middle-income countries. Aggression and Violent Behavior, 101507.https://doi.org/10.1016/j.avb.2020.101507. Maker, A. H., Shah, P. V., & Agha, Z. (2005). Child physical abuse: Prevalence, characteristics, predictors, and beliefs about parent–child violence in South Asian, Middle Eastern, East Asian, and Latina women in the United States. Journal of Interpersonal Violence, 20, 1406–1428. https:// doi.org/10.1177/0886260505278713 Malik, F. (2010). Determinants of child abuse in Pakistani families: Parental acceptance-rejection and demographic variables. International Journal of Business and Social Science, 1, 67–80. Maiter, S., Alaggia, R., & Trocmé, N. (2004). Perceptions of child maltreatment by parents from the Indian subcontinent: Challenging myths about culturally based abusive parenting practices. Child Maltreatment, 9, 309–324. https://doi.org/10.1177/1077559504266800 Mir, A. (2006, October 27). Corporal punishment ‘strictly banned’. Gulf News. https://gulfnews. com/world/asia/pakistan/corporal-punishment-strictly-banned-1.261957 Naz, A., Khan, W., Daraz, U., Hussain, M., & Khan, Q. (2011). The impacts of corporal punishment on students’ academic performance/career and personality development up-to secondary level education in Khyber Pakhtunkhwa Pakistan. International Journal of Business and Social Science, 2, 130–140. Nazar, N., Osterman, K., & Bjorkqvist, K. (2019). Physical punishment at school in three educational systems in Pakistan. Journal of Educational Health and Community Psychology, 8, 14–31. NCCR. (2001). Violence against children in the family and in schools. Submission by NGS Coalition on Child Rights Pakistan to the CRC Day of General Discussion, September 28, 2001. NGOs Coalition on Child Rights/UNICEF. NGO Coalition on Child Rights with UNICEF. (1998). Corporal punishment in primary schools of North West Frontier Province Pakistan. Obeid, R. A. (1988). An Islamic theory of human development. In R. M. Thomas (Ed.), Oriental theories of human development: Scriptural and popular beliefs from Hinduism, Buddhism, Confucianism, Shinto, and Islam (pp. 155–174). Peter Lang. Pakistan Penal Code Act XLV. (1860). Plan Pakistan. (2013). Stopping the fear: Why teachers use corporal punishment. Plan Pakistan. Profanter, A. (2007). Che Charta Dab Dey, Halta Abad Dey: A Pushto saying meaning "Where there is physical punishment, there is order and respect. Peter Lang. Rasool, G., Awaisi, Z. H., & Khalid, A. (2011). Puberty growth spurt age in local population—A study. Pakistan Oral & Dental Journal, 31, 78–83. Riaz, W. (2019, September 6). Punjab minister visits Hunain’s family, promises to introduce legislation against corporal punishment. Dawn. https://www.dawn.com/news/1503886/punjab-min ister-visits-hunains-family-promises-to-introduce-legislation-against-corporal-punishment. Society for the Protection of the Rights of the Child. (2012). Violence against children: Corporal punishment. In The state of Pakistan’s children (pp. 158–165). http://www.sparcpk.org/ Stewart, S. M., Bond, M. H., Zaman, R., McBride-Chang, C., Rao, N., Ho, L. M., & Fielding, R. (1999). Functional parenting in Pakistan. International Journal of Behavioral Development, 23, 747–770. Stewart, S. M., Bond, M. H., Ho, L. M., Zaman, R. M., Dar, R., & Anwar, M. (2000). Perceptions of parents and adolescent outcomes in Pakistan. British Journal of Developmental Psychology, 18, 335–352. Straus, M. A. (1996). Spanking and the making of a violent society. Pediatrics, 98, 837–842. Straus, M. A., Douglas, E. M., & Medeiros, R. A. (2014). Primordial violence: Spanking and its relation to psychological development, violence, and crime. Routledge. Thomas, R. M. (Ed.). (1988). Oriental theories of human development: Scriptural and popular beliefs from Hinduism, Buddhism, Confucianism, Shinto, and Islam. Peter Lang. Tomoda, A., Suzuki, H., Rabi, K., Sheu, Y. S., Polcari, A., & Teicher, M. H. (2009). Reduced prefrontal cortical gray matter volume in young adults exposed to harsh corporal punishment. NeuroImage, 47(Suppl 2), T66–T71. https://doi.org/10.1016/j.neuroimage.2009.03.005.

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Vittrup, B., Holden, G. W., & Buck, J. (2006). Attitudes predict the use of physical punishment: A prospective study of the emergence of disciplinary practices. Pediatrics, 117, 2055–2064. https:// doi.org/10.1542/peds.2005-220 World Bank. (2021). World development report 2021. WDR 2021. https://wdr2021.worldbank.org/ the-report. Zolotor, A., Theodore, A., Runyan, D., Chang, J., & Laskey, A. (2011). Corporal punishment and physical abuse: Population-based trends for three-to-11-year-old children in the United States. Child Abuse Review, 20, 57–66. https://doi.org/10.1002/car.1128.

Chapter 6

Child Sexual Abuse in a Trusted Relationship: Trauma or Confusion? B. N. Roopesh

Introduction The definition of child sexual abuse (CSA) varies. However, CSA is defined as a crime involving a child in sexual activity with an adult or elder person (generally five or more years older). It may involve contact or non-contact sexual acts. Contact acts include unwanted touching, masturbation, oral-genital contact, digital penetration, and vaginal and anal rape. Non-contact acts include voyeurism, exposure, making sexual comments, and showing pornography to children (Gilbert et al., 2009; Putnam, 2003; WHO, 2002). Statistics vary among studies due to various factors, such as (i) definitions used for child sexual abuse, where narrow definitions which include only contact abuse, and from people who are 5 years or older can produce lesser estimates compared to broadbased definitions that include non-contact abuse and from even peers can show higher prevalence rates; (ii) differences in the sampling where random, demographically representative, and community sample will be relatively lesser and more accurate compared to convenient; non-representative; and clinical sample; (iii) method of data collection, where estimates vary with respect to whether the study used direct faceto-face interviews, questionnaires, telephone interviews or were restricted to official reports. The use of latter source is known to yield significantly lower estimates; and (iv) culture or the country where the study is carried out, where, in some countries CSA is significantly higher compared to others (e.g. about 34% in Africa and 9% in Europe), and on the other extent, in some cultures, there is significant underreporting of CSA (Singh et al., 2014). According to a meta-analysis study that included studies from several countries, 1 in 5 women and 1 in 13 men, which is about 20% women and 8% men were likely to have been abused when they were minors (Pereda et al., 2009; Stoltenborgh et al., 2011). Child sexual abuse happens in all types of economies and culture (Deb & Madrid, 2014). Among the perpetrators, majority of CSA is B. N. Roopesh (B) Department of Clinical Psychology, NIMHANS, Bengaluru, India © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_6

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committed by males and about 90% of the abuse happens within a trusted relationship, or the abuse is committed by someone the child knows and trusts, such as members of the family, close relatives, family friends, neighbours, coach, or teachers (Gorey & Leslie, 1997). Reporting of child sexual abuse to legal authorities varies with respect to several factors. In general, reporting of child sexual abuse is very low in India, as indicated by two local studies (Deb & Mukherjee, 2009; Modak, 2009), compared to industrialized countries. Csorba et al. (2006) remarked that reporting of cases of sexual abuse is always very low across geographical boundaries. It is usually due to a combination of multiple factors, such as disbelief that such an event could happen or has happened; not knowing how to react or what to do; difficulty in confronting the perpetrator; perpetrator being in a dominant position or close relative; unsure about legal proceedings or poor conviction rates; delay in the legal process and multiple visits to courts; financial issues from travelling to courts; difficulty obtaining days off from work and loss of wages while doing so for parents; multiple direct and/or indirect pressure not to report; fear of causing further harm or mental anguish to the child (secondary victimization); fear of child’s future with respect to school or marriage; and fear of victim blaming and stigma from the society. The majority of abuse that gets reported are severe in nature, occurred frequently, or perpetrated by many, and/or usually done by someone outside the trusted relationship with respect to the child (breaking the silence, child sexual abuse in India. Human rights watch—USA, 2013). Similarly, children who are sexually abused do not report it to their parents or others, for fear that they may either not be believed, or that the child themselves might be blamed for the abuse, fear of being punished, fear of being stopped from something (e.g. going to school), fear of not knowing what will happen and fear of spoiling the relationship among family members (Deb & Mukherjee, 2009; Modak, 2009). Further, in many instances although young children feel uncomfortable, they may not know that what is happening to them is sexual abuse and/or may not know the words to describe either the body parts or the abusive action that has happened to them. This is further increased in children who have developmental, speech, or intellectual disability; as well as with children who have cognitive/brain deficits. In addition, a culture of silence and social stigma further discourages a victim’s family member from reporting the incident of sexual abuse to the authorities (Mukherjee, 2006). Compounding the issue is the significant shortage of adequately trained mental health professionals to deliver psychosocial aid/treatment, as well as physicians to address and handle the sensitive medical issues of sexually abused children. Therefore, the majority of sexually abused children live with the adverse psychological effects of the abuse life long, affecting their mental health, personality, interpersonal relationships, and career development (Deb & Sen, 2005).

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Common Myths Due to the efforts of many NGOs and media, people are aware of child sexual abuse, but many are still not aware about the form, modality, and the extent of it. Many people tend to perceive it as a distant phenomenon far removed from one’s personal life. The common myths about CSA is that it is rare; mainly perpetuated by strangers, that those who sexually abuse children are mentally ill or are perverts, that it happens only to girls, it is a phenomenon caused due to Westernization or modern lifestyle and happens mainly in cities. However, sexual abuse is highly underreported by the child themselves as well as by the family, and this feeds the perception of CSA thus being a rare event and ‘happens somewhere out there’. Another aspect of CSA is that all the perpetrators are not mentally ill or perverted, in the sense that the majority of them are people who otherwise lead a regular life, oftentimes holding respectable positions in the community, without any apparent psychological problems that require them to consult mental health professionals. CSA on boys usually is far less reported than girls, due to several reasons, such as the perception that boys should be strong, and importance given to sexual activity in boys (whatever may be the nature of it) among male peers. Sexual abuse has been happening throughout history and across the cultures or economies. It is neither restricted to Western lifestyle or dressing nor is it restricted only to cities.

Effects of Sexual Abuse The effects of sexual abuse vary with respect to the gender, type, and frequency of abuse; number of perpetrators; the extent of force involved; the age of the victim; the relationship with the perpetrator; resilience of the child; how the family and society treat the abuse and/or supports the child; and the legal process involved. In terms of gender, female children are affected more as compared to males. Contact abuse and within that penetrative abuse causes more negative effects compared to non-penetrative and non-contact abuse. The more the physical force or violence involved, the adverse effect. Age has a nonlinear effect, and the effects are closely related to other factors listed here. The closer the relationship with the perpetrator, the more disturbing the effects. Resilience of the child plays a significant role, and this is associated with several factors, such as the child’s easy temperament and pleasant disposition, resourcefulness, relationship with significant others and social support, hobbies, and self-esteem. Family can protect the child by supporting the child, for example, by validating the child’s feelings and normalizing routines. Society can do more by creating adequate awareness and mechanisms that will help in the prevention of the sexual abuse of children. Legal system can adopt more child safe and child friendly practices, shift addressal of the cases, and with more conviction that addresses retributive, preventive, and reformative practices (Astbury, 2013; Sinanan, 2015).

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The effects of CSA can be categorized into psychological, behavioural, and interpersonal problems. Depending on the factors associated with CSA that were mentioned above, the adverse effects range from mild to severe, as well as short to long-term consequences. Some of the common short-term effects usually observed are fear, anxiety, withdrawal, irritability, and anger outbursts. Depending on the severity, it can also lead to other problems such as sleep disturbance, bed wetting, decline in academic performance, and school dropout. Sometimes, the effects are seen in the form of age-inappropriate increased sexual interest and sexualized behaviour. The long-term effect of the sexual abuse is usually seen in young adults or adulthood where the person experiences difficulties with self-esteem, trust issues, interpersonal relationship, and sexual functions (Paolucci et al., 2001). In a study of high school students in Goa, India, Patel and Andrew (2001) found that one-third of the children surveyed had experienced some form of sexual abuse, and these individuals had significantly poorer academic performance, poorer mental and physical health, greater substance abuse, poorer parental relationships, and higher rates of consensual sexual behaviours than their non-abused counterparts. Adults, who were sexually abused as children, can develop depression, become dependent on alcohol and drug abuse, and sometimes end up being re-victimized (Paolucci et al., 2001). Few of those who were abused as children themselves become perpetrators when they become adults. This is sometimes referred to as the ‘cycle of abuse’ in the literature. It is also seen that few children do not experience any symptom after the sexual abuse. Given these, mental health professionals might generally consider these children to be afraid or in denial of their emotions as a way of coping with the stress of the abuse. However, research shows that this is not true in a substantial number of cases (Clancy, 2009; Loftus & Ketcham, 1994). One of the worst negative effects of sexual abuse of children is adjustment problems in later life, as reported by a number of researchers (Deb & Walsh, 2012). For example, Swanston et al. (2003) explored the psychological adjustment of 103 sexually abused children (mean age = 19.1) in Sydney after 9 years of reporting of sexual abuse to Child Protection Units in two children’s hospitals in Sydney and compared the same to non-abused young people of similar age and gender. Findings revealed that the sexually abused young people performed more poorly than nonabused young people on psychometric tests of depression, self-esteem, anxiety, and despair. The longer the duration of abuse, the greater was the likelihood of negative effects in the form of emotional and behavioural trauma and school problems. Ray and Jackson (1997) found that family characteristics, especially family environment, were significantly related to sexually abused children’s current social and psychological adjustment. In a Kolkata-based study, Deb and Mukherjee (2011) made an attempt to understand the adjustment capacity and depression of sexually abused girls in the age group 13–18 years in Kolkata, India. The study also attempted to understand the perception of the sexually abused girls towards the psychological interventions, i.e. individual and group counselling, which they had received. Findings disclosed that 69.2% of sexually abused girls suffered from moderate or severe depression compared with 27.5% of non-sexually abused girls. The study also found that 20.8 and 60.1% of sexually abused girls had poor levels of social and emotional

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adjustment, respectively, compared with 4.17 and 32.5% of non-sexually abused girls. Overall, the perception of more than two-thirds of the sexually abused girls of the rehabilitation homes about the counselling process was found to be positive. Furthermore, the girls who reported considerable gains from counselling had better adjustment capacity, compared to those who reported no benefit from counselling.

Belief in Trauma It is a general belief among many people who are in the field of child sexual abuse that child sexual abuse is a traumatic experience for the child. According to this view, every sexual child abuse induces traumatic feelings in the child. This view and belief seem to have been percolated to the general public too, where almost all published or reported cases of child sexual abuse are automatically considered as traumatic. This can also be seen when one does a literature search on the ‘effects of child sexual abuse’ in popular search engines, such as ‘Google’, where most of the articles/writeups that show up in the first few pages of the search engine mention that the effects of CSA result in trauma/post-traumatic stress disorder/are traumatic for the child. Rarely do the articles/write-ups, whether it is from an academic/institute or a blog from an individual, differentiate the effects of child sexual abuse with respect to type and/or extent of abuse. Given this, it might confuse any reader that any type of child sexual abuse automatically results in trauma. Here, the question that needs to be asked is, does all abuse result in trauma or post-traumatic stress disorder? To answer this, one needs to understand what trauma and/or post-traumatic stress disorder is. Trauma generally refers to extreme consequences and is usually equated with shock and a great deal of suffering, most often associated with situations such as some calamity, extreme violence, murder, rape, and the like. American Psychological Association (APA, 2021) defines it as an ‘emotional response towards any event that is terrible in nature, such as rape, accident, natural disaster’. It also mentions that the immediate or short-term effects for such events are shock and denial, whereas the long-term impact can be flashbacks, unpredictable emotions, difficulty in relationships, and even physical symptoms like nausea or headache. If a person has undergone trauma, s/he will experience symptoms such as fearfulness, depression, sadness, guilt, self-blame, anxiety, sleeplessness, somatic symptoms, eating problems, dissociative episodes, sexual and relationship problems and get repeated thoughts of the traumatic experience (Hall & Hall, 2011). In addition, culture significantly influences how an abuse victim interprets and assigns meaning to the traumatic event, as well as how victims convey the experience of these events through thoughts, emotions, and behaviours. As mentioned earlier, some children who are sexually abused do not report the abuse and do not show symptoms of trauma (Cashmore & Shackel, 2013), and this is more the case if the abuse has been perpetrated especially by a trusted person. Adherents of the trauma experience might believe that if the child is not experiencing the symptoms of the trauma, then that child might have repressed the memories of

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the abuse. This belief might lead to an assertion that as the child sexual abuse is so traumatic to the child, the child might unconsciously repress and/or suppress the whole experience as a process of the ego to cope up with the traumatic experience (Clancy, 2009). Hence, the argument that this repression and/or suppression are responsible as to why some children do not report sexual abuse and/or do not feel any negative effects of the abuse. It is generally believed that the repression of these memories in childhood will have adverse consequences during adulthood. The believers of the traumatic experience model of child sexual abuse usually do not draw much of a distinction between types and frequency of abuse, or who the perpetrator is from the child’s point of view. For them, all types of abuse are the same, irrespective of whether the abuse is contact or non-contact, penetrative or non-penetrative, carried out by a trusted known person or a stranger, by one person or many, and/or forced or non-forced. For them all types of abuse result in traumatic experiences either immediately, or if not, the effects will surely be manifested later in adulthood. However, even though some do believe that a more severe form of sexual abuse as well as abuse by somebody in a close relation causes more trauma, it is an after-thought or reported upon further enquiry. It is a common, firm, and accepted belief in almost all the legal systems across the world that a minor or child cannot make some decisions about sexual behaviours and cannot give consent. Even in cases where children give permission, it is clearly understood that the permission is not ‘consent’. Given this background and belief, those who adhere to the traumatic experience model of child sexual abuse automatically assume that the experience of abuse is traumatic, and if there are no symptoms of trauma either in short term or long term, it might be that the child has repressed the memories. However, the same people might not take into account the circumstances wherein a particular child did not oppose the abuse, for some reason; and due to which in later life, the child might end up blaming themselves and experience feelings of guilt, for they might consider that they were party to the abuse. Hence, in this scenario, the lack of the trauma symptoms might not be due to the repression. Substantiating this, psychological studies that have looked into the cognitive phenomenon of repressed memory of child sexual abuse cast doubts about the repressed memory phenomenon (Loftus & Ketcham, 1994; Whittier, 2011).

Trauma or Confusion One of the main reasons for the belief that child sexual abuse results in traumatic experience is that child sexual abuse is viewed from an adult centric point of view. That is, the adult projects her/his views, opinions, and beliefs about the experience of child sexual abuse onto the child. For adults, sexual abuse is a traumatic experience, and this feeling is projected onto the child, and believe and expect (rather involuntarily) that the child also might be experiencing the abuse as traumatic (Clancy, 2009). That is, the adult thinks like, if the experience is traumatic to me, then it

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must be the same for the child. Further, as adults also have the societal and natural expectations to protect children from all the harm, such as sexual abuse, it becomes their responsibility. It is more so when they have their own children and grandchildren. This can be easily observed in the media (such as television, movies) rating, and screening, where adults decide what is permitted and what is not permitted for children to view. Adults have clear boundaries with respect to their personal and intimate space. They have definite conceptualizations regarding their body, and that it belongs to them. They have control over who can broach their personal and intimate space and who cannot, how much, and what time. This perception and belief will make their body an integral part of their self, which is associated with all aspects of their life. Further, adults also have beliefs about what are another person’s personal space and private body; what is sex and related issues, what can be considered as abuse and what is not. These beliefs may not be exactly shared by or seen in children. Children’s knowledge and awareness vary in all the above aspects. They may not know about personal space, who can breach them and who cannot and how much. Further, even if they have some knowledge about boundaries, personal space, and ownership of their bodies, it might be amorphous or inconsistent. This can be attributed to the usual upbringing of children in many societies. Children are rarely given independence or have a say in many things. Adults decide what is good for them. For example, in many societies, parents feel it is ok for the female child to sit on an adult male’s lap, even when the adult is an uncle or a family friend. When in these situations, if the child shows reluctance or refuses to sit, parents might ask or instruct the child to sit. The same thing might happen with respect to hugging and kissing the child by an adult apart from the parents. Sometimes, even if the parents are reluctant, they will keep quiet as they themselves might not be sure what to say or how to stop an adult, for example, their friend/relative, from hugging or kissing their child. This sends a very confusing and different message to their children. That is, when the children see that their own parents did not say anything or stop the uncomfortable experience from happening, they too might find it extremely difficult to resist or reject any such behaviour. Usually, young children have either poor understanding or have only a vague knowledge about sex. Furthermore, they may not know about what is sexual abuse, even though they might know that something is not alright. In addition, if the perpetrator concocts a story around the abuse (e.g. that the abuse act is a forgiveness ritual for a mistake done by the child), as it usually happens with young children, it will be difficult for the child to perceive the act as sexual abuse. A related issue deals with the aspect of cognitive development. Cognitive functions in young children that are necessary to understand what is good and what is not are not fully developed. This is especially true about sex and sexual abuse. This is compounded by society’s restrictions and limitations on talking or discussing about sex with young children. In this scenario, unless the sexual abuse involves force, violence or is done by someone outside the trusting relationship, it would be difficult for the young child to perceive it as not good.

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The following example emphasizes the cognitive development factors. A child’s uncle creeps to the child’s bed during night, talks to the child affectionately, abuses the child, and gives chocolates and gifts after that. But the same uncle talks less and avoids the child during the day time (Virani, 2000). Here, the child is confused as to ‘who is my real uncle?’ is it the one that the child sees in the night or the one the child encounters during day time. Other factors that influence the perception of abuse are the upbringing of the child by the parents. Many parents insist that the child is to follow what is said without questioning; parents oftentimes do not provide reasons for why they want the child to behave in a particular way, and many times parents say ‘do as I say but not as I do’. In this environment, if abuse happens, the child might believe that the adults have the right to do whatever they want to the child, and that the child should just accept it. In addition, there are parents who punish (e.g. spanking) the child for even small mistakes and sometimes even without knowing the cause of the child’s behaviour. One such common example that can be seen almost everywhere in some of the societies is that, when a child falls to the ground from a tree while playing outside the house and gets injured, one of the first things some parents do is to scold and spank the child for climbing the tree or playing that particular activity. This sends a wrong message to the children that if I get into any harm, whether it’s my mistake or if somebody else does it on me, I will be the one to get punished. Given these experiences while growing up, a child might develop less attachment with as well as fear of the punishing parent, both of which are not conducive to reporting the abuse. Closely associated with the above factors is that one of the cognitive development aspects of childhood is that of egocentric thoughts and beliefs, where for a child, the world revolves around the child itself, due to which whatever happens to, around, and with respect to the child. Given these factors, the child has high chance of believing that it is s/he who is responsible for the abuse and not the abuser and takes the blame on herself/himself with self-statements such as ‘I might have done something wrong’ and ‘I deserve this, or else why would he do this for me.’ This might result in confusion or dilemma and can lead to hesitance and delay in reporting immediately after the abuse has occurred. This is especially so, where the abuse has been perpetrated by a trusted person, after a long time of grooming, and/or when no force is used. Not reporting the abuse immediately after it has happened for the first or after a delay further increases the confusion that the child undergoes, such as ‘I kept quiet for the first few times, is there a problem with me?’; ‘I did not report it to anyone immediately after it happened, so will others think I encouraged it because I did not report?’ When these thoughts occur, any child might find it difficult to report after a delay. Compounding the issues, as many perpetrators are known to children and might live close to children, children might see and meet their perpetrators on a regular basis, and on these occasions, as it is usually expected by the society (which does not know the abuse has happened), the child is expected to behave as usual and/or respectfully towards the perpetrators. This can lead to further confusion that, ‘I interacted with him normally for several days after the abuse has happened, and now if I report, won’t my parents think that I am telling lies?’

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It is quite well known that child sexual abuse happens after a prolonged period of grooming the child for the abuse. Grooming the child for sexual abuse involves can be of different stages of which two are mentioned here. In earlier stages, it can take the form of ‘giving special privileges for the child’. These can be giving special positions in the sports team, giving special coaching, giving rides in the vehicle, showing favouritism, and giving gifts and money. Once the child has taken the privileges, the relationship between the perpetrator and child gets relatively strengthened, the child might feel that it is somewhat obligated to the perpetrator, and/or the child might find it extremely difficult to say no to the perpetrator. In this state, the perpetrator may use a later stage of grooming, which can be considered as ‘sexual grooming behaviours.’ These can include bathing the child, accidently touching genitalia of the child, wrestling or swimming coaching that involves touching the child’s genitalia, discussing the child’s development of its genitalia, and discussing the sexual development under the guise of education (Pollack & MacIver, 2015). Actual sexual abuse usually follows the above grooming practices. As some of the above activities involve the fondling of the genitalia of the child, and as an erogenous zone, when touched, tickled, or fondled, genitalize produces pleasurable sensations. Hence, when a child who has been abused has experienced any such sensations, there is a very high chance for the child later in its life to feel that they in fact liked the act of abuse. Given this, the child later in life can think that when they liked such an act, how can they complain and/or they may not show the expected symptom of the trauma or post-traumatic stress disorder. However, they might show the other effects of abuse later in life, such as sense of betrayal, guilt, shame, self-blame, low self-esteem, lack of trust in relationships or relationship failures (Paolucci et al., 2001), but not the symptoms of trauma, such as shock, fear, flashbacks, or nightmares (Fanflik, 2007). Given the above, when the therapist expects that every child who has undergone sexual abuse to have the symptoms of trauma and PTSD and when the child does not show these symptoms, few things can result. The therapist might think that the child has denied and/or repressed the traumatic feelings and tries to unearth those feelings, and/or might have doubts about whether or not the abuse has happened. Either of these will result in poor rapport, poor empathy, and poor validation of the victim’s feelings and situation. On the other hand, the victim might feel that they are not properly understood that they don’t fit into the classic expected role of child sexual abuse victim, and that something is wrong with them. This can adversely affect the therapy and in turn the victims (Clancy, 2009).

Conclusion and Recommendations A majority of children are fairly resilient. They usually outgrow various adverse experiences that have occurred in childhood. This applies even more to non-sexual, abusive experiences. One of the factors that influence the resilience of the child to any adverse experience is how the parents and surroundings react to the same. For the psychologist treating the child who has been sexually abused, the child’s wellbeing

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and mental health are far more important than legal issues related to the perpetrator. Therefore, primarily a good treatment plan is to make the child function as normally as possible and help to cope up with the abuse and to prevent further adverse effects of the sexual abuse, such as secondary victimization. If the clinician believes that all child sexual abuse results in trauma, and expects the child has the symptoms of PTSD and tries to treat it as such, even when the child does not report any trauma feelings or symptoms, real healing cannot take place. Given this, clinicians should be sensitive about what actually is experienced by the child and work towards the wellbeing of the child. A number of steps are suggested for addressing this sensitive issue: (i) (ii) (iii)

(iv)

(v) (vi) (vii)

(viii) (ix)

(x)

There is a need to extend unconditional mental health support to the victim and their family members by professional psychologists or counsellor. Continuous/periodic supportive counselling services to be provided to the victim and other family members. Therapists should be aware of all aspects of the child sexual abuse, and especially that some children might not show the classic symptoms of trauma or post-traumatic stress disorder. Ensuring safety of the child, as in a number of cases where either biological father or close family members are involved in the crime so the child must be shifted to a safe custody. Otherwise, the morale of the child and career will be badly affected. There is a need to report each and every case of child sexual abuse to the competent authority for justice and safety. Concerned authorities and legal professionals should prevent the secondary victimization. Perpetrators should be sensitized about the negative effect of the act, and they should be counselled instead of keeping them left out from the intervention strategies. Not to stigmatize the child and allow the child to resume all daily activities. As already the POCSO act expects mandatory reporting of child sexual abuse incidents to the authorities. Given this every attempt should be made to make it a smooth process (Deb, 2015). More child sexual abuse awareness is to be conducted in schools for the teachers as well as the parents.

References American Psychological Association. (2021). Trauma. Retrieved September 29, 2021, from https://www.apa.org/topics/trauma#:~:text=Trauma%20is%20an%20emotional%20respons e,symptoms%20like%20headaches%20or%20nausea Astbury, J. (2013). Violating children’s rights: The psychological impact of sexual abuse in childhood. InPsych, 35. https://psychology.org.au/inpsych/2013/october/astbury

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Breaking the silence. Child sexual abuse in India. USA, Humans rights watch (2013). Available from http://www.hrw.org/sites/default/files/reports/india0113ForUpload.pdf Cashmore, J., & Shackel, R. (2013). The long-term effects of child sexual abuse. Child Family Community Australia (CFCA) Paper No. 11. Clancy, S. A. (2009). The trauma myth. Basic Books. Csorba, R., Lampe, L., Borsos, A., Balla, L., Poka, R., & Olah, E. (2006). Female child sexual abuse within the family in a Hungarian country. Gynecologic and Obstetric Investigation, 61(4), 188–193. Deb, S., & Sen, P. (2005). A study on psychological trauma of young trafficked women. Presented in the 6th Asian Conference on Child Abuse and Neglect held in Singapore during November 16–18, 2005. Deb, S. (2015). Legislation concerning reporting of child sexual abuse and child trafficking in India: A closer look. In M. Ben, & B. C. Donald (Eds.), Mandatory reporting laws and the identification of severe child abuse and neglect. Springer. Deb, S., & Madrid, B. (2014). Burden of child abuse and neglect with special reference to sociolegal measures: A comparative picture of India, Philippines and Japan. In J. Conte (Ed.), Child abuse and neglect: Worldwide (pp. 77–106). PRAEGER. Deb, S., & Mukherjee, A. (2009). Impact of sexual abuse on mental health of children. Concept Publishing Company. Deb, S., & Mukherjee, A. (2011). Background and adjustment capacity of sexually abused girls and their perceptions of intervention. Child Abuse Review, 20, 213–230. https://doi.org/10.1002/ car.1153 Deb, S., & Walsh, K. (2012). Impact of physical, psychological, and sexual violence on social adjustment of school children in India. School Psychology International, 33(4), 391–415. https:// doi.org/10.1177/0143034311425225 Fanflik, P. L. (2007). Victim responses to sexual assault: Counterintuitive or simply adaptive? Report of the American Prosecutors Research Institute. Gilbert, R., Widom, C. S., Browne, K., Fergusson, D., Webb, E., & Janson, S. (2009). Child maltreatment 1: Burden and consequences of child maltreatment in high-income countries. The Lancet, 373, 68–81. https://doi.org/10.1016/S0140-6736(08)61706-7 Gorey, K. M., & Leslie, D. R. (1997). The prevalence of child sexual abuse: Integrative review adjustment for potential response and measurement biases. Child Abuse and Neglect, 21(4), 391–398. https://doi.org/10.1016/S0145-2134(96)00180-9 Hall, M., & Hall, J. (2011). The long-term effects of childhood sexual abuse: Counseling implications. http://counselingoutfitters.com/vistas/vistas11/Article_19.pdf Loftus, E., & Ketcham, K. (1994). The myth of repressed memory: False memories and allegations of sexual abuse. St. Martin’s Griffin. Modak, S. (2009). Violence against children in Tripura and its impact (Dissertation). Calcutta University. Mukherjee, A. (2006). A study on the impact of sexual abuse on mental disposition of girl children (Unpublished Doctoral Thesis). University of Calcutta. Paolucci, E. O., Genuis, M. L., & Violato, C. (2001). A meta-analysis of the published research on the effects of child sexual abuse. The Journal of Psychology, 135(1), 17–36. https://doi.org/10. 1080/00223980109603677 Patel, V., & Andrew, G. (2001). Gender, sexual abuse and risk behaviors in adolescents: A crosssectional survey in schools in Goa. National Medical Journal of India, 14, 263–267. Pereda, N., Guilera, G., Forns, M., & Gomez-Benito, J. (2009). The prevalence of child sexual abuse in community and student samples: A meta-analysis. Clinical Psychology Review, 29(4), 328–338. https://doi.org/10.1016/j.cpr.2009.02.007 Pollack, D., & MacIver, A. (2015). Understanding sexual grooming in child abuse cases. ABA Child Law Practice, 34(11), 165–168.

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Putnam, F. W. (2003). Ten-year research updates review: Child sexual abuse. Journal of the American Academy of Child and Adolescent Psychiatry, 42(3), 269–278. https://doi.org/10.1097/00004583200303000-00006 Ray, K. C., & Jackson, J. L. (1997). Family environment and childhood sexual victimization. A test of the buffering hypothesis. Journal of Interpersonal Violence, 12(1), 3–17. https://doi.org/ 10.1177/088626097012001001. Sinanan, A. N. (2015). Trauma and treatment of child sexual abuse. Journal of Trauma and Treatment, S4, 024. https://doi.org/10.4172/2167-1222.S4-024 Singh, M. M., Parsekar, S. S., & Nair, S. N. (2014). An epidemiological overview of child sexual abuse. Journal of Family Medicine and Primary Care, 3(4), 430–435. https://doi.org/10.4103/ 2249-4863.148139 Stoltenborgh, M., van Ijzendoorn, M. H., Euser, E. M., & Bakersman-Kranenburg, M. J. (2011). A global perspective on child sexual abuse: Meta-analysis of prevalence around the world. Child Maltreatment, 16(2), 79–101. Swanston, H. Y., Plunkett, A. M., O’Toole, B. I., Shrimpton, S., Parkinson, P. N., & Oates, R. K. (2003). Nine years after child sexual abuse. Child Abuse and Neglect, 27(8), 967–984. https:// doi.org/10.1016/S0145-2134(03)00143-1 Virani, P. (2000). Bitter chocolate: Child sexual abuse in India. Penguin Books. Whittier, N. (2011). The politics of child sexual abuse. Oxford University Press. World Health Organization. (2002). World report on violence and health. World Health Organization, Office of Publications.

Chapter 7

Conflict in Kashmir: Psychosocial Consequences on Children Waheeda Khan

Abstract Armed conflict in Kashmiri has negatively impacted all inhabitants of the valley, but most serious effects are seen on children. Conflict has filled the tender hearts of children with anger and frustration, and they have lost their peace of mind. Health, which is mostly valuable for a child, is crippled by armed conflict, and children suffer from psychological problems of anxiety, depression, post-traumatic disorder, etc. It has taken away from them the happy period of childhood and left them stressed with a number of adult responsibilities. Some are left in orphanages as they have lost their caretakers at the time when they need them most. Armed conflict is leaving its long-term effect by compromising education of children which is most important for the future development of society. Since the abrogation of Article 370 of the Constitution of India which gave special status to the state of Jammu and Kashmir, the people of Kashmir remained inside their homes for a prolonged time. During this period, almost everything was suspended including mobile and Internet services, educational institutions, business, transportation. This paper explores how such experiences have affected the mental wellbeing, cognitive, social and emotional development of these children. Non-governmental organizations working in Kashmir should organize special programs to provide counseling/mental health first aid to the affected children and their parents. Overall, the mental wellbeing of children and adolescents should be strengthened and more so during COVID-19 pandemic, which has added mental health burden in the lives of young Kashmiri children.

Introduction Violence, abuse, neglect of children are common; they are abused and neglected by their parents or other caregivers everywhere in the world. But, the true extent of such things is not easy to measure as it is less reported, varies from place to place, and is context specific. Relations are also observed between conflict and worse conditions of such children. As in case of violence against intimate partners, child W. Khan (B) Professor, Faculty of Behavioural Sciences, SGT University (UGC Recognized), Gurugram 122505, Haryana, India © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_7

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abuse includes physical, sexual, and psychological abuse, as well as neglect. Probably, the broadest implication of this statement is the data available on physical violence, compiled by the Innocent Research Centre for the UN Secretary General’s Study on Violence against Children (2006), which led to an estimate of between 500 million to 1.5 billion children experiencing violence annually. Reliable data on non-fatal child abuse is scarce, but studies from various countries suggest that children below the age of 15 years are frequently victims of abuse or neglect. In most places, boys are the victims of beatings and physical punishment more often than girls, while girls are at higher risk of infanticide, sexual abuse, neglect, and being forced into prostitution. Children who face abuse and neglect appear to be associated with increased rates of mood disorders and anxiety problems. The strongest association was observed with post-traumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD). Depression and withdrawal symptoms were common among children as young as 3 year old, who experienced emotional, physical, and environmental neglect (Dubowitz et al., 2002). Other psychological and emotional conditions associated with abuse and neglect include panic disorder, dissociative disorders, attention-deficit hyperactivity disorder (ADHD), depression, anger, PTSD, and reactive attachment disorder (Teicher, 2000). An estimated over 10% of the children are affected by the armed conflicts worldwide which have both direct and indirect effects leading to immediate as well as long-term harm. The direct effects are associated with the trauma both physical and psychological, displacement and death, whereas indirect effects are associated with a number of factors which include unsafe and inadequate living conditions, displacement-related health risks, separation from family, caregiver’s mental health, environmental hazards, destruction of property, economic infrastructure, health, public health, and human rights violations. Children are also attacked by the combatants and recruited to take part in combat, even sometimes forced to do so in a number of ways. Therefore, armed conflict for children is both a toxic stress and a significant social determinant of their health status (Slone & Mann, 2016). The condition of children is worsening in states of armed conflict, and Kashmir is no exception. The impact of conflict in Kashmir is such that the exposure to actual armed conflict is limited, but the detrimental effects are in terms of repression, loss of security, income and service access, disrupted schooling, displacement, military harassment, and other forms are visible in the lives of children and their families (Wessells, 1998). Since the initiation of armed conflict in Kashmir, it has undergone many transformations at the micro- and macro-levels, with major implications for women and children. The impact has major consequences on the survival, development, mental health, and overall wellbeing of children and adolescents (Khan & Ghilzai, 2002). The major problems that children are suffering because of continued armed conflict in Kashmir, are presented under the following headings.

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Social Disruption Some of the environmental threats to children commonly associated with conflict include displacement from homeland, family dispersal, separation and discord, destitution, loss of service access, social interaction, and the presence of military personnel. Usually, a number of military camps are found to be located near schools in Kashmir which create a threatening atmosphere for students and teachers alike, particularly for females who fear sexual harassment, etc. Often, the disruption occurs in Kashmir during the times of combat and children somehow manage to leave their village and remain in their relative’s place till the situation improves.

Civil and Political Violations The close presence of large numbers of security personnel often leads to human rights abuse, and much more than this, it entails the militarization of society, the strain of life under constant vigilance, restriction of movement, frequent harassment, and intimidation. Checkpoints, surveillance operations, interrogations, search operations in homes and places of work, restrictions on the press and activists, all undermine normal interaction and community life in many conflict regions (Machel, 2001). In Kashmir also, civilians resent frequent searches and intimidation by the security forces. They feel angry about arbitrary change in laws by the military personnel and their counter-insurgency operations. Such happenings create a sense of mistrust, insecurity, and helplessness in the lives of common people and their children. A study conducted by Jong et al. (2008) in Kashmir showed that almost half of the respondents (48.1%) mentioned that they felt safe only occasionally or never, and they had to suffer crackdowns, frisking by security forces, roundup raids, damage to property, burning of houses, mistreatment, humiliation, and threats. It was found that nearly one in ten people (9.4%) lost one or more members of their nuclear family because of violence. Almost 11.6% interviewees mentioned that they had been victims of sexual violence since 1989. People dealt with stress by isolating themselves (22.3%) or becoming aggressive (16%). Jong et al. (2008) reported frequent direct confrontations with violence since the start of conflict, including exposure to crossfire (85.7%), round-up raids (82.7%), the witnessing of torture (66.9%), rape (13.3%), and self-experience of forced labor (33.7%), arrests/kidnapping (16.9%), torture (12.9%), and sexual violence (11.6%). Males reported more confrontations with violence than females. In a recent study, Dar and Deb (2021b) found high prevalence of conflict-trauma among Kashmiri youth which was 100% in both the gender for any two traumatic events as a result of armed conflict. The high prevalence of experiences were found to be the feelings of insecurity (97.3%), fear caused by search operations, curfew and crackdown (89.2%), participating in a protest or witnessing it (88.3%), injury caused by pellets/bullets to the close relations, such as family members or friends (76.5%), exposure to violence through media (74.3%).

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Transformation in Roles and Responsibilities When families undergo times of deprivation and material loss, it is not surprising that they may turn to their children as an economic resource. This is true in many places but particularly so in a conflict ridden situation when regular breadwinners are absent, killed, or injured. The likelihood of hazardous work increases in conflict because of the reduction in normal economic opportunities and the prevailing climate of lawlessness and impunity. It will also depend on local cultural factors which, for example, may create few obstacles to the employment of boys but ensure that girls are largely prevented from pursuing any public economic activity. In Kashmir as well, the sons are encouraged to migrate for work. The Hanji community increasingly relied on the earning capacity of their children in carpet weaving. Some families have become so indebted that they have committed their children in bonded labor to the owners of carpet factories. During conflict, children who have lost their father or the prime bread earner are left to run the households with younger siblings or simply left to fend for themselves on the streets of larger towns. Conflict increases the pressure on the young children to work, possibly at the expense of their schooling. It also leads to under-nourishment and malnutrition; inability of parents to pay for the basic necessities of school education, such as uniform and writing material etc., and thus leading to the child’s withdrawal from religious, social, and cultural events. The survey done by Dabla (1999) revealed that 84.7% of such child respondents lived with their mothers, 4% with their uncle, 9% with mother’s father, and 2% with their father’s father. These children faced problems like economic hardships, psychological setbacks, denial of love and affection, and apathy by relatives and friends. Total dropouts among child respondents were 57% during 1989–1999; 27% at primary level, 48% at middle level, and 25% at the matric and above level. Children who were not going to school were engaged in domestic work (3.7%), handicrafts (37.8%), automobile workshops (3.7%), non-governmental service (3.7%), and business houses (3.65%). These child workers felt that they got lesser wages and were exploited regularly.

Vulnerability to Children Many conflicts are now being fought with a combination of high-tech hardware and traditional weaponry. The variety of combat activities enabled by this mix of weaponry leads to the injury and death of child civilians in a wide range of situations. Some of the most common are: (a)

Bystander Injury. The sudden outbreak of gun battles between opposed forces may cause injury to children caught up in crossfire. This is a particular problem in Kashmir due to the fact, already noted, that many army checkpoints and camps, which are obvious targets of militant attacks are situated very close to schools.

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Bombing and Shelling. The increasingly sophisticated weaponry used in launching of shells and bombs which are both dropped and planted usually in markets, posed an unavoidable threat to children and their families. In addition to the number of casualties resulting from a single incident, the unpredictable nature of such activities contributes to an atmosphere of fear and anxiety. Like other countries, Kashmiri young boys are also taken along with military personnel who use them as a shield while searching houses. Militants have also used these children to protect themselves in a confronting situation with army personnel. Even if these children are not in direct conflict, however the experience of such torture have long lasting psychological impact in their later life.

Loss of Parents Orphanages seeking to accommodate children who have lost the care of their families due to conflict have become commonplace in Kashmir. It is reported that Kashmir has 33,000 conflict widows and only 8.7% remarried, and it has also created conditions where children are abused by step parents. Residing in orphanages, children are exposed to new risks, incidences of orphan children being abused and beaten for petty reasons in Kashmir are often reported. UK-based child rights organization, Save the Children, has revealed that the estimated population of orphans in Jammu and Kashmir is 214,000, and 37% of them were orphaned due to the armed conflict (Kumar, 2012). The report titled “Orphaned in Kashmir—The State of Orphans in Jammu and Kashmir” based on a study conducted in six districts of the state revealed that 37% of the orphans lost one or both parents due to the conflict, while 55% were orphaned due to the natural death of parents and remaining 8% due to other reasons. The proportion of children orphaned due to conflict is highest in Anantnag district of south Kashmir (56%), followed by Ganderbal (48%), Baramulla (33%), and Rajouri (31%), moreover, the number of orphans is higher in the valley than Jammu region. The study revealed that 5% of the orphans were either physically abused or intimidated, such as having guns pointed at them, threatened by armed actors, accused of providing support to the fighting sides, physically assaulted and hurt, used as bait to capture their parents or as human shields during the conflict. “Among the orphans attending schools, a large number said that the main distraction in school was that they had worries about their families (28%), noise of explosions during conflict (19%), and intimidating presence of troops (13%),” the report adds. As per the survey, one-third of the orphans had faced emotional stress during the conflict, “while 38% felt despair and skepticism about the future, 32% said that their anxiety was triggered by sudden loud noises or seeing battle uniforms.” The child rights group has made a number of recommendations for overall betterment of orphans in the state like formulation of child protection policy, setting up of child protection committees.

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Education of Children It is a widely accepted fact that schooling is vital for children’s social and cognitive development. In the conflict situation of Kashmir, regular school attendance and formal education entail considerable risks for students. One major effect of the violence reported was fear among children (24.6%), and 15.5% were unable to attend their schools (Jong et al., 2006). Frequent “Hadtal” on different conflict-related issues has deteriorated the quality of education. This “Hadtal” can go for months together, thus having strong negative repercussions on the young generation of Kashmir. In previous years, Kashmir experienced long-term “Hadtal” which could go for 4– 6 months on different conflict-related issues like Amarnath cave, Nelofar, and Asiya case. Students were later examined for half of their syallabi, which was assumed to be a way out in such a situation but actually damaging their future. Children learnt new ways of ventilating by showing aggression and were given due reinforcement for the same, although this does not lead to any positive growth in them. Madhosh (1999) in his study revealed that strife in the violence torn valley liquidated the educational system, tore the age-old socio-cultural fabric, and stress had a telling effect on the biophysical, psychological, and social health of children. Exposure to violent conflict had a large and statistically significant negative effect on the enrollment of girls, and they are less likely to complete their mandatory schooling. Hassan (2012) in a study on the impact of conflict on education stated that the impact of armed conflict on Kashmiri society has been deeper, wider, and has engulfed the totality of social dynamics. Education has been the major causality as a result of the conflict. Severe effects on attendance in the educational institutions (83%), and quality of education and its effectiveness (68%) were observed. Moreover, missing large number of classes have also put pressure on children and their academic performance, leading to failure and leaving education midway because of the interrupted education or lack of income. A recent study by Dar and Deb (2021a) revealed that 99.3% of the respondents disclosed their education being adversely affected by the conflict and violence in Kashmir resulting in the loss of educational year (82.4%).

Aggression/Stone Pelting The on-going turmoil has taken a paradigm shift when people, especially children, started expressing aggression by pelting stones and bearing its negative consequences. They throw stones on armed personnel at small distances in which they too are beaten and injured. Khan, Maqbool, Abdulla and Ken (2012) studied different types of eye injuries (between June and September 2010) and reported that most of the victims (75%) were young boys between 16 and 26 years with mean age of 20.95, 95% of cases were males. The main cause of injury was stones (48.3%) and pellets (30%) besides rubber bullets, sling shots, and tear gas shells.

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Most of the stone pelters were school and college going students. When any one among them injured or killed, it further fumigates the entire peer circle and escalates the tension. On March 18, 2011, 5255 persons, including 799 students, were arrested across the state for allegedly resorting to “stone pelting” during summer unrest. Different reasons have been given by different parties for stone pelting which actually represent their own political interests. However, Margoob (2010) a wellknown psychiatrist of the valley commented that recent developments of defying law and order could also be a manifestation of the ever-increasing indescribable levels of frustration and anger among this “trauma generation,” who have hardly seen a minute of complete peace or tranquility in their lives.

Loss of Childhood Childhood is known for freedom, fun, and playing different games, and Kashmir before armed conflict was no exception. Children used to stay out late in the evening and play different games. The charm would add more during the holy month of Ramzan in which children, especially girls could sing songs till late evening, and this was part of the Kashmiri culture. But now, the situation is totally different. Children are involved more in indoor games and have lost all those fun-filling opportunities. They are more tense and stressed and have lost the real childhood.

Mental Health Armed conflict in Kashmir has a high impact on mental health of children. Empirical studies on children in an armed conflict showed the detrimental effects on children’s mental health and wellbeing. The psychiatric literature shows that conflict situation increases disorder prevalence (Hoge, 2004). For example, Saima and Sharma (2011) conducted a study to see the mental health of children of “intact” and “disrupted” families. The results revealed that the mental health of children belonging to disrupted families was significantly lower when compared with the children of intact families. Some of the commonly observed mental health problems in the valley are described below: (a)

Post-traumatic Stress Disorder (PTSD) Millions of children are exposed to traumatic experiences each year. A significant number of these traumatized children develop a clinical syndrome with significant emotional, behavioral, cognitive, social, and physical symptoms called PTSD (Perry & Azad, 1999). Kashmir being a conflict zone is not free from it, about 30–50% showed PTSD. A study conducted by Margoob (1995) on children in Kashmir reported that out of 103 children 37 showed symptoms of PTSD. In another study on orphan children, PTSD was found to be

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(b)

the commonest psychiatric problem (40.62%) followed by Major Depressive Disorder (25%) and Conversion Disorder (12.5%) as reported by Margoob et al. (2006). Exposure to political hardships not only increases children’s psychological symptoms but also makes their psychological coping modes ineffective in mitigating this relationship (Punamiki & Suleiman, 1990). A study by Dabla (2001) reported that the most crucial problems the children faced after the death of their father are economic hardship. Yousuf and Margoob (2006) conducted a study on 100 cases of PTSD in children, in the age range of 03–16 years, in Govt. Psychiatric Diseases Hospital, Srinagar. The most common traumatic event experienced was witnessing the killing of a close relative (49%), followed by witnessing the arrest and torture of a close relative (15%). The commonest symptoms were somatic complaints followed by convulsion symptoms. Bhat and Rangaiah (2015) studied the relationship between armed conflict and post-traumatic stress disorder in a sample of 797 students of Kashmir. The results showed that 49.81% of the respondents were found to be in the diagnosable range for post-traumatic stress disorder. The nature and frequency of some of the conflict-related events such as a family member being dead and missing, personally being threatened with death, witnessing distressful media portrayal of conflict, a feeling of living in the conflict, and a higher level of personal exposure to conflict emerged as risk factors of post-traumatic stress disorder. General Anxiety and Depression Kashmiri children are found to have general anxiety symptoms more apart from other problems. The continuous threat and unpredictability due to armed conflict have given rise to such problems. Children are always apprehensive and insecure about themselves and their family, and this could be the core reason behind the anxiety problems they are afflicted with. Many children are reported as being phobic of army personnel. Depression is another problem which has been seen rising in the past two decades in the valley. Amin and Khan (2009) reported that due to continuing conflict in Kashmir during the last 18 years, there has been a phenomenal increase in psychiatric morbidity. They revealed that the prevalence of depression is 55.7% and the highest prevalence rate of 66.7% was observed in the 15–25 year old age group. Depression is much higher in rural areas (84.7%) as compared to urban areas (15.3%). Paul and Khan (2019) in their study on school children (N = 1000) from 12 schools of Shopian district of south Kashmir reported that the most commonly found mental disorders were anxiety (8.5%), followed by mood disorders (6.3%) and behavioral disorders (4.3%). The percentage of school-going children with mental disorders in Kashmir is much more than the other states of India. Dar and Deb (2020) in a recent study found that depression was significantly associated with low family income and being male in the conflict-hit Kashmir. Results also revealed that being male, living in a rural place with poor family income, and less educated mothers were found to be significantly associated with higher anxiety in the participants.

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(c)

Dissociative Disorders

(d)

Dissociative disorders which were quite common in the Freudian times can now be seen in abundance among Kashmiri children. The well-known fact is that these disorders have some stressor as a cause and thus stands true for Kashmiri children as well. The effect of armed conflict in the form of repression of desires, threats, suppression, humiliation, and insecurity is part of culture now and could easily lead to such consequences. At times, it is associated with parenting which too is somehow affected by the present situation. Most of the school teachers are now unable to handle such emerging problems among young students. Feelings of Insecurity/Suppression The feeling of insecurity is common among people of Kashmir and children. When a child arrives home late from school, the anxious reaction of parents clearly indicates the deep-rooted insecurity which is a result of armed conflict. Children do not feel free to move as parents keep on telling them about harmful consequences. This insecurity is found more among girls than boys (Raina & Bhan, 2013). Women and girl children feel more insecure, as a result of cases of molestation and rape. It restricts their normal movement, and they are usually accompanied by elders, causing feeling of more suppression. A study done by Jong et al. (2008) revealed that Kashmiri women are among the worst sufferers of sexual violence in the world. Interestingly, the figure is much higher than that of Sierra Leone, Sri Lanka, and Chechnya. Rape is not incidental to conflict. It can occur on a random and uncontrolled basis due to the general disruption of social boundaries and the license granted to soldiers and militants.

Dar and Deb (2021b) in a latest study on the prevalence of trauma among Kashmiri youth observed that 19.5% of the research participants were exposed to the sexual harassment either themselves or of their family members, 68.4% reported being abused physically, verbally or emotionally, 58.9% witnessed encounters between armed militants and armed forces, 62.5% reported killings of their family members, relatives or friends, and 50.9% reported their family members being threatened with death as a result of armed conflict in Kashmir.

Rebellious Nature The generation gap between parents and the young generation has widened due to the present volatile scenario. The younger generation do not see parents as their role models when it comes to political issues; rather blame them for not doing anything about it. So, they start experimenting with their own aggressive methods to express their suppressed feelings and would go against any authority. Margoob (2010) a well-known psychiatrist of the valley reported that since the young brain is yet to fully develop with psychological mechanisms; children/adolescents are much more

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vulnerable to emotional actions and reactions. When they assume that they are getting pushed against the wall, they get dominated by their emotions and stop caring for the consequences. Youngsters identify with the group rather than with their individual identities and can accordingly get heavily involved in activities that essentially had been non-existent in the society earlier. High level of traumatic violence in Kashmir resulted in mental and physical health deterioration in addition to the closure of schools (Dar & Deb, 2020). According to a report by Jammu Kashmir Coalition of Civil Society (2018), conflict violence has resulted in the death of 318 children in the region between 2003 and 2018. “Children in Jammu and Kashmir are living in the most militarized zone of the world, with the presence of a million troops, which exposes them to the risk of all six grave violations against children as laid out in the United Nations Convention on the Rights of the Child,” the 2018 report said. Psychological trauma may become evident in disturbed and antisocial behavior, such as family conflict and aggression toward others. This situation is often exacerbated by the availability of weapons and by people becoming habituated to violence after long exposure to conflict. The impact of conflict on mental health is, however, extremely complex and unpredictable. It is influenced by a host of factors such as the nature of the conflict, the kind of trauma and distress experienced, the cultural context, and the resources that individuals and communities bring to bear on their situation (Summerfield, 1991). According to the findings on traumatized children, childhood trauma not only has the capacity to cause short-term symptoms, but it can also affect a child’s overall personality development, interpersonal functioning, self-esteem, and coping ability throughout their lifespan (Arroyo & Eth, 1985). Of greater concern is that generations of children who are growing up with chronic violence in their lives, it may reach adulthood with the perception that violence is an acceptable means of resolving ethnic, religious, or political differences.

Conclusion Armed conflict in Kashmiri has a very negative impact on all inhabitants of the valley, but most serious effects are seen on children. It has engrossed their whole life and hampers their overall development, be it physical or psychological. It has led to loss of their values and has been affected by structural changes in the society. Children have lost the feeling of security even while being with their family and perceive themselves as helpless. Conflict has filled their tender hearts with anger and frustration, and they have lost their peace of mind. Health, which is mostly valuable for a child, is crippled by armed conflict, and children suffer from psychological problems of PTSD, anxiety, depression, etc. It has taken away from them the happy period of childhood and left them stressed with a number of adult responsibilities. Some are left in orphanages as they have lost their caretakers at the time when they need them most. Armed conflict is leaving its long-term effect by compromising education of children which is most important for the future development of society. Since the

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abrogation of Article 370 of the Constitution of India which gave special status to the state of Jammu and Kashmir, the people of Kashmir remained inside their homes for a prolonged time due to the heavy deployment of troops and strict restrictions imposed by the government. Almost everything was suspended including mobile and Internet services, educational institutions, business, transportation. Such experiences have a grave impact on the mental wellbeing, cognitive, social and emotional development of these children. Non-governmental organizations working in Kashmir should organize special programs to provide counseling/mental health first aid to the affected children and their parents. Overall, the mental wellbeing of children and adolescents of Kashmir should be strengthened, and more so during COVID-19 pandemic, which has added the mental health burden in the lives of young Kashmiri children.

Recommendations The issue under discussion is very grave in nature and needs rigorous efforts to curb at different levels; however, some of the helpful recommendations following Reddy and Reddy (2003) and others are given below: • In conflict time, army/security personnel’s camps should not be established near schools. • Clinical psychologists/counselors should be appointed in every school. • School buses to be used for the security of children while traveling. • Condition of orphanages to be made better. • Education should be given a priority and should not get disturbed by hurdles etc. • Education should focus on imbibing values and religious teachings without misinterpreting in wrong ways; parents should be provided psycho-education. • Right parenting and modeling for children should be focused, and exposure to negative impact of media should be minimized. • Security personnel should not be allowed to demonstrate violence in public. • An interdisciplinary approach including psychologists should be followed in forming the policies/preventive/rehabilitative measures in dealing with impact of violence on children. • Information should be shared across national and international authorities to promote effective response to all problems of children affected by armed conflict. • Government and NGOs must make efforts to reconstruct the economy of the affected families by providing income—generating assets. • UNICEF and other NGOs working for rehabilitation of affected children in war/conflict should guarantee the rights of children as enshrined in the Convention of Rights of the Child and as per the law of land. • Public education awareness campaigns on the dangers of drug abuse, child abuse/neglect, mental/physical health aspects, nutrition, child care, education, and gender sensitization, etc. should be organized by the state and center.

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Acknowledgements The academic input given by Dr. Mohd Altaf (Assistant Professor, Govt. Degree College, Kulgam, J&K) and Dr. Aehsan Ahmad Dar (Assistant Professor, SGT University) is gratefully acknowledged.

References Amin, S., & Khan, A. W. (2009). Life in conflict: Characteristics of depression in Kashmir. International Journal of Health Sciences, 3(2), 213–223. Arroyo, W., & Eth, S. (1985). Children traumatized by central American warfare. Post-traumatic stress disorders in children. APA Press. Bhat, R. M., & Rangaiah, B. (2015). Exposure to armed conflict and prevalence of posttraumatic stress symptoms among young adults in Kashmir, India. Journal of Aggression, Maltreatment & Trauma, 24(7), 740–752. Dabla, B. A. (1999). Impact of conflict situation on women and children in Kashmir: Report of the research project. Kashmir University, Department of Sociology. Dabla, B. A. (2001). Orphans in the orphans’ valley: Need for the help network. New Hope, 2(1). Dar, A. A., & Deb, S. (2021a). Mental health in the face of armed conflict: Experience from young adults of Kashmir. Journal of Loss and Trauma, 26(3), 287–297. https://doi.org/10.1080/153 25024.2020.1739367 Dar, A. A., & Deb, S. (2021b). Prevalence of trauma among young adults exposed to stressful events of armed conflicts in South Asia: Experiences from Kashmir. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication.https://doi.org/10.1037/tra 0001045 Dar, A. A., & Deb, S. (2020). Psychological distress among young adults exposed to armed conflict in Kashmir. Children and Youth Services Review, 118, 105460. Dubowitz, H., Papas, M. A., Black, M. M., & Starr, A. H. (2002). Child neglect: Outcomes in high risk urban preschoolers. Pediatrics, 109, 1100–1107. https://doi.org/10.1542/peds.109.6.1100 Hassan, A. (2012). Impact of the conflict situation on education in Kashmir (a sociological study). Studies of Changing Societies: Comparative and Interdisciplinary Focus, 1(5), 121–134. Hoge, M. (2004). Combat duty in Iraq and Afghanistan: Mental health problems, and barriers to care. New England Journal of Medicine, 351(1), 13–22. https://doi.org/10.1056/NEJMoa040603 Jammu Kashmir Coalition of Civil Society. (2018). Impact of violence on the children of Jammu and Kashmir. Retrieved August 05, 2021, from https://jkccs.net/wp-content/uploads/2018/03/2018Impact-of-Violence-on-Children-of-JK-JKCCS.pdf Jong, K. D., Ford, N., Kam, S., Lokuge, K., Fromm, S., Galen, R. V., & Kleber, R. (2008). Conflict in the Indian Kashmir valley I: Exposure to violence. Conflict and Health, 2(10), 1–7. https://doi. org/10.1186/1752-1505-2-11 Jong, K. D., Kam, S. V., Fromm, S., Galen, R. V., Kemmere, T., Weerd, et al. (2006). Kashmir, violence and health: A quantitative assessment on violence, the psychosocial and general health status of the Kashmiri population. http://www.artsenzondergrenzen.nl/pdf/kashmirfinalversion22 1106.pdf Khan, W., & Ghilzai, S. (2002). Impact of terrorism on mental health and coping strategy of adolescents and adults in Kashmir. Journal of Personality and Clinical Studies, 18, 33–41. Khan, S., Maqbool, A., Abdulla, N., & Ken, M. Q. (2012). Pattern of ocular injuries in stone pelters in Kashmir valley. Saudi Journal of Ophthalmology, 26(3), 327–330. https://doi.org/10.1016/j. sjopt.2012.04.004. Kumar, R. (2012, May). Children of conflict, they need a helping hand. http://www.greaterkashmir. com/news/2012/May/26/children-of-conflict-7.asp Machel, G. (2001). The impact of armed conflict on children. David Philip.

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Madhosh, A. G. (1999). The present turmoil and plight of children in Kashmir. Kashmir University, Faculty of Education. Margoob, M. (2010, August 4). It’s the manifestation of anger among Kashmir’s trauma generation. http://articles.timesofindia.indiatimes.comarticles.timesofindia Margoob, M. (1995). Depressive disorders in Kashmir. JK-Practitioner, 2(1), 22–23. Margoob, M. A., Rather, Y. H., Khan, A. Y., Singh, G. P., Malik, Y. A., Firdosi, M. M., & Ahmed, S. (2006). Psychiatric disorders among children living in orphanages experience from Kashmir. JK Practitioner, 13(11), 53–55. Paul, M. A., & Khan, W. (2019). Prevalence of childhood mental disorders among school children of Kashmir Valley. Community Mental Health Journal, 55(6), 1031–1037. Perry, B. D., & Azad, I. (1999). Post-traumatic stress disorder in children and adolescents. Current Opinions in Pediatrics, 11(4), 310–316. Punamiki, R. L., & Suleiman, R. (1990). Predictors and effectiveness of coping with political violence among Palestinian children. British Journal of Social Psychology, 29(1), 67–77. https:// doi.org/10.1111/j.2044-8309.1990.tb00887.x Raina, S., & Bhan, K. S. (2013). A study of security-insecurity feelings among adolescents in relation to sex, family system and ordinal position. International Journal of Educational Planning and Administration, 3(1), 51–60. Reddy, G. N., & Reddy, S. N. (2003). Managing childhood problems: Support, strategies and interventions. Kanishka Publishers. Saima, & Sharma, N. (2011). Mental health status of children of Kashmir: A study from Anantnag district. Journal of Psychology, 2(2), 109–113. Slone, M., & Mann, S. (2016). Effects of war, terrorism and armed conflict on young children: A systematic review. Child Psychiatry & Human Development, 47(6), 950–965. Summerfield, D. (1991). The psychosocial effects of conflict in the third world. Development in Practice, 1, 59–173. Teicher, M. D. (2000). Wounds that time won’t heal: The neurobiology of child abuse. Cerebrum: The dana forum on the brain. Science, 2(4), 50–67. United Nations Secretary General Study. (2006). Violence against children. http://www.unviolenc estudy.org/ Wessells, M. G. (1998). The changing nature of armed conflict and its implication for children: The Graca Machel/U. N. Study. Peace and Conflict: Journal of Peace Psychology, 4(4), 321–334. https://doi.org/10.1207/s15327949pac0404_2. Yousuf, A., & Margoob, M. A. (2006). Pediatric PTSD: Clinical presentation, traumatic events and socio-demographic variables—Experience from a chronic conflict situate. The Practitioner, 13(11), 40–44.

Chapter 8

Ritual Male Circumcision: Quo Vadis? Esther I. J. Erlings

Introduction “Tradition is powerful” writes Cohen-Almagor (2021:2) about Ritual Male Circumcision (RMC). The practice today remains important in various religious and cultural communities, even where other practices may have faded (ibid). Parents often make the decision to circumcise their sons out of genuine care for their children’s interests, and as Marshall’s suggests, “circumcisions are usually performed in a spirit of benevolence and with attempts to mitigate pain and suffering and to promote post-procedure healing” (2009:51). However, RMC has become controversial for a variety of reasons connected with children’s physical and psychological well-being, as well as opportunities for religious choice. This raises the question whether benevolence, care and parents’ sincerity are sufficient to justify RMC (Brigman, 1984–1985). Recent developments have indicated that perhaps they might not, or no longer, be, as discussed in this chapter. Following a brief overview of RMC and discussion of international law’s indecisiveness on the matter, the chapter examines the evolving situation in three countries where circumcision has until late been unregulated (England), regulated, or even facilitated (The Netherlands) or questioned per se (Germany), pointing towards a certain convergence of national attitudes. It then turns to key considerations in the current debate surrounding ritual male circumcision: children’s physical and psychological well-being, and children’s autonomy and opportunities for future decision-making. This is followed by a discussion of the rising sense of hypocrisy and xenophobia that is risking to cause a stalemate in the debate on RMC. The final section engages with the quo vadis; where do we go from here? Nota bene, this chapter is concerned with RMC on minors who are too young to consent (or withhold consent) to the procedure; it does not deal with the circumcision of legally competent adolescents or adults. E. I. J. Erlings (B) Flinders University, Bedford Park, Australia e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_8

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Ritual Male Circumcision (RMC): The Practice and Its Origins RMC refers to a religion- or culture-based intervention whereby a boy’s foreskin (prepuce) is removed from the penis for non-therapeutic reasons. The amount of skin removed depends on techniques used, and on convictions as to what constitutes a genuine circumcision (Pollack, 2008). The practice is distinct from therapeutic circumcision (circumcision to treat or respond to a medical condition) or routine circumcision, which is performed for the perceived benefits it will accord to the child (even if these cannot be conclusively proven—see inter alia Earp et al., 2017; Hill & Denniston, 2003; Koninklijke Nederlandsche Maatschappij tot bevordering der Geneeskunst (KNMG), 2010; Snyder, 2008). Circumcision pre-dates most religions; there is evidence that it has been undertaken for about four millennia (Johnson in Baum, 1999), if not longer (Franz, 2019; Marshall, 2009 who traces the practice to pre-historic hunting traditions). Irrespective of its likely secular origins, RMC has since become a defining manifestation of Judaism, where it is deemed to represent the Covenant of God with man (Leviticus, 12:4) and Islam, which includes reference to circumcision in the Sunnah, the teachings of the Prophet Muhammad that exist alongside the Holy Qur’an (Marshall, 2009; Rassbach, 2018). Some Orthodox Christian denominations also practice circumcision as part of religious precepts, and, culturally, the practice is dominant on the African continent in particular (UNAIDS, 2007). Judaism requires the circumcision of boys to be carried out on the eighth day after birth, whereas under Islam, there is no agreement on the right moment, which may be just after birth up to early adolescence (Baum, 1999; Schmitz, 2001). Circumcision under both religions is seen as a rite of initiation; the child becomes a member of the religious community. Moreover, the religious community is often deeply intertwined with cultural affiliation and personal identification. As Cohen–Almagor notes, those who no longer fully practice Judaism “still define themselves as secular Jews” and they practise RMC “because they wish to maintain their association” (2021:5, emphasis original). This explains why, although other manifestations may no longer take place, parents continue to have their sons circumcised (KNMG, 2010) and attempts at regulation of the practice have been so deeply felt.

RMC Under International Law It is often thought that international law provides parents with a right to make their children engage in religious practices of the parents’ denomination, and that by virtue of this right parents can impose RMC (see Jacobs & Arora, 2015; Nieuwenhuis, 2014). Yet international law is more nuanced. Human rights provisions do not as such grant parents religious rights over their children beyond the right to shield them from State indoctrination (Erlings, 2020). However, there is recognition of the

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parental role in the upbringing of children, and international law can accommodate many of the parental rights that may be granted to parents at the national level. Still, to be compatible with international law, such parental rights and the exercise of the parental role must serve children’s interests and not go contrary to their personal rights (ibid). This is causing a conundrum in the case of RMC and has led to international bodies taking an evasive approach.

The United Nations The main United Nations (UN) treaty concerned with children’s rights is the Convention on the Rights of the Child (CRC). Its monitoring body the Committee on the Rights of the Child (CmRC), has critically approached RMC on several occasions, although it has not yet outright condemned RMC. Most recently, it declared inadmissible ratione temporis a case in which the complainant had claimed that the RMC performed on him as an infant violated CRC articles 2 (non-discrimination and protection), 3 (best interests), 16 (privacy) 19 (protection against maltreatment) and 24(3) (harmful practices), thereby avoiding the need to provide a clear value judgment on the practice from the perspective of children’s rights (CmRC, 2020). Notably, the implementation handbook of the CRC invites review of all practices that may harm children, including “all forms of […] circumcision” (Hodgkin & Newell, 2007; Hofvander, 2008). Since its adoption, the CmRC’s approach has, in fact, become more critical. Whereas in the past the CmRC merely expressed concern about the health of children undergoing circumcision in unsafe or unhygienic conditions (CmRC, 2000; CmRC, 2001), in 2013, it considered traditional male circumcision under the heading of “harmful practices” in Israel’s Concluding Observations (CmRC, 2013a). Change is also apparent in other corners of the United Nations. Male circumcision likely falls into the category of ceremonial acts or rituals associated with certain stages of life as protected by Article 18(1) of the International Covenant on Civil and Political Rights (ICCPR) (Human Rights Committee (HRC), 1993) and, in the past, the UN Special Rapporteurs on Freedom of Religion and Belief have suggested that RMC should be permissible as an aspect of parents’ right to freedom of religion under that provision and article 18(4) (respect for parental convictions) (Bielefeldt, 2015; Vidal d’Aleida Ribeiro, 1986).1 Over time, the Special Rapporteurs have nonetheless become more cautious. Rapporteur Bielefeldt’s, 2016 country report on Denmark, for example, reflects both the appreciation of RMC as an important religious practice to certain communities, as well as the changing perspectives regarding its justifiableness: The issue of circumcision is complex and has many medical, psychological, cultural and religious facets. Controversies exist concerning all these different aspects of the phenomenon. Within the human rights community, too, the circumcision of underage boys has led to an ongoing polarization […] However, it is all the more important that those engaging in public

1

Note that the views and reports of Special Rapporteurs are non-binding.

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debate be aware of the sensitive character of the theme and how deeply it affects many Jews and Muslims in their religious identities (Bielefeldt, 2016).

Moreover, whilst the current Special Rapporteur has found that limitations and bans on RMC “may interfere with the ability of Jews to observe rituals and ceremonies in accordance with the precepts of their religion or belief”, he refrained from stating that such interference would also constitute a violation of rights (as opposed to an interference) (Shaheed, 2019). Similar caution now reigns communications by the World Health Organisation (WHO), a specialised agency that has traditionally cooperated with UNAIDS to promote male circumcision as a preventative strategy in the fight against HIV/AIDS. UNAIDS’, 2008 guidance report on “Safe, Voluntary, Informed Male Circumcision” devotes several paragraphs to the circumcision of minors unable to consent, with the guiding principle being the best interests of the child. After having been given all relevant information (including on risks involved in the procedure), parents are free to decide on circumcision, although the report provides a nudge towards deferral until the child can take his own decision, stating: Parents considering circumcision of an infant boy should be provided with all the facts so they can determine the best interests of the child. In these cases, determining the best interests of the child should include diverse factors–the positive and negative health, religious, cultural and social benefits. Because the HIV-related benefits of circumcision only arise in the context of sexual activity, and because male circumcision is an irreversible procedure, parents may consider that the child should be given the option to decide for himself when he has the capacity to do so (UNAIDS, 2008).

By contrast, its contemporary WHO’s report on “Traditional Male Circumcision” (WHO, 2009), whilst placing emphasis on accompanying RMC with education on reproductive health (something only possible in the case of elder children), considered that young children could undergo circumcision upon the decision of a parent or another family member. The report recommends that children be circumcised at younger age (before adolescence when they might commence sexual activity), and, worryingly from a family and relationship perspective, it suggests that women can “secretly” take their boys to hospital at a “younger age” for a medical circumcision allowing for safety whilst fulfilling the traditional circumcision requirement (WHO, 2009). Since then, the WHO has refrained from commenting on RMC and seeks to avoid having to pronounce on infant circumcision at all. In its 2020 Guidelines on Voluntary Medical Male Circumcision (VMMC), the organisation notes that infants are excluded from the guidelines, which now focus on adolescents and adults only, but that: Countries that are planning to include infants (or a mix of age groups) as a strategy for achieving sustainable VMMC coverage are encouraged to carefully consider risks and benefits, acceptability issues and ethics and human rights, as well as what resources are available to safely deliver early infant male circumcision (WHO, 2020).

Like the other UN bodies, the WHO seems no longer comfortable with taking a clear position on RMC. The UN is, however, not the only organisation sitting on the

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fence when it comes to RMC; following an initial critical approach, the Council of Europe now appears to equally shy away from voicing a clear opinion.

The Council of Europe Following several reports in which the Council of Europe’s (CoE) Committee on Equal Opportunities for Women and Men (Zapfl-Helbing, 2004) and Venice Commission (2008) told States not to unduly restrict RMC as this was “clearly a manifestation of religion protected by international instruments” (Venice Commission, 2008), the European Court of Human Rights held in 2010 that “the rites and rituals of many religions may harm believers’ well-being, such as […] circumcision practiced on Jewish or Muslim male babies”.2 It did not comment further on whether these practices should be limited. Three years later (in the wake of the German circumcision decision discussed below), the CoE’s Parliamentary Assembly took a stronger stand and adopted a recommendation and resolution on the physical integrity of children (Parliamentary Assembly, 2013a, b). The latter describes RMC as a: [Category] of violation of the physical integrity of children, which supporters of the procedures tend to present as beneficial to the children themselves despite clear evidence to the contrary.

Although the resolution and accompanying report do not call for the outright prohibition of RMC, but for its regulation, the resolution garnered much criticism. A countermotion stating that the Parliamentary Assembly supported the right of parents to have their children circumcised was tabled, but not adopted (Parliamentary Assembly, 2013c). In 2015, the Assembly further clarified its 2013 resolution. It again called RMC a “divisive issu[e]” and recommended “out of a concern to protect children’s rights that the Jewish and Muslim communities surely share” that Member States should: provide for ritual circumcision of children not to be allowed unless practised by a person with the requisite training and skill, in appropriate medical and health conditions. Furthermore, the parents must be duly informed of any potential medical risk or possible contraindications and take these into account when deciding what is best for their child, bearing in mind that the child’s interest must be considered the first priority (Parliamentary Assembly, 2015).

Barely short of rejecting the practice altogether, the Assembly clearly takes a critical approach. Yet its resolutions are non-binding. By contrast, the CoE’s adjudicatory body, the European Court of Human Rights, has since 2010 been eager to avoid pronouncing itself on the matter of RMC. Both in 2016 and 2018,3 the Court was presented with a circumcision case (the 2016 one being the precursor to the 2

Case of Jehovah’s Witnesses of Moscow and others v. Russia, European Court of Human Rights, application 302/02, with judgment of 10 June 2010 § 144. 3 The 2016 case is not publicly available but mentioned in CmRC (2020); S.A. v Turkey, European Court of Human Rights, application 62299/09, with judgment of 16 January 2018.

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abovementioned CRC case and directly questioning the lawfulness of RMC), and both times, it declared the application inadmissible. This allowed the court to evade a decision on the merits, which would have had to include a value judgment on the permissibility of RMC. Like its international counterpart, the CoE is keen not to touch what has become a very thorny issue, and, as a result, the matter of RMC’s continued existence is left to Member States.

RMC Under Domestic Law and Practice England In the 2018 criminal case of R v M(B), the English Court of Appeal identified RMC as an exception to the rule that it is not in the public interest to cause actual bodily harm without a pressing reason, despite consent. This was “not to say that [RMC] receives universal support from all sections of society, but the exception [is] so deeply embedded in our law and general culture that it would require Parliament to [prohibit the practice]”.4 The finding echoes a 2015 landmark case in which the President of the Family Division ruled that, whilst male circumcision constituted “significant harm” in the sense of child protection legislation, intervention would not be warranted, because the harm was not due to unreasonable parenting.5 As His Honour stated (at [72]): Society and the law, including family law, are prepared to tolerate non-therapeutic male circumcision performed for religious or even purely cultural or conventional reasons …[;] “reasonable parenting” is treated as permitting male circumcision.

Both courts left it to the legislator to take action, but Parliament has yet to take steps towards regulation. As a result, RMC is not legally subject to any medical or basic hygiene requirements unless it is performed by a registered medical practitioner (see below). However, there are no restrictions on who can perform the procedure.6 This situation has led to the practice of “kitchen table circumcisions”, where a boy is circumcised at home, often on the kitchen table (hence the name), without anaesthetics, and minimal or no sanitary precautions (Anwar et al., 2010; Pringer & Brereton, 1991). England has also seen the advent of “circumcision camps”, where a large number of boys are circumcised at the same time. Hygiene conditions at these camps can be appalling; Paranthaman et al. describe a circumcision camp at a library where hand-washing facilities were not present in the room, only “four packs of instruments were used over the course of 3 days”, and it was “difficult to obtain reliable information on where and how decontamination of instruments took 4

R v M(B) [2018] EWCA Crim 560 at [39]. Re B (Children) (Care Proceedings) [2015] EWFC 3. 6 However, the courts have expressed a preference for circumcisions to be performed in a medical context. See AT v FS & Anor 2011 WL 5105519. 5

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place, although it was clear that full infection control precautions were not implemented” (2011:281). Of the boys for whom follow-up information was available (29 out of the 32), 13 had developed complications and six required hospital admission due to the seriousness of their complications (ibid). This compares negatively with general complication rates, which are contested (Cohen-Almagor, 2021), but have been estimated at the higher end at 1.5–6% (higher for children over 12)7 in a hospital setting (Weiss et al., 2010). What is particularly noteworthy is that apparently no legal action was taken against the parents or organisers, although the circumciser faced disciplinary proceedings as a registered medical practitioner (Paranthaman et al., 2011). A similar hesitance to attribute liability featured more recently, when the Crown Prosecution Service decided not to prosecute a doctor who had circumcised an infant brought in by paternal relatives without the mother’s consent (the relatives themselves had initially also been arrested but were released without charge) (Dyer, 2017). In the face of inaction by the government, professional and religious bodies have themselves taken steps to regulate RMC in England. The General Medical Council (GMC) obliges doctors who perform RMCs to ensure that they have the skills and experience to perform the procedure, use appropriate means, and maintain hygienic conditions (GMC, 2013). Doctors must also obtain the child’s consent if they “have the maturity and understanding to give it” (ibid: 4), but in any case should consider whether the procedure is in the child’s best interests. These rules apply to registered practitioners whether they act in professional or private capacity. Hence, registered practitioners who perform RMCs outside of work (as happens frequently)8 are still bound by the rules, and disregard for such has resulted in an increasing number of disciplinary proceedings.9 The British Medical Association (BMA) updated its guidelines on RMC in 2020. The new guidelines note that lawful RMC comprises compliance with children’s best interests, valid consent (of both parents), and competent performance (BMA, 2020). Given the associated medical and psychological risks, refusal of the child irrespective of their age must be honoured, and sole parental preference is no longer enough to justify non-therapeutical circumcision. An actual assessment of children’s interests must take place, considering health interests, as well as children’s social and cultural circumstances, identity and sense of belonging, and religious requirements (ibid). The increasingly stringent rules for medical practitioners do nonetheless not apply to non-practitioners, including religious circumcisers such as Mohelim. Here, religious organisations themselves have stepped in, 7

Though this is equally contested; Dalton, for example, argues that “To be brutally frank, infant circumcision is ‘safer’ because infants do not report complications” (Barkham, 2012). 8 Circumcisions are not normally covered by the National Health Service [although medical indications can be given for minor problems that would not otherwise require intervention (Dalton, 2008)], which causes a push out of the professional health circuit. The value of health practitioners performing RMCs in the community to prevent recourse to “untrained and non-expert individuals” has been recognised by the courts: General Medical Council v Chaudhary [2017] EWCA 2561 (Admin). 9 See, e.g. Siddique v General Medical Council [2015] EWHC 1996 (Admin); General Medical Council v Chaudhary [2017] EWCA 2561 (Admin); Lowbridge (2019).

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seeking to strike a balance between children’s well-being and religious requirements, including with a view to avoiding prohibition altogether. In 2016, for example, The Initiation Society Working Group on Medical Standards in Brit Milah published guidelines for Mohelim that retain metzitzah (oral suction) whilst introducing strict requirements for training, hygiene, and aftercare. The main venue for state-sponsored limitations remains the family court in divorce or care proceedings. Whereas two united parents in an intact family enjoy full liberty to consent to RMC in either safe or more questionable conditions, the same is not true where parents are separated from each other, or from their children.10 As illustrated by the 2015 case referenced above,11 family court judges are increasingly willing to accept that circumcision sits ill with children’s physical, health-related and autonomy interests, whilst religious, cultural, and community interests no longer automatically prevail. An assessment of the child’s welfare, lifestyle and upbringing, attitude of the primary caregiver, the potential strengthening or weakening of family ties,12 the risks, pain, and stress the operation would cause, as well as its irreversible nature today virtually always lead the court to conclude that “it should be for the [child] to make his own informed decision” when competent to do so.13 Although it remains conceivable that circumcision of a child in temporary care may be ordered where the parents have maintained close ties with the child and are highly practising members of their community, it seems safe to say that in the case of two divorced parents circumcision will not be ordered if one of the parents objects. This aligns with current medical codes of practice, which require dual consent. Yet it is important to note that the reasoning would not focus on parental disagreement, but on children’s physical and autonomy interests. Parents in such circumstances are encouraged to spend time with their children, help them understand their identity, provide them with resources related to their faith, and engage them with the religious or cultural community that forms part of their heritage.14

The Netherlands The freedom to practise one’s religion is one of the core values of Dutch society, intimately linked with the country’s history.15 Both individual and parental religious rights enjoy high levels of constitutional protection (Nieuwenhuis, 2014), and the 10

Re J [1999] 2 F.L.R. 678; Re B (Children) (Care Proceedings) [2015] EWFC 3. Re B (Children) (Care Proceedings) [2015] EWFC 3. 12 By contrast, sibling unity has been rejected as a valid reason: F v M, A, B (Children by their guardian) [2016] EWFC 40. 13 S (Children) [2004] EWCACiv 1257, per Thorpe LJ, at 6. Confirmed on Appeal S (Children) [2004] EWCACiv 1257. See also Re J [1999] 2 F.L.R. 678; M v F [2021] EWHC 1616 (Fam). 14 See M v F [2021] EWHC 1616 (Fam). 15 The independent Netherlands arose in part as a reaction of the Protestant provinces to Catholic Spain, which governed The Netherlands and persecuted religious dissent (Blockmans et al., 2018). 11

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government accommodates religious practices at levels that would be unconstitutional elsewhere.16 However, this does not translate into unlimited freedom. Whilst controversial religious practices may not be banned, there is a tendency to regulate them. This is also the case for RMC (Smith, 1998). Circumcisions can only be performed by registered doctors in public hospitals or private clinics because the procedure has been recognised as a “reserved procedure” under the Individual Health Care Professions Act (Wet op de beroepen in de individuele gezondheidszorg) (Kema & Van Hest, 2019). Circumcisions by a traditional circumciser are illegal (Schmitz, 2001), and the same is true for “kitchen table circumcisions” (those performed in ways not meeting medical standards for safety and professionalism).17 Although there was some confusion in the past around whether a trained Mohel could legally perform circumcisions (Schmitz, 2001), it is now clear that this is not the case and in 2019 the Healthcare Inspectorate indicated that it would clamp down on unregulated circumcisions (Kema & Van Hest, 2019).18 Both parents have to consent to a RMC. Moreover, as a medical procedure, children up from the age of 12 need to co-consent, and children over 16 can take their own decisions regarding circumcision.19 The mandatory medicalization of circumcision has led to the emergence of specialised circumcision clinics, which characterize the Dutch circumcision landscape (Zorgwijzer, 2021). These clinics allow for rituals surrounding the circumcision as long as they do not hinder the surgeon during the procedure, whilst at the same time offering a clean medical environment with qualified and specialised doctors and surgeons (Besnijdenis Centrum Nederland, 2012). Since the government decided in 2005 to no longer cover RMC under the national health insurance (Ministerie van Volksgezondheid, Welzijn en Sport, 2005), circumcision clinics have proven a valued alternative to the less personal and significantly more expensive procedures in public hospitals (Trouw, 2005; Zorgwijzer, 2021). The increased regulation of circumcision has gone hand in hand with increased questioning of RMC. In 2010, the Dutch Medical Association (KNMG) adopted the official position that RMC conflicted with the foundations of medicine and children’s rights and should be subjected to “a powerful policy of deterrence” (KNMG, 2010:4). It argued that sufficient evidence of RMC’s (preventive) health benefits did not exist, whereas the procedure entailed the risk of physical and psychological complications; that a form of unjustifiable discrimination had come into existence as female circumcision was outlawed in all its forms (even those less severe than RMC); and that parental rights to freedom of religion could not outweigh the child’s own rights to freedom of religion and physical integrity (ibid). The organisation 16

For example, based on article 23 of the Constitution, religious schools are financed/subsidised by the State. 17 Conclusie Advocaat-Generaal, 04 November 2014, Parket bij de Hoge Raad, zaak 13/00654, ECLI:NL:PHR:2014:2255. 18 See also 26 January 2018, Regionaal Tuchtcollege voor de Gezondheidszorg, zaak 161/2017, ECLI:NL:RTGZRZWO:2018:31 for reprimand of a registered doctor who had performed RMCs in unhygienic conditions in an asylum seeker centre. 19 Articles 447(1), 450(2) and 465(1) Wet op de Geneeskundige Behandelingsovereenkomst (Medical Treatment Agreement Act).

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recommended work towards eradication, not via legislation for fear of the practice going underground, but via a dialogue with all parties concerned. A swift reaction followed from the Council for Public Health and Care Services, a (now defunct) advisory body to the Dutch government and parliament. The Council argued that the comparison between male and female circumcision was out of place and stated it disagreed with the KNMG on prioritizing physical integrity over religious interests (Raad voor Volksgezondheid en Zorg, 2010). Not long after, the government was prompted to provide a response via Parliamentary questions. The responsible minister noted that the position statement was merely the opinion of an (independent) organisation and therefore not the responsibility of the Dutch State (Tweede Kamer, 2011). A prohibition “would limit the freedom of religion”, which would only be allowed “by means of legal regulation, when a legitimate aim is present and there is proportionality between the protected interest and the limitation” (ibid). The minister found no ground for a prohibition, because, when correctly performed, RMC would not “lead to negative effects on physical and mental functioning” (ibid). Since then, the issue has not officially featured in Parliament again, and political parties (as opposed to some individual members) are wary of touching the issue. When the Dutch public broadcaster (NPO) approached all political parties for their standpoint on RMC in 2021, not one was willing to provide a position statement on a matter that had reportedly become “too complicated” (Redactie Alicante, 2021). Only the KNMG publicly retains its view that circumcision is undesirable, and a dialogue should lead to its abolition (KNMG, 2020). Like in England, legal developments have primarily taken place in the courts, even if the higher courts have similarly sought to avoid the question of the legality of RMC per se. In 2007, a family law judge prevented the circumcision of a child in care because the request was not religiously motivated, and culture or tradition could not prevail in a situation where the child would continue to live with foster siblings who were not circumcised.20 Once competent, the child could make his own decision. The same has been held in case of parental disagreement; if parents cannot agree, the RMC should not be carried out and “may take place at a later point in time when the child is himself capable of making the decision”.21 Notwithstanding the fact that RMC is a common procedure within certain communities, it has been found to legally constitute an unusual procedure that is non-therapeutic and invasive, especially insofar it is irreversible.22 Therefore, consent of both parents is required where the child is incompetent, whether parents are divorced or not. Without dual parental consent, the performance of the circumcision constitutes a tort with damage consisting of pain, complications (if any) and loss of self-determination,23 as well as

20

31 Juli 2007, Rechtbank Zutphen, zaak 83927 JE RK 07-110, LJN BB0833. 26 November 2002, Gerechtshof’s-Hertogenbosch, zaak R200200450, LJN: AF2955 §4.4. 22 21 September 2016, Rechtbank Rotterdam, zaak C/10/495177/HA ZA 16-165, ECLI:NL:RBROT:2016:7437. 23 Ibid. See also 07 November 2018, Rechtbank Midden-Nederland, zaak C/16/453302/HA RK 18-18, ECLI:NL:RBMNE:2018:5461 on damages for a botched circumcision. 21

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a reason for disciplinary proceedings.24 What is more, the Dutch Supreme Court held in 2014 that a parent who allows their child to be circumcised without consent of the other parent is guilty of criminal assault and battery where they (should have) know(n) that the other parent did not consent, since RMC causes harm and cannot be defined as a non-detrimental act/treatment.25 Interestingly, a key argument advanced by the defendant father was the existence of a defence based on the “historically accepted character of ritual male circumcision” (het van oudsher aanvaarde karakter van rituele jongensbesnijdenis) (§ 2.3). Yet, having concluded that the defendant had deliberately circumcised the children behind the mother’s back and on that basis alone violated the criminal law, the Supreme Court excused itself from having to engage with the matter of RMC’s acceptability per se. In doing so, it followed the example of the Council of State (The Netherlands’ highest administrative court), which had previously evaded the question whether RMC could violate the prohibition of inhuman, cruel, or degrading treatment,26 both adjudicators thus placing the ball back in Parliament’s court.

Germany In the summer of 2012, the Cologne Regional Court caused a national and global uproar, when it ruled that RMC was an unjustifiable violation of the rights of the child (see, e.g. Eddy, 2012; Pekárek, 2015).27 A doctor had been prosecuted after complications following a RMC required a child to be taken to hospital. Both parents had consented to the procedure, and the doctor had provided appropriate aftercare. Therefore, the decision centred on the legality of circumcision itself. The Cologne court held that circumcision amounted to bodily harm in the sense of assault (Körperverletzung), and [at III] that: [T]he right of parents to determine the religious upbringing of their children does not have priority when balanced against the child’s right to physical integrity and self-determination, so that their consent to circumcision goes against the best interests of the child.

It considered that circumcision was a substantial and irreparable alteration of the child’s body, which, additionally, interfered with the right of the child to later decide on his own religion. The court further found that it would not be an unreasonable limitation of parental rights in upbringing if parents would have to wait until their child would be old enough to decide for himself whether he wished to wear the mark of their religion, or not. Reactions to the judgment varied considerably: the Association for Paediatric Surgeons welcomed the decision (Deutsche Gesellschaft für Kinderchirurgie, 24

For a discussion see 21 September 2016, Rechtbank Rotterdam, zaak C/10/495177/HA ZA 16-165, ECLI:NL:RBROT:2016:7437. 25 09 December 2014, Hoge Raad, zaak 13/00654, ECLI:NL:HR:2014:3538. 26 23 Mei 2007, Raad van State, Afdeling Bestuursrechtspraak, zaak 200701063/1, LJNBA6061. 27 Dr. K. Landgericht Köln, 07.05.2012, Wa. 151 Ns 169/11.

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2012a), as did a large part of the general public (Franz, 2019; Hernández Aguilar, 2021). Those fighting for children’s rights seized the opportunity, and immediately after the ruling, a Rabbi was prosecuted for circumcising boys as a non-medical practitioner (to be dismissed later on) (Ewing, 2012). The German Medical Association was less positive about the ruling: it feared that the practice would go underground if declared illegal (Landesärtzekammer Baden-Württemberg, 2012). Doctors were nonetheless advised to place a stop on ritual circumcisions until legal certainty would arise and many did so (Pekárek, 2015). Religious organisations for their part strongly condemned the ruling (ibid; Salaymeh & Lavi, 2020). The president of the Central Council of Jews even doubted whether life for Jews in Germany would still be possible after the decision (Der Spiegel, 2012). Critique of anti-Semitism and cultural insensitivity unleashed an immediate political reaction. Afraid that the judgment would make the country “laughing stock” in Europe, the German chancellor assured the public that Germany would still allow RMCs (DPA, 2012). The city of Berlin announced that, under certain conditions, RMC would be lawful in Berlin (DPA, 2012), and Parliament ordered the government to draft legislation specifically allowing RMC to take place under specified circumstances (Deutscher Bundestag, 2012a). Within weeks a bill was introduced—and adopted, allowing for medicalised RMCs (“in accordance with medical standards”) to be performed on incompetent minors, subject to parental consent, and excepting instances in which the best interests of the child would be endangered. In addition, religious organisations would be allowed to designate persons “having received such education as to have reached a competence similar to that of a doctor” to perform RMCs within the first six months of birth (meaning that an educated Mohel can perform the procedure) (Deutscher Bundestag, 2012b; Pekárek, 2015, now article 1631d Civil Law (Bürgerliches Gesetzbuch)). The bill engendered its fair share of criticism, though not from the religious communities involved (Neukirch, 2012). The German Medical Association argued that the first limb of the proposed law would need an express statement reserving the procedure to doctors (Arztvorbehalt) (Bundesärtzekammer, 2012), whilst the paediatric surgeons restated their opposition to RMC on non-consenting minors tout court (Deutsche Gesellschaft für Kinderchirurgie, 2012b). Left-wing opposition parties put forward a series of amendments (Deutscher Bundestag, 2012c), envisaging in particular a prohibition to perform RMCs on boys below the age of 14, so that children could take the decision themselves when sufficiently mature (ANP, 2012). The suggestions and critique turned out to be of no avail: just before the end-of-year recess, the German Parliament by significant majority adopted the new law in its original form.28 Since adoption of the law, State and disciplinary intervention has been more cautious. Whereas in 2006 a man, who had been appointed as a circumciser in Turkey and had carried out circumcisions as a non-doctor under bad hygienic circumstances, 28

Gesetz über den Umfang der Personensorge bei einder Beschneidung des männlichen Kindes vom 20. Dezember 2012. Bundesgesetzblatt Jahrgang 2012 Teil I Nr. 61, Bonn 27. Dezember 2012, p. 2749.

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was convicted of assault (Günter Jerouschek, 2008; Hans, 2012), in 2019, a disciplinary tribunal considered it could not be proven beyond reasonable doubt that a doctor, who had learnt to circumcise in Yemen and had allegedly conducted circumcisions under questionable circumstances with resulting complications, had engaged in professional misconduct (although it played a role that the professional body had failed to properly substantiate its allegations).29 By contrast, as is the case in England and The Netherlands, the courts have placed great emphasis on parental consent, and have allowed limitations where families are no longer intact. Already before the law’s enactment, a Frankfurt court had ruled that each parent holding parental responsibility would need to consent to a RMC for consent to be valid.30 Interestingly, the relevant case was brought by the child himself against his father, who had procured the RMC. The court held that the procedure had violated the child’s right to self-determination, physical integrity, and fundamental personal rights, including the right to choose his own religion, and it awarded compensation.31 Following adoption of the new law, the Hamm Higher Regional Court has held that, in case of parental disagreement, a RMC cannot go ahead and the ultimate decision would have to be taken by a neutral third party, deciding on the basis of the child’s best interests.32 The court rejected the mother’s request for an order to have the child circumcised, noting that she would only be able to take the decision if she had sole parental responsibility and after she would have informed herself. The same case also referenced an unreported 2013 decision in which the family court sided with foster parents against the circumcision of a child in care.33 More recently, circumcisions that involve removal of tissue have been recognised as a level 2 medical intervention given the possible complications and their irreversible nature.34 This means that doctors must secure express consent from both parents, failing which they commit a civil wrong for which damages will be available. It is likely that RMCs that do not meet the legislative requirements also constitute criminal assault, though given the 2012 upheaval, the State may today be reluctant to prosecute such cases. Overall, although the circumcision debates in England, The Netherlands and Germany started from three different standpoints, a convergence in the legal landscape appears to be arising. All jurisdictions have experienced a strong move towards medicalization within an environment in which RMC is increasingly questioned. However, with the exception of unavoidable situations, governments and (higher) courts have sought to avoid the question of RMC’s legality per se. At the same time, the courts generally have begun to recognise RMC as a form of (significant) bodily harm that could violate both the criminal and civil laws and may sit ill with children’s interests and rights. This has, inter alia, led to the family courts virtually 29

OVG Nordrhein-Westfalen, 10.12.2018, 13 B 576/18. OLG Frankfurt 4. Zivilsenat, 21.08.2007, 4W 12/07. 31 Ibid, in particular at [19]. 32 OLG Hamm, 30.08.2013, 3 UF 133/13. See also BundesverfassungsGericht, 13.02.2013, 1 BvQ 2/13. 33 Decision of 23 May 2013, cited in OLG Hamm, 30.08.2013, 3 UF 133/13. 34 OGL Frankfurt am Main, 16.07.2019, 8 U 228/7. 30

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always deciding that circumcision should be postponed until the child can take his own decision in cases where parents disagree, or the child is in care. That situation raises hard questions around equality in two respects. First, indirect discrimination might arise between religions that prefer RMC on newborns and those that practice circumcision at a later age, because in most cases families are still intact when the child is born. It is salient that all cases in which religion was cited involved Muslim parents. Most importantly, it seems hard to justify that children in intact and separated families allegedly have such different interests, especially when considering key concerns around well-being and autonomy that have driven the debates. These are next discussed with reference to children’s rights.

The Child’s Well-Being and Autonomy The matter of circumcision has been considered from many angles, including children’s rights versus parental rights, bodily integrity versus religious rights and archaic religion versus modern secular societies (Hernández Aguilar, 2021). In this section, the emphasis is on the concerns that relate to children’s physical and psychological well-being and autonomy, which may be compromised by RMC. It is in that respect important to remember that children’s best interests must always be considered holistically and comprise a variety of factors, including cultural and religious factors (BMA, 2020; CmRC, 2013b). At both national and international levels, it is considered to serve children’s interests for children to share a culture and religion with their parents (Erlings, 2020). The Committee on the Rights of the Child has also recognised that children’s participation in a community’s cultural life is important for their sense of belonging (CmRC, 2013c). RMC is intimately connected with these aspects of religion, culture, and belonging, which are echoed in parental motivations for the practice. Yet, spiritual and cultural welfare are not trump cards, and identity, culture and religion are not static (Tobin, 2013). As a result, the expression of spiritual welfare via circumcision may today no longer be supported when the wider matrix of children’s interests is taken into account, including, e.g., physical well-being.

The Physical Well-Being of the Child and Later Adult Historically, the child’s physical well-being has been the principal object of critique on RMC and regulation of its practice. The focus of especially those that seek to regulate RMC with a view to its continued existence revolves primarily around the provision of safe circumcisions that cause children as little pain as possible (see, e.g. Cohen-Almagor, 2021). Those questioning the practice per se tend to place emphasis on the undermining of children’s physical well-being, often by describing

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the possible, and sometimes horrible, complications that can arise following a circumcision (Franz, 2019; Richards, 1996; Snyder, 2008; Williams & Kapila, 1993), with some calling the practice child abuse (Brigman, 1984–1985; Richards, 1996; Svoboda et al., 2016). The overviews of potential complications are many, and vary significantly (see, e.g. Boyle et al., 2002; Morris et al., 2019; Weiss et al., 2010). Therefore, the only thing that can be sensibly said about complications is that their existence has been documented, though their exact rates are highly (and fiercely) contested (Cohen-Almagor, 2021; Earp et al., 2017), whilst we lack reliable and representative data (Munzer, 2017), especially when it comes to RMC outside medical contexts. Leaving aside the thorny issue of complications, the emphasis on the medical–physical aspects of circumcision can be explained by three factors. Firstly, notwithstanding arguments around harm as setbacks to interests overall (Munzer, 2017), a form of physical harm is done to children who are circumcised. It is now accepted that infants can feel pain and that they do indeed feel pain during and/or after a circumcision, depending on the use of anaesthetics (Boyle et al., 2002; Marshall, 2009; Myers & Earp, 2020; Snyder, 2008). The deliberate infliction of pain on children is a practice that is hard to justify and societies have long started the move away from tolerance based on religious motives. Corporal punishment is often mentioned as a comparator (Pekárek, 2015), but perhaps more to point has been the widespread prohibition of tattooing minors, which deprived Coptic Christian parents of effectuating a rite of initiation into the community by having a small cross tattooed on the child’s wrist (see Langlaude, 2007). The latter example also speaks to the argument around physical alteration in the circumcision debate: harm is caused because the child’s physique is altered irreversibly and without medical necessity. This issue is further discussed below under the headings of autonomy and hypocrisy. The second reason for the reliance on physical integrity arguments is that both national and international law offer various legal provisions that problematise this aspect of RMC. National provisions on assault and battery (and sometimes child protection) have been found to apply to RMC, with parental consent only barely still featuring as a justification of the bodily harm involved (see above). In addition, most countries already have provisions that prohibit forms of circumcision on girls that could easily be extended to boys (Earp et al., 2017; Franz, 2019; KNMG, 2010). At the international level, a plurality of provisions has been said to apply to the encroachment upon physical integrity caused by RMC. The ECHR offers Articles 3 (the right not to be subjected to inhuman and degrading treatment) and Article 8 (the right to privacy, which has been interpreted as including physical integrity, especially with regard to consent in the medical context), with Article 20(1) of the European Convention on Human Rights and Bioethics (prohibition of non-therapeutic tissue removal from those who cannot consent) similarly applicable (Fortin, 2009; Hill & Denniston, 2003). Circumcision is also considered to be contrary with the ICCPR articles on torture and inhuman and degrading treatment (Article 7), the security of the person (Article 9) and the special protection to which children are entitled (Article 24) (Bhimji, 2000; Doctors Opposing Circumcision, 2016; Svoboda, 1997). Under the CRC, an argument is made to consider RMC as a traditional practice prejudicial to the health of a child (Article 24), in addition to declaring the practice a violation

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of the right not to be subjected to violence when in the care of parents (Article 19), the right not to be subjected to inhuman or degrading treatment (Article 37) and even the right to life, as circumcision may lead to death as a result of complications (Article 6) (ibid; Hodgkin & Newell, 1998; Svoboda et al., 2016). As previously noted, international bodies themselves have now discussed RMC within the context of traditional practices harmful to health and physical integrity, strengthening these views. The third reason for the prevalence given to physical integrity arguments is that they allow for the questioning of RMC on religious grounds, and could lead to an internal groundswell of change. Whilst the majority view might still be that RMC “is not bodily harm, but rather bodily improvement” (Salaymeh & Lavi, 2020:14) and a religious requirement, both Jewish and Muslim writers (Braver Moss, 1991; Mahdawi in Aldeeb Abu-Sahlieh, 1994; Pollack, 2008; Rothenburg, 1991) and organisations (e.g. Muslims against the Circumcision of Children, Jews against Circumcision, or The Israeli Association against Genital Mutilation) reject RMC on the basis that it runs contrary to fundamental religious precepts, rather than being in accordance with them. Pollack, a Jewish author and educator, writes that RMC is wrong because “it violates the most fundamental Jewish principles of sanctifying life” (2008:193), and Muslims against the Circumcision of Children quote from the Holy Qur’an: Allah is the One who made the Earth a habitat for you, and the sky as a structure, and He has designed you, and has perfected your design (Holy Qur’an 40, p. 64).

Both the Jewish and Muslim faiths consider life and health to be sacred and prohibit the intentional hurting of living beings (Braver Moss, 1991; Pollack, 2008; Pont, 2008; Smith, 1998). As a result, adherents of both faiths have argued that RMC violates the rights of children and should be replaced with other rites of initiation. An increasing number of Jewish parents, for example, now celebrate Brit Shalom (a naming ceremony) instead of Brit Milah (circumcision) (Cohen-Almagor, 2021; Franz, 2019). The debate around children’s physical integrity has increased awareness that RMC is painful and an intervention causing irreversible alteration of the body (even if the latter is intended). Most proponents are now willing to explore ways to make the practice safer and less painful. Arguments around the child’s physical well-being thus tend to lead to regulation and medicalization, which may in turn embed the practice. Yet there are equally important interests to consider that are not easily solved with medicalization, such as psychological well-being.

The Psychological Well-Being of the Child and Later Adult Moving beyond physical well-being, RMC has also been questioned from the perspective of psychological well-being. As is the case for complications, the incidence of possible negative psychological effects is extremely controversial and data often anecdotal (Munzer, 2017), though today it would be hard to deny the existence

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of potential psychological repercussions. These indicate that the intended benefits of cultural and religious appreciation and belonging do not always arise. Research on psychological effects has historically been linked with the pain RMC causes. In a seminal article on religious circumcision of children aged 4– 6, Cansever (1965) argued that the painful experience of circumcision led to a weakening of ego, feeling of helplessness, less efficient functioning, anxiety, and aggressive behavior. As a defence mechanism, children either acted unsocialized, or withdrew and isolated themselves (ibid). Similar results have been obtained in more recent studies on neonates subjected to circumcision, adding that the traumatic experience and change in behavior can also negatively affect attachment to parents (Dixon et al., 1984; Laibow in Pollack, 2008). The experience of circumcision can make infants and children feel “anxious, fearful, and vengeful” (Chamberlain, 2008), and in severe cases may lead to Post Traumatic Stress Syndrome (PTSD) even in environments with greater pain control/medicalization. Boyle et al. (2002) provide an extensive overview of the literature in the field and conclude that, although research suffers from sampling issues, high percentages of PTSD have been found following routine, religious and cultural circumcisions, either medical, or traditional (Boyle et al., 2002). These possible psychological repercussions place RMC under scrutiny from the perspective of Article 19 of the CRC, which prohibits mental violence to be inflicted upon children in parental care (Hodgkin & Newell, 1998), as well as Article 24(3) CRC (harmful practices) (Hodgkin & Newell, 2007) and Article 5 of the UN Declaration on the Elimination of All Forms of Intolerance and Discrimination Based on Religion and Belief, which exhorts States to eliminate traditional practices that are injurious to children (Brems, 2006). Rather than detriment, the psychological benefits of RMC are often advanced as a key reason supporting the practice, in particular the resulting sense of belonging and avoidance of stigmatisation when compared with peers (see BMA, 2020; Pekárek, 2015). The latter is a problematic argument: stigmatisation suggests a negative reaction from a group that expresses intolerance, and should itself be questioned (though, fortunately, reports exist to the effect that in practise the feared stigmatisation often does not eventuate (Cohen-Almagor, 2021; Goldman, 1999)). Moreover, if (virtually) none of the community’s young children were circumcised the issue would not arise. With regard to the sense of belonging, as Myers and Earp (2020:658) argue, the “cultural [and religious] benefit depends on how the affected individual personally relates to the culture or sub-culture of their birth” and to the circumcision itself. Some ritually circumcised men feel mutilated by the procedure (Remennick, 2021) and reconstructive surgery is sometimes practised (Schultheiss et al., 1998). The potential negative psychological consequences and rejection caused by routine circumcision (Goldman, 1999; Munzer, 2017) may not to the same extent arise in contexts where circumcision is celebrated as a religious rite of initiation (Yavuz et al., 2012). Yet even in that case, adults may come to regret RMC (Remennick, 2021), especially as their ties to the community become more fluid. As was aptly put by a social worker in an English case:

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When [the child] is older he may be very happy that he was circumcised- he may strongly align with the Muslim faith and traditions and may be happy that the procedure has been undertaken. However, there is also a possibility that [he] may not align himself with the Muslim faith or traditions as an older child and may view his circumcision in a negative way. The only way … to garner his wishes and feelings on being circumcised is if the procedure took place when he is of an age where he can express his own wishes and feelings.35

This also speaks to the matter of autonomy.

Autonomy and Self-determination of the Child In the past, the RMC controversy centred predominantly on whether parents’ freedom of religion and the need to provide a child with a primary culture and education could justify the causing of harm through circumcision (Baum, 1999; Freeman, 1999). This resulted in an emphasis upon regulation to reduce the harm. Although harm reduction proposals are still prevalent (Cohen-Almagor, 2021), attention has shifted to personal autonomy and self-determination, and the child’s own right to freedom of religion. As a result, the entire practice of permanently marking a child has come under scrutiny. The argument that RMC is contrary to the autonomy rights and interests of children because of the permanent mark it leaves has been made for some time. It has been put forward that RMC violates the child’s right to freedom of religion under international law protected by Articles 18 ICCPR, 14 CRC and 9 ECHR (Bhimji, 2000; Fortin, 2009; Gilbert, 2007; Svoboda, 1997), or respect for the child’s person under Article 16 CRC (Svoboda, 1997). Moreover, the CRC obliges adults to let children participate in decisions that affect them according to their age and maturity (Article 12); including health decisions such as RMC (Hodgkin & Newell, 1998). The autonomy interests that a child has, and his moral right to an open future (Feinberg, 1980), could therefore potentially bar the legitimacy of circumcision (Fox & Thomson, 2008; Gilbert, 2007; Schiratzki, 2011). However, at the time, some authors had doubts about the extent to which the law would support autonomy arguments on the basis of self-determination or religion (Marshall, 2009; Schiratzki, 2011). Times have changed. Today, a previously suggested idea that retrospective consent by a majority of men and the existence of reconstructive procedures (despite practical unavailability) meets the requirements of autonomy (Baum, 1999), for example, seems flawed. Autonomy is forward-looking. We now know that international law and national courts value children’s autonomy rights and self-determination, including in matters of religion, and that there is no longer an automatic priority of parental wishes (Erlings, 2020).36 This includes postponing actions that are not reasonably reversible such as circumcision, so that children can decide on their own path once 35

M v F [2021] EWHC 1616 (Fam), at [31]. Notably, the CmRC (2016) has issued a General Comment that made parental rights accessory (and subject) to the child’s own exercise of their personal right, ending a longstanding debate in favour of children’s own choices and practices. The Committee has long been critical of imposed practice upon children (Erlings, 2020).

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they are competent to do so, as exemplified by the above-cited court decisions (see also Chambers, 2018). Autonomy interests have been recognised as significant interests for children that require protection (Brighouse & Swift, 2014; CmRC, 2013b; Eekelaar, 1986). Salaymeh and Lavi (2020:443) have offered critique on this notion of autonomy (and religiosity) permeating the RMC debate: The secular (Christian-mediated) understanding of religiosity is based on a notion of autonomous choice. The notion of religiosity as choice diverges from how Jewish and Islamic traditions historically constructed the practice of circumcision. For both Jews and Muslims, one is born into a tradition … one does not choose to become Jewish or Muslim and then choose to manifest this choice … Indeed, with the exception of apostacy, even extreme violations of law do not release one from the community.

This may be accepted as true. However, it cannot detract from the fact that universally applicable human rights norms include personal rights to freedom of religion and manifestation for children that are autonomy-based and focus on choice and the potential for change (see, e.g. Erlings, 2020; HRC, 1993). Whilst such norms may be subject to criticism (Langlaude, 2007), they indicate a global appreciation of the value of children’s self-determination that is finding increasing expression with regard to RMC. At the same time, there are elements of cultural ignorance and insensitivity that risk undermining an open exchange on the future of RMC. These are an unnecessary “holier than thou attitude” and rising xenophobia dominating the debate, as next discussed.

Hypocrisy and Xenophobia In her critique on ethical approaches towards RMC, Coene (2018) points out a key concern in the current RMC debate. The circumcision dilemma tends to be presented as one of religion versus physical integrity, but fails to examine what is meant or covered by physical integrity (see also Rassbach, 2018; Salaymeh & Lavi, 2020). Arguments are often grounded on the idea that Western societies are tolerant and religion or culture cause physical integrity problems, without acknowledging the various cosmetic interventions to which children are subjected in order to be “better accepted in society” (Coene, 2018:22). An example of such would be otoplasty (ear pinning), which is a non-therapeutic intervention regularly practised on pre-teens with the goal of societal acceptance and avoiding stigmatisation (Vlahovic & Haxhija, 2017). The procedure involves incisions, removal of tissue, post-operative pain, and a recovery period, and could be sourly regretted now that such “elf ears” have become popular (Zuo, 2021). Yet, few would call out this affront to a child’s physical integrity because it is not generally seen as one within our cultural understanding. Likewise, RMC may not be seen as interfering with integrity in the communities that practice it, but as improvement of the body (Salaymeh & Lavi, 2020). This does not mean that there is no interference, but it raises the valid argument that the questioning of RMC is hypocritical if there is no simultaneous questioning of other non-therapeutic

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interventions to which children may be subjected for even less pressing cultural or societal concerns (see Rassbach, 2018). The answer to this should surely be, as Chambers (2018) and Earp et al. (2017) propose, a wholesale examination (and elimination) of all non-therapeutic interventions on children’s bodies, rather than allowing them by default. Yet, for as long as that has not happened, the objections of hypocrisy and singling out of certain religious and cultural practices constitute an understandable, if defensive, response in a polarised debate. Intertwined with the matter of hypocrisy is that of Xenophobia. Although Special Rapporteur Shaheed noted in 2019 that restrictions on RMC did not appear “solely driven by anti-Semitism” ([42]), the circumcision debates have become a forum for rising xenophobia (Bielefeldt, 2016; Pekárek, 2015; Rassbach, 2018). RMC is not irregularly typed an archaic and barbaric ritual, practised by alien (Jewish and Muslim) communities seeking to impose parallel societies upon secular nations (Hernández Aguilar, 2021; see also Salaymeh & Lavi, 2020). The link, Rassbach (2018:183) argues, “between restrictions on minority religious practices and antiimmigrant and anti-foreigner sentiment is … fairly clear”. For those targeted, it may be difficult to separate attacks on their person and community from those on a practice like RMC. Yet without diminishing the unacceptable incidence of racism and xenophobia, maintaining RMC because there is xenophobia would be an unhelpful conflation. As Chambers (2018:21, footnote omitted) argues “the movement to proscribe circumcision can mobilise racism and religious bigotry. But its justification need not be bigoted”. There are indeed good reasons to question RMC that go beyond antiminority sentiment. However, it is unlikely that any true debate about the practice can take place when mutual respect is undermined by xenophobia and anti-Semitism.

Ritual Male Circumcision: Quo Vadis? Over the last few years, there has been a significant development towards the medicalization of RMC at national and international levels, as well as via professional and (sometimes) religious organisations. Whilst medicalization addresses some of the most pressing concerns from the perspective of children’s interests and welfare, the latter call for further steps towards the abolition of RMC. It is notable that, whenever judges in the jurisdictions included in this chapter have considered whether RMC should be ordered, they have found that children’s interests prompted postponing of the procedure. These judgments and accompanying legal frameworks also highlight questionable inequalities arising from the current situation. Muslim parents are disproportionately affected by cases requesting the postponement of RMC and medical (consent) requirements; medicalised RMC may become a practice of the affluent only due to its cost; but mostly, it is unexplainable why children in intact families should be treated differently from children in separated families when the concerns emphasised are the procedure’s impact, irreversibility, and allowing the child to make their own commitment to a community. If, as I believe it is, genuine respect for the person a young boy is and will be requires leaving the circumcision

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decision to him when he is old enough to make it, then that should be the case for all children. The question therefore becomes more one of RMC per se. As this is considered a politically sensitive issue, governments, higher courts and international bodies have sought to avoid it. This is unhelpful. It has the consequence of charging domestic judges in the criminal and family jurisdictions with the task of effectively completing an important social debate by themselves. It also prevents a larger debate that should be had around non-therapeutic interventions on children more widely, especially where these are irreversible and motivated by acceptance within a societal community. What is more, avoiding the issue also means that there can be no true confronting of xenophobic or anti-Semitic attitudes. There have been calls for, and attempts at, legislation that would point blanc prohibit RMC. Any such prohibition in the existing climate will likely cause the practice to go underground. Change should come from within a community. RMC is important to especially Muslim and Jewish communities, though that does not mean that change is not possible. Religion, culture and tradition are not static concepts. Change is already occurring with alternative ceremonies celebrating a child’s welcome to the community. The door is ajar for a meaningful debate around RMC, but whether this can be had will depend on the levels of understanding and introspection demonstrated by all participants. The defensiveness that current hypocrisy and xenophobia cause works to undermine the potential for any form of genuine interaction. Consequently, where RMC is headed will ultimately depend on whether an adult conversation can be had about the practice of a ritual on children (of course, however possible, with input from those children).

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The Initiation Society Working Group on Medical Standards in Brit Milah. (2016). Guidelines for the practice of Brit Milah. The Initiation Society. Tobin, J. (2013). Justifying children’s rights. International Journal of Children’s Rights, 21(3), 395–441. Trouw, Redactie religie en filosofie. (2005). Besnijdenisklinieken opened in rap tempo vestigingen. Trouw. Retrieved December 18, 2012, from http://www.trouw.nl/tr/nl/4324/Nieuws/archief/art icle/detail/1724139/2005/08/02/Besnijdenisklinieken-openen-in-rap-tempo-vestigingen.dhtml (no longer accessible) Tweede Kamer der Staten General. (2011). Vragen van het lid Wiegman-van Meppelen Scheppink. Vergaderjaar 2011–2012. Aanhangsel van de Handelingen. Ah-tk-20112012-406. UNAIDS. (2007). Male circumcision: context, criteria and culture (Part 1). Retrieved July 31, 2021, from https://www.unaids.org/en/resources/presscentre/featurestories/2007/february/20070226m cpt1 UNAIDS. (2008). Safe, voluntary, informed male circumcision and comprehensive HIV prevention programming. Guidance for decision-makers on human rights, ethical and legal considerations. UNAIDS. Venice Commission (European Commission for Democracy through Law) and OSCE/ODIHR Advisory Council on Freedom of Religion and Belief. (2008). Joined opinion on freedom of conscience and religious organizations in the republic of Kyrgyzstan. Opinion 496/2008. Council of Europe, Document CDL-AD 032. Vidal d’AleidaRibeiro, A. (1986). Implementation of the declaration on the elimination of all forms of intolerance and of discrimination based on religion or belief. UN Doc. E/CN.4/1987/35. Vlahovic, A. M., & Haxhija, E. Q. (2017). Pediatric and adolescent plastic surgery for the clinician. Springer. Weiss, H. A., Larke, N., Halperin, D., & Schenker, I. (2010). Complications of circumcision in male neonates, infants and children: A systematic review. BMC Urology, 10, 2–14. https://doi.org/10. 1186/1471-2490-10-2 Williams, N., & Kapila, L. (1993). Complications of circumcision. British Journal of Surgery, 80, 1231–1236. https://doi.org/10.1002/bjs.1800801005 World Health Organization. (2009). Traditional male circumcision among young people. World Health Organization. World Health Organization. (2020). Guidelines: Preventing HIV through safe voluntary medical male circumcision for adolescent boys and men in generalized HIV epidemics: Recommendations and key considerations. World Health Organization. Yavuz, M., Dogangun, B., & Demir, T. (2012). The effect of circumcision on the mental health of children. Turkish Journal of Psychiatry, 23(1), 63–70 [English Translation]. Zapfl-Helbing, R. (2004). The involvement of men, especially young men, in reproductive health. Report of the Committee on Equal Opportunities for Women and Men. Council of Europe, doc. 10207. Zorgwijzer. (2021). Besnijdenis (Mannen) (2021). Zorgwijzer. Retrieved July 31, 2021, from https:// www.zorgwijzer.nl/vergoeding/besnijdenis Zuo, M. (2021). China’s ‘elf ear’ cosmetic surgery is increasingly sought by young people seeking a thinner, slimmer face. South China Morning Post. Retrieved July 31, 2021, from https://www.scmp.com/news/people-culture/social-welfare/article/3136795/chinas-elf-earcosmetic-surgery-increasingly

Chapter 9

Child Well-being at the Crossroads: The Impact of Parental Work and Lifestyle Choices from a Socio-ecological Perspective Tusharika Mukherjee

Introduction Science and research in the last decades have unraveled many mysteries of child development. Prenatal care, immunization, antibiotics, nutrition, hygiene, and mental health interventions have helped us come a long way in promoting health and preventing risks. However, the changing socioeconomic and cultural climate has exposed our children to new-age challenges of well-being and survival that some prefer to describe as the millennial morbidities (Palfrey et al., 2005; Schor, 2015). The complexity of socio-ecological transformations has urged child health agencies and policy makers to address the multidimensionality of child needs and well-being in a new light and estimate the lifelong effects of choices we make today. Neurology and child development researches show that infancy and early childhood are marked with swiftest development of new synaptic connections, and this rate is influenced by the family environment (Greenough et al., 2002). The well-being of the children is a complex interplay of healthy and safe environment, stable and nurturing relationships, and adequacy of health care and nutrition that facilitate growth and learning (Shonkoff et al., 2012). The fundamental questions around child health and well-being seldom find simple answers. These questions form an indispensable and often a critical part of most parents’ daily concerns and constitute the substructure on which the parent–child relationship is founded. In addition to the parenting styles and social interaction patterns inside or outside one’s family, certain choices and behaviors displayed by adults create an environment that can have subtle to pronounced impact on children sharing the same household. Research on child health establishes family environment as the primary social context, albeit much of it is a reflection of the non-contiguous ecology built upon the socioeconomic progression of societies, communities, cultures, and global trends. In line with this, the chapter aims to institute child health and well-being T. Mukherjee (B) Justus-Liebig University, Giessen, Germany © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_9

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within a socio-ecological paradigm of interacting elements that define the present world. Drawing from Urie Bronfenbrenner’s conceptualization of human development (Bronfenbrenner, 1989; Kilanowski, 2017), we examine lifestyle choices and habits of parents as the most proximal environment (microsystem) constructed and perpetually influenced by parents’ immediate environment (exosystem) and a more distal sociocultural context (macrosystem). It is important to note that the overall sociocultural context is regulated and fortified by the intermediary systems forming a feedback loop, and that the emergent ecology is highly complex and dynamic. In the following sections, we focus on parental choices on adherence to consumer culture and materialism, work–life interface, sleep habits, and exposure to digital devices, interacting to create an environment in which our children socialize and mature. A multilevel analysis, presented in the conceptual model (Fig. 9.1), will provide new directions to medical sciences, genetics, psychology, and socialization approaches and facilitate reimagining of child health and well-being concerns.

Fig. 9.1 Socio-ecological overview of factors impacting child health and well-being

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Child Consumerism: An Emergent Psychosocial Paradox Common in urban living, an increase in television viewing, partly due to the declining popularity of outdoor physical activities and sports, has made children an easy target for advertising and marketing consumer goods. Advocates of consumer rights cite children’s active involvement in purchase decisions as an expression of autonomy and competence (Buckingham, 2011). Companies now rely upon investing in marketing strategies to entice children into buying licensed products with brand imaging, including clothes, virtual games, and even unhealthy products like fast foods, alcohol and tobacco, and e-cigarettes (Lapierre et al., 2017). Research indicated that a major share of the advertising targeting children belonged to four major industries, fast food, candies, toys, and cereals (Kunkel et. al., 2004). Food advertisements largely promote food high in calorific value but low on nutrition (e.g., chocolates, chips, ice creams, breakfast cereals, confectionary, and soft drinks) and occupy a sizeable proportion of the television viewing duration (Akta¸s Arnas, 2006). The author also reported that children are more likely to express their desire to buy products they view on the television. Kids-based marketing is frequently built upon characters (cartoon characters, super heroes, animated figures or brand icons from movies or sports), making it a persuasive tool to ensure motivated consumption by the young minds while limiting the authentic consumer information. The marketing tactics for the same products are very carefully designed to attract children of different age groups, especially to avoid disenfranchisement of older children or parents (Lawrence, 2003). In response to the popular view of the perils of children’s intense engagement with manipulative marketing, Buckingham (2011) argues that child development in a consumer world is rather a labyrinth of social exchange with parents and peers. The author further notes that in addition to the social relationships that define the extent of commercialization in children, it is the overarching consumer culture which constructs the parent– child discourse, making this a recursive and a complex psychosocial phenomenon. Parents’ own consumer choices and lifestyle decisions are nested within the cultural context, forming the groundwork for children’s perception of money and material. For instance, though the consumer culture in the USA has a materialistic undertone, many have incorporated philanthropy, frugality with self-sufficiency, and the ideal of ‘plain living and high thinking’ in their life choices (Kasser, 2005). A direct consequence of kids-based advertising is the proliferation of the tendency to endorse materialism and linking acquisition and possession of goods to one’s own happiness and well-being (Hayes, 2021). Evidence shows that adolescents may perceive possession of material goods (like clothing, cell phones, and money) as vital for life satisfaction and social progress (Chaplin & John, 2007; Sweeting et al., 2012). Materialism impacts socialization and shapes the perception of adolescents (9–14 year olds) in a way that they begin to associate wealth with intelligence, high achievement, and increased sociability (Goldberg et al., 2003). Salient aspects of materialism in children and adolescents include frequently engaging in buying behavior rather than other activities, equating money with pleasure, deriving satisfaction from the material possessions, admiring other children who own special games

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and clothing, and aspiring to earn large amounts of money in future (Goldberg et al., 2003). Precisely, materialism amounts to shifting one’s orientation to acquisition of objects and making it the central value of life (Fournier & Richins, 1991). Children can be persuasive enough to compound the materialistic orientation in parents. Lenka and Vandana (2016) observe that parents with higher disposable income tend to purchase based on their perception of latest trends and peer influence, primarily to achieve social acceptance. The social comparison and acceptance embody materialistic orientation in children, wherein a failure to possess desired objects renders feelings of inadequacy. Lenka and Vandana further note that repeated exposure to advertisements and ubiquitous marketing messages serve as environmental contributors to consumerism in children from higher socioeconomic class. However, the influence of social class remains a contentious issue due to the lack of consistency in findings. In a study on children aged 8–10 years, Chaplin et al. (2014) found no economic class-based difference in materialism, rather adolescents from lower economic backgrounds had higher proclivity toward materialistic gains. Liet al. (2018) assert that seeking and owning material possessions serve as a compensation for the persistent lack of resources and financial insecurity. Interviews with children from financially weaker families indicate that low self-esteem predicts high materialism, which is partly attributable to their ungratified psychological needs and the families’ inability to provide emotional support essential for positive selfevaluation (Li et al., 2018; Chaplin et al., 2014). Twenge and Kasser (2013) note that the expanding penetration of material marketing into our lives has led to the growing acceptance for instant wealth and celebrity status, as witnessed in the reputation of the reality shows featuring both adults and children. Adolescents high in materialism show low self-esteem, higher smoking and drinking, and increased aggressiveness toward peers (Kasser, 2005). Marketing tactics may propel material desires in children, but the roots of materialistic socialization found within the family are nurtured by the parent’s desire to provide their child space for expression independence, and empowerment, identified by Viviana Zelizer in 1985 as the ‘valorization of childhood.’ Parent’s materialism finds a reflection in children’s compelling material goals, impoverished interpersonal relationships, and high competitiveness (e.g., Kasser & Ryan, 2001; Sheldon et al., 2000). Buckingham (2007) elucidates that as parents struggle to dispense sufficient time for parenting either due to personal choice or work compulsions, they are more likely to indulge in materialism as a compensatory behavior. An organic fallout of materialism is compulsive buying, a dysfunctional consumer behavior with adverse psychological consequences (Dittmar, 2005). Family environment can modulate motivated purchase and ownership by encouraging or disapproving the display of such temperaments in children (Gwin et al., 2005). Families were spending money on excess clothing, food is a norm, and children and adolescents indulge in compulsive buying; whereas, intangible family resources like time, attention, affection, and discipline impede compulsive purchase (Gwin et al., 2005). The effect of psychosocial resources and emotional support on children’s buying behavior has received support in studies on disrupted family structures (e.g., divorced parents) where higher compulsive buying is associated with depleted parental attention and

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supervision (Roberts et al., 2003). Secondly, similar to the adults relying on uncontrolled buying as a primary coping mechanism for stress and negative emotions, Roberts and Roberts (2012) observed that an increasing number of early adolescents are leaning on motivated purchases as a coping strategy against academic stress. In addition to coping and mood repair, addiction, seeking self-identity, and depression are the underlying conditions for the irresistible impulse to buy (Dittmar, 2005). The intergenerational rise in the culture of consumerism and materialistic role modeling evolved within the socio-ecological climate of social insecurity and instability (Twenge & Kasser, 2013). Those valuing materialism as their central life principle are more likely to be driven by materialistic ideals in their work–life as well (Promislo et al., 2010). Work centrality is frequently upheld as the mechanism that maximizes income and material possessions, ensures success in material competitions, and enriches living with the desired commodities. Similar to the adverse effects on life in general, materialism propagates lower work-related well-being as the motivation to work is not embedded in autonomy, intrinsic need fulfillment, and work ethics. Low work satisfaction, low engagement, burnout, turnover intentions, workplace risk behavior, and substance use emerge as the work-related outcomes (Giacalone et al., 2008; Kasser & Kanner, 2004; Unanue et al., 2017). A somewhat counterintuitive theory is that materialism does not always warrant work centrality as younger adults endorsing it may have an increased sense of entitlement and assume their privileges without striving for it (Twenge & Kasser, 2013). Nonetheless, subscription to money and material utilitarianism circumscribe the choices one makes in the work and non-work domains of life.

Work–Life Interface and Parental Stress The controversy surrounding career and family life has been around for decades. Though industrial and organizational psychology, mental health, and stress management domains have accorded substantial emphasis to the work–life interface, the impact on child health and well-being appears somewhat elusive in the extant literature. Working mothers versus homemakers, full-time versus part-time employment, long working hours, and poor working conditions of parents have been frequently attributed as the environmental conditions predicting child welfare. Since the onset of the pandemic, remote working and homeschooling have made the psychological interference of work–life choices with child rearing more prominent. Work–life balance or a lack of it has broader implications for quality of life in general (Guest, 2002). Much rests on the way the two domains of life and their relationship are perceived and regulated. For example, one could cognitively choose to keep the two domains segmented with no sizeable influence on each other, or allow partial to complete spillover with one imprinting the other positively or negatively, or one domain compensating for the deficiency in another by enabling fulfillment (Guest, 2002; O’Driscoll et al., 2006). Irrespective of whether the work and nonwork domains are instrumental in maximizing enrichment or yielding pressure and

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strain in each other, both domains have boundaries that people navigate on a daily basis (Clark, 2000). This merger of work and life is dynamic and has residues on both parents’ and their children’s health and well-being (e. g., Dinh et al., 2017). Strenuous working experiences, like long working hours, unsupportive working culture, and job insecurity, impinge upon parenting and manifest in undesirable parent–child interaction and child behavior (Galambos et al., 1995). Managing the demands of work can be a relatively arduous task in dual-earner and single parent families (Greenhaus & Singh, 2004). Single parent families most often consist of mothers as the family earner, which necessitates employment of the mother and runs the risk of leaving the traditional role expectations unfulfilled. In a Honk Kong-based study, Lau (2010) found that the linkage between quality of fathering and child’s self-esteem is predicted by the father’s emotional stability and active emotional involvement. Even in families with both parents, the work–life conflict is compounded by the dyadic overlap of one parents’ work–life handling on the other (Vieira et al., 2016) and illustrated by the buffering effect of mother’s accommodation on father’s work–life conflict (Dinh et al., 2017; Radcliffe & Cassell, 2015). Whether people can seamlessly transition between work and life or have distinct physical and psychological boundaries is mediated by the level of control they can exercise over their different life domains. Hoppmann and Klumb (2012) found higher positive and lower negative effects in parents who can command their work and life goals in their daily routines. Inability to cope with work demands or work-based burnout stretches to an overwhelming stress for parents. The mental and physical exhaustion is associated with parenting advances to parental burnout (Mikolajczak et al., 2019) with physical and psychological costs for both the parent and the child. The monotony in child care, high parenting expectations, and lack of resources in meeting parenting demands leads parents to be emotionally detached from their children and experiences a sharp decline in their efficacy as parents (Mikolajczak et al., 2019). Parental burnout has been found to be associated with suicidal and escape ideation, psychological escaping through substance use, hypothalamic–pituitary–adrenal (HPA) axis dysregulation-induced sleep problems, and parental violence (Roskam et al., 2021). Parents responding to the new challenges during the COVID-19 pandemic including financial insecurity, the work from home model, homeschooling, and unavailability of social support have witnessed a rapid rise in child abuse and neglect (Griffith, 2020). Child’s perception of parents’ work–life balance is crucial in determining parent– child interaction outcomes. Children’s assessment of their parent’s behavior either as coercive, autonomy supporting, or warm percolates into their own well-being (Matias & Recharte, 2021). Comparable to the early foundations of gender role identity, household labor distribution, and spousal choices, Lupu et al. (2018) assert that child’s work–family conception is set early in childhood through the work–life decisions of parents. Describing this as the ‘hereditary production of attitudes,’ the authors argue that whether individuals will mirror or reject the parental work–life model depends largely on their own childhood experiences. While some volitionally

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emulate or distance themselves from their parent’s style, those who do that unwillingly (e.g., children of an excessively ambitious or a reluctant stay-at-home parent) are more likely to assess their socialization as faulty and feel acutely conflicted in their work and family maintenance as adults (Lupu et al., 2018). A longitudinal study carried out among Australian parents and children over a period of 10 years (children aged from 4–5 years to 12–13 years) reported that as parents move in and out of work–life conflict, it leaves a mark on their children’s mental health. Dinh et al. (2017) argue that this back and forth movement alters children’s immediate social environment by transforming parent’s mental health, conjugal harmony, and parents–child relationship. The authors found that mother’s chronic work–life conflict had the strongest negative impact on the child’s emotions, conduct, hyperactivity, and peer interaction. Father’s sudden decline in work–life balance is also linked with poor mental health of the child, whereas the reverse is true when fathers are successful in navigating the work–life disequilibrium. The gender-based differential effect is attributable to the socially prescribed roles which dispose mothers to customize their work as per the child’s needs, which can include compensating for the father’s lost time and quality of interaction with the child (Radcliffe & Cassell, 2015). This maternal gatekeeping magnifies the work–life conflict of the mother and cascades over the child’s socio-emotional well-being (Dinh et al., 2017). Psychological distress and sleep problems associated with work are contingent on whether work and life provide resources for mutual enrichment or generate pressure and conflict. Jacobsen et al. (2014) assert that work-family trade-off can predict perceived sleep inadequacy, short sleep durations, and sleep maintenance. Work–life conflict-induced sleep insufficiency concurs with high work demands and lower decision authority, schedule control, and family-supportive supervisor behavior (Buxton et al., 2016). Buxton and colleagues further reported that employees living with children are more likely to experience sleep insufficiency, poor sleep quality, and symptoms of insomnia. Fathers in dual parent–single earner families are more prone to poor sleeping when they experience work–life conflict (Magee et al., 2018). Parent’s inadequacy of time for sleep, self-care, and leisure while negotiating work and family responsibilities creates a contiguous burden on the child’s health and well-being.

The Biopsychosociology of Child Sleep Health One of the most prominent biological impacts of modern living has been on our sleep. 24/7 working, shift work, intercontinental traveling, and being surrounded by electronic devices have created a web of sociocultural and lifestyle patterns that interfere with the endogenous circadian rhythm (Shochat, 2012; Liu et al., 2003). The natural consequences include changes in sleep patterns, inadequate sleep, problematic sleep habits, and daytime sleepiness (Shochat, 2012; Drake et al., 2003). Sleep problems in children can be a source of concern for parents, educators, and pediatricians; however, a major bulk of children reporting adequate sleep also indicates their difficulties in dealing with daytime sleepiness and a consequent inability

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to cope with academic pressure (Drake et al., 2003; Mercer et al., 1998). A myriad of issues reported by children (as measured by the Pediatric Daytime Sleepiness Scale, Drake et al., 2003) comprises getting drowsy or falling asleep during classes, sleepiness interfering with their home assignments, lack of alertness, trouble getting out of bed in the morning, and perceiving inadequacy in sleep. Sleep problems can have damaging effects on the child’s physical, cognitive, and emotional development (Covington et al., 2019; Galland et al., 2012; Liu et al., 2003). Sleep difficulties like short sleep durations have been consistently linked with higher risk of being overweight and obesity from as early as infancy through adolescence (Miller et al., 2018). Further, poor sleep health has adverse immunological consequences and exacerbating effects on preexisting comorbidities, negative impact on self-regulation and attentional capacities, low threshold for negative affect, decreased physical activeness, and poor neuroendocrine function and glucose metabolism (e.g., Dahl, 1996; Ordway et al., 2021; Van Cauter & Knutson, 2008; Williams et al., 2017). Although sleep primarily is a biological mechanism of homeostasis, establishment of sleep patterns and habits is actively shaped by the social relationships embedded in the sociocultural context (Owens, 2005). Sedentary lifestyle among urban children, exposure to electronic gadgets until bedtime, and consumption of unhealthy foods and weight gain are contributory factors to changes in sleep patterns among children, as also witnessed during the COVID-19 lockdowns (Bruni et al., 2021). Smaldone et al. (2007) found close ties between family factors and inadequate sleep in approximately 15 million children in the USA. From the sociocultural perspective, co-sleeping with parents has been shown to impact children’s (including infants) sleep–wake regulation, sleep latency (time taken to fall asleep), daytime naps, bedtime resistance, and frequent nocturnal waking (e.g., Galland et al., 2012; Iwata et al., 2013; Liu et al., 2003). Co-sleeping or bed sharing (family bed) has been frequently frowned upon as a major contributor to poor sleep quality and myriad of sleep problems among children. In contrast to solitary sleepers, bed-sharer parents report higher likelihood of their children developing sleep problems like frequent nighttime waking, separation effect, waking up in distress, and expressing fear of darkness when put to bed (Hayes et al., 2001). Bed sharing is also associated with poorer self-soothing skills, frequent parent-seeking, and the need for reassurance during sleep hours, leading to chronic sleep disturbances for both the child and parents, and provokes negative perception of the child (Hayes et al., 2001). The American Academy of Pediatrics holds that co-sleeping is associated with increased likelihood of the sudden infant death syndrome (SIDS), parental stress, and sleep inadequacy, whereas independent sleeping is associated with fewer sleep issues (Covington et al., 2019). In most families, parents make efforts in establishing and maintaining a bedtime routine through social cues for children to ensure adequate nighttime sleep and prevent daytime sleepiness. A major diversion in sleep routines emerges from independent versus aided sleeping observed in different societies. Despite the evidence that raises questions against bed sharing, the debate surrounding its benefits continues through the sleep rituals in diverse countries that point at the complex interplay of socialization and cultural environment as the key determiner of these effects. For

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example, a China-based longitudinal study spanning birth to 18 years of child’s life found that bed sharing in infancy and early childhood was unassociated with sleep problems or sexual dysfunctions, rather bed sharing facilitated cognitive development (Okami et al., 2002). Contrarily, parent–child bed sharing can have potential long-term benefits for development of intimacy, trust, and attachment security. In the context of SIDS, McKenna and McDade (2005) highlight that a co-sleeping primary caregiver reduces the likelihood of infant mortality by at least 50 percent; however, these outcomes are to a large extent predicted by the intention or supervision of the caregiver. Precisely, bed sharing would be protective or hazardous for the child and can be estimated from the levels of sensory vigilance of the caregiver, caregiver’s (mostly mother’s) smoking habits, sleeping arrangements where pillows and duvets are common, infants co-sleeping with older children, and some high-risk factors like maternal exhaustion, substance use, and leaving the infant unattended in bed (McKenna & McDade, 2005). Similarly, urban living has promoted several alternatives to maternal care including artificially formulated milk, which has replaced the advantages of frequent breastfeeding while co-sleeping. While bottled milk has enabled solitary sleeping in infants, it has also increased the risks of SIDS from infants lying in a prone (on stomach) position, especially in cultures where co-sleeping is impugned (McKenna et al., 2007). A careful examination of social background and cultural norms associated with caregiving activities and parent– child attachment is crucial before an outright disallowance of co-sleeping practices. While co-sleeping has been a convention in countries like India, Japan, and Hong Kong, a rise in co-sleeping ranging between 20% and 60% has been reported in the last decades in European countries like Ireland, Germany, Italy, Austria, Denmark, and Sweden (Blair, 2008). In addition to the cross-cultural variations of co-sleeping habits and arrangements, the associated environmental influences mediate its effects on sleep quality warrant consideration. Iwata et al. (2013) in their study on Japanese co-sleeping parents and children observed that in contrast to the bed sharing habits, the sleep timings were a better predictor of sleep quality. Iwata and colleagues further noted that parents falling asleep with children have disturbed sleep and do not easily recognize sleep problems in their child, which in turn sustains sleep difficulties in the children. Allied to the issues surrounding sleep habits is the extent to which technology consumption by parents and children is creeping into their interpersonal relations and daily activities, including sleep. A recent survey in the USA found strong associations between smartphone (mobile device) usage and sleep (Robb, 2019). The survey revealed that as much as 62% of parents and 39% of children keep their devices within reach during bedtime, 29% of children sleep with their mobile gadgets. Parents and children report waking up at least once or not sleeping at all during the night due to the social media notifications and the urge to check emails. Moreover, using digital devices (except as an alarm) within 30 minutes of sleeping and waking up has become an integral part of the sleep–wake routine for many (60% of parents and 64% of adolescents). Interestingly, both children and parents acknowledge the damaging effects of digital device usage on their sleep hygiene and attribute their nighttime device usage to academic and work pressure. Similar to overexposure to digital content like texting at

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bedtime predicting increased body mass index, increased hours of television viewing or screen time negatively impact sleep quality and child health (Fuller et al., 2017).

Screen Time and Digital Dependence Children are increasingly becoming major consumers of screen-based content. Screen time in the last two decades has proliferated through the growing usage of televisions, computers, gaming consoles, smartphones, tablets, video chatting, and screen-based learning devices. The American Academy of Pediatrics (AAP) recommends no screen time for children under 2 years and not more than 1 h for children aged 2–5 years of age. In reality, the usage is much higher and has been consistently rising as children begin to attach their academic and entertainment needs to screen viewing. For example, a 2014 study among children under 2 years in the USA revealed more than 3 h of screen time, almost twice as much as found in 1997 (Chen & Adler, 2019). The 2020 report of the American Academy of Child and Adolescent Psychiatry published that children between the ages 8 and 12 years spend from 4 to 6 h of daily screen time, with that figure reaching 9 h for the teenagers. Similarly, in the UK, an estimated 75% of infants (under the age of 12 months) exceeded the recommended screen time for that age (Barber et al., 2017). Cultural variations are also evident in television viewing, irrespective of the nation’s economic viability. Notwithstanding, the majority can be observed to have deviated from the recommended screen time. A worldwide study comprising data from 37 countries found that prolonged television viewing among adolescents (over 5 hours daily) ranged from 17–20 percent in China and India to 70–78% in Morocco and Ivory Coast (Braithwaite et al., 2013). An Indian study carried out in the urban areas revealed that 99.7% of children below the age of 18 months were exposed to television and smartphones, among which as high as 50 percent were exposed to more than 2 hours of screen time each day (Meena et al., 2020). Television viewing has been linked with several negative health outcomes among children (Bleakley et al., 2013). Reduced attention span, inability to control impulses, reduced empathy, and a 49% increased risk of delayed expressive language skills are some of the adverse effects of using screens beyond the recommended limits among babies and toddlers (Da Silva, 2016; UNICEF, 2021). A readily observable physical health outcome is children being sedentary leading to poor physical and cognitive development (American Psychological Association, 2020; Barber et al., 2017). Cognitive issues rising from extended screen time include problems with attention, sleep, aggression, and school readiness (Zimmerman & Christakis, 2005). An US study of children between 2–17 years reported linkages between an average 4 hours of digital viewing with lower psychological well-being, lower curiosity, reduced emotional stability, increased distractibility, and higher difficulties in finishing tasks (Twenge & Campbell, 2018). The viewing outcome depends largely on the content as children run the risk of being exposed to violence, cyber bullying, adult content, prejudices and stereotypes, substance use, and advertising commercials targeting

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children. Davison et al. (2005) argued that in contrast to alcohol consumption, risky sexual behavior, and other health impacting actions, television viewing has become a part of family’s time together. The authors identified salient predictors of children’s screen time (mostly television) as (i) mother’s/ fathers’ TV viewing schedule, (ii) parents using TV viewing for entertainment and recreation, (iii) family co-viewing habits, and (iv) parental control. Television viewing remains by far the biggest contributor to the screen time, and the duration can be determined by the parent’s television time and their intention of reducing the viewing time of their children (Bleakley et al., 2013). As parents act as role models for children’s screen viewing, evidence shows a strong correlation between parent and child screen time (Pearson et al., 2020). Precisely, much depends on the parents as they act both as gatekeepers as well as models of viewing habits and a source of guidance and intervention (Davison et al., 2005). As observed by Meena et al. (2020), the screen time of children was not a matter of concern for 72% of the parents in urban India. Barber et al. (2017) observed that the children’s screen time increased with every additional hour of mother’s television viewing time. During the prolonged battle against the COVID-19 pandemic, as most children had to restrict their mobility as a preventive measure, the world witnessed an unprecedented rise in the screen time. This occurred concurrently with the decline in the time outside the home due to lockdowns and home quarantines. Approximately, 90% of school students and younger children availing kindergartens and day care facilities globally were home contained for most part of the pandemic (UNICEF, 2020). Most countries responded to this crisis by initiating Internet-based teaching–learning, the way many professions switched to technology-based communication and work (Wiederhold, 2020). Many families where Internet gaming and use of social media by children were frowned upon took to online education and communication overnight without preparing or learning about the consequences of the increased reliance on the screen. Reports suggest that the screen time has risen to 6 h a day from an already high 3 h a day, the number rising even higher for many (Parents Together, 2020). Individuals striving to gain social engagement resorted to social media and social simulation gaming very early on in the pandemic (UNICEF, 2020). While Internet-based education, socialization, and entertainment became a possibility for a section of the society, children belonging to the lower-income families particularly in the rural sectors suffered in this race of digital connectivity. Immediate fallout of the aggravated urban–rural divide has been cited as a contributing factor to the digital exclusion of many children, impacting their academic and psychosocial well-being (Wong et al., 2015). Wong et al. (2015) in their comparative analysis of low-income-no-Internet and low-income-with-Internet children in China observed that the deprived group scored low on developmental outcomes like aspirations, self-esteem, perceived efficacy, academic performance, as well as social relationships. A host of collateral effects of the increased use of digital devices and screen time with long-term repercussions for public health observed during the pandemic includes the following:

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(i)

Progressive Myopia: The digital virtual learning has increased the risk of myopia progression in school children. 2020 witnessed a 1.4 to 3 times rise in myopia prevalence in 6–8-years-old children (Wang et al., 2021), thus earning itself the label ‘quarantine myopia’ (Pellegrini et al., 2020). Wong et al. (2021) in their review emphasize the protective advantage of outdoor activities against the onset of myopia, with an increase in 40 minutes of additional time spent outdoors reducing the incidence of myopia by 23%. In another study, Wu et al. (2018) have shown that an outdoor time of over 11 hours/ week is associated with an estimated 54% lower likelihood of myopia progression in both myopic and non-myopic children. The incidence of reduced visual acuity is higher in countries with higher academic pressure (Wong et al, 2021). Despite the recommendations of public health agencies on limiting the screen time for non-educational purposes, digital learning is no longer an alternative but rather an essential, in many countries the only, medium of continuing education. It is hence a necessity that educational programs are devised with prevention of progressive myopia as a criterion. This coupled with parental education on providing at least 2 hours of daily outdoor activities to their children is the way forward in dealing with the rising risk of myopia becoming an epidemic among the younger generations Cardiovascular Risk Factor: It is well established in medical science that sedentary time increases the risk of obesity, high blood pressure, and insulin resistance. However, the growing incidence among children during the COVID-19 pandemic has alarmed public health authorities on the ill effects of snacking associated with increased screen time (Nagata et al., 2020). For example, studies have linked daily screen time with cardiometabolic risk (measured via systolic blood pressure, glucose, triglycerides, waist circumference, and non-high-density lipoprotein cholesterol) in young children (Sivanesan et al., 2020). Sedentary screen time frequently coexists with unhealthy snacking, serving as stimulus for one another (Pearson et al., 2020). Chaput et al. (2011) blame it on the mental-reward system as the primary underlying mechanism, whereby the satiety signal is delayed due to the exposure to the screen. The pandemic induced a sedentary screen-based behavior in many families where the intake of fruits and vegetables was replaced by consumption of snack foods and packaged foods that are low in nutritional content (Pearson et al., 2020). Screen time for non-educational and entertainment purposes risks exposing children to advertisements of unhealthy foods and drinks and instilling a desire and demand for its consumption (Russell et al., 2019). Interventions targeting diet-related behavior modification in children have often incorporated sedentary screen time behavior modification, and reducing screen time has facilitated reduction in snacking (Evans et al., 2012) which in turn can reduce the risks of cardiovascular issues. Stress: Children and adolescents are not only physically active during the normal school hours, but they also spend time socializing and learning from their peers. Restricted physical activity and social engagement combined with increased screen time have contributed to poor stress regulation in terms of

(ii)

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high sympathetic arousal and cortisol dysregulation (Lissak, 2018). A 2016 study in the USA found that after 1 hour of daily screen time (irrespective of smartphone, television, virtual games, and other electronic devices), every additional hour negatively impacted psychological well-being, curiosity, selfcontrol, emotional stability, and task accomplishment (Twenge & Campbell, 2018). The report also suggested that adolescents exposed to screen for more than 7 hours per day were twice as likely to be diagnosed with depression and anxiety as compared to the low screen users (1 hour screen time daily). Screeninduced sleep deprivation, cell phone dependency, and nighttime digital device usage predict suicidal ideation and depressive symptoms. Similarly, aggressive and fast paced screen content is linked with dopamine activation and mimicked attention deficit hyperactivity symptoms (Lissak, 2018). Adolescents are more likely to own and depend on their smartphone for social connectivity in lieu of face-to-face human interaction, which has been shown to undermine the positive effects of such interaction on well-being (Dwyer et al., 2018). Dependence: Screen use has also grown to be addictive for children with excessive exposure to unregulated screen time, bearing neurobiological likeness with substance dependence behavior, withdrawal, and tolerance (American Academy of Child and Adolescent Psychiatry, 2020). Screen dependence is manifested in a wide range of pathological usage of technology use among children including Internet-gaming disorder which has serious health implications and social impairment (Paulus et al., 2018). This classification as a dependence disorder comes in the wake of children (aged 8–10 years) spending over 8 h daily on screen. The prevalence is even higher among adolescents who spend over 11 hours daily on Internet use and virtual gaming (Paulus et al., 2018). Psychophysiological indicators of screen dependence include deficient self-regulation, feelings of guilt and depression, lowered decisionmaking abilities, reward system dysregulation, escapism, low self-esteem, and impoverished self-efficacy (Paulus et al., 2018). Children with screen dependency are frequently seen to be preoccupied, failing to limit their digital activities, losing interest in outdoor activities, using screen time to alleviate negative emotions, and lying about their screen time. Contrarily, refraining from screen usage (social media) for a week can potentially elevate perceived wellness (e.g., Tromholt, 2016).

From the socio-ecological standpoint, television viewing can be regarded as a risk factor for children falling victim to aggressive marketing strategies. With the rise in screen time and dependence on digital devices, children are more likely to express their own food choices, which are motivated by the advertisements. Though there is lack of consistency in evidence directly linking screen time with excessive food consumption or obesity in children, sedentary lifestyle induced by television viewing and social media operates as a robust mediator (Halford et al., 2004). For example, a three-year follow-up study revealed that two additional hours of television viewing per day preceded overconsumption and gaining excessive weight (Kaur

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et al., 2003). Screen time is reported to also stimulate food intake, especially the products children are exposed to through advertisements (Halford et al., 2004). Halford and colleagues observed that overweight and obese children, as compared to the lean children, successfully identified food advertisements representing their higher exposure to televised food commercials. It can be reasonably assumed that what children watch on screen is a potential driver of their choices and that in turn influences the choices of their parents. Parents reimbursing their lack of time by subscribing to the child’s choices tend to opt for unplanned buying and value decisions based on brand choices and appearance rather than quality and need. Mangleburg (1990) contends that parents being the primary socializing agents for children can effectively set a ceiling on the persuasive influence children can have on their own purchase decisions, thereupon inculcating responsible consumer behavior in children. Mangleburg further notes that children’s purchase intentions are often a reflection of their parent’s consumer attitudes, in a way that children can be less influential in purchase decisions when parents situate their decisions on nutrition and quality.

Future Directions for Research and Practice The debate on nature versus nurture has found new dimensions with the renewed focus on parental choices, autonomy, and expression. Research in this area has made strides toward elucidating the primal and long-term effects of these choices. Using a socio-ecological framework, this chapter has integrated theory and evidence that underpins our understanding of child health and well-being. The conceptual model presented here holds promise for empirical work to investigate the relationships between individual, psychosocial, and contextual factors, including longitudinal research. The relationships proposed in the conceptual model provide implicit implications for policy and practice. Subscription or tacit agreement to the dominant sociocultural ideologies and beliefs serves to reinforce them in children, as has been witnessed with materialism. Parents, educators, and policy makers need to address the issues of socialization of children as ‘consumers’ and its residues on identity and selfesteem (Chaplin & John, 2007). The prevalent glorification of luxury and conspicuous consumption and the tendency of children to attach themselves to materialistic messages by the media put children at risk (Ku et al., 2014). Media and consumer literacy are paramount for individual decisions about the health issues of themselves and their children. Parental choices regarding food, including formula feeding in infants, are driven by food prices, market trends, and social acceptance. Consumer decisions can be efficiently regulated through consumer education and awareness, leading to a more mindful selection between popular high-calorie-inexpensive food and nutrition. The increasing popularity of sugar-based products for children has long-term consequences for both food affordability and public health. The rise of mega-cities and urbanized living has enabled processed food and retail chains to thrive by replacing fresh and local food causing a global nutrition imbalance and a

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public health catastrophe (Drewnowski, 2016). The impact on children’s food choices can be readily observed through their decline in immunity and rise in lifestyle-related disorders like obesity. Socially responsible advertising, for example, providing nutritional description (Gray, 2005), is crucial from the public health perspective. Marketers and media houses are urged to self-regulate in undesirable advertising, while parents are urged to limit screen time and guide children in demarcating what is needed from what is desired (McNaught, 2021). The work–family conflict lens entails programs and policies that would enable parents to integrate the work and non-work domains efficiently. Community support programs can be designed to facilitate enhancement or work and reduce demands of work and family. Social support at the workplace via a supportive organizational culture, supervision, and coworkers can buffer against job burnout (Demerouti et al., 2001) and a collateral parental burnout. Similarly, parental support and non-pharamacological interventions may prove beneficial for sleep management. Practicing consistent sleep routines and hygiene promotes better sleep in children (Galland & Mitchell, 2010). Parents may be suitably informed about creating a favorable sleep environment, consistent bedtime and wake-time, and active lifestyle, as a step toward preventing sleep problems and other allied health consequences. Finally, the digital engagement in children sustains a balance between the sociocultural connotations of digital empowerment and parental discretion in screen exposure. Empowerment through expression of choice and autonomy in decision making is the new discourse, nevertheless, as individual stakeholders as well as part of larger community and nations we must also disambiguate individual autonomy from corporate profiteering and sociocultural hegemony. Even today, the dominant mode of making decisions regarding children among parents and educators hinges on the ‘well-becoming’ paradigm focusing on the future productivity (Ben-Arieh, 2010). As we move toward an improved understanding of a more discerning ‘well-being’ criterion, the focus shifts to our attitudes and actions today.

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Shonkoff, J. P., Garner, A. S., Siegel, B. S., Dobbins, M. I., Earls, M. F., McGuinn, L., Pascoe, J.,…, & Wegne, L. M. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232–e246. Sivanesan, H., Vanderloo, L. M., Keown-Stoneman, C., Parkin, P. C., Maguire, J. L., Birken, C. S., & TARGet Kids! Collaboration (2020). The association between screen time and cardiometabolic risk in young children. The International Journal Of Behavioral Nutrition And Physical Activity, 17(1), 41. https://doi.org/10.1186/s12966-020-00943-6 Smaldone, A., Honig, J. C., & Byrne, M. W. (2007). Sleepless in America: Inadequate sleep and relationships to health and well-being of our nation’s children. Pediatrics, 119(Supplement 1), S29–S37. Sweeting, H., Hunt, K., & Bhaskar, A. (2012). Consumerism and well-being in early adolescence. Journal of Youth Studies, 15(6), 802–820. Tromholt, M. (2016). The Facebook experiment: Quitting Facebook leads to higher levels of wellbeing. Cyberpsychology, Behavior and Social Networking, 19, 661–666. Twenge, J. M., & Campbell, W. K. (2018). Associations between screen time and lower psychological well-being among children and adolescents: Evidence from a population-based study. Prev Med Rep., 12, 271–283. Twenge, J. M., & Kasser, T. (2013). Generational changes in materialism and work centrality, 1976– 2007: Associations with temporal changes in societal insecurity and materialistic role modeling. Personality and Social Psychology Bulletin, 39(7), 883–897. Unanue, W., Rempel, K., Gómez, M. E., & Van den Broeck, A. (2017). When and why does materialism relate to employees’ attitudes and well-being: The mediational role of need satisfaction and need frustration. Frontiers in Psychology, 8, 1755. UNICEF. (2020). Rethinking screen-time in the time of COVID-19. https://www.unicef.org/global insight/stories/rethinking-screen-time-time-covid-19. Accessed August 5, 2021. UNICEF (2021). Babies need humans, not screens. UNICEF Parenting. https://www.unicef.org/par enting/child-development/babies-screen-time. Accessed August 5, 2021. Van Cauter, E., & Knutson, K. L. (2008). Sleep and the epidemic of obesity in children and adults. European Journal of Endocrinology, 159(suppl_1), S59–S66. Vieira, J. M., Matias, M., Lopez, F. G., & Matos, P. M. (2016). Relationships between work—Family dynamics and parenting experiences: A dyadic analysis of dual-earner couples. Work & Stress, 30, 243–261. https://doi.org/10.1080/02678373.2016.1211772 Wang, J., Li, Y., Musch, D. C., Wei, N., Qi, X., Ding, G., et al. (2021). Progression of myopia in school-aged children after COVID-19 home confinement. JAMA Ophthalmol., 139, 293–300. Wiederhold, B. K. (2020). Children’s screen time during the Covid-19 pandemic: boundaries and etiquette. Cyberpsychology, Behavior, and Social Networking, 359–360. https://doi.org/10.1089/ cyber.2020.29185.bkw Williams, K. E., Berthelsen, D., Walker, S., & Nicholson, J. M. (2017). A developmental cascade model of behavioral sleep problems and emotional and attentional self-regulation across early childhood. Behavioral Sleep Medicine, 15(1), 1–21. Wong, C. W., Tsai, A., Jonas, J. B., Ohno-Matsui, K., Chen, J., Ang, M., & Ting, D. (2021). Digital screen time during the COVID-19 pandemic: Risk for a further Myopia boom? American Journal of Ophthalmology, 223, 333–337. https://doi.org/10.1016/j.ajo.2020.07.034 Wong, Y. C., Ho, K. M., Chen, H., Gu, D., & Zeng, Q. (2015). Digital divide challenges of children in low-income families: The case of Shanghai. Journal of Technology in Human Services, 33(1), 53–71. Wu, P. C., Chen, C. T., & Lin, K. K. (2018). Myopia prevention and outdoor light intensity in a school-based cluster randomized trial. Ophthalmology, 125, 1239–1250. Zelizer, V. (1985). Pricing the priceless child: The changing social value of children. Basic Books. Zimmerman, F. J., & Christakis, D. A. (2005). Children’s television viewing and cognitive outcomes: A longitudinal analysis of national Data. Archives of Pediatric and Adolescent Medicine, 159(7), 619–625. https://doi.org/10.1001/archpedi.159.7.619

Chapter 10

Children Witnessing Violence in India: Nature, Risk Factors, Impact and Prevention Strategies Rituparna Chakraborty and Aneesh Kumar

Introduction Children witnessing violence is a serious public health concern for the nation. Across all stages of development from even before birth, life events, experiences, and environment significantly impact the individual’s ability and adaptability throughout later life, shaping their personality and lifestyle (Tharp et al., 2012). Children victims of abuse and neglect are often exposed to other forms of risks like exposure to domestic violence and environmental stressors, including disturbing family environments, witnessing adults indulge in violent behaviours (McGuigan & Pratt, 2001; Hartley, 2002; Dong et al., 2004). These factors mostly co-occur and often affect a child in a similar pattern. Family violence causes higher disturbance in children than witnessing or exposure to community violence (Margolin & Gordis, 2000). Especially witnessing violence may include partner violence or violence by family chaos which may lead to divorce, separation or even bereavement (Mills et al., 2000). The witnessing of violence by children can be auditory, visual, or inferred, including cases in which they witness the consequences of violence, such as injuries to family members or damage to property or even witnessing adults fighting or using alcohol and drugs (Dong et al., 2004). Factors like poverty, parental unemployment, substance abuse, and mental illness can trigger violence and increase the risk for the children to be victims and witnesses (Gewirtz & Edleson, 2007; Hartley, 2002). Poverty, neighbourhood disadvantage, violence outside the home (Herrenkohl et al., 2008) and the community setup or even political stability can be risk factors. Alcohol and drug abuse by the father tampers the family atmosphere, and it increases the risk of domestic violence and intimate partner violence (Hartley, 2002). R. Chakraborty · A. Kumar (B) Department of Psychology, CHRIST (Deemed to be University), Bengaluru, India e-mail: [email protected] R. Chakraborty e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_10

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Victims of witnessing violence may show mental health concerns similar to those of direct victims of abuse. The impact of such exposure may range from feeling of fear and shame to feeling of severe anxiety and depression (Russell et al., 2010). Long-term exposure can have later developmental concerns and put children at the risk of developing behavioural problems, including eating disorders, school dropout, suicide attempts, delinquency, violence, and substance use in later life (McCabe et al., 2005; Fergusson & Horwood, 1998), and even at the risk of being abusive partners and parents to antisocial citizens (McCabe et al., 2005). Long-term studies have shown that exposure to violence is as located with poor health outcomes (Danese et al., 2009).

Defining Children Witnessing Violence Children’s exposure or witnessing of violence has not been much defined. Children witnessing these violent events are invariably an at-risk population (Fergusson & Horwood, 1998; Fusco & Fantuzzo, 2009). Children witness domestic violence (McGuigan & Pratt, 2001). Even professionals fail to recognize the impact of such violence of an individual development (Postmus & Merritt, 2010). Children are generally affected by violence either by witnessing the traumatic events within the family or society and the experience of a state of mind in parents and others, which would either help them recover from the trauma or predispose and affect their mental health (McIntosh, 2002). Violence and exposure of it are continuous within most environment (Fusco & Fantuzzo, 2009). A child may witness partner violence, alcohol abuse from their early years of life, so the violence has an impact on their mental health and wellbeing, which, if not addressed, would become irreversible. Research also indicates the lack of proper tools to assess exposure to violence (Edleson et al., 2007). In 2000, the Minnesota legislature essentially repealed the 1999 changes to the definition of child neglect. It first replaced earlier legislation with a revised definition. Specifically, it states: Sec. 2. [626.5552] [Child Exposed to Domestic Violence]. (a) A child is considered to have been exposed to domestic violence when: (1) a parent or other person responsible for the care of the child engages in violent behaviour that imminently or seriously endangers the child’s physical or mental health; (2) a parent or other person responsible for the care of the child engages in repeated domestic assault (3) the child has witnessed repeated incidents of domestic violence; or (4) a parent or other person responsible for the care of the child engages in chronic and severe use of alcohol or a controlled substance that adversely affects the child’s basic needs and safety. [(S.F. 3410, 2000 Leg., 82nd Legislative Sess.), (Minnesota Department of Human Services, 2000 in Edleson et al., 2006)]

A recent study (Poddar & Mukherjee, 2020) reported that 53% of Indian children are victims of some form of abuse and violence. Although there is a significant dearth of statistics on Indian children who are indirectly exposed to violent environments, it can be assumed that the prevalence of children witnessing some degree

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or intensity of violence would be significantly higher than the number of direct victims of similar incidents. There is an imminent need to identify the apparent and subtle signs and symptoms of discomfort among such children, which may help to provide necessary aids of support. These signs and symptoms could range from mild mood incongruence to severe trauma or depression. There can be apparent and subtle negative cognitive and behavioural alterations among children exposed to violent environments. There are multiple myths and misconceptions related to children witnessing violence. Significant ones are that their young age will prevent them from understanding the reality of the vicious events, and their fragile memory will prevent them from remembering the incidents. This chapter discusses the risk factors and implications of how multiple research studies over the years have shown such conceptions to be false. Children are most affected by violent events at an early age, and the memory of witnessing such events creates long-term scars on their later development. Children in Indian societies witness a range of such events in their everyday lives in varying degrees and intensities, from micro-level violations to macro-level violence (Deb et al., 2017). Such exposure can be broadly classified into two general categories—exposure to in-house or family violence and exposure to social or community violence. These potential avenues of exposure and few individual factors are discussed through an ecosystem model of risk factors for children witnessing violence.

Risk Factors: The Ecosystem Model Exposure to violence and risk factors varies at both source and target, in intensity and degree. While some children can be considered at-risk, some environments may have a higher potential for exposure or risk. Difficult temperament is a compelling individual risk factor for children witnessing violence. Children with a difficult temperament and high impulsivity are predisposed to problem behaviours (Karreman et al., 2010). Such children may also be considered vulnerable when witnessing violence at a regular frequency and intensity, which may further aggravate their difficulties in self-regulation. Self-regulation is considered as one of the most important factors in bringing stability and resilience among children. Self-regulation even works as a protective factor and helps in building resilience among children who are exposed to violence (Yule et al., 2019). On the other hand, lack of self-regulation works as a risk factor when children witness violence in any form. A low level of self-regulation is an individual factor that impairs emotional and behavioural adaptive abilities among children. It makes them vulnerable to disruptive psychological and behavioural outcomes even with low to moderate levels of exposure to violence. Following Bandura’s (2017) model, it can be said that such children are also at high risk of habitual imitations of violent acts. Maltreatment is a significant risk factor among children witnessing violence. This factor is contextually rooted in the physical, cognitive, and emotional domains

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of development. The prevalence of physical abuse and maltreatment of children in cases of domestic violence between parents is significantly high across the world. The ecological model of child maltreatment explained the webbed contributions of individual, family, social, and community risk factors for children witnessing violence (Little & Kaufman Kantor, 2002). Suppose the child suffers from physical or psychological limiting conditions or disabilities. In that case, these become additional risk factors, placing such children at higher risk of being exposed to and being impacted by violent events occurring in the vicinity (Sullivan, 2009). Exposure to violence, coupled with their struggle to function optimally at physical, cognitive, or emotional domains, may lead to disastrous impediments in the way of optimal holistic development. They can deteriorate in their existing condition, escalating their struggle, leading to various additional disorders like depression, behavioural pathology or antisocial behaviours. Social risk factors for children witnessing violence can be multifaceted, which covers a range of social phenomena. Bullying at educational institutions or by peers or playmates is a major one. The relationship of being bullied, becoming a bully, and witnessing intimate partner violence at home is connected in complex and integrated ways (Lucas et al., 2016). The majority of children, around the world, who either classify as bullying victims or perpetrators usually are witnesses of domestic violence (Baldry, 2003; Laeheem et al., 2009; Lucas et al., 2016; Zhu et al., 2018). On the other hand, witnessing bullying victimization can create a similar impact of being abused or bullied through vicarious learning, leading to a culture of fear and silencing. Maltreatment and neglect of children by teachers or other authorities in educational institutions can serve as another social risk factor. Witnessing victimization of other children through discipline methods like corporal punishment cause equivalent emotional and cognitive damage in children like the one being direct victims of the same (Breen et al., 2015). In India, corporal punishment is still used at large at home and schools, especially in rural and semi-urban areas, putting children at higher risk for emotional and behavioural pathology in later lives. Exposure to violent media is another sociocultural risk factor for young children. Indian media is known to glorify and glamourize violence in terms of heroic acts; even children shows are not exceptions. There have been multiple discussions regarding Indian media’s blatant disregard for necessary social responsibility and sensibility in a graphic representation of violence (Ravi, 2011). The creation and perpetuation of such a culture, where violent victimization and perpetration are glamourized, put young impressionable minds at higher risk of cognitive and behavioural maladjustment. Community violence along with socio-economic disadvantage in a child’s immediate environment is a significant risk factor for deterioration in mental health. India is a country with a very high frequency of community violence, not limited to communal violence alone. A 2017 statistics of India reflects a count of an average of 161 riots, irrespective of its communal nature, daily in this country (Rawat, 2019). Such a community serves as an inevitable risk factor for associated psychopathological disadvantages among children. Although in few cases, such adverse circumstances may work as a thrust towards building resilience, with significant strides from the children and supportive systems towards positive adaptations (Gorman-Smith & Tolan,

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2003; O’Donnell et al., 2002). In such scenarios, family, peers and teachers function as support systems to deal with challenging circumstances and attain a resolution of the crisis. But in the majority of cases, children witnessing community violence are at higher risk of immediate and long-term cognitive, emotional, and behavioural maladjustment. Witnessing violent events and victimization at a regular and substantial amount, more so among socio-economically impoverished segments, may lead to psychological distress like post-traumatic stress disorder or depression among children (Overstreet, 2000). As a long-term effect, such exposure may gradually impact academic developments leading to poor academic performance among children, irrespective of mediation by depressive or aggressive traits (Henrich et al., 2004). Hamby and Grych’s (2013) poly victimization model explains how multiple environmental risk factors, like maltreatment and violence at home, school, and community, can work in collaboration as exponentially escalating risk factors for children witnessing violence. Multiple victimizations, concurrently occurring at multiple spaces, also work as push factors for a child’s future movement towards the perpetrator end in the victim-perpetrator continuum.

Impact of Witnessing Violence Children in today’s world are witnessing a spectrum of violence, starting from everyday low-intensity violations to high-intensity gross violence. Such exposures have the potential for scarring them in almost all possible domains of life space. The impacts of being witness to aforesaid events can be immediate as well as long term. Family conflict, essentially parental conflict and disharmony, is a significant source of witnessed violence in the immediate environment of a child. As per a 2020 report, India’s top crime against women is domestic violence (Dhawan, 2020), which indicates the incidence of the issue and urges the need to look into the impact of such events on children in the family. Witnessing physical conflict between parents leads to long-term psychological and social maladjustment among children (Henning et al., 1996). In a classic patriarchal structure (Kandiyoti, 1988) of India, intra-familial violent incidents are frequently witnessed by children, with minimal effort from elders to shelter them, and have higher potential of being internalized and normalized. The persistent and almost unavoidable exposure to sociocultural and media violence along with domestic ones, completes the circle of violent environment for most Indian children. Based on models of repeated activation neural pathways, it has been predicted that low to moderate intensity and intermittent exposure to violence can help building resilience, through specific sort of brain development, whereas high intensity or chronic stress exposure may lead to functional deficit of brain activation, especially in the stress response system of the brain (Perry, 2001). Emotion regulation is done majorly by brainstem and midbrain areas, where an optimal level of exposure to negative environmental cues helps building an efficient threat response neural system.

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However, researchers (Sapolsky et al., 1990) have indicated the negative effects of chronic exposure to violent and threatful incidents, especially for a developing brain. Chronic exposure may lead to deterioration of brain functioning, consequently leading to physical, cognitive, and behavioural impairment. The bio-psychosocial model of development enlightens the necessity of an optimal environment in each of these aspects for children to thrive. Domestic violence is prevalent during the pregnancy stage. A recent review (Priya et al, 2019) on Indian women reported that 23% of women faced domestic violence during pregnancy, with 60% of them being physically harmed. Such incidents are harmful exposures not only for the unborn child but also for other children in the household. Infants and children of early age are more vulnerable to such exposures (Borrego et al., 2008), with a lack of developed meaning-making schema and response system to such violence. Affective responses of a child depend significantly on the ways the socio-cognitive meaning-making system functions (Vaish et al., 2008), developing cognitive attributions based on social cues or cues from the immediate environment and reinforced by the reward punishment system. In the scenario of witnessing various types and intensities of violence, children start accepting that as a usual phenomenon, coupled with reinforcements, creating an emotional response of fear and repressed aggression (Malchiodi, 1997). Frequent and stylized media representations of violence (Bandura, 2017), even in children’s shows (Wilson et al., 2002) and digital games (Cat, 2019), also work as reinforcement, shaping an accepted and normalized schema of violence, even glorifying it. Following Bandura’s model (Mncanca & Okeke, 2019), it can further be explained how such schema consequently shapes violent behaviour in children’s immediate and extended social environment. The emotional development of a child is fundamentally based on attachment styles along with innate temperament. Witnessing violence and traumatic experience in childhood, especially within the home environment, may significantly disrupt an optimal attachment with the caregiver, leading to insecure or disoriented attachment (Carpenter & Stacks, 2009). Theories of human attachment illustrate consequential long-term effects of lack of secure attachment, impacting an individual’s future social adjustment, cognitive attributional pattern, and behavioural outcomes. The generalization of aggressive, insecure schema shapes the path to future disruptive intimate relationships. Early age exposure to persistent abusive environments has the potential to shape a convoluted sense of morality (Posada & Wainryb, 2008) among children, like engaging in antisocial behaviour even when it is not aiding survival. The intersectional model of interpersonal violence and violence against children indicates that in classic patriarchal societies witnessing interpersonal violence at an early age is often construed as a legitimate show of authority and as ways to enforce gender norms (Namy et al., 2017), which consequently may impact the moral development of a child. This scenario is further jeopardized by persistent violence modelling in the social and vicarious environment. In association with gender identity development, such backdrop may affect children’s perception of gender roles and expected sociocultural hierarchy. It may lead to a vulnerable, submissive, insecure identity development among female children, whereas shaping an authoritative, aggressive, insecure identity among male children.

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Witnessing violence within the immediate and extended environment is not restricted to witnessing the act, but also the consequences of it. Bronfenbrenner’s ecological theory (1992) explained the synergic role of macro-, exo- and chronosystems on an individual’s development. On one hand, exposure to consequences of violent events can create a cognitive justification of using violent means (Posada Gilède, 2012) as a medium of retributive justice or to accomplish desired goals, thus leading to a cycle of aggression. Here, the child may be reinforced to use violent measures under less threatening circumstances, eventually forming an aggressive habit response. Such behavioural responses have unquestionable potential to jeopardize future social adjustment. Behavioural analysis of children with antisocial behaviour frequently shows similar socio-cognitive cycles (Ireland & Smith, 2009; Sousa et al., 2011). On the other hand, such exposures may lead to both positive and negative socio-cognitive results. Moderate levels of exposure along with witnessing resilient responses from victims may create resilience learning and abilities to deal with challenging circumstances in the child. Exposure to severe and frequent violence and witnessing victimization may lead to trauma and a culture of silence. Indian culture rarely advocates voicing against violence, where children’s testimony or reporting of such incidents are also ignored or silenced frequently. Such scenarios influence internalizations of vulnerability and consequentially perpetuate fear and silence response among children. In this sociocultural context, such a response system makes children further vulnerable to future violent experiences.

Prevention and Intervention Strategies Working in prevention and intervention efforts for children witnessing violence is a challenging task. These efforts require professionals, policies and community support (Carlson, 2000). Hence prevention and intervention efforts need multidimensional strategies and team. For example, mothers can be key agent to identify and prevent abuse and creating safe spaces for children (Berson et al., 2012). Awareness and knowledge impact public attitudes towards abuse (Kumar et al., 2013; Yekta et al., 2011). Child abuse is a problem that has been taken up for implementation without having ascertained the nature and magnitude of the problem. A strong theoretical framework is required for reporting and prevention programmes (Mathews, 2015). The greatest barriers to identifying victims reported were a lack of training and awareness (Beck et al., 2015). Current approaches that generally follow the style of after-the-fact planning are inadequate to address a problem of this magnitude, especially for treating victims and punishing offenders; development and rigorous evaluation of CSA prevention strategies are critical (Mendelson & Letourneau, 2015; Glover & Justis, 2015). The intervention strategies need to be more grounded in the realization that there is a need for change in the discourse of child-rearing within potentially violent environments.

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The characteristics of a prevention programme include the length, intensity and frequency of the programme or intervention, the target audience, the approach or framework used, the location and the need areas focused (Osofsky, 2003). The nature of the violence, the child’s age and gender, exposure to other forms of abuse, and the presence of protective factors which may act as possible buffers, such as social and family support, need to be analysed while planning interventions (Carlson, 2000). There is a need for evidence-based programmes (Kyegombe et al., 2015; Pepler et al., 2000). While working on prevention strategies for children witnessing violence, we need to first look at the locations of issues. These fall into two general categories, exposure to community violence and exposure to family violence (Finkelhor, 2009). The broad social background of a child also can function as a contributory risk factor. Hence prevention strategies should be planned to focus on the location of the issue and the child.

Goals of Prevention and Intervention The purpose of prevention programmes is to intervene with caution and care towards the children. The goal is to (a) prevent exposure to violence, (b) mitigate the impact when it occurs, and (c) spread awareness about the problems of exposure to violence (Berson et al., 2012). The goals can be achieved by engaging all the stakeholders in the prevention initiatives. It is essential to understand and analyse the recent and related incidents of exposure to target the precaution areas (Kumar et al., 2018). Constituting monitoring agencies at the local level to encourage recognition and reporting of violence involving children will be adequate to prevent exposure to a greater extent. Using trauma-informed practices at school and other training programmes will build the capacity among the stakeholders to address the issue. The public health model of prevention (Fig. 10.1) explains prevention before the

Fig. 10.1 Model of prevention. Adapted from http://citeseerx.ist.psu.edu/viewdoc/download?doi= 10.1.1.608.6447&rep=rep1&type=pdf

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occurrence, preventing recurrence, and preventing later development of disability or illness. Based on prevention levels, school interventions can be categorized into three tiers or levels, primary, secondary and tertiary (Tobin & Sugai, 2005). School interventions can be broadly classified into three sections based on the approaches, namely: Universal: Community or Institution-Wide Programmes (Tier One). These types of interventions are primary level and provided to all members of the community or institution. Such prevention programmes are planned for all members to eliminate the possibility of the problem occurring. The primary objective of such programmes is to educate, break myths, and increase awareness. For example, a school-based psycho-education programme to prevent bullying and abuse would help children and staff understand the harmful effects of bullying, be sensitive, and respond when bullied or victimized. School-based interventions to teach children skills of prosocial behaviour and empathy would prevent bullying and aggressive behaviour (Flannery et al., 2003; Van Acker, 2007; Thompson and Trice-Black, 2012). Such programmes would aim at creating a positive school culture (Thomas et al., 2018). Communitybased preventive measures using media campaigns and awareness sessions help in curbing violence. When parents and community members become aware of the impact of violence on children, they would take better-informed steps and strategies. Bringing all stakeholders to address the issue, analysing the recent incidents for understanding their causes of exposure and efficient monitoring agencies, educating, recognizing and reporting violence at home or community is the basis for effective community involvement Chamberlain, 2014. Trauma-informed practices in schools and other training programmes are crucial for preventing violence (Berson et al., 2012). Target: High Risk or Vulnerable (Tier Two)Interventions that focus on children who are at risk or vulnerable to witnessing violence (Hester et al., 2004). This is secondary level prevention. For example, children living in disadvantaged backgrounds would be vulnerable to witnessing violence. Identifying the vulnerable and at-risk groups of witnessing violence is a challenging task. Violence exposure in the family and the community is common in all societies. The risk factors are intertwined with all forms of abuse and violence related to adults and children. A more global approach is required to prevent children from witnessing violence. The priority for this should be to focus on the prevention of violence in any form. The international initiatives of the INSPIRE (2016) guidelines elaborate on seven key strategies to end violence against children. They include, 1. 2.

3.

Implementation and enforcement of laws. For instance, ban violent punishments by parents/caregivers Norms and values emphasizing changing harmful social norms like gender bias and stereotypes by effective community mobilization and interventions specifically targeted at problems Promoting safe environments by identifying hotspots and curbing the spread of violence

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Parent and caregiver support by planning for home visits and target parent/caregiver by evidence-based intervention programmes. Income and economic strength by improving financial status, promoting group savings schemes and microfinance along with initiatives combined with gender norms and sexual abuse awareness programmes Education and life skills emphasizing the importance of safe schools and evaluating school environments. And also increase knowledge on violence and all forms of exploitation by promoting life skills and social training programmes. (Adapted from End violence against children. Retrieved from: https://www.end-violence. org/inspire)

The Global Status Report on Preventing Violence against Children (2020), based on the INSPIRE recommendations, reports that despite government support for INSPIRE approaches in many countries, more efforts are required to ensure it reaches needed children. A detailed explanation of different country’s position in responding and preventing violence can be found in the 2020 report. It is iterated that low and middle-income countries need increased support for INSPIRE implementations. Special emphasis is given to education and life skill approach for increasing participation in school-based programmes, building positive school environments and violent free climate. Teaching to manage emotions, developing prosocial behaviour, respecting relationships, reducing bullying and violence among peers help prevent violence. Further, providing knowledge about child sexual abuse, intimate partner violence, the importance of consent and openness to seek help whenever necessary promotes confidence in children and prevents becoming a victim. INSPIRE strategies also recommend parental and caregiver support programmes. It is vital to encourage parents to be involved in information and skill-building programmes like nurturing, non-violent parenting with the help of community workers like social workers and nurses. Home visitation programmes can also be effective for child maltreatment prevention. The strategies also include addressing the norms and values which are harmful and restrictive through community and bystander interventions—for instance, identifying challenging norms of intimate partner violence and devising interventions promoting equitable gender attitudes and community responsibility of protection. Of all the approaches, the most important of the strategies is targeting the broader contextual risk and vulnerability factors. It is called the safe environment approach. This approach aims to prevent violence by broadly implementing hotspots and developing programmes through multi-sectoral community partnerships, stopping the spread of violence by training credible community members for detecting violence and interrupting conflicts. The approach also focuses on community safety by designing and modifying public places with different levels of risk for violence. The safe environment approaches are well implemented by changing people’s perceptions, attitudes and actions and encouraging a positive mindset towards prevention. The prevention efforts for at-risk groups will be complete by providing adequate response and support services. The strategies include clinical support provided during interventions to recognize signs and symptoms of violence and refer victims. The

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therapeutic and counselling approaches are also required in interventions to deal with symptoms of PTSD, depression, emotional and behavioural disorders related to experiencing or witnessing violence. Interventions should involve social welfare services for improving the conditions of children. The juvenile justice system incorporates therapeutic interventions to change destructive thought patterns and antisocial tendencies. Indicated and Intensive at Risk (Tier Three) This level focuses on children who are already the victims. The target of intervention is to reduce the symptoms and help children recover from the trauma and negative impact of witnessing violence. This tertiary level of prevention requires utmost care and sensitivity in dealing with children during interventions. Children exposed to different forms of violence need specific approaches to intervene and provide therapy or treatment. Witnessing severe forms of violence leads to adverse psychosocial difficulties and functional impairments (Saltzman et al., 2001). The individual approach to treatment may not provide enough support to children for handling the trauma and stress of violence. Young children need parent supported programmes to reap the benefits of intervention. Involving key caregivers, usually, the mothers will have more impact on children. For instance, in a study conducted on child–parent psychotherapy versus the individual treatment programmes on children exposed to violence in marital relationships (Lieberman et al., 2005), the research demonstrated increased efficacy of the child–parent psychotherapy individual treatment. They identified increased relational process and maternal responsiveness towards trauma of the preschoolers. The mothers who thought that children were too young to notice and get influenced by witnessing violence had changed views about how they are negatively impacted. The mothers were able to discuss trauma and violence after the therapeutic intervention openly. The self-esteem and confidence of children who witness violence are at risk of negative impact. The adverse problems may lead to behavioural and emotional issues. Children exposed to domestic violence at home may develop negative attitudes and seek inappropriate strategies to reduce stress. They assume that family members using violent ways are justified if they also use it (Haj-Yahin & Dawud Nousri, 1998). Schultz et al., (2007), examined the use of Equine Assisted Therapy (EAT) to treat children exposed to violence. The therapeutic tool in this therapy is the horse. The horse is generally considered a powerful animal. The sessions were conducted in a non-threatening environment created to associate the horse’s features, and mirror hose features to gain insight into the “self”. The therapeutic process is so designed that children regain their confidence and lessened feelings of powerlessness to help them cope with the trauma. Hence, confidence and self-esteem are heightened to deal with future exposure to violence in a constructive manner. This approach also includes the benefits of play therapy when applied to children in therapeutic settings. As a result, they identify emotions, develop empathy and learn problem-solving skills (Kersten & Thomas, 2000). This approach for children exposed to family violence showed improvements in GAF (General Assessment of Functioning Scale). It was found that an increase in the number of EAT sessions led to a rise in GAF.

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Further, in this regard, school mental health professionals’ role needs to be examined (Thompson & Trice-Black, 2012). School-based interventions focused on training to identify children exposed to different forms of violence. The professionals should use non-structured and structured therapeutic approaches to deal with children exposed to violence. The study also identified that children who learned to cope with family aggression and violence (disruption) focused on school learning and had developed better perspectives about life. Consequently, children overcame the feelings of powerlessness and stopped fearing things they could not control.

Key Components of Prevention and Intervention Strategies Culturally Competent Interventions should be need-based and match the culture the target group or community (Nastasi et al., 2004). Hence professionals should understand the cultural systems, values, local needs and systems. Understanding the culture and values of the community would help the professionals to identify the need areas and design best possible interventions for the groups. Identifying potential intervention falls within this matrix would aid in selecting an intervention that will facilitate achieving the goal. The aspect of multicultural issues and cultural competence is also a concern while adapting evidence-based interventions. Cultural competence is defined as “a set of knowledge-based and interpersonal skills that allow individuals to understand, appreciate and work with individuals of cultures other than their own” (Walker, 2005, p. 57). Five essential components of cultural competence and care are identified as knowledge and acceptance of cultural differences, cultural self-awareness, understanding the dynamics of differences, developing basic knowledge of the child’s culture, and adopting skills to fit the child’s cultural context family. Further failure to understand the child and family background ends up in unhelpful assessments, underuse of resources, alienation of the family from the welfare system, and non-compliance among receivers of the interventions (Walker, 2005).

Developmentally Appropriate Prevention and intervention programmes can be effective if the practices are based on evidence of typical child development. For developmentally appropriate practices involvement of parents, teachers, caregivers and professionals are essential. Developing interventions based on a child’s physical, emotional and socio-cognitive level is crucial for obtaining intervention goals. The knowledge of the developmental spectrum helps to understand and adopt proven strategies and encourages to meet the needs of target children. The developmentally appropriate methods can be either

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structured or unstructured interventions. The interventions for children witnessing violence can be through problem-solving role plays, identifying feelings, and understanding safety skills. Techniques like games, puppet shows, stories and videos can help address the issues related to self-esteem and safety attitudes about violence (Jaffe et al., 1986). The other methods include bibliotherapy: using stories and videos for helping children learn non-violent means of conflict resolution (Butterworth & Fulmer, 1991); play therapy: suitable for elementary school children use of toys as an effective means of communication. The limitation of the capacity for abstract thinking is overcome by using toys for expressing emotions and communicating the traumatic experiences are verbalized through representative play as well (Sweeney & Homeyer, 1999).

Evidence-Based Intervention Interventions may not be affordable nor feasible in reality for the target setting. When the interventions are available and affordable, then there are promises for implementation. Ideally, interventions have to be implemented as they are designed. Even though it is possible, modifications are required considering the available resources in the school. Formal and researchable ways of understanding the child’s experiences and devising preventive programmes are crucial in blocking violence. Many programmes target child–parent or parent only (specifically mothers)/child only approaches. But evidence suggests that inclusion of any parent is essential to improve relationships at home, demonstrate positive discipline practices and provide a safe place for anxious parents to share experiences with other parents (MacMillan & Harpur, 2003). Further, the mother–child group model is found to be the best community programme. The mothers are most supportive in identifying problem behaviours, exploring emotions, and bursting myths compared to separate child or mother programmes (Jaffe et al., 2004). The presence of the mother and the child in the same programme has essential benefits that ease change in attitude and behaviours. The interventions are complete and successful when they help the parents and children to be free from the effects of violence beyond the programme settings. They must have access and awareness of support services available for them. However, a perfect programme for helping children needs more research on marital conflict, different forms of domestic violence, neglect and abuse of children and parenting skills and lack of it. The available programmes also need thorough systematic evaluations to be applied to all social and cultural settings.

Multidisciplinary and Multimodal Community interventions and prevention need collaboration across disciplines, and each professional has different contributions to make. To understand the dynamics

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and prevent violence, it is essential that all professionals work towards a common goal, make resources available enforce the law, consider developmental stages of children, intervene early, provide safety and support mothers, have sound knowledge of issues and strive towards creating a culture of non-violence (Jacobson, 2000).

Role of Teachers and School Staff The school staff, including administrators, teachers, counsellors and support staff, are the key members of any school intervention. Prevention efforts for CWV need early intervention. The adolescent issues like homicide and assault are mainly due to the adverse experiences of childhood (Flannery et al., 2003). Young children display violent behaviours because they were exposed to it for the long term, either at home or in the community. Such children need early preventive intervention because they are at risk for violence perpetration in future (Lochman & Dodge, 1994). Research in this area indicates that most behaviours can be altered and corrected at school by providing a positive social environment (Kumar & Paul, 2019). The common problem with CWV is aggressive behaviour; many studies hint at targeting this behaviour for managing other behavioural issues. For instance, the Good Behaviour Game (GBG) suggests adopting classroom behaviour management for aggression and problem behaviours. The teacher can use concrete reinforcements to teams of students who refrain from using undesirable behaviours (Kellam & Anthony, 1998). The same programme extended to families and parents’ groups is called LIFT (linking the Interests of Families and Teachers) (Stoolmiller et al., 2000). Similarly, the CCPRG (Conduct Problems Prevention Research Group, 1999), carried out fast track prevention trials to check the long-term benefits for preventing antisocial behaviour. The programme is based on the developmental aspects of children from kindergarten to grade I. This approach is found to be effective for aggressive behaviour reduction and increasing social competence among children. Further, the peacebuilders (Flannery et al., 2003) emphasize on elementary school children. The programme focused on altering the culture and entire school environment. Prosocial behaviours were rewarded, and conflict mediation programmes were conducted. In this programme, five simple rules were laid for all students and staff like praising others for desirable behaviours, avoiding putting down others, taking advice from wise people, noting and correcting harmful behaviours and being aware of rights and wrongs. Such programmes can bring about a great deal of change in the problem behaviours of children and foster a sense of worth and confidence to see the positive side of life for CWV.

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Parent Involvement A healthy parent–child relationship includes the ability of the parents to communicate with the child, have a genuine concern for the child and have responsible attitudes towards their upbringing. Parent support is the key protective factor where resilience can be built with the interplay of individuals and the environment (Brookmeyer, Henrich, & Schwab-Stone, 2005; Masten, 1999). Family involvement in counselling and school can strengthen communication and positive outcomes (Vaishnavi & Kumar, 2018). A multidimensional approach between family and community can eliminate the after-effects of violence exposure and related behaviour problems. The understanding of the social world begins from the social cognitions that emerge from the family. For instance, a biased social cognition, hostile and aggressive behaviour may be acquired from exposure to anger and conflict (Schultz et al., 2000; Dodge et al., 1995). Similarly, the risk and impact of CWV can be overcome by nurturing attributes of parents and involvement in an intervention programme for benefits (Masten, 2001).

Community Partnerships and Community Advocacy Community partnership to protect children aims to bring about reforms in different components of actions. The four interdependent components that can be identified are; (a) development of individual courses of action for families and children by identifying potential risks, (b) Creating effective neighbourhood networks mainly for providing services, support, and information to public, (c) child protective agencies to involve in policy, practice, culture, and d. localize decision making by electing representatives from the agencies and community members (Rosewater, 2006).

Implication and Recommendations The chapter implies that children exposed to violence need to be given serious attention. Mindful interventions need to be structured and carried out, focusing on the issue’s developmental, social, and cultural roots. A multidisciplinary teamwork connecting homes, schools and the community would help in managing the concern. The chapter also points out the need for awareness among teachers, parents and the public. The chapter recommends efforts to support and educate parents, especially in the prevention of child maltreatment. The measures should focus majorly to curb family and domestic violence. There is also a significant need to focus on modifying the child-rearing practices within the present sociocultural discourse of India, which reinforces desensitization towards everyday violations and violence. The preventive measures taken should

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also reach the backward and underserved communities, battling the myth of children witnessing violence being an urban phenomenon. It would create awareness and highlight the need for researchers and professional teams, including physicians and psychologists, to probe deeper into the risk factors and prevention. The legal system also has to recognize the need to protect and care for these children. Their approaches need to be grounded in the sociopolitical reality of the location of the issue. The chapter indicates the imminent requirements of child protection policy modifications, accommodating the indirect and micro- and macro-level exposure to violence among children along with direct victimization.

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Chapter 11

Untold and Painful Stories of Survival: The Life of Adolescent Girls of the Paniya Tribes of Kerala, India T. S. Saranya, Shayana Deb, David Paul, and Sibnath Deb

Introduction Adolescent boys and girls of marginalized communities across the world are always vulnerable to neglect, risk and exploitation due to lack of social support, poor educational background of the parents and poverty. They are deprived of care, guidance and nutrition, and they hardly get opportunities to study and develop their skills. Although a good number of them get admitted in the primary school, a large number of them drop out of schools at the primary, upper primary and secondary levels. Latest data of 2019–2020, regarding school dropout rate of marginalized children, indicates that 18.64% of Scheduled Caste and 24.03% of Scheduled Tribe children in India leave the school at the secondary level, as compared to 10.94% children of the General community and 16.49% of the Other Backward Class community children (Source: National Informatics Centre (NIC), Ministry of Electronics and Information Technology (MeitY), Government of India). The adolescents who drop out of schools are not encouraged for re-admission in the school, rather parents prefer to engage them in some economic activities or in tasks of farming, especially in the rural belt. So far as the nutritional well-being of adolescent girls is concerned, a number of studies reported a high prevalence of malnutrition among marginalized adolescent girls in India (Bharati et al., 2009; Kurz & Johnson-Welch, 1994). In this regard, T. S. Saranya Department of Applied Psychology, Pondicherry University, Pondicherry, India S. Deb Department of Psychology, CHRIST (Deemed to be University), Bengaluru, India D. Paul · S. Deb (B) Rajiv Gandhi National Institute of Youth Development, Sriperumbudur, Tamil Nadu, India D. Paul e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_11

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Sachan et al. (2012) made an attempt to find out the factors responsible for prevalence of morbidity among school-going adolescent girls of Lucknow in North India. The study found a significant correlation between the morbidity of adolescent girls with caste, birth order, type of family, socio-economic status (SES), cohabitation with parents/guardian and general personal hygiene. Abuse of adolescents in the form of corporal punishment, and verbal and sexual abuse, is a global public health challenge. Adolescents of marginalized communities are more vulnerable to sexual harassment and abuse, which impact their later life adversely, in terms of discontinuation of education (Leach & Sitaram, 2007).

Tribal Groups in India Multiple tribal groups originate from India. India is home to the second largest tribal population in the world. The tribal groups account for 8.6 percent of the country’s total population (Census Report, 2011). Majumdar defines tribal groups as a collection of families or group of families bearing a common name, members of which occupy the same territory, speaks the same language and observes certain rules regarding marriage, profession or occupation and has developed a well-assessed system of reciprocity and mutuality of obligations. When compared to other communities, tribal population in India have the highest mortality rate and the most cases of epidemic diseases (Indian Ministry of Tribal Affairs, 2004). Indian tribes are more prone to alcoholism and smoking (Subramanian et al., 2004). Despite continuous actions and the implementation of welfare schemes, tribes in India continue to be underprivileged and marginalized, and their health and quality of life fall far short of national expectations (Indian Ministry of Tribal Affairs, 2004).

Paniya Tribals of Kerala According to the 2011 Census Report, the Scheduled Tribe population in Kerala is 426,204, accounting for 12.7% of the state’s total population. They are a disadvantaged group of individuals, with a literacy rate of 49.5 percent, compared to the state literacy rate of 93.9% (Census Report, 2001). Paniyas have a population of 92,500, with 64% of them living in the highlands of Kerala (Census Report, 2011). Paniya is derived from the Malayalam word “pani,” which means work. The majority of the Paniya sect is employed as laborers or farmers. Previously, they were employed as bonded laborers for the upper classes. Paniyas are believed to be of Dravidian descent. There is also a wide belief that Paniyas have an African origin. The European planting community brought the Paniya sect from Africa to Northern Kerala to work in their fields (Thurston, 1909). Paniyas use the Paniya language to communicate, which is a dialect of Malayalam.

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The Paniyas are settled in the northern districts of Kerala, namely Wayanad, Kannur, Malappuram and Calicut. Most of the Paniyas are living in the forest and hills. The Government of India has given them a special status by considering them as part of the Scheduled Tribes.

Cultural Practices and Rituals of Paniya Tribes of Kerala Paniyas offer their worship in a place called KuliTara, which is found only in Wayanad. In other areas, Paniyas offer their prayers in temples or churches. Paniyas have a common priest in a particular settlement area. He offers prayers and conducts rituals, though it is found that the members of the Paniya community now depend more on the priests of Hindu temples than their own priests. They believe in their traditional gods and goddesses like Kuliyan, Mariyamma, Kattu Bhagavathi, Kuttichathan and Kali, along with other gods like Vishnu, Shiva, Ayyapan, Jesus and other Prophets, belonging to different ethnic roots. Paniyas celebrate their own festivals like Maarikoottu, Puttariunu, Kudukkachery and Valliyoorkavu utsavam.

Child Rearing Practices of Paniya Tribes of Kerala These days, the Paniya tribes do not practice any pre-birth customs (attupundayattu) and rituals. Unlike earlier days, they prefer hospitals for deliveries, over midwives. Paniyas practice post-delivery rituals like naming ritual, first food feeding ritual and ear-boring ceremony, like that of Hindus. Paniyas believe that children are a gift from god. They equally accept both girl child and boy child. Some of the rituals like ear-boring ceremony and naming ceremony are not performed publicly for the children of unwed mothers. The broad objective of this chapter is to discuss the issues and concerns of the adolescent girls of Paniya tribes, in terms of alcohol addiction, menstrual management and hygiene practices and abuse experienced by them.

Evidence Concerning Major Issues of the Paniya Tribal Community The quality of the life of Paniya tribes is low when compared to the other communities of the country. More than half of the Paniyas have poor sanitation facilities, low housing standards and adverse living conditions. Contaminated drinking water, improper use of toilets and poor hygienic practices make them vulnerable to several

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illnesses. Despite their high health needs, they hesitate to seek health service (Haddad et al., 2008). Unhygienic living conditions and vulnerability to epidemic diseases are major hazards for the Paniya tribal community. Children and adolescents are the hope and future of any community, but Paniya adolescents are perpetually leading an unhealthy lifestyle with poor oral hygiene and poor sexual hygiene. Adolescent girls of Paniya communities are using old clothes instead of sanitary napkins, which can cause health issues. Saranya (2018) undertook a study to understand the issues and challenges of the Paniya tribal adolescents, with reference to menstrual management and menstrual hygiene practices. The investigation also attempted to explore the practice of alcohol consumption among the same community and different forms of abuse experienced by the adolescent girls. In order to gather detailed information, a semi-structured interview schedule was designed, in addition to case studies and observational methods. The study site was a tribal village in the Calicut district which has a total population of 3,086,293 (Census of India, 2011). The data was collected from the tribal villages of Pullurampara, Vattachira and Koduvally of Calicut district. Participants of the study were 35 Paniya tribal adolescents, aged 14–18 years, out of which 20 were girls and 15 were boys. Findings disclosed that more than 50% of the participants were women, and most of the participants were aged 17. The majority of the participants had at least one sibling. About half of the participant’s monthly family income was between Rs. 1000/- to Rs. 3000/-. More than 75% of the participants reported that their parents are not educated and engaged in seasonal employment. Most of the Paniya tribal adolescents had forsaken their studies. About 28% of the Paniya adolescents became school dropouts at the primary level, because of multiple factors like lack of guidance, poor quality teaching, distance of school from their house, engagement in family activities and taking care of minor children. The major findings which emerged from the study are presented under three broad categories: • Alcohol consumption • Menstrual hygiene and sanitation • Experiences of verbal, physical and sexual abuse. (i)

Alcohol Consumption

Alcohol consumption is a major problem of the Paniya community. Both men and women consume alcohol, and it is considered to be a normal cultural practice. Adolescents also consume alcohol, and while administering the questionnaires, few adolescents were found intoxicated, and they were not able to provide information. During the festivals, they provided alcohol for everyone in the community, except children below 5 years. Alcohol consumption results in poverty, as they spend most of their income toward it. It also affects family life, interpersonal relationships, education and job. The Paniya community does not consider alcoholism as a problem. They consume and serve alcohol to every member, including women and children, during rituals and festivals.

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This study also revealed that 51 and 9.1% of Paniya parents and adolescents consume alcohol almost regularly. Those adolescents who consume alcohol said that it affected their studies. The following two case studies describe how the discontinuation of education made adolescents dependent on alcohol: Case Study 1: (Alcoholism: A perspective of an adolescent boy) Case “A” belongs to the Paniya family of the Pullurampara Paniya settlement in the Calicut district. He works as a manual laborer and is 18 years old. He is a school dropout who only completed till the eighth grade. He lives with his parents in his own shelter, which he built with the assistance of the government. He attended a primary school in the surrounding neighborhood before transferring to a high school in the city. He was unable to adapt when he moved to a new setting. At the age of 14, he began working as a craftsman, abandoned his studies and began drinking alcohol. Now, he is unable to forsake his addiction and finds it difficult to earn a living, and he himself believes that alcoholism is a harmful habit that is wrecking his life. He claims that alcoholism runs in his family in Pullurampara, because both of his parents used to drink. He believes that he will never be able to achieve great things or make a lot of money in life, but will try to get out of this habit. Case Study II: (Alcoholism: A perspective of an adolescent girl) Case “B” is a member of the Malappuram district’s Paniya community. She is 16 years old and a seventh grade dropout. She lives with her mother, three younger siblings and her stepfather. Her father died of liver ailments, caused by excessive alcohol intake, and both her mother and stepfather are alcoholics. Her parents did not perceive the value of education and forced her to discontinue her studies. She is now able to support herself by working in nearby cultivable plots. She worries that alcoholism is ruining the lives of all the youngsters in the settlement. She thinks that alcohol is the enemy of every single child in the Paniya community, and she hopes that the government and other authorities would solve this issue. (ii)

Menstrual Hygiene and Sanitation

Unhygienic living conditions and vulnerability to epidemic diseases are major hazards for the health and life of the Paniya community members. Children and adolescents are the hope and future of any community, but the Paniya adolescents are leading unhealthy lifestyles with poor oral hygiene and sexual hygiene. Adolescent girls of Paniya communities are using old clothes instead of sanitary napkins during menstruation, which can cause health issues. Evidence from a Kerala study indicates that 90% of Paniya adolescents were not aware about the menstruation process till their first periods, and 60% of the adolescent girls used old clothes for menstrual management. They also reported that water scarcity made their days of menstruation miserable. In a secondary study, Kaur et al. (2018) observed similar findings, i.e., “little, inaccurate or incomplete knowledge about menstruation of adolescent girls, or women is a great hindrance in the path of personal and menstrual hygiene management.”

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Further, the authors observed that girls and women do not have much knowledge about reproductive tract infections, caused due to ignorance of personal hygiene during menstruation. Generally, in rural India, majority of the girls and women do not have access to sanitary products or are unable to afford such products due to their high cost. Therefore, they mostly rely on reusable cloth pads which they wash and use again. The following case study illustrates the knowledge of Paniya adolescent girls about menstrual hygiene: Case Study III: (Menstrual Hygiene: Perspective of an adolescent girl) Case “C” is a resident of the Paniya community in the Calicut area. She is 15 years old and does not attend school. She had her first menstruation when she was 13 years old. She had no idea about menstruation or how to manage it. She hurried to her mother and convinced that she had an illness. Her mother handed her some old clothes and forced her to spend a week in her “padi,” or hut. She has never used sanitary napkins for menstruation management and has no idea regarding their utility. She washes and dries old garments in the sun. During rainy days, she finds it difficult to dry her garments, and there is scarcity of pure cotton clothing. “I really wish I didn’t get periods throughout the rainy season,” she observed. (iii)

Experiences of Verbal, Physical and Sexual Abuse of Paniya Tribal Adolescents: Evidence from Kerala

Paniya adolescents were subjected to abuse in the form of verbal, physical and sexual violence. About half of the Paniya adolescents were subjected to verbal abuse. About 29.1% experienced physical abuse, and 25.20% were victims of sexual abuse in their lifetime. The following case study is a bright example of how Paniya adolescent girls become a victim of sexual exploitation, because of their innocence, and suffer lifelong for the same. Case Study IV: (Surviving from sexual abuse) Case “D” is a member of the Paniya settlement in Malappuram. She is illiterate and is 18 years old. She is a mother of a girl child. She stays with her brother and his family. Her daughter is staying in a Balika Sadan in the Malappuram district. She visits her daughter once in 6 months and is not able to bring her home due to various personal problems. She became a mother at the age of 16, and the father of her child is an outsider. She was sexually exploited by an outsider on the promise of marriage. Her family members have sustained their anger, and only her elder brother forgave her and allowed to stay with him. But, he is not willing to take care of the child because he does not want an illegitimate child in his home. She was not able to lodge a police complaint due to pressure from both within the community and outside it. She is very sad about what happened to her during childhood and is guilty of not performing the responsibilities of a mother. She believes that her daughter knows the situation very well and does not have any complaints. She wants her daughter to study well and settle in her future. She is planning to marry an individual from her

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own community, and he has promised her that he will take care of her child. But, she has no plan to bring her to the tribal settlement and spoil her future. Paniya adolescent girls are sexually abused, mostly by outside tourists. As a result of this, some of them conceive and deliver a baby and finally struggle a lot to raise the child since they are not mature enough to do so. Some of them also become victims of false promises of marriage, made by individuals of the neighboring community, and then, when the adolescent girls become pregnant, the perpetrator disappears. Although the Paniya tribal community does not stigmatize adolescent girls for premarital pregnancy, they do not provide much support to come out of the problem. Premarital pregnancy is one of the reasons for school dropouts and leading a poor quality of life. In sum, alcohol consumption is the main problem among the Paniya community of Kerala. For them, alcohol is an inevitable part of their livelihood (Mohindra et al., 2010). More than 50% of the Paniya parents consume alcohol as part of cultural practices, which affects their family peace. Mohindra et al. (2011) conducted a study to find out the use of alcohol and its effect upon the Paniyas of Kerala. They found that alcohol consumption is increasing at an alarming rate among the Paniya youth, and they work in the fields and farms of outsiders and receive alcohol as remuneration for their labor. About 28% of Paniya adolescents discontinued their studies due to the lack of educational facilities near their settlement. For higher education, they need to stay in the residential hostels. Most of the adolescents stated that they do not like to stay away from their family members and the environment. For the tribal people, their forest and their surrounding are their immediate family member, and a life away from their immediate environment causes distress among them. The school dropout rate among ethnic minorities is common (Griffin, 2002). The reason behind it is that the minorities cannot adhere to the culture and the environment of other groups. They tend to quit rather than being odd. Tribal schools were built to avoid this “cultural shock” by the Government of Kerala, but unfortunately, all these schools were far away from the tribal settlements and forests. Awareness programs concerning regarding menstrual hygiene and menstrual management are very low among the adolescents of the Paniya community, as they did not receive adequate information about menstruation from any of the sources. Talking about menstruation is considered a taboo among the community members. This results in seclusion of menstruating women from various activities. Lack of sanitation and proper menstrual management materials make periods miserable for Paniya women. Lack of resources and adverse climate also affect their well-being during menstruation. Psychological abuse was found to be more prevalent (69.9%) among Paniya adolescents, followed by physical abuse (29.1%). The main reason for verbal abuse is the prevalence of alcohol consumption among the elders of the household. Mcford stated that alcoholism of parents is the main reason for child abuse. About onefifth (25.20%) of Paniya adolescents were victims of sexual abuse in the form of

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unwanted physical interactions and abusive verbal interactions during their childhood. The tribal members are more vulnerable to sexual abuse, both from within the community and from the outside. Robin et al., (1997) conducted a study to find out the impact of child sexual abuse among indigenous tribes. They collected data from 582 America Indian Tribes and found that 49% of them were sexually victimized during childhood. Paniya community members are also subject to verbal abuse from the members of other communities. Verbal abuse in schools makes Paniya adolescents uncomfortable, and it prompts them to stay in their hamlet. Childhood adversities like physical abuse are common among ethnic minorities, especially among indigenous tribes, and the experience of childhood abuse can lead to alcohol dependence (Koss et al., 2003). Poor sanitation is another major issue prevalent among the Paniyas. Poor environmental and personal hygiene lead to many epidemic diseases in the area. In this regard, Deepa et al., (2011) conducted a study to find out the oral hygiene practices among the Paniya tribes. They found that regular tobacco and betel consumption leads to dental problems among Paniyas, and most of them do not brush their teeth and have poor oral hygiene. Paniya adolescents also do not receive proper health care facilities. The figure is very low. This may have happened as the tribes do not consider health as a serious matter of concern, and they practice their own biomedicines and cultural practices to cure illnesses by themselves (Badami, 2010). The mortality rate is high among the Paniya tribe members. In a study by Anish et al. (2010) in the Paniya tribal areas of Kerala, it was found that 31 deaths occurred in the area from 2005 to 2010 due to non-communicable diseases. Most of the victims perished at a young age. The adolescent girls reported that they do not receive adequate health care facilities. In fact, the health status of tribal women in Kerala is in a sorry state. Women from lower castes have a higher prevalence of health problems than those from higher castes, as disclosed by a study. They also found that low economic condition and lower caste together contribute to the poor health condition among the women of Kerala.

Conclusion As far as the socio-economic background of the Paniya community is concerned, they are part of the marginalized section of the society, and it is very difficult for them to manage a family of four to five members, with a meager income. Alcohol consumption is a cultural practice which has an adverse impact on the happiness of the family, and it is one of the main causes of abuse of the children in the family. Paniya adolescent girls possess poor knowledge about menstrual hygiene, resulting in health problems. A large number of adolescent girls experience psychological, physical and sexual abuse. Some of them conceive a child because of sexual abuse and experience challenges to extend care toward the child.

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Way Forward • Forming a self-help group for improving the economic condition of the Paniya tribes and in this regard, local NGOs should act as facilitators. • Encouraging children to get admitted to the schools and continue their studies. Also, monitoring children’s school attendance and providing support to them for education in terms of study materials, school uniform and guidance for study, in a central location of the village, is also necessary. • Engaging the public representative and other community leaders and school teachers to organize and participate in various welfare activities for the Paniya tribal community in Kerala. • Sensitizing the Paniya tribes about best practices concerning health and hygiene and making them aware of the adverse impact of alcohol consumption and the rights of children. • Adolescent girls and their parents should be encouraged to report sexual abuse cases to the police or child welfare committee. Mental health support should be extended to adolescent girl victims of sexual abuse. • Local panchayats should address other important issues like sanitation facilities and safe drinking water, in and around the village where the Paniya people reside. Local NGOs should be encouraged to join hands with the Panchayat and the block offices for the overall development of the area and well-being of the Paniya community. Implications of the Field-based Evidences Evidence generated from the empirical investigation threw light on the life of one of the marginalized sections of the society, that is, the Paniya adolescents. The findings of the present study are an eye opener for the tribal welfare policymakers of the Kerala government, and they should think about improving the situation of adolescents, in terms of educational facilities, nutrition and their safety. Lack of educational facilities in and around the village is the main cause of the low level of literacy among the Paniya community. Efforts should be made to arrange for vocational training programs for the Paniya adolescents, who are out of school or had never been to school, so that they can lead an independent life.

References Anish, T. S., Vijayakumar, K., George, D. R., Ramachandran, R., & Lawrence, T. (2010). Deprived among marginalized-Health status of women in a tribal settlement. Int Res J Soc Sci, 3(2), 77–84. Badami, S. (2010). Between medicine and manthravadi: Agency and identity in Paniya health. South Asian History and Culture, 1(2), 301–314 (2010) Bharati, P., Shome, S., Chakrabarty, S., Bharati, S., & Pal, M. (2009). Burden of anemia and its socioeconomic determinants among adolescent girls in India. Food and Nutrition Bulletin, 30(3), 217–226.

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Deepa, K. C., Jose, M., & Prabhu, V. (2011). Ethnomedicinal practices for oral health and hygiene of tribal population of Wayanad, Kerala. International Journal of Research in Ayurveda & Pharmacy, 2(4). Deprived among the marginalized–health status of women in a tribal settlement. International Research Journal of Social Sciences, 77. Griffin, B. W. (2002). Academic disidentification, race, and high school dropouts. The High School Journal, 85(4), 71–81. Haddad, S., Feletto, M., Mohindra, K. S., Contreras, G., & Narayana, D. (2008). Comparative health outcomes of Paniya tribes (Wayanad, Kerala): The need to address their differential vulnerability. South Asian History and Culture, 1(2), 301 India, P. (2011). Census of India 2011 provisional population totals. New Delhi: Office of the Registrar General and Census Commissioner. Koss, M. P., Yuan, N. P., Dightman, D., Prince, R. J., Polacca, M., Sanderson, B., & Goldman, D. (2003). Adverse childhood exposures and alcohol dependence among seven Native American tribes. American Journal of Preventive Medicine, 25(3), 238–244. Kurz, K. M., & Johnson-Welch, C. (1994). The nutrition and lives of adolescents in developing countries: Findings from the nutrition of adolescent girls research program (p. 1). ICRW Reports and Publications. Kaur, R., Kaur, K., & Kaur, R. (2018). Menstrual hygiene, management, and waste disposal: practices and challenges faced by girls/women of developing countries. Journal of Environmental and Public Health. Leach, F., & Sitaram, S. (2007). Sexual harassment and abuse of adolescent schoolgirls in South India. Education, Citizenship and Social Justice, 2(3), 257–277. Ministry of Tribal Welfare. (2004). Government of India. https://tribal.nic.in/ Mohindra, K. S., Narayana, D., Anushreedha, S. S., & Haddad, S. (2011). Alcohol use and its consequences in South India: Views from a marginalised tribal population. Drug and Alcohol Dependence, 117(1), 70–73. Mohindra, K. S., Narayana, D., Harikrishnadas, C. K., Anushreedha, S. S., & Haddad, S. (2010). Paniya voices: a participatory poverty and health assessment among a marginalized South Indian tribal population. BMC Public Health, 10(1), 1–9. Robin, R. W., Chester, B., Rasmussen, J. K., Jaranson, J. M., & Goldman, D. (1997). Prevalence and characteristics of trauma and posttraumatic stress disorder in a southwestern American Indian community. American Journal of Psychiatry, 154(11), 1582–1588. Sachan, B., Idris, M. Z., Jain, S., Kumari, R., & Singh, A. (2012). Social determinants and its influence on the prevalence of morbidity among adolescent girls. North American Journal of Medical Sciences, 4(10), 474. Saranya, T. S. (2018). Perceived parental care and support services and its relationship with mental health of Paniya Adolescents, Unpublished Doctoral Thesis submitted to the Pondicherry University. Subramanian, S. V., Nandy, S., Kelly, M., Gordon, D., & Smith, G. D. (2004). Patterns and distribution of tobacco consumption in India: cross sectional multilevel evidence from the 1998–9 national family health survey. BMJ, 328(7443), 801 Thurston, E. (1909). Castes and tribes of southern India, Vol. 7-T to Z.

Part II

Status of Children Under Difficult Circumstances

Chapter 12

Children of Stigmatized Parents: Concerns and Fostering Holistic Development Aishwarya Gautam and Subhasis Bhadra

Introduction Stigma is a social process in which certain individuals or groups are undervalued due to undesirable attributes perceived by others (Goffman, 1963). These attributes indicate some difference or a deviation from the norm (Jones et al., 1984). This commonly includes perceived weakness or dangerousness of character (Goffman, 1963) and non-conforming behavior (Link & Phelan, 2001; Major & O’Brien, 2005; Room, 2005). Stigma causes social exclusion, which can have a negative influence on physical and mental health along with an impact on socioeconomic status (Major & O’Brien, 2005; Room, 2005). Many research studies have documented that the impact of stigma befalls on the individuals with their mere association with the discredited people (Goffman, 1963; Jones et al., 1984). This was referred to as courtesy stigma by Goffman whereas other authors called it secondary (Ogunmefun et al., 2011) or associative stigma (Mehta & Farina, 1988). Because of the proximity, dependency and genetic relationship with the stigmatized person, family members are especially susceptible (Goffman, 1963; Mehta & Farina, 1988). Studies have pointed out that families may be blamed or viewed as contaminated by others (Corrigan et al., 2006). Apart from this, families are likely to feel self-stigma in which they internalize the devalued perspectives of others about them and this has a detrimental effect on their well-being (Mak & Cheung, 2008). Various studies reflect that courtesy stigma persists among families stigmatized due to mental illness (Phelan et al., 1998), intellectual disabilities (Ali et al., 2012), Alzheimer’s disease (Werner et al., 2011), HIV (Cree et al., 2004; Ogunmefun et al., 2011), alcohol and drug abuse (Marshall, 2013), divorced parents (Cetinkaya & Ercin, 2014), sex workers (Dutt, 2021), and many more. Families of criminals are A. Gautam · S. Bhadra (B) Department of Social Work, School of Social Sciences, Central University of Rajasthan, Bandarsindri, Kishangarh, Ajmer, Rajasthan, India © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_12

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also stigmatized due to their association with the offender (Murray & Farrington, 2008). Re-conceptualizing stigma in connection to disclosure can help us rethink how we understand concealment and silence in families as a reaction to stigma with its own set of repercussions. Silence surrounding the mental illness among parents is linked with and contributes to inadequate literacy around mental health. This may lead to increased social withdrawal and self-stigmatization for the entire family, thereby worsening the repercussions of intergenerational illness experiences and limiting access to effective treatment and support (Trondsen & Tjora, 2014).

Conceptualizing Stigma Previous studies documented the views on the discrediting nature of stigma and its associative characteristics impacting the family members especially the children (Gaiha et al., 2020; Goffman, 1963; Mehta & Farina, 1988). Ostracization and social inequality faced by stigmatized individual leads to their marginalization which further stigmatizes them making it difficult to emerge out of the stigma. Stigma depicts a set of shared attitudes, beliefs, and values which can be conceptualized at both individual and cultural levels. Stigma takes the form of thoughts, feelings, and behaviors at an individual level that expresses prejudices against people affected with it. Whereas stigma at cultural level is manifested in policies, laws, discourse, and socioeconomic conditions of stigmatized people (Fig. 12.1). Stigma is faced by individuals in different domains which is attempted to be indicated through the various circles of stigma. Following are the perceived reasons why individuals are stigmatized under each circle.

Health Stigma related to health undermines and increases various processes like availability of resources, behavioral and psychological responses, social relationships and stress which ultimately lead to adverse health outcomes. People feel stigmatized based on their health status due to the perception that • • • • • •

they possess inability to perform everyday chores they are immobile they are unproductive workforce their characteristics are contagious their disease can be genetically transmitted their health is the result of previous birth’s wrongdoings

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Profession

Health

Mental Illnesses Intellectual Disabilities Physical Disabilities Leprosy HIV Mental Retardations

Life Event

Rohingya Muslims and refugee communities Pakistani Hindus Migrants from North East

Sex Work Manual Scavenging Sanitation Work Exotic dancer/bar dancer

Crime accused Alleged criminals Women labeled for witchcraft Rape survivors Alcohol and drug abusers Divorced

Homosexuals Kinner community Single Mothers

Gender IdenƟty

Blemishes of Character

Fig. 12.1 Circles of Stigma (developed by the authors)

Profession People affected with stigma related to profession face social marginalization and discrimination which results in adopting the behavior of concealment of their professional identity from their families. It affects their earnings and functionality of the families because of the perception of • dirty work • lower caste • unskilled labor.

Life Events People are affected by various incidents which are not necessarily the outcomes of their birth identities. Consequences of uncontrolled incidents in life push them into marginalization which results in stigmatization because they are perceived to be • persecuted from home country • refugees (like Rohingya Muslims) • those who snatch rights of locals

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• unlike the natives • petty thieves.

Gender Identity Simply conforming to a particular gender may also lead to stigmatization because of the perceived deviance from societal values and social roles. Stigma related to gender identity exists because of – • • • •

non-acceptance of same-sex relationships illegitimacy tag on fatherless child rejection by family belief that they perform black magic/sorcery (esp. Women labeled for Witchcraft).

Blemishes on Character Character of a person needs validation from society and functions as per the approved social norms. When the character is spoiled or possessed with a mark which is against the societal conformation of the set norms, stigma sets in affecting the everyday functioning of the individuals/groups because such people are perceived to be • • • • •

having socially unacceptable behavior mentally unfit having a bad character using drugs which leads to criminal activity violent with no self-control and weak-will

All these factors further jeopardize the conditions of stigmatized people by pushing them deeper toward marginalization and poverty. People are disadvantaged and marginalized due to the lack of social networks, reciprocity, and trust. Marginalization is perceived through the lens of power and status through which people exercise their skills, knowledge, material, and symbolic endowments (Bourdieu, 1972; Brann-Barett, 2011). Stein (2003) underlined that the stigma and discrimination faced by the families is similar to the mentally ill patients themselves especially in cases of schizophrenia. He further highlighted that the substance using patients and their families face the most stigma as compared to all disorders. These patients and their families have deeply internalized the stigma and feeling of discrimination that it affects their selfidentity and many other aspects of their lives including marriage, business, education, relationships, etc. Stigma is perceived more severe in Asian countries where family is an important institution in an individual’s life which has highlighted this fact that the families of mentally ill persons also bear the brunt of stigma and discrimination similar to the patients, especially in case of chronic disorders such as schizophrenia.

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Further, the substance using patients and their caregivers had the highest total stigma of all disorders. These feelings of stigma and discrimination are deeply entrenched in the psyche of the patients and their family members affecting many spheres of their life (marriage, business, education, relationships, etc.,) and self-identity.

Effects of Stigma on Parenting Understanding the dynamics of stigma is important because research has shown that the stigmatization of individuals and social groups has deleterious material effects. For instance, in a meta-analytic review of 134 psychological studies into the relationship between enacted stigma (i.e., discrimination) and mental and physical health outcomes, Pascoe et al. (2009) found that perceived discrimination has a significant negative effect on both physical and mental health, leading to heightened stress responses (i.e., higher cortisol secretions, elevated blood pressure and increased heart rate) and is strongly associated with participation in unhealthy behaviors. Social injustice faced by stigmatized individuals has a substantial impact on everyday events and interactions. But not everyone behaves the same way as a result of the onset of prejudice and discrimination they go through. They may behave in the same manner but it depends on the pattern and frequency of this behavior that is significant to the impact it can have on their lifestyle and safety. Stigma is not only directed because of one aspect but can have additional consequences that too can have adverse effects on social and domestic harmony ultimately impacting parenting. Stigmatized parents are part of a non-homogenous group, and hence, any broad generalizations must be interpreted as such. Stigma can be experienced in different contexts and due to various reasons. Overemphasis on these complexities is only relevant to guard against over-categorization and over-simplistic analysis to prevent it from leading to misunderstanding and misinterpretation. The goal of any generalized statement is to allow for a broad mapping of the territory in order to arrive at constructive assessments and understandings. It is widely believed that a good parent is someone who nurtures, provides for and protects the child. Mothers said that these were the unflagging rights and responsibilities of the parents and the eventual goal of parenting (Eaton et al., 2016). But because stigma affects the everyday events and functioning of a person, it may have a significant effect on their parenting. When parents are stigmatized due to health issues, especially mental illness, it clearly has the risk factor for developing psychiatric disturbance among children (Beardslee, Versage, & Gladstone, 1998) operating through multiple interactive, psychological and genetic mechanisms. Men or women with mental disability who are parents also face the blame of contaminating their children too which leads to separation of their child from them and placing her/him in institutional care which triggers the stigmatization for children also (Solantaus & Puras, 2010). Hence, mothers and fathers conceal the challenges they face in parenting while experiencing mental distress to avoid separation (Cremers et al., 2014). Discriminatory nature of child welfare practices results in feelings of

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loss, fears, and grief by parents about the influence of these practices on the children (Kaplan et al., 2009). The (in)ability to realize the role of an idealized parenting brings shame among parents and leads to intensified self-stigma internalized by them. Parents whose professions are stigmatized have to conceal their work from their families and especially children to protect them from developing negative person hoods and subjectivities. In order to hide the work they do to earn a living, they have to become an invisible public parent to their children resulting in spending less time with them. They even avoid being recognized as a parent in public. For keeping their profession a secret, they have to avoid social interactions in the neighborhood, limiting the talks that can be had at home or relying on individuals who are aware of their occupations to not expose it (Walters, 2019). Mothers who are rape survivors face social exclusion and are frequently condemned. Stigma attached to rape magnifies the hardships faced by the victims and their families. Myths related to rape lead to stigmatization which promote social climate that makes sexual violence seem defensible and acceptable. Prolonged effects of rape affect the way survivors approach parenting and stigmatization make it more difficult. The repercussions of sexual trauma may affect the relationship between mother and child in many ways especially if the child in question is born out of rape (Duncan, 2006). Previous research studies have indicated that sexual abuse traumas from past along with neglect, adversities, and child maltreatment create risks that distort the ability of the mother to comfort, care for, protect, and nurture her child (Duncan, 2004; Polusny & Follette, 1995; Schore, 2001). But stigmatized mothers also tend to become over-protective while raising their children, especially making them aware of their right to give consent before anyone tries to touch them even if it is out of genuine love (Duncan, 2006). Problematic alcohol and drug misuse has been linked by a significant body of research with various forms of child maltreatment and poor parenting both (Famularo et al., 1992; Reder & Duncan, 1999). Substance abuse is mostly perceived as a character weakness or a controllable behavior which makes it a highly stigmatized practice. Psychological and physical effects of substance misuse can translate into limited attention and time being provided to children, conflictual relationships and inconsistent care to them (Barnard, 1999). Substance abuse can lead to symptoms of apathy, feelings of paranoia, distorted image of children, altered perceptions, or listlessness (Seval Brooks & Fitzgerald, 1997). Substance misusing parents show loss of emotional control which deeply effect children due to violent, confusing, or frightening behavior (Laybourn et al., 1996; Seval Brooks & Fitzgerald, 1997).

Impact of Parental Stigma on Children Following the discussion on the impact of stigma on parenting, we will now turn our attention to the repercussions of parental stigma on child development and welfare. Laybourn et al. (1996) pointed out that “various aspects of a child’s situation interact with each other to produce different levels and time scales of impact.” The effects of parental stigma can be countered by diverse protective factors such as the personality

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of child and coping mechanisms of children as well as other people in their social system (Rutter, 1990; Howe et al., 1999). Although these factors are only likely to be helpful if children have a sense of self-esteem and confidence, a variety of problemsolving strategies and experiences of surviving or engaging with stressful situations (Rutter, 1990). Vulnerability among children depends on the extent to which they are directly involved in the problematic behavior of parents regardless of its seriousness. Children who are subject to aggression, neglect, violence, or rejection due to stigma, or those who face stigma-induced paranoia and delusions are the children who are the most vulnerable (Quinton & Rutter, 1985). Stigma may have a significant impact on parenting when parents are affected with mental illness which in turn affects children’s development. Along with that, mental disturbances in children have always been blamed on the parents which limits the scope of diagnosis and treatment. Stigma is operated at multiple levels viz a viz, social policy, public media, communities, schools, families, and individuals. Overcoming strategies require changing efforts which span throughout these interconnected spheres influencing stigma (Hinshaw, 2005). Stigma and discrimination related to HIV continue to be encountered round the globe, which disrupted the access to services and scale up efforts for HIV care, prevention, treatment, and support (UNAIDS, 2014). Documentation of stigma has been done of wide range of conditions like HIV (Nayar et al., 2014), epilepsy (Viteva, 2012), disability (Ali et al., 2012), tuberculosis (Courtwright & Turner, 2010), leprosy (van Brakel et al., 2012), and various mental illnesses (Kleinman, 1995). Stigma associated with these disabilities and diseases is not only limited to people affected by it but those as well who are directly connected with them such as caregivers, immediate family members, and children. Children who have been orphaned due to AIDS in parents face higher levels of mental health burden than those orphaned due to other reasons (Cluver, 2011; Cluver et al., 2010, 2013) which is exacerbated when stigma is also entangled (Cluver et al., 2008). Perkins et al. (2002) explored courtesy stigma by studying the children whose mothers had intellectual disabilities. He tried to understand the relationship between stigma and the attachment those children have with their mothers, self-esteem among them, and the quality of care provided by these mothers. The assessment was done using a self-developed 6-item measure which assessed the comfortability of the child to go in public and have friends around. In cases, where mother was perceived to be caring the child showed lower stigma while higher stigma was associated in cases where mother was perceived to be an ambivalent or cold caregiver. According to the findings, direct relationship was established between secure attachment with the mother and self-esteem among children. It was found out that warm caregiving acted as a catalyst in improving the mother–child attachment despite the presence of stigma. Small size of the sample and use of non-validated stigma scale were the limitations of the study. Children of deceased or disabled parents will be more vulnerable to elevated levels of anxiety, fear, depression, change in social and behavioral patterns and become more susceptible to transmission of any of the parental conditions. Lack of support to

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such children also makes them vulnerable—“The most important factor in the differential outcome is the presence, duration and quality of the parents’ social support” (O’Neill, 1985). Systematic analysis of the impact of parental stigma on children is extremely necessary to map a complete picture around child development. This can be understood under the following four heads.

Learning and Development of Children Discrimination and stigma based on health and socioeconomic status can have a considerable impact on a child’s health by diverting or impeding health and development pathways and outcomes. Studies on stigma related to these conditions have showed that the social processes of discrimination and stigmatization can have complicated and rather devastating consequences on the health and welfare of people, families, and the entire communities (Nayar et al., 2014). The potential consequences of psychiatric disorders among parents on children have been widely recognized in recent years. Various aspects of development among children can be influenced such as their cognitive, behavioral, physical, social, and emotional development. Although a variety of environmental and hereditary factors are the deciding components in linking children’s difficulties and psychiatric disease among parents, there is strong evidence that family contact and parenting quality are crucial meditation (Barnes & Stein, 2000; Murray et al., 2003). “Anticipated embarrassment and public humiliation” deemed a higher risk than “having unfulfilled practical and emotional needs,” resulting in the emergence of a “culture of secrecy” (Murphy et al., 2017). Children are expected to preserve the secret of the family to avoid humiliation; as a result, they avoid social activities, limiting prospects for seeking help and social development (Murphy et al., 2017). Children whose parents lack mobility due to their illness or disabilities, take on the roles of carers from a very young age. This can seriously jeopardize their health, educational, emotional, and social experiences. According to several studies, children are bullied and teased at school (Fudge and Mason, 2004), excluded from communal events and are socially avoided (Dam et al., 2017; Hinshaw, 2005; Koschade & Lynd-Stevenson, 2011). Young people became disengaged from education as a consequence of these experiences, which limited their access to vocational options and leisure activities (Gray, 2008). Nonetheless, some of the outcomes of being stigmatized were positive, as studies with children showed that they developed empathy and resilience as a result of dealing with the emotions of other people (Corrigan et al., 2005). Young carers are conceptualized as competent social agents. Emotional and behavioral maladjustments have been documented by researchers among children whose parents were either diseased or living with disability (Aldridge & Becker, 1999).

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Home Environment A stimulating and enriching home environment fosters brain development and healthy growth by providing the child with emotional support, opportunities, and love for exploration and learning. In families which face social exclusion, there are fewer emotional and economic resources to fulfill the stimulation needs of children which may impact their growth and development. Haug Fjone et al. (2009) documented the perception of young people considering artistic expression and solitude as “normal.” Lack of openness and information about mental illness of the parent caused children to take the blame for the problems of their parents (Hinshaw, 2005; Trondsen & Tjora, 2014), become angry since they are unable to understand the symptoms or behaviors of their parents’ mental illness (van der Sanden, Pryor, Stutterheim, Kok, & Bos, 2016) or avoid cordial relationship altogether with the parent (Bosch et al., 2017; Jeffery et al., 2013). Such experiences impact the interactions families have with their children and the bond they share impacting the architecture of the brain. When we strive to understand the significance of the environment in children’s development, one of the most commonly discussed aspects of parenting is responsive parenting. According to research, responsive parenting has the potential to foster normal developmental trajectories for children in high risk particularly those from low-income households or those born prematurely (Landry et al., 2001). Unresponsive parenting, on the other hand, may impair the development of children, especially those who are at higher developmental risks (Landry et al., 1997). Children who do not receive nurturing care in their early years are more likely to face learning difficulties in school, which reduces their future economic opportunities and has an influence on their families’ and societies’ prosperity and well-being (WHO, 2018). Social exclusion impacts the mental health of a person but if there already is a mental illness faced by any individual, rejection and avoidance from the society can further impact their relationships with the children which affect the healthy home environment children must be entitled to have for their betterment. Children of parents who have been incarcerated face multiple disadvantages such as unlikeliness of living in a two-parent house, monetary hardship, and less chances of having stable housing (Geller et al., 2009). Rag-pickers live in makeshift settlements in areas not recognised by government making them vulnerable to face the stigma. Due to the nature of their profession, their settlements are also surrounded by garbage and filth which are the only materials of play for their children. Their childhood development is degenerated as the children start rag-picking from as young as 5 years of age either by helping parents to segregate waste at home or by accompanying them to the dumpsite (Naftalin, 2004).

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Access to Adequate Services In the context of HIV, inequality, discrimination, and stigma contribute to children’s and parents’ negative outcomes related to health and have a disproportionate effect on the marginalized group of people (Catro & Farmer, 2005). Survival of children is very much influenced by stigma especially when families fear accessing the services of Prevention of Mother to Child Transmission (PMTCT). Social ostracism is faced by the whole family when any of the parents is suffering from mental illness as it is a very common outcome of stigma. In the process of managing stigma, families tend to conceal the mental illness of the parent which restricts them from gaining quality treatment or professional services (Hinshaw, 2005). Children learn from their parents, and hence, they themselves start hiding their conditions and are likely to become less expressive which further impacts their capacities to seek help from appropriate platforms. Stigmatized parents face discrimination and prejudice while accessing healthcare and education for their children that they are discouraged to pursue these services which impacts the development of the children. Children of sex workers suffer from unavailability of basic needs, nutritional deficiencies, social handicaps, and minimal healthcare (Das, 1991). Exclusion from the community impacts the everyday functioning of the family members and children face discrimination from neighbors and friends. Having learnt the art of hiding the family problems, children also tend to conceal issues they face from their families and are not upfront to seek professional help much needed for a better development.

Safety and Security Another consequence of stigma was a lack of willingness or ability on the part of children and parents to seek help or interact with mental health support and services (Cremers et al., 2014; Hinshaw, 2005; Kaplan et al., 2009; van der Sanden et al., 2016). Stigma may lead to feelings of isolation and hopelessness, shame and lack of understanding by people around. This may frustrate the individuals directly facing the stigma whose brunt is often faced by their children. Children may experience fear when caregivers they are close to leave them or threaten to leave them or punish them. They are most often punished harshly by being beaten by belts and sticks which may cause uncontrollable stress and fear among them affecting their response system in ways that lead to social, mental, and emotional maladjustment. Children in such situations learn to not trust adults, withdraw socially or develop anger issues by expressing aggression toward weaker children. Significant harm is most likely to be faced by those children who are the subject of violence, neglect, aggression, and rejection at the hands of the parents especially those who are substance abusers (Quinton & Rutter, 1985). Concealment of the

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condition which leads to stigma is a common practice among people facing stigma. Their children learn the same and try to hide the difficulties they go through and the maltreatments they might be encountering at the hands of others (Van Doesum et al., 2016). This seriously jeopardizes their safety as they might be subject to physical, verbal, or sexual abuse. It is significant to ensure the mental health of stigmatized parents in order to prevent maltreatment and make the children feel secure and safe. Children whose parents face stigmatization become highly vulnerable to following an impaired developmental trajectory. Their situations become highly stressful as they experience less stimulating environments and are characterized by deprivation of basic facilities. Children face a lack of emotional attachment, caring, and stimulating environment. The neighbors also avoid them which make their external environment weak. A child’s life becomes crippled due to stigma attached to their parents, and this takes a toll on their overall development.

Policy and Legislative Interventions In order to preserve civil rights, a legal system is mandatory for nations that can potentially eradicate discrimination. It is quite clear that infrastructure of enforcement is also lacking in developed nations along with developing ones. Previous studies have demonstrated that most discrimination related to disability is not being investigated by government officials in developed nations such as the USA (Moss et al., 2001). It is also evident that places where legal systems do function properly, individuals do not regard them as a reliable source of protection. There is also a possibility that law can be a part of this issue by enforcing stigma since it is evident from the example like preventing individuals with HIV to become soldiers or, cancelation of driver’s license for those who are suffering from epilepsy. Government laws and policies safeguard and normalize stigmatized populations using legislative approaches. One simple example is the USA, which imposed the Civil Rights Act of July 1964 leading to the prohibition of discrimination regarding ethnicity, religion, and origin of birth in services at public facilities and voter registration. Back in 1966, hospitals were required to eradicate discrimination to receive funds (Almond et al., 2006). According to the Educational Amendments Act, 1972s Title IX discrimination was barred from academic programs and recently extended to the protection of sexual minority students (United States Department of Education Officer for Civil Rights, 2010). Certain laws protecting the LGBT community including laws availing same-sex marriage contribute to evidence regarding the value of legislative interventions. A study done by Hatzenbuehler et al. (2012) demonstrated that post legalizing same-sex marriages, there was a decrement in the frequency of medical as well as mental care visits. A study performed by Diop (2000) demonstrated that governmental policies can reduce stigma at lower system levels. It is evident that facilities such as free education and access to antiretroviral therapies can greatly reduce stigma at the intrapersonal level which also resulted in increased HIV testing. A survey study done in Nepal

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by Cross (2006) found that patients with leprosy carried a self-driven initiative by implementing changes at the structural level. Another study done at the intrapersonal level demonstrated that American students of African origin had less chances of being assigned to remedial education which suggest an upwardly cascading affect. Other than this, the USA witnessed the Black Lives Matter Movement in 2012 as a response to the death of Trayvon Martin. Black lives have never been of importance in the USA since its beginning. Enslavement, oppression, and stigmatization happened there of black people due to their skin color and various biological characteristics used to happen there. Even after the abolition of slavery, blacks were discriminated and stigmatized but after post-Civil rights movement things began to change. When George Zimmerman, a member of neighborhood watch was acquitted after killing Trayvon Martin, the phrase “Black Lives Matter” was invented (Tanika, 2016). The Constitution of India defends the right to life and personal liberty of every person irrespective of their caste, class, gender, religion, or race. It also talks about prohibition of discrimination on all grounds. In order to ensure the implementation of constitutional provisions, strong legislations are required to make sure that they ease treatment, minimize suffering, maximize liberty, and are fair, equitable, and proportionate for people facing stigma and social exclusion. India’s Mental Health Act, 2017, talks about reducing stigma and enhancing inclusion by planning, designing, funding, and implementing stigma reduction programs in an effective manner (Mental Healthcare Act, 2017). Leprosy is a highly stigmatized disease in India, and hence, Law Commission has recommended in its report published in 2015 on Eliminating Discrimination Against Persons Affected by Leprosy to remove such terms from all government documents and statute books for reducing the stigma perpetuation associated with it. The Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Act, 2017, has been formed for the main purpose of addressing the stigma faced by people infected with HIV/AIDS, ensuring privacy and confidentiality while providing services related to HIV/AIDS, and ensuring legal accountability by strengthening existing programs to control AIDS. It talks about prohibition of acts of discrimination in housing, employment, and education. The Rights of Persons with Disabilities (RPWD) Act, 2016, defines discrimination and mentions about it in almost all sections in order to ensure equality, access to quality resources, and promote inclusivity. Laws cannot improve the differences created by stigma since there are multiple components in the process that are out of reach from the legislation. Considering the healthcare sector, studies have found that getting diagnosed with mental illness is a huge barrier to seeking mental help (Corrigan, 2004). Likewise, anti-discrimination laws cannot safeguard handicapped children whose parents are against the thought of their children getting labeled with a mental illness (Kauffman et al., 2007). Law has been one of the most important tools in nullifying the effects of stigma by safeguarding information as well as forbidding discrimination that can lead to stigmatization. However, it should be clearly understood that law also has limitations. It has the potential to address behavior but does not necessarily change an individual’s attitude that induces the behavior.

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It is understandable that law cannot exercise its powers in every situation. For example, individuals repudiated from one’s family or rebuffed by one’s partner. Discrimination laws in various countries are made based upon notion of intent. It is often seen that judges demand proof related to an individual actively disliking someone else and intending to do harm in such a case. Also, it has been frequently found that legal remedies are not significant enough to understand the act of stigma in individuals. Also, it is not enough to assure individuals with stigmatized conditions to come up front and resist such conditions.

Conclusion Stigma is a serious issue in our society that has an impact on how health, economic, housing, and social resources are distributed. Stigma impacts at many levels in our society which are macro- (structural/cultural), meso- (institutions, community, family), and micro-level (self-stigma). Stigma has various structural components that work at an extremely subtle level similar to institutionalized racism which is influenced by unequal power as evidenced in policies, regulations, practices, and so on. One strategy is to try to modify society’s perceptions of excluded groups. Another option is to work with people in these groups to develop interventions that reduce the influence of unfavorable societal stereotypes and beliefs so that they are not internalized. Many groups such as poor, people with HIV/AIDS, mental illness, LGBTQ, rape survivors, substance abusers, sex workers, refugee population, people with Alzheimer’s, autism, epilepsy, etc., have a history of being stigmatized and marginalized. Stigma does not just impact the person directly facing it but its brunt is also felt by people dependent on the stigmatized individual especially children. If protective elements are not mobilized, parental stigma can have serious negative implications for children and leave a lengthy shadow, leading to issues in adulthood. Children of stigmatized parents are at high risk of a wide range of developmental difficulties. It impacts their learning and developmental aspects as children in stigmatized environments can have adverse effects on their health and welfare. Stigmatized conditions also affect the home environment which makes it less stimulating and brings in constraints in the everyday interactions among the family members. Labels of stigma limit the accessibility to adequate basic services and also affect the security aspect among children. Legislations related to a few stigma affected conditions are in place but their implementation is a challenge. Legal remedies are often insufficient to dissuade people from pursuing stigma or, more crucially, to reassure people with stigmatized conditions that they can actively reject stigma or risk going out in public. Intervention in families which are living with stigma must be reconsidered. These should involve interdisciplinary efforts with disciplines such as public health, social work, anthropology, psychology, law, criminal justice, public policy/administration, economics, medicine, business, and nursing. The interventions must target all levels from micro- to meso- to macro-enabling social workers to lead the way in addressing

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and identifying structural factors, working with institutions and communities for reducing prejudice and discrimination, advocating for these groups, and networking with people from various stigmatized groups to help them in resisting and reducing the impact of stigma.

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Jeffery, D., Clement, S., Corker, E., Howard, L. M., Murray, J., & Thornicroft, G. (2013). Discrimination in relation to parenthood reported by community psychiatric service users in the UK: A framework analysis. BMC Psychiatry, 1–9. Jones, E. E., Farina, A., Hastorf, A. H., Markus, H., Miller, D. T., & Scott, R. A. (1984). Social stigma: The psychology of marked relationships. Freeman. Kaplan, K., Kottsieper, P., Scott, J., Salzer, M., & Solomon, P. (2009). Adoption and Safe Families Act state statutes regarding parents with mental illnesses: A review and targeted intervention. Psychiatric Rehabilitation Journal, 91–94. Kauffman, J., Mock, D., & Simpson, R. (2007). Problems related to underservice of students with behavioral disorders. Behavioral Disorders, 43–57. Kleinman, A. (1995). The social course of epilepsy: Chronic course of illness as social experience in interior China. In A. Kleinman (Ed.), Writing at the margins: Discourse between anthropology and medicine (pp. 144–172). University of California Press. Koschade, J. E., & Lynd-Stevenson, R. M. (2011). The stigma of having a parent with mental illness: Genetic attributions and associative stigma. Australian Journal of Psychology, 93–99. Landry, S. H., Smith, K. E., Miller-Loncar, C. L., & Swank, P. R. (1997). Predicting cognitivelinguistic and social growth curves from early maternal behaviors in children at varying degrees of biological risk. Developmental Psychology, 33(6), 1040–1053. Landry, S. H., Smith, K. E., Swank, P. R., Assel, M. A., & Vellet, S. (2001). Does early responsive parenting have a special importance for children’s development or is consistency across early childhood necessary? Developmental Psychology, 37(3), 387–403. Laybourn, A., Brown, J., & Hill, M. (1996). Hurting on the Inside. Aldershot: Avebury. Link, B. G., & Phelan, J. C. (2001). Conceptualising stigma. Annual Review of Sociology, 363–385. Major, B., & O’Brien, L. T. (2005). The social psychology of stigma. Annual Review of Psychology, 393–421. Mak, W. S., & Cheung, R. (2008). Affiliate stigma among caregivers of people with intellectual disability or mental illness. Journal of Applied Research in Intellectual Disabilities, 532–545. Marshall, O. (2013). Associative stigma among families of alcohol and other drug users. Edith Cowan University, 1–86. Mehta, S., & Farina, A. (1988). Associative stigma: Perceptions of the difficulties of college-aged children of stigmatized fathers. Journal of Social Clinical Psychology, 192–202. Moss, K., Burris, S., Ullman, M., Johnsen, M., & Swanson, J. (2001). Unfunded mandate: an empirical study of the implementation of the Americans with Disabilities Act by the Equal Employment Opportunity Commission. Kansas Law Rev, 1–110. Murphy, G., Peters, K., Wilkes, L., & Jackson, D. (2017). Adult children of parents with mental illness: Navigating stigma. Child and Family Social Work, 330–338. Murray, J., & Farrington, D. P. (2008). The effects of parental imprisonment on children. Crime and Justice: A Review of Research, 133–206. Murray, L., Matt, W., Murray, J., & Cooper, P. (2003). Self-exclusion from health care in women at high risk for postpartum depression. Journal of Public Health Medicine, 131–137. Nayar, U. S., Stangl, A. L., Zalduondo, B. D., & Brady, L. M. (2014). Reducing stigma and discrimination to improve child health and survival in low- and middle-income countries: Promising approaches and implications for future research. Journal of Health Communication: International Perspectives, 142–163. O’Neill, A. M. (1985). Normal and bright children of mentally retarded parents: The Huck Finn syndrome. Child Psychiatry and Human Development, 255–268. Ogunmefun, C., Gilbert, L., & Schatz, E. (2011). Older female caregivers and HIV/AIDS-related secondary stigma in rural South Africa. Journal of Cross Cultural Genterology, 85–102. Pascoe, E. A., & Richman, L. S. (2009). Perceived discrimination and health: A meta-analytic review. Psychological Bulletin, 531–554. Perkins, T. S., Steve, H., Kay, D., Flory, M. J., & Vietze, P. M. (2002). Children of mothers with intellectual disability: Stigma, mother–child relationship and self-esteem. Journal of Applied Research in Intellectual Disabilities, 297–313.

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Phelan, J. C., Bromet, E. J., & Link, B. G. (1998). Psychiatric illness and family stigma. Schizophrenia Bulletin, 115–126. Polusny, M., & Follette, V. (1995). Long-term correlates of child sexual abuse: Theory and review of the empirical literature. Applied and Preventive Psychology, 4, 143–166. Quinton, D., & Rutter, M. (1985). Family pathology and child psychiatric disorder: A four year prospective study. Wiley. Reder, P., & Duncan, S. (1999). Lost innocents: A follow-up study of fatal child abuse. Routledge. Room, R. (2005). Stigma, social inequality and alcohol and drug use. Drug and Alcohol Review, 143–155. Rutter, M. (1990). Psychosocial resilience and protective mechanisms. Cambridge University Press. Schore, A. (2001). The effects of early relational trauma on right brain development, affect regulation, and infant mental health. Infant Mental Health Journal, 22, 201–269. Seval Brooks, C., & Fitzgerald, R. K. (1997). Families in recovery: Coming full circle. Paul H. Brookes Publishing Company. Solantaus, T., & Puras, D. (2010). Caring for children of parents with mental health problems—A venture into historical and cultural processes in Europe. International Journal of Mental Health Promotion, 27–36. Stein, A. (2003). The impact of parental psychiatric disorder on children. BMJ, 242–243. Tanika, S. (2016, November 1). #BlackLivesMatter: This Generation’s Civil Rights Movement. #BlackLivesMatter: This generation’s civil rights movement. Portland State University. The United States Department of Justice. (2010). United States Department of Education Officer for Civil Rights. Department of Justice. Trondsen, M. V., & Tjora, A. (2014). Communal normalization in an online self-help group for adolescents with a mentally Ill parent. Qualitative Health Research, 1407–1417. UNAIDS. (2014). Reduction of HIV-related stigma and discrimination. UNAIDS. van Brakel, W. H., Sihombing, B., Djarir, H., Beise, K., Kusumawardhani, L., Yulihane , R., & Wilder-Smith, A. (2012). Disability in people affected by leprosy: The role of impair- ment, activity, social participation, stigma and discrimination. Global Health Action, 5. van der Sanden, R. L., Pryor, J. B., Stutterheim, S. E., Kok, G., & Bos, A. E. (2016). Stigma by association and family burden among family members of people with mental illness: The mediating role of coping. Social Psychiatry and Psychiatric Epidemiology, 1233–1245. Van Doesum, K. T., Riebschleger, J., Carroll, J., Grove, C., Lauritzen, C., Mordoch, E., & Skerfving, A. (2016). Successful recruitment strategies for prevention programs targeting children of parents with mental health challenges: An international study. Child and Youth Services, 156–174. Viteva, E. (2012). Impact of stigma on the quality of life of patients with refractory epilepsy. Seizure, 64–69. Walters, V. (2019). Parenting from the ‘Polluted’ margins: Stigma, education and social (im)mobility for the children of india’s out-casted sanitation workers. South Asia: Journal of South Asian Studies, 42(1), 51–68. Werner, P., Mittelman, M. S., Goldstein, D., & Heinik, J. (2011). Family stigma and caregiver burden in Alzheimer’s disease. The Gerontologist, 89–97. WHO. (2018). nurturing care for early childhood development. WHO.

Chapter 13

Safety and Welfare of Children Under Institutional Care in India: A Situation Analysis K. Bhuvaneswari, Shayana Deb, David Paul, and Sibnath Deb

Introduction As per the UN Convention on the Rights of the Child (1989), a family is the best place for healthy mental stability, proper career and social development of a child. During the development phase, a child needs parents’ love and affection which, in turn, makes a child comfortable and confident. If biological parents are not available, it is the responsibility of the respective local and/or state government to take care of the child’s upbringing, as indicated by various legislative measures. Sadly, a large number of children live in different institutions across the society and experience various challenges which they bear silently. It has been observed that, wherever and whenever there is a lack of care and protection, children face many difficulties and the severity of it often leads to the death of the child. If the child survives the difficult situation, the negative consequences aggravate the growth and development of the child. The negative consequences depend on the form and severity of the abuse, risk and various protective factors present within the individual, the family and in the society. As we know that the social and economic prosperity of a nation largely depends upon the presence of robust citizens within its fold, referring to children and youth. Mental health professionals and child policymakers at the national and international levels are unanimous in their opinion that quality child upbringing is very essential K. Bhuvaneswari Department of Psychology, Kasthurba College For Women, Puducherry, India S. Deb Department of Psychology, CHRIST (Deemed to be University), Bengaluru, India D. Paul · S. Deb (B) Rajiv Gandhi National Institute of Youth Development, Sriperumbudur, Tamil Nadu, India D. Paul e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_13

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for optimal utilization of the potential of a child, which has been reflected in all international policies. For example, the Millennium Development Goals, established in 2000, emphasized upon health and education of all children. Of the total eight goals, three were directly related to the survival and development of children. The second goal is about achieving universal primary education while the fourth one talks about reducing child mortality. The fifth goal stressed upon improving maternal health. The eight Millennium Development Goals were revisited in 2015, and the United Nations came out with Sustainable Development Goals, set to be achieved by 2030. Sustainable Development Goals has 17 well-defined goals and some of the goals are directly related to the healthy growth and development of children, like Goals 3, 4 and 5, aiming at improving the health, education and equality among the children (“Sustainable Development Goals: Sustainable Development Knowledge Platform”, n.d.).

Need for Child Welfare Children across the society experience various forms of neglect, abuse, maltreatment and discrimination, without any fault of their own, which adversely affect their mental health, physical health, socialization tendencies and career growth, and they remain vulnerable to mental health challenges in later life. If the growth and development of a child is affected, irrespective of the severity of the consequences of neglect, abuse and maltreatment, it gets reflected on the society, both during the childhood, as well as when the child grows into an adult (WHO, 2005). Therefore, it is necessary to ensure quality care, safety and healthy upbringing of every child. For orphaned and destitute children, institutional care became a major pathway for their upbringing in a reasonably healthy environment, with basic care and support facilities.

Child Welfare in India Ancient India placed great importance to “The Family”, especially the perception of “The Joint Family”. Children, disabled, diseased and aged found a dignified space to inhabit and were not considered as a burden in such familial structures. They became part of the institution, irrespective of their ability and also contributed to the economic development of the family. A married couple anticipate that their offspring will find meaning in their life as well as perceived the child as a satisfying factor in the marriage, per se. Many ceremonies, customs, conventions, rituals are followed for purposes of care and protection during prenatal, natal and postnatal periods of childhood and adolescence, which are recorded in the ancient texts (Barooah, 1999). The system of celebrating

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the attainment of developmental milestones during childhood was prevalent in all religions, though the ways and means were different. The review of various child welfare measures taken by the Government of India after independence reveal that every five-year plan in India focused on some dimensions of child welfare and well-being and made appropriate efforts to achieve the goal through formulation of suitable programmes. For example, the first five-year plan (1951–56) put major emphasis on recognizing the different fields of social welfare, which have been taken care of by the voluntary organization. Health, nutrition and education of children were the thrust areas for the development of children. Thereafter, in 1952, the Indian Council for Child Welfare (ICCW) was established as a registered voluntary organization with an aim to organize training programmes for capacity building of personnel working as Anganwadi Workers and in other child welfare schemes. In addition, ICCW works for advocating children’s rights, provides training, conducts programmes for children, supports sponsorship, rehabilitation and conducts national integration camps and adventure camps (“Indian Council for Child Welfare”, 2010). Further, the establishment of the Central Social Welfare Board (CSWB) in 1953, for the refinement of voluntary actions by the organization, became a significant platform for collaborative efforts between the government and voluntary organizations. The second five-year plan (1956–61) emphasized on bringing legislation for the welfare and protection of children and thus, the Children’s Act was passed in 1960. The Children’s Act has a number of provisions for the overall welfare of the children. The distinctive needs of the child, as well as the efforts needed to coordinate many sectors, were recognized during the third five-year plan (1961–66). Nutritional programmes for the children were planned and the Kothari Education Commission paved the way for universal education for children. During the fourth five-year plan (1969–74), cooperation and support were extended in the form of financial commitments by the Government, towards the voluntary organizations, through People’s Action for Development in India (PADI), in 1973. National Policy for Children, 1974, considered children as supremely important assets and shouldered the responsibility of rearing healthy children in the society. It also clearly stated that the families needed to be strengthened for the full potential of growth of the children. During the fifth five-year plan (1974–79), Integrated Child Development Services (ICDS) was launched, in 1975, as one of the unique programmes for early childhood care and development in the world. Children aged between 0 and 6 years, pregnant women and lactating mothers are the beneficiaries of this scheme. The nature of services provided under the scheme include supplementary nutrition, preschool education, nutrition and health education, immunization, health check-up and referral services. ICDS benefitted a large number of children towards improving their health status, socialized them through non-formal education and prepared them for formal schooling. In rural areas, this scheme sensitized expecting and/or pregnant mothers for periodical health check-ups, resulting in delivery of healthy babies. Yet another

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milestone in child welfare was the formation of the National Children’s Fund in 1979, named Rashtriya Bal Kosh. The main concern of the sixth five-year plan (1979–84) was to develop a comprehensive Minimum Needs Programme to meet the basic needs of the poorest, especially in the rural areas. The government attempted to improve elementary education, adult education, rural health, rural water supply, nutrition, etc. The government felt the need of the support of the voluntary organizations to implement these programmes and the role of people’s participation and voluntary organizations were highlighted in the seventh five-year plan (1985–90). The Planning Commission formed during the seventh five-year plan stressed upon the vital role of alternative mechanisms for aiding the government to reach the poor rapidly. The Child Labour (Prohibition and Regulation) Act, 1986, was passed by the Indian Parliament during this plan period, for prevention of child labour. The seventh fiveyear plan sustained its commitment towards child welfare by establishing the Department of Women and Child Development, National Child Labour Project, in 1987, and formation of the Central Adoption Resource Authority in 1990. The eighth five-year plan (1992–97) paved the way for people’s participation in human development. A high-level meeting between the Planning Commission, voluntary organizations and the government, in 1994, identified the following core areas of concern, viz. health, family welfare, education, development of women and children, problems of urban dwellers and street children. The National Plan of Action for the Girl Child (1991–2000) was formulated by the government to address the specific needs of girl children in India. In response to this plan of action, many states introduced various schemes to care and protect the girl children. Schemes like “Cradle Baby Scheme” in Tamil Nadu, “Apni Beti Apna Dhan” in Haryana, “Raj Lakshmi Scheme” in Rajasthan, came into existence after that. The U.N. Commission on Human Rights in 1979 reviewed the proposal and formed a working group for the drafting convention. Thus in 1989, the United Nations Convention on the Rights of the Child was finally drafted. The Convention became a law within 9 months of approval by the U.N. General Assembly. India ratified the United Nations Convention on Rights of Children on 11th December 1992, which has more than forty rights for children and young people, and talked about establishing centres on survival, development, protection and participation of children, across the world without any discrimination. The eighth five-year plan (1992–1997) continued its commitment towards children, particularly girl children. The Department of Women and Child Development framed the National Nutrition Policy in 1993, with an objective towards enhancing the nutritional status of the children. During the ninth five-year plan (1997–2002), Sarva Shiksha Abhiyan (SSA) was launched (2001–2002), which emphasized on education for girls, children with special needs, children belonging to the SC community, ST community and other marginal sections. In the tenth five-year plan (2002–2007), it was emphasized that all children should be enrolled in schools by 2003 and all children must complete 5 years of schooling by

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2007, in addition to emphasizing on reduction of gender gaps in terms of literacy, by 2007. During this period, the National Charter for Children (2004) was adopted and it was stressed that every child needed to possess this inherent right, by facilitating healthy growth and development of children, while strengthening the family, the society and the Nation. The Prohibition of Child Marriage Act was passed in 2006, prohibiting solemnization of child marriages of a girl or boy child, under the age of 18 years. The development of the child is at the centre of the eleventh plan (2007–2012). The National Plan of Action for Children (NPAC) 2005 centres on four key areas, viz. ICDS, Early Childhood Education, Girl Child and Child Protection.

Need for Institutional Care Institutional care is necessary to provide a safe shelter to orphan and destitute children and children from very poor families, for their healthy growth and development, as every child is highly potent and creative and their rights need to be protected. Providing basic minimal facilities, as well as safety and care, might bring a miraculous change in their lives. In every country, there is provision for institutional care of children in need and in conflict with the law. Children in conflict with the law should be placed in institutes or Government Observation Homes for their behavioural development and for giving them skill-based training programme, in addition to orienting children about various socialization processes, so that after a certain period, when they are released from the correctional home, they can find a job, based on their skills and can lead an independent life. Otherwise, these children may get involved in socially deviant activities under the influence of deviant group members. Sometimes, for their survival, they indulge in stealing vegetables and pickpocketing. More specifically, institutional care is required for a range of factors and it varies from child to child and their family situations. However, the broad factors include, • Poor or Low Socio-economic Status Poor economic condition is one of the prime reasons for a large number of children to come under institutional care. Parents living below the poverty line prefer to place their children in institutions with an understanding that their children will get proper food and shelter (Pinheiro, 2006). • Disintegrated Family Family disintegration, owing to various reasons, necessities placing children in institutions as an alternative arrangement, for their welfare. Some of the common reasons of family disintegration include death of one parent, prevalence of domestic violence, substance addiction by one or both parent, separated parent, physical or mental illness of parent(s), extramarital relationships and so on (Save the Children 2014). Family disintegration brings serious mental disturbances for the children. Parental love and

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affection are necessary for the emotional security and self-confidence of the children. Therefore, every institution should possess trained psychologists to address the mental health needs of the children. Sometimes, mothers at home play the role of psychologists in many instances. • Domestic Violence Domestic violence is a global public health challenge. It happens mostly due to lack of adjustment, intolerance and mental health challenges of either of the parents, dependence on substance and poverty. Globally, a large number of children become the victims of domestic violence, which adversely affects their overall growth and development. Therefore, the children who witness domestic violence may be shifted to institutions for their betterment. • Children with Special Needs A large number of children suffer from various forms of disabilities, which require special training under institutional care. Children with special needs include children with intellectual disability, visual impairment, hearing impairment and children with HIV. In general, a good number of parents perceive children with disabilities as a burden. Institutional care for special training might improve the conditions of the children requiring special needs. • Disaster-Affected Children A good number of children become orphaned because of disaster or crisis, i.e. death of either of the parents or both the parents. Families living in conflict zones are vulnerable to various forms of risk. Children of these categories require safe shelter, and that is why, circumstantial compulsions bring these children to different institutions. (i)

Bullet Children in Conflict with the Law

Children, coming from poor families, often get involved in unlawful activities under peer group influence. For example, children from families, living along the borders of India and Bangladesh, tend to cross the border and come to India, knowing it fully well that the Border Security Force will arrest them for crossing the border without valid documents, and put them in the Government Juvenile Observation Homes, where they will get two meals a day. Here, violation of law happens for survival and not for any other reason. The issue requires attention of local government authorities in Bangladesh, for helping poor families improve their economic condition, in terms of helping them start various income generating activities and children should be admitted to schools and encouraged to continue studies. The objective of this chapter is to examine the status of Indian children under institutional care.

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Situation Analysis of Institutional Care India shelters several abandoned, surrendered and trafficked children. This includes orphans, including the children who are unable to be taken care of their families and who are rendered homeless. Limited research is carried out on issues and concerns of children under institutional care and styles of functioning of different institutions across the world, as it is a very sensitive issue and institutional authorities are always apprehensive about the outcomes of such research. Therefore, they do not encourage researchers to conduct any study covering children of their institutions. Children who are in need of basic support, protection and care and who do not have any resort but are compelled to go astray, are made to stay in various childcare institutions, like children’s homes, open shelters, observation homes, special homes, places of safety and specialized adoption agencies. It is enumerated that for over 90% of the children, who require protection and care, institutional care is the only possible choice. The country had 9500 institutions with a total capacity to accommodate about 3,70,000 children, of which, 91% of these homes are being run by non-government organizations, who work not for profit (Jain, 2019). As per the study by the Ministry of Women and Child Development, Government of India, there are 9589 homes across the country, out of which, only 845 (9%) of the childcare institutions were supported by the Government. They accommodate a total of 3,70,227 children (53.9% boys and 46.1% girls), who required protection and 7422 children, who were in conflict with the law (Ministry of Women and Child Development, 2018). It was reported by the Government of India that as of 2019, there were 7466 childcare institutions which were registered under section 41 of Juvenile Justice (Care and Protection of Children) Act, 2015, among the institutions which provided child protection (Press Information Bureau 2019). Some of the earlier studies reported that children under institutional care suffer from adjustment and emotional problems like depression, especially those, who experienced neglect and abuse (Gearing et al., 2013; Stellern et al., 2014; Vorria et al., 2006). Placing children under institutional care, when it is not recommended, may lead to decrease in baseline functioning, when it comes to the rate of improvement (Chor et al., 2014). The frequent decision-making on institutionalization, when the child enters the child welfare system, hampers not only the development, but it may also be detrimental for the life of the child. There is a notable difference in temperament and character traits between adolescents who are resilient, and adolescents with mental health problems in institutional care (Witt et al., 2014). The issues pertaining to children in institutional care are ubiquitous, and the long lasting maladaptive effect hampers the emerging adolescence and adult life. The Government of India considered children as “supremely national asset” in the National Policy (The National Policy for Children 2013). There are incidents of child sexual abuse in some institutes, as reported by newspapers (Sairam, 2014), mostly

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due to the lack of security arrangements. Safety of children in the institutions should be given priority. • Unmet Basic Needs Evidence highlights that children in some institutions do not get proper care and guidance (“Denied care in homes, kids go into world scarred” 2014). Rather, they are deprived of adequate food, sometimes medical care and safety (McCall et al., 2014). Lack of hygienic conditions and absence of proper medical care in some institutions lead to health problems (“10 girls of a home suffer from food poisoning”, 2015; “Yet another children’s home in Trichy violated rights” 2016; “Private children’s homes aided by corrupt system”, 2014). During lunch or dinner, if any child asks for a second serving, he/she is denied, as disclosed by the children (“The Pastor at the home loved to torture them” 2014; “We were tutored to say that we are treated well”, 2014). • Poor Infrastructure There are a number of childcare institutions across the country, which are run by the government and non-government organizations. Some of them have good infrastructure while some are in a bad condition, which require renovation, for creating a healthy ambiance. Some of the government observation homes were made with accommodation facilities for 200 children, but, in reality, more than double the number of children are accommodated, which leads to uncomfortable living environments and overcrowded situations and it is very difficult to provide quality care and support to all the children with limited manpower. This issue requires the attention of policymakers and authorities of the institutions, for taking the needful measures. Issues and concerns of disadvantaged children under institutional care require the attention of the government, so that they get the opportunity for proper growth and development with requisite education and skill-based training. Social audits conducted on childcare institutions revealed that about 1504 childcare homes were not having basic toilet facilities, out of which, it was further investigated to identify that, 434 homes did not provide any kind of privacy in toilets and bathing areas for the inmates. It was also reported that, in more than 10% per cent of the childcare institutions across the country, isolated toilet facilities for toddlers and children were not provided. The report also expounded that as many as 373 homes lacked the provision of clean, seasonal and age appropriate clothes, articles and toiletries for the individual inmates, while another 1069 childcare homes were not having facilities of individual beds for the residents (The Tribune, 2018). • Physical Abuse Physical abuse of children is a cultural practice. It is considered to be the best option for disciplining children. In normal families and in some educational institutions in India, physical punishment of children is still prevalent. Sometimes, elders and/or caregivers use cane, bamboo and blackboard dusters to punish children, in addition to slapping children. In the institutions where disadvantaged children stay, physical

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punishment of children is often reported (“Children make ‘damning’ statements against persons running the home” 2015; “Boy rescued from street says he was beaten by caretaker” 2015; “Teen abused, assaulted in Bangalore Govt-run home”, 2014). Physical abuse cases are mostly not reported to appropriate authorities. Subsequent to the sexual exploitation of girls, which was exposed at childcare institutions in Deoria, Uttar Pradesh and Muzaffarpur, Bihar, in 2018, social audits of the childcare homes across the country were ordered. 7,163 childcare institutions, accommodating about 2.56 lakh children throughout the country, were audited, and it revealed that 2,764 institutions (39%) did not have procedures to avert abuse of all kinds, which resulted in trauma among the inmates (The Tribune 2018). • Sexual Abuse Unfortunately, when disadvantaged children are put in different institutions for safety, they do not really feel safe and secure in some of them. Media reports often demonstrate incidents of sexual abuse of children in different institutions across the country. For example, a girl child, aged 14 years, delivered a girl baby and was rescued from an unregistered home (“Officials’ ignorance adds to children’s woes”, 2015). Sexual abuse of girl child and getting impregnated in some homes, is a common phenomenon, which often go unnoticed (“Child Welfare panels fail, abuse continues at homes” 2014). Children with disability are more vulnerable to sexual abuse in shelter homes (“Nari Niketan rape case: Ex-staff held” 2015). Sexual abuse of inmates in a balika griha at Muzaffarpur, Bihar, in 2018, is another instance (The horror story inside an Indian children’s home 2018). After raids by the NCPCR at two children homes in Delhi, cases were registered for alleged violation of norms, under the Juvenile Justice (Care and Protection of Children) Act, 2015 (Sexual abuse: FIR against 2 child homes in Delhi 2021). • Child Trafficking Trafficking of orphaned and destitute children for commercial reasons and keeping them in different shelter homes is another reality. These children are often used for commercial sexual exploitation (“Child rescued from unlicensed home, fourth in 3 days” 2015). Between 2011 and 2019, a large number of children (n = 38,503) were trafficked, as reported by the National Crime Records Bureau (Dhar, Arshia, 15 June 2020). Kidnapping minor children to earn money is another challenge for the society and law enforcement agencies. In an incident in Mumbai, a 10-month old child was kidnapped and sold for 3 lakh rupees (Child Trafficking Racket In Mumbai Busted, Four Arrested: Police, 2021). Police busted a child trafficking racket in Madurai, during which, two children were rescued from a couple, who were sold by an NGO, which provided shelter for their destitute mothers (Devanathan, 2021).

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Child Labour Engaging children in some activities of the institution or shelter homes, for developing good habits, is a good practice. It will train them to become independent. However, in some shelter homes and institutions, children are used as child labour and are bound to work for certain hours in the day (“All work, no play in this children’s home”, 2014). ILO and UNICEF reported that child labour in India has risen to 160 million, being the first increase in the last two decades. It also warns that over 9 million additional children are at high risk of becoming child labourers, consequent to the COVID-19 pandemic (Child Labour: Global Estimates, 2020). • Non-compliance with the Rules and Regulations of JJ Act A large number of shelter homes and institutions do not comply with the rules and regulations of Juvenile Justice (Care and Protection) Act 2021, resulting in rendering poor quality of services to the children. Low standards of care, with regard to nutrition, education and rehabilitation, are observed in Institutions, as a result of non-compliance with the rules (Mukhopadhyay & Bhalla, 2016; “Yet another children’s home in Trichy violated rights” 2016). Most of the homes and institutions do not have qualified mental health professionals, medical officers and trainers for imparting skill-based training to the children (“State’s social defense dept. headless” 2012). The study conducted by the National Commission for Protection of Child Rights (NCPCR) revealed that over 23% of the childcare homes across the country have not engaged any individual as a cook, whereas, another 48% of the childcare homes have, neither a trained counsellor nor hired the services of a professional, for rendering counselling services to the inmates. The findings of this study also brought to light the information that 29% of these child care spread across the country, had workers and employees who did not possess basic knowledge and did not undergo any form of training on the process of rendering any kind of services to the children, who reside in these homes. Additionally, it was observed that over 70% of the childcare institutions in India did not provide any sort of training to its employees on various aspects of psycho-social rehabilitation, protection of child rights or caring for the needy children, even after engaging them for some time. (The Tribune, 2018).

Latest Evidence Bhuvaneswari (2017) carried out a study in Puducherry, covering 26 institutions, with an objective to understand the demographic and socio-economic background of children under institutional care and their perception about the care and services provided there. Findings revealed that about half of the children came from rural areas while 29% came from the urban areas. The remaining 20% hailed from the semi-urban areas.

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Two-thirds (60%) of the children belonged to the age category of 14 to 16 years, and they were studying in the 9th standard and 10th standard. Two-thirds of the children had been staying in the institution for more than two years. Changing trend of families was very much evident as the majority of the children were from nuclear families (63%) and others were from joint families (33%). Female children were more in number as many institutions catered to female children in Puducherry. Parents wish to keep the male child in the family and want to admit female children in institutions for reasons such as safety, education and discipline. About three-fourth of the children were staying in the institutions for more than two years, while more than one-fourth were staying in the institution for more than six years. In case of 12% of the children, both parents had expired while 35% children lost either of their parents. Parents of 7% children got married to another person. Marriage is intact in the case of 43% of the children. About half of the child population under institutional care were from disorganized families or from families with low socio-economic status, or had been a victim of domestic violence or children of alcohol addiction abuse, or a combination of two or more family situations, resulting in admission into the institution. Hence, family disorganization is apparent from the data and it could be factored in as a major reason for the children being admitted into the institution for care and protection. So far as basic needs are concerned, a great majority of the children responded that they get adequate food and opined that the quality of it is good. These findings are parallel to the previous documented study by Embleton et al. (2014). Embleton et al. (2014) remarked that “group care homes were more likely to meet the basic needs. The probable reason behind the basic needs of the children being met by the institution could be due to the State Advisory Board as well as the District Advisory Board formed by the Department of Social Welfare in the year 2015 to inspect the different institutions in Union Territory of Puducherry. In addition to the inspection made by the Board, periodical monitoring by the ICPS staff and Child Welfare Committee might have helped to improve the quality of care in institutions in Pondicherry”. Regarding adversities experienced by children under institutional care, 58.3%, 49.6% and 4.8% reported experience of physical, psychological and sexual abuse, respectively. At the same time, they stated that their personal relationship with the service providers was good and they expressed that they felt safe (95%) and happy (85.7%) in the institution. Although more than three-fifths would like to live with their own family (68%), more than one-fourth (32%) of them preferred to stay in the institution. These findings are contradictory. On one hand, children reported experience of abuse, and on the other hand, they said that they are safe and felt happy. It might be due to fear and feeling of insecurity. Secondly, in India, corporal punishment and psychological abuse are considered to be normal and part of the disciplinary measures. Children, who are orphans or those who lost either of their parents, thought that the present shelter is better since there is no other option for them to survive. So far as leisure time activities are concerned, they get the opportunity to play with other children, watch TV and play indoor games. About half of the children

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(48%) under institutional care require immediate mental health support services, as they were found to be emotionally disturbed. Despite the satisfaction and happiness in institutional stay, about half of the female children were of the opinion that family is the best place to be mentally happy and for receiving emotional support, love and affection. Most of the leisure time is being spent playing with other children. The majority of the children felt safe and happy in the institutional environment in Puducherry as found out by Bhuvaneswari (2017) in her study. Some children under institutional care had good relationships with the service providers and some expressed that they did not have good relationships and few others even mentioned that their relationship with service providers was not at all good. In another study, authors reported that children under institutional care perceived it to be a good and caring environment (McCall et al., 2014). The probable reason for the positive response of some children in the current study could be that adolescent children spend quality time with their peers and relate less with the service providers, hence their response regarding their relation with service providers was very casual.

Measures Taken by International Agencies Concerning Institutional Care Laws, policies and schemes often directly or indirectly demote institutionalization of children, and it is considered as a last resort. The Government of India has laid much importance on the family even before the proliferation of the institutions. Bullet The United Nations Convention on the Rights of Children (UNCRC, 1989) The UNCRC is the international yardstick that define the protection of children for their healthy upbringing. Articles 3, 4, 5, 12, 13, 14, 16, 17, 18, 19, 20, 21, 26, 27 and 30 of UNCRC lay importance on strengthening family care, both directly and indirectly. The UN Guidelines for the Alternative Care of Children (2009) also emphasized on parental care for better and healthy upbringing of the children. Two core principles related to alternative care of children are the principles of necessity and appropriateness. UN Guidelines for the alternative care of children on family-based care includes, “The family being the fundamental group of society and the natural environment for the growth, wellbeing and protection of children, efforts should primarily be directed to enabling the child to remain in or return to the care of his/her parents, or when appropriate, other close family members” (Paragraph 3). “Removal of a child from the care of the family should be seen as a measure of last resort and should, whenever possible, be temporary and for the shortest possible duration” Paragraph 14).

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“The use of residential care should be limited to cases where such a setting is specifically appropriate, necessary and constructive for the individual child concerned and in his/her best interests” (Paragraph 21). “While recognizing that residential care facilities and family-based care complement each other in meeting the needs of children, where large residential care facilities (institutions) remain, alternatives should be developed in the context of an overall deinstitutionalization strategy, with precise goals and objectives, which will allow for their progressive elimination” (Paragraph 23).

Social Welfare Measures Taken by Government of India for Child Welfare While every child has the right to lead a quality life, their growth and development depend on the way they are nurtured in their families, educational institutions and society. Not all children are endowed with a nurturing environment. Several children hail from various difficult situations, who become orphans, destitute, abandoned, circumstantial victims, etc., who are forced to live in impoverished conditions, with no means of subsistence. On the other hand, several children are confined to helpless situations as a consequence of coercion and victimization, resulting from crime and cruelty. It is therefore imperative to protect, support and safeguard children hailing from such distressing situations. The state also has a predominant role in arranging for welfare measures for such disadvantaged children by providing appropriate aid, guidance and protection. The Government of India and the state governments in India have various pro-social schemes and initiatives for the protection and safety of children, which are grounded on the rights-based approach, rather than looking at these disadvantaged children as objects of charity. While it is not possible to delineate every single initiative of various state governments, an attempt has been made to present, in the following section, the major policies and schemes of the Government of India, which aim at promoting the welfare of children. Other social welfare measures include (i) The National Policy for Children 1974, 2013; (ii) National Policy on the Voluntary Sector (2007); (iii) The National Commission for Protection of Child Rights (NCPCR) established in 2006; (iv) The Central Adoption Resource Authority (CARA); (v) Integrated Child Protection Scheme (ICPS, 2009); (vi) Rashtriya Bal Kosh (National Children’s Fund); (vi) Track Child Web Portal; (vii) UJJWALA Scheme and so on. All these schemes have emphasized on welfare and well-being, as well as the safety of all children. For example, the National Policy for Children, 1974 and 2013, had given much importance to family for optimal growth of children and society has to support the family stating that. • all children have the right to grow in a family environment, in an atmosphere of happiness, love and understanding; • families are to be supported by a strong social safety net in caring for and nurturing their children.

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Legislative Measures for Protection of Child Rights in India A number of legislative measures have been taken by the Government of India, from time to time, to ensure the protection and safety of the children in India, besides several provisions in the Indian Constitution (1947) and the Indian Penal Code (1860). For example, • The Prohibition of Child Marriage (Amendment) Bill, 2021 raises the legal age of marriage for women from 18 to 21 years. • The Juvenile Justice (Care and Protection) Act 2021 has clearly stated that institutionalization should be the last resort for children and has set guidelines, ranging from physical infrastructure to inspection committees, to be formed for monitoring the institution. • The Immoral Traffic (Prevention) Amendment Bill, 2006, is an amended version of the Immoral Traffic (Prevention) Act, 1956, which combats trafficking and sexual exploitation for commercial purposes (PRS Legislative Research 2006) • The Protection of Children from Sexual Offences Act, 2012, is a legal obligation in safeguarding children from sexual assault, sexual harassment and pornography. Sexual exploitation and sexual abuse of children are heinous crimes, which need to be effectively addressed with a view towards protecting the rights of the child. • The Right to Free and Compulsory Education Act 2009 entitles education for all children between the ages of 6 and 14, including free and compulsory education, as well as attendance and completion of elementary education. The most vital part of the act is to provide education, that is, free from fear, stress and anxiety. • The Street Children (Rehabilitation and Welfare) Act, 2014, aims to provide rehabilitation and welfare measures for the street children by providing custody in children homes. The measures aim to discourage street children from returning to their earlier activities such as rag picking, begging, shoe polishing, working as potters or performing acrobatics at road crossings or public places. Providing free educational facilities, vocational training and facilities for developing moral values and other skills to make them self-dependent and providing them with employment opportunities on completion of education and vocational training are some other objectives of this act.

Conclusion Institutional care is an alternative option to house disadvantaged children for their safety, healthy growth and development. Although the facilities are not adequate as compared to the needs of the disadvantaged children, it caters to the minimum needs of a large number of children across the society. The ratio of children versus number of homes further strengthens the idea that there is a need for rationalization of CCIs/homes, which requires a deeper analysis and systematic planning. Safety and security is a challenge in some institutions and that is why in the Juvenile Justice (Care

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and Protection) Act 2021, District Magistrates and Additional District Magistrates are given more responsibility to monitor the styles of functioning of institutions in their jurisdiction. A number of social and legislative measures are in place in India for ensuring protection of child rights and safety of every child. It requires close monitoring to ensure effective implementation. Way Forward Effective implementation of any welfare scheme requires manpower with passion, to work sincerely. From first-hand experience of the author(s) of evaluating various intervention programmes, it has been observed that an individual’s personal characteristics, like interest and passion for a particular work, dedication, perseverance, honesty and integrity, leadership quality, management skills and hard work, make a big difference. Therefore, the authority of any organization and/or institution should identify human resources for taking care of disadvantaged children with similar qualities. Of course, attracting a good human resource with a moderate salary might be challenging. In that case, an authority of an organization should try to increase the salary for the right person. Serving disadvantaged children for their career growth is highly satisfying. However, for improving the living conditions and ensuring the safety and the healthy growth and development of children under institutional care, a number of measures are suggested based on evidence and first-hand experience of the author(s). They include. • The Management Committee of the institutions should consist of a public representative, a parent representative, a local medical professional, a social activist and a legal professional. Efforts should be made to bring representatives from the local industry, and in turn, it might help to get support under Corporate Social Responsibility. • Efforts should be made to generate evidence while (i) conducting a facilitative and/or baseline study, covering institutions located in different regions, to understand the situation; (ii) conducting studies to understand children’s perception about the institutions and issues and challenges faced by them, and suggesting need-based measures for ensuring safety and conducive living environments and (iii) conducting studies to understand the perspective of service providers and management about their issues and challenges and coming out with a set of way forward measures towards an effective service delivery system, by engaging children. • Developing a daily routine for the children, to discipline them and for their holistic growth and development. • Engaging children in various activities of the institutions to develop a sense of belongingness. • Ensuring academic guidance to children for their studies and engaging the retired teachers and other people of the locality. • Ensuring mental health support and medical support facilities in addition to extracurricular activities and games and sports for children of the institutions.

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• Arranging various cultural programmes and competitions for children, to make their life in institutions more engaging, enjoyable and refreshing. • Arranging periodic meetings with the parents and parents’ interaction with the children, for the welfare and better mental health of the children. • Close monitoring of activities of the children and safety of the children should be given utmost importance. • Improving the documentation system and keeping all documents updated are imperative.

References 10 Girls of a home suffer from food poisoning (2015, November 16).The Hindu, p. 5. All work, no play in this children’s home. (2014, August 26). The Times of India, p. 1. Bhuvaneshwari, K. (2017). Mental health of children under institutional care: An empirical investigation [Unpublished Doctoral Dissertation], Pondicherry University. Barooah, P. (1999). Handbook on Child, with historical background (Vol. 79). Concept Publishing Company. Boy rescued from street says he was beaten by caretaker. (2015, February 2). The Times of India, p. 3. Boy found murdered at rescue home, sodomy suspected. (2015, January 24). The Times of India, p. 9. Child Labour: Global estimates. (2020). Trends and the Road Forward. Excerpts from https://www. unicef.org/india/press-releases/child-labour-rises-160-million-first-increase-two-decades Child Trafficking Racket In Mumbai Busted, Four Arrested: Police. (September 04, 2021). All India Asian News International. Retrieved from https://www.ndtv.com/india-news/child-trafficking-rac ket-in-mumbai-busted-4-held-2529874 Child Welfare panels fail, abuse continues at homes. (2014, August 28). The Times of India, p. 5. Chor, K., McClelland, G., Weiner, D., & Jordan, N. A. (2014). Out-of-home placement decisionmaking and outcomes in child welfare: a longitudinal study. Springer Science and Business Media. Devanathan, V. (July 1, 2021). Tamil Nadu child trafficking: Police rescue two children. The Times of India. Retrieved from https://timesofindia.indiatimes.com/city/chennai/tn-child-trafficking-copsrescue-2-kids/articleshow/84000126.cms Denied care in homes, kids go into the world scarred. (2014, August 28). The Times of India, p. 9. Dhar, Arshia. (June 15, 2020). Four survivors of trafficking on life in lockdown, and why it has meant a resurgence of old fears, uncertainties. Firstpost. Retrieved from https://www.firstpost. com/long-reads/four-survivors-of-trafficking-on-life-in-lockdown-and-why-it-has-meant-a-res urgence-of-old-fears-uncertainties-8473711.html Embleton, L., Ayuku, D., Kamanda, A., Atwoli, L., Ayaya, S., & Vreeman, R. (2014). Models of care for orphaned and separated children and upholding children’s rights: Cross-sectional evidence from western Kenya. BMC International Health and Human Rights, 14(9), 1–18. Gearing, R., MacKenzie, M., Schwalbe, C., Brewer, K., & Ibrahim, R. (2013). Prevalence of mental health and behavioral problems among adolescents in institutional care in Jordan. Psychiatric Services, 64(2), 196–200. Horror stories from a shelter for runaway kids. (2012, July 3). The Times of India, p. 3. Indiafilings. (2021). Rashtriya Bal Kosh retrieved from https://www.indiafilings.com/learn/rashtr iya-bal-kosh/

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Integrated Child Protection Scheme (ICPS). (2018). Ministry of Women & Child Development, Government of India. Retrieved from https://wcd.nic.in/integrated-child-protection-sch eme-ICPS Jain, V. (May 1, 2019). Childcare institutions: The need for a new approach. India Development Review. Retrieved from https://idronline.org/childcare-institutions-the-need-for-a-new-app roach/ McCall, R. B., Groark, C. J., & Rygaard, N. P. (2014). Research, practice, and policy issues on the care of infants and young children are risk: The articles in context. Infant Mental Health Journal, 35(2), 87–93. Ministry of Women and Child Development, Government of India, New Delhi. (2016). UJJAWALA: a comprehensive scheme for prevention of trafficking and rescue, rehabilitation and re-integration of victims of trafficking and commercial sexual exploitation. Retrieved from https://wcd.nic.in/sch emes/ujjawala-comprehensive-scheme-prevention-trafficking-and-rescue-rehabilitation-and-re Ministry of Women and Child Development , Government of India, New Delhi. (2016). Universalization of Women Helpline Scheme Implementation Guidelines for State Governments/UT Administrations. Retrieved from https://wcd.nic.in/sites/default/files/WHL_G.pdf Ministry of Women and Child Development, Government of India, New Delhi. (2017). One Stop Centre Scheme Implementation Guidelines for State Governments/UT Administrations. Retrieved from https://wcd.nic.in/sites/default/files/OSC_G.pdf Ministry of Women and Child Development, Government of India, New Delhi. (September, 2018). The Report of the Committee for Analysing Data of Mapping and Review Exercise of Child Care Institutions under the Juvenile Justice (Care and protection of Children)Act, 2015 and Other Homes, Volume-1. Mukhopadhyay, T., & Bhalla, V. (2016). Case study on compliance of juvenile justice (care and protection of children) rules, 2007 by juvenile institutions in Kolkata. Institutionalised Children Explorations and beyond, 3(1), 29. https://doi.org/10.5958/2349-3011.2016.00003.7 National tracking system for missing & vulnerable children. (2017). Ministry of Women & Child Development, Government of India. Retrieved from https://trackthemissingchild.gov.in/trackc hild/index.php Nari Niketan rape case: Ex-staff held. (2015, December 14). The Times of India, p. 8. Officials’ ignorance adds to children’s woes. (2015, November 29). The Hindu, p. 7. Press Information Bureau, New Delhi. (November, 28, 2019). Unregistered Child Care Institutions—Ministry of Women and Child Development. Retrieved from https://pib.gov.in/PressRele asePage.aspx?PRID=1593993 Private children’s homes aided by a corrupt system. (2014, August 25). The Times of India, p. 6. PRS Legislative Research. (25 September, 2006). The Immoral Traffic (Prevention) Amendment Bill, 2006. Retrieved from https://prsindia.org/billtrack/the-immoral-traffic-prevention-amendm ent-bill-2006 Sairam, R. (2014, June 13). Two minor girls were raped at knifepoint. The Hindu. Pollachi. Retrieved from http://www.thehindu.com/todays-paper/tpnational/tp-tamilnadu/two-minor-girls-raped-atknifepoint/article6109593.ece ‘Sexual abuse’: FIR against 2 child homes in Delhi. (February 5, 2021). The Indian Express— Express News Service, New Delhi, retrieved from https://indianexpress.com/article/cities/delhi/ sexual-abuse-fir-against-2-child-homes-in-delhi-7175040/ State’s social defence dept headless. (2012, July 3). The Times of India, p. 5. Stellern, S., Esposito, E., Mliner, S., Pears, K., & Gunnar, M. (2014). Increased freezing and decreased positive affect in post institutionalized children. Journal of Child Psychology and Psychiatry, 55(1), 88–95. Teen abused, assaulted in Bangalore govt-run home. (2014, August 23). The Times of India, p. 8. The Central Adoption Resource Authority (CARA). (2021). Ministry of Women & Child Development, Government of India retrieved from http://cara.nic.in/ The Child Labor (Prohibition and Regulation) Act (1986). The Juvenile Justice (Care and Protection) Act 2000

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The National Commission for Protection of Child Rights (NCPCR). (2013). Retrieved from https:// ncpcr.gov.in/ The National Policy for Children, 2013 The Pastor at the home loved to torture them. (2014, August 28). The Times of India, p. 5. The Prohibition of Child Marriage Act (2006). The Protection of Children from Sexual Offences Act, 2012 The Right to Free and Compulsory Education Act 2009. The Street Children (Rehabilitation and Welfare) Act, 2014. The Tribune, New Delhi. (November 16, 2018). Over 2,700 childcare homes lack measures to prevent child abuse: Govt report. Retrieved from https://www.tribuneindia.com/news/nation/over2-700-childcare-homes-lack-measures-to-prevent-child-abuse-govt-report-171169 The UN Convention on the Rights of the Child (1989). Vorria, P., Papaligoura, Z., Sarafidou, J., Kopakaki, M., Dunn, J., Van Ijzendoorn, M., & Kontopoulou, A. (2006). The development of adopted children after institutional care: A follow-up study. Journal of Child Psychology and Psychiatry, 47(12), 1246–1253. We were tutored to say that we are treated well. (2014, August 28). The Times of India, p. 5. Welfare groups violating Juvenile Justice Act: CWC. (2016, January 18). The Times of India, p. 3. WHO. (2005). Atlas: child and adolescent mental health resources: global concerns, implications for the future. Witt, A., Schmid, M., Fegert, J., Plener, P., & Goldbeck, L. (2014). Temperament and charactertraits as protective factors among adolescents in juvenile residential facilities. Praxis Der Kinderpsychologie Kinderpsychiatrie, 63(2), 114–129.

Chapter 14

Child Safety and Well-Being During the COVID-19 Pandemic Bishakha Majumdar

Introduction Children are not the face of this pandemic. But they risk being among its biggest victims, as children’s lives are nonetheless being changed in profound ways. All children, of all ages, and in all countries, are being affected, in particular by the socio-economic impacts and, in some cases, by mitigation measures that may inadvertently do more harm than good… This is a universal crisis and, for some children, the impact will be lifelong. —UNICEF (2020a)

The single biggest crisis of global proportions that the world has seen in the last two decades has been the COVID-19 pandemic - that started off from Wuhan, China, and eventually engulfed the human settlements of the world in almost its entirety. While the virus has claimed over four million lives worldwide, still more have fallen victim to the disruptions brought about by the surge of this communicable disease. Job losses due to lockdown, closing of businesses and lack of access to regular means of livelihood has jeopardized social security and financial stabilities for many families. This is coupled with changes in lifestyles and activities—from education to socialization to seeking of essential services. What has remained less discussed in this plethora of changes is the impact of the pandemic on the children. While children have remained partly shielded from the economic upheaval owing to their limited role in the economy of nations, the uncertainties in family resources have considerably affected the future of the children. At the same time, widespread transformation in educational, socialization, healthcare, and training practices has affected the well-being of children as they negotiate the changing world order with their limited resources.

B. Majumdar (B) Indian Institute of Management Visakhapatnam, Visakhapatnam, India © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_14

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Children: The Vulnerable Other Unlike many other organisms, human beings have a relatively long period of transition from birth to maturity, making childcare and family an important part of the development of children. Childhood, the period between infancy and puberty, is a critical period for growth, development, and enculturation of the young citizens of a country. Often hailed as the formative years of life, childhood is marked by development of body and mind through nurturance, professional training, and social training. Enculturation, education, and childcare are the responsibilities of the primary caregivers of the child, typically the parents and guardians. However, across the world, researchers have regarded children as the one of the most vulnerable targets in times of social disturbances, such as war, famines, civil unrest, economic downturn, and pandemics. This happens because children are rarely insulated from the environmental stressors to which their guardians are exposed. At the same time, children are less equipped than adults to negotiate their realities and alter them to their advantages. This leaves children vulnerable to environmental constraints and demands (e.g. de Miranda et al., 2020). Finally, laws and policy interventions often overlook the children as the invisible other, owing to poor understanding of the realities of the children and an erroneous assumption that benefits provided to adult members of the families automatically percolate to the children (e.g. Collins, 2019). This leaves the lives of the children doubly uncertain in the times of crises, partly owing to their missing representation in policy concerns and partly due to poor understanding of the issues of the children, and their multiple vulnerabilities, inside the home and outside.

Impact of the COVID-19 Pandemic on Children Disruption of Family Orders: Deaths in the Family The outbreak of the pandemic in 2019 raised serious concerns about the vulnerable sections of the population such as children and aged people. Children typically are seen as one of the most vulnerable groups when it comes to communicable airborne diseases—partly arising from their higher susceptibility to infections as compared to adults, and partly because of the difficulty in making children adhere to healthappropriate protocols. An almost universal closure of school, playgrounds and other places of entertainment where children could visit could significantly shield children from the direct impact of the pandemic. According to a May 2021 report by UNICEF, based on data collected till 2020, approximately 14% of the global cases of COVID19 have been reported in people below 20 years of age, of which 31% occurred in children aged 9 and below (UNICEF, 2021b). Again, only 0.3% of the COVID-19related deaths globally have been reported in children and adolescents, of which children account for less than 0.1% (UNICEF, 2020b).

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However, the relatively optimistic figures pale into insignificance when compared to the grim statistic of deaths of parents and caregivers of children. While children could remain relatively shielded from the impact of the pandemic owing to closure of places of congregations, the same was not true for many adults who were in essential services or had to step out of homes for a living. While the first wave of the pandemic took a heavy toll on the senior citizens across countries, the second and third waves primarily affected the young and middle-aged adults—most of whom were part of the working populations, and in many cases primary earning members of the families. A significant percentage of the deceased were also primary caregivers for children. According to a Lancet study (Hills et al., 2021), more than 1.1 million children worldwide lost their primary caregivers between 2020 and 2021. India ranked third in terms of the worst-affected countries in this regard, with 0.18 million children in India having lost a parent or a primary caregiver in the COVID pandemic. In July 2021, the National Commission for Protection of Child Rights (NCPCR) reported that over 75,000 children in India have lost one or both parents to the pandemic since 2019, with most of the affected children aged between 8 and 13 (DNA, 2021). Loss of parents and/or primary caregivers has been one of the most debilitating impacts of the pandemic on the children. The effect of this loss spreads across many facets. First, it left many children, particularly those too young to take care of themselves, without a guardian and vulnerable to life threats and exigencies. Secondly, many of the primary caregivers or parents died without any security cover for their children, inheritance plans, and plans for guardianship, leaving their children vulnerable to exploitation. The number of children having lost a father is almost five times as much as those having lost a mother in India, which has significant implications in terms of financial security and stability in a society where men tend to be the primary breadwinner of the family (The Hindu, 2021a). Many orphaned children have lost their homes and are forced to live in foster homes, with relatives, or with government shelters, depriving them of the security of their familiar settings. Such children have become vulnerable to deprivation of their inheritance, denial of a healthy home environment and parental love, separation from siblings and relatives due to fostering and adoption policies, and exposure to threats such as poverty, trafficking, abuse, and violence. Even for those who are fortunate to find stability in a familiar environment with related people, the trauma of the sudden unexpected death of a parent or a primary caregiver may burden the child with an emotional baggage to last a lifetime, and give rise to childhood depression, anxiety, and post-traumatic stress.

Poverty While loss of life has been the direct impact of the pandemic, an indirect impact far larger in scope has been that of loss of livelihoods and poverty. The pandemic-induced lockdown has hit the living conditions of billions of people worldwide since 2019. The impact is particularly prominent for those in the unorganized sector. Many small businesses closed during the pandemic due to lack of demand, such as restaurants,

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clothing, handicrafts, small stores, and street side vendors. The lockdown severely disrupted the livelihood of daily wagers and contract workers, many of whom faced layoffs due to falling demands in economies and closure of non-essential factories. Even in the organized sector, 2020 saw many layoffs and salary cuts, as companies struggled to stay afloat. This disordering of the sources of family income has directly affected the children. The number of children living in poverty worldwide was projected to rise from 582 million in 2019 to 715 million in 2020 and come down slightly to 700 million in 2021 (UNICEF, 2020a). The situation is expected to be worse for children who have been already living in poverty (UNICEF and Save The Children, 2020). Sellaraju (2021) reports the debilitating conditions for street children, for whom the pandemic has meant a loss of livelihood and increased exposure to violence and abuse. Financial instability is also a stark reality for households where one or more members have been affected with COVID-19—owing to skyrocketing medical expenses, loss of earning members, and disruption of normal living. The impact of poverty on children is far-reaching and damaging. Lack of resources has denied many children proper nutrition and healthcare that are critical for survival in pandemic conditions. UNICEF (2020b) projects that over 94 million children were at risk of missing measles vaccine in 2020, due to lockdowns across nations, and concentration of medical resources in COVID care. The same is true for several other vaccine programmes globally, such as DTP3. This is likely to expose children to renewed risk of other opportunistic and often fatal infections. A World Health Organization (WHO) survey also reported that mental healthcare was disrupted by the pandemic in 93% of nations (Sen, 2021). The pandemic has also jeopardized access to the other essential of childhood—education. Loss of income in families is also pushing children into the workforce early on, exposing them to work-related health hazards, exploitation, and risk of abuse. Pandemic has also led to a spurt in child marriages across the world. Closure of schools has been found to trigger child marriages across many developing nations (UNICEF, 2020a). Economic insecurity has also been a triggering factor, making parents opt for child marriages to reduce the burden on their families. The United Nations Population Fund (UNFPA) estimated 23 million child marriages between 2020 and 2030, of which approximately 13 million is expected to be a fallout of the pandemic-related crises (UNFPA, 2020). Childline, the helpline dedicated to children in India, also reported a 33% hike in distress calls related to child marriages (Bahl et al., 2021).

Impact on Education and Skill-Building Few other areas have felt the direct impact of the COVID-19 pandemic on children as prominently as has education. As the preliminary incidence of the disease from China gradually escalated into a worldwide problem, one of the first responses of nations was to close places of congregation where the virus could spread and multiply. Understandably the first brunt of it came on educational institutions, to

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protect children from forced exposure owing to avoidable activities. An UNICEF estimate states that schools have shut down for 1.68 billion children worldwide in 188 countries (UNICEF, 2020a). As the pandemic continued, schools and colleges moved online—replacing regular classroom contact hours with online classes and activities. While initially online schooling was viewed with scepticism by many educational experts and was widely viewed as a stop-gap initiative, successive waves of the pandemic have made reopening of the schools difficult, and in many cases almost impossible. Moving of educational activities online has several positives. One, it has provided a significant boost to digitalization of educational activities, such as (1) use of technology-enabled teaching, (2) online record-keeping and data gathering, (3) reduction of wastage through widespread digitalization of examination scripts, reading materials, and academic assignments, and (4) training of the teaching staff and the students alike in use of digital contrivances such as laptops, smartphones, smart classrooms, digital presentations, online polls, and games. This has contributed to the digital empowerment of a generation growing up as digital natives, equipping them to join the hybrid workforce of the future. Second, online classrooms prevented the exposure of children and teachers, while keeping the academic exposure continuous as the pandemic stretched. Online examinations made it possible to add qualifications and encourage academic progress for children, making it easier for children to return to schools, as they are opening gradually in most countries. Online education, however, has come with a series of challenges that could have a long-lasting impact on children and youth. The first problem is that of access, which limits a vast majority of children across the world from accessing school education. The pandemic has vastly escalated the incidences of school dropouts, as students could not keep up with online classes in areas with poor connectivity. Again, children from poor families often do not have access to the digital devices and the electricity needed for online schooling. This leads to a significant gap in the learning pace and the knowledge gained by children from different strata of the society—leading to a chasm that becomes increasingly difficult to bridge as time progresses. Even when accessible and readily available, digital education has its own set of challenges that is increasingly being recognized. Researchers indicate that online classrooms require children to sit for long hours before the computer screen leading to early onset of what has been named the ‘Zoom fatigue’ (Pepper et al., 2021). Prolonged exposure to digital devices is affecting the physical and mental health of children—leading to damage to eyesight, orthopaedic problems due to stationery positions, boredom, and restlessness (e.g. Chen et al., 2020; Grover et al., 2021). Data from China show that prolonged exposure to digital classrooms has been associated with incidences of myopia in children, something that is also fast becoming a reality in India (Chen et al., 2018; Saxena et al., 2017). Online education is new to the teachers, affecting the quality of exchange in classrooms, class disruptions, and poor learning by the students (e.g. Jena, 2020). Online classrooms also limit the scope for physical activities, group interaction, and practical exercises, making it difficult to teach skills that require complex machinery, handholding, and one-on-one mentoring. Science

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education and technical and vocational education have taken a backseat, owing to lack of access to laboratories and workshops. Online classes also make it difficult for teachers to provide individualized attention to children—leading to a stark gap in childhood mentoring. This in turn is escalating problems for children with developmental disorders and children with learning difficulties, who are far more likely to remain forgotten in a virtual classroom. Further, much of the teaching and training of children with developmental disability has been hands-on, leading to a complete gap in the area; as such children are often not equipped to negotiate the digital environment in a self-driven manner to access knowledge (Mahapatra & Sharma, 2021). According to reports from medical experts in Andhra Pradesh, India, behavioural issues have worsened in children with autism and autism spectrum disorders during the pandemic, owing to the closure of special schools (The Times of India, 2021). Closure of schools and sports grounds has also severely limited the scope of peer learning. Working in groups, learning from friends, and teaching and guiding peers are critical childhood learning experiences that remain mostly denied to a generation who get to meet their peers only in a restricted online environment. This further adds to the workload of the teacher and hampers the learning experiences of the individual child, particularly the developmentally backward ones (e.g. Pandit & Agarwal, 2021).

Denial of Social Experiences and Social Distancing In 2021, a video went viral of a toddler taking a walk in the park, who reacted to most stimuli in the environment, such as a fire hydrant or park railings, by spreading her hands before them and then rubbing her hands vigorously. Born and growing during the pandemic, the child had learnt to regard almost every new inanimate object she sees as a hand sanitizer dispenser (The Indian Express, 2021). This incident, while small, provides a view of the colossal transformations of the idea of childhood for those growing up in 2020 and 2021, and the long-term impact of the pandemicinduced lockdown on the children’s mental health and social development. While the stress and burnout of working professional remained a major talking point in the discussion on mental health during the pandemic, concern has emerged for the mental well-being of the non-working population—senior citizens and children, who remained more or less confined to the restricted spaces of their homes for a good part of 2020 and 2021. The effect has been particularly impactful for young children, as this has denied them opportunities to socialize with people beyond their immediate families, form friendships with other children of their age, and be introduced to the nuances of institutional discipline in the form of schooling, team sports and protocols of behaviour in public places. Researchers have expressed concern that these might interfere severely with a child’s ability to socialize as an adolescent later—making him or her socially incompetent, introverted, and suffering from social anxiety (e.g. Xiang et al., 2020). Devoid of experience of public discipline, norms, and orders, generations may grow up to be indiscipline, confused about social and

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legal boundaries, and the consequences of action in the social world. Social isolation is also denying children the opportunity to form friendship gangs, which are critical parts of the developmental stages of the children (Holiday, 2021). This denies children the social network of contemporaries that would provide them support and access to resources later (e.g. Araújo et al., 2021). It also has the danger of creating in children a constricted view of diversity and privileges, by denying them the opportunity to mix with and empathize with people who are not like them. The COVID-19 pandemic has been found to be worrying in terms of its impact on the mental health of children. In a systematic review of research on the pandemic in 2020, Araújo et al. (2021) reported repeated incidents of ‘severe anxiety or depression among parents and acute stress disorder, post-traumatic stress, anxiety disorders, and depression among children’ leading to ‘risk of developmental delays and health problems in adulthood, such as cognitive impairment, substance abuse, depression, and non-communicable diseases’. While adults have been relatively more equipped to deal with the many difficulties brought about by the pandemic, owing to a clearer understanding of the issues and more control on the behavioural choices, for children the picture has been different. For many children, the risk of the pandemic has been a poorly understood issue, making many of the restrictions seem arbitrary and often draconian. At the other end, children with working parents had to negotiate the reality of letting their parents face the risk of infection and life threats on almost a daily basis. Fear of infection for parents and other loved ones has been an often-cited issue in research on mental health of children during the COVID-19 pandemic. In an interesting research with Spanish children, Idoiaga et al. (2020) reported that children tended to view the coronavirus as an ‘enemy’ and were less worried for their own safety than for the safety of their grandparents. Further, children reported emotions such as guilt, nervousness, fear, boredom, anger, loneliness, and sadness in association with the pandemic-induced lockdown.

Locked Down: Violent Homes and Abuse The pandemic has also led to a rise in the incidents of child abuse. As members of the family were forced to live together at home, sometimes in constricted spaces, the resulting resource crunch and maladaptive patterns of interactions have often escalated rates of domestic violence (e.g. Dong & Bouey, 2020). Another risk is that of sexual abuse, which is often perpetrated by family members or close acquaintances of the child, and usually goes unnoticed. While in some countries there has been an escalation in the number of complaints of child abuse and intimate partner violence, in other countries there has been a decline (e.g. Lee, 2020). However, the decline may not be indicative of greater harmony, but is possibly due to the restricted access of the vulnerable population to means of assistance in the pandemic. In the case of children, being away from schools where they could have sought help from other concerned adults has escalated the problem as well (World Health Organization, 2020a).

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The Digital Divide and the Privilege Divide The millennial generations have often been called Digital Natives—adolescents and youths who are being exposed to the digital technology from a very young age, have digital devices at home and use it on a regular basis, and have been using digital technology for at least the last five years (International Telecommunication Union, 2017; Kesharwani, 2020). This is true for the children growing up in 2021, who from their very childhood have an overwhelming exposure to digital technology and firsthand experience and expertise of using them, unsupervised or otherwise. However, close on the heels of the popularization of the term Digital Natives has been the crisis of Digital Divide—or unequal access and outcomes from digital technology for individuals born in the same generation (Sambuli & Magnoli, 2019). Researchers such as Scheerder et al. (2017) report that digital divide occurs when there is starkly unequal access to digital technology among individuals of the same age, unequal skills about use of digital technology even when devices are available, and unequal benefits drawn out of the use of the digital technology. The question of the Digital Divide became prominent in the context of COVID19 pandemic when instant schools went online. While workers whose office went virtual were either already digitally empowered or were digitally equipped by their employers, the same was not true for the educational system. As a result, a vast majority of children and their parents across nations were left to their own devices to gain an access to virtual schooling. The result of this has been stark differences in access and utilization of the educational system by children from different backgrounds. A 2020 Report of UNICEF showed that 1.3 billion school-going children did not have access to the internet during the pandemic (UNICEF, 2020c), because of which an estimated 463 million children were not able to access remote schooling (UNICEF, 2020a). This has been projected to increase the percentage of children lacking access to education and health from 47 to 56% (UNICEF and Save The Children, 2020). Digital divide has resulted in school dropouts, stunted educational levels, and even suicides, as children are unable to access the basic amenities of education in the pandemic (DebBarman, 2020; Fegert et al., 2020). What is more alarming about the digital divide is that it is almost always correlated with the availability of privileges or lack of it. Researchers have identified wealth as the single-most important correlate of the digital divide because the access and utilization of digital technology necessitates resources. For instance, children in poor countries lost as much as four months of schooling as opposed to only 4 weeks in high income countries (UNICEF, 2020d). Other correlates of the digital divide have been gender, location, and ethnicities (Blank & Groselj, 2014; Van Deursen et al., 2017). Thus, the pandemic has, in many ways, served to carry forward and amplify the privilege gaps of the previous generation into the newer generations, the impact of which is likely to affect nations for decades to come.

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Measures Adopted to Address the Impact of the Pandemic on Children The issue of the adverse impact of the pandemic on young children has been a matter of policy concern for quite a while now. On the outbreak of the pandemic in 2019 and early 2020, the first reaction of most national and local governments had been focused on prevention of infection in children, to protect them from the dangers of a novel and little-understood illness. As a result, the almost universal policy adopted in around 188 nations has been closure of schools and places of congregations for children (UNICEF, 2020d). As the pandemic stretched on, most nations, particularly those that are digitally equipped to some extent, have shifted to the online mode of learning, striving to provide children a continued experience of education and skilling. While this move has been primarily beneficial for millions of children worldwide, it has, however, brought in its wake, several consequences, such as the slipping of children from the safety net due to the digital divide, damage to physical and mental health due to prolonged virtual exposure, and denial of critical social experience to the children in early developmental years. As a result, policymakers are increasingly focusing on targeted intervention to address the challenges of children in the pandemic (UNICEF, 2021a). One critical concern has been the issue of vaccines. Almost simultaneously with the imposition of the lockdown, nations and pharma companies around the world started investing in development of vaccines and medicines for the prevention and cure of COVID-19. Understandably, almost all of these were focused on the adult population, partly to avoid the risk of clinical trials of a hastily-developed drug on children first, and partly due to the prioritization of the adult population as being at primary risk from the pandemic. The low figures of incidence and mortality due to COVID-19 on children has also confirmed the logic in this move. In late 2021, there are few COVID-19 vaccines in the world that could be administered to children, barring one or two that are in the late stages of clinical trials or early adoption, such as the Pfizer/BioNTech COVID-19 vaccine (Harvard Health Publishing, 2021) or India’s DNA-based vaccine ZyCoV-D. Delay in the development of vaccines has restricted the mobility of children and further delayed the return to the old normal when it comes to schooling and socialization. In India, the pandemic has panned out in waves with differential impact on different age groups. The second wave has been particularly devastating with close to 0.4 million deaths in India, a significant part of whom have been adult members of the working population—breadwinners for their families and primary caregivers for their children. To assist the bereaved children, the Government of India launched the PMCares for Children Fund (www.pmcareforchildren.in) in March 2020, that targeted developing a database for such bereaved children, providing them assistance for school education, health insurance, and a consolidated sum of INR 1 million each when they reach the age of 23 (The Hindu, 2021b). Many state governments of India had also announced aid for children orphaned by deaths during the pandemic (Moneycontrol News, 2021a).

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When it comes to mental health of the children in the pandemic, governments and non-governmental organizations across the world launched advisories, programmes and outreach programmes, to help children and caregivers in dealing with mental health issues and pandemic-related stress. For example, the WHO and UNICEF came up with tips for parents for effective management of the stress of children during the pandemic (e.g. World Health Organization, 2020a). In India, the Ministry of Health and Family Welfare, in collaboration with NIMHANS, Bangalore, issued advisory on best practices for mental wellness of children during the pandemic and launched a toll-free helpline to provide remote counselling to distressed individuals. One of the biggest interventions of the Government of India in the battle against COVID-19 has been the rollout of the largest vaccination programme of the world. In 2022, India has administered 1.72 billion vaccines to the Indian citizens, which exceeded the entire population of Europe, and that too at a phenomenal pace, administering up to 0.25 billion vaccine shots in a single day (https://www.mygov.in/cov id-19). At the same time, vaccine for those aged between 14 and 18 was started in 2022, and 52% of the targeted age group has received the first dose of the vaccine in less than a month’s time (The Economic Times, 2022). This superior pace of vaccination has two positive implications when it comes to well-being of children in the subcontinent—one, children are less likely to get infected from vaccinated adult family members, and two, vaccinated pregnant women and lactating mothers are expected to pass on part of the immunity to their unborn children and infants, respectively, providing the future generations an inborn immunity against the virus (Roy, 2021). India is also in the stage of launch of the Zydus Cadila’s DNA vaccine ZyCoV-D designed for children, with a targeted launch date in 2022 (Thaker, 2022).

What May Be Done Since the first pandemic of the new millennium has become a reality for the globe, the understanding about the disease and ways to negotiate its physiological, psychological and societal impact has also undergone vast changes. The changes brought about by many of the measures adopted during the pandemic are expected to have long-lasting impacts that are likely to be influential even when the pandemic is gone. One interesting example is the ‘Cave Syndrome’ that is surfacing in working professionals, characterized by an unwillingness to go back to physical workplaces even after they are opened up—partly driven by the convenience of remote workplaces and partly due to the fear of infection and future waves of the pandemic, which remain despite vaccination. In the context of the children, this problem may take interesting shapes. According to some researchers, children often tend to be more resilient to life’s changes than adults and are more adaptable to new conditions, owing to less baggage of prior entrenched learning and prejudices, and more openness to new experiences. At the same time, in line with the Critical Period Hypothesis, denial of developmental experiences in early childhood may lead to a constricted ability to adopt them later. Several preventive measures are therefore needed to ameliorate the

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impact of the pandemic-induced changes in children and to fill up the gaps that are being created by the New Normal.

Safeguarding the Health: Preventive and Curative Measures The primary question of well-being of children in the COVID-19 pandemic centres around physical health. The numerous variants of the virus that have surfaced since 2020 has made it difficult to predict with confidence if existing measures of healthcare would prove sufficient for combatting future strains. Again, successive variants have proven particularly fatal for different age groups. For instance, the third wave of the pandemic, in many nations, is feared to turn out damaging for child health, leading to renewed concerns about returning to the Old Normal in terms of education and socialization of children. The delay in the development of a reliable vaccine suited for children has further added to the problem. There needs to be increased and concentrated efforts in development of vaccines curated to the non-adult population, so that the prevention of the disease among the children could be prevented. Closely related to the problem of vaccine availability is the problem of vaccine hesitancy. In many nations of the world such as the USA and the UK, there has been strong resistance against COVID-19 vaccines, on the grounds of problematic and sometimes fatal side effects, coupled with the reduced efficacy of vaccines over time. Recent clinical studies demonstrating the reduced efficacy of the Pfizer vaccine, the most widely administered vaccine in the USA and Europe, has added to these apprehensions. While in many cases, the questions raised are valid and deserve knowledgeable and transparent answers, vaccine hesitancy among caregivers and family members are increasing the risks of children from COVID-19 infection owing to transmission from adults. It is the need of the hour to establish clear communication from policymakers and manufacturers of vaccines dispelling the myths against the vaccines and at the same time being transparent about its efficacy and durability. Moreover, governments should make efforts to share knowhow about development of COVID-19 vaccines, so that the effective vaccines could be reengineered and administered in different parts of the world at cheaper costs. India has been one of the pioneering countries of the world in this front, sharing the knowhow of the home-grown vaccine Covaxin, with one of the highest efficacy rates in the world, and also sharing the technology of the CoWin platform, the online registration platform for COVID-19, vaccines, with several other nations of the world (World Health Organization, 2021). More effort is needed in terms of global cooperation, so that the benefits of vaccines and healthcare reach all children of the world comparably, and privilege gaps do not build up. An area of concern when it comes to well-being in the pandemic is the availability of health facilities for children. Soon after the second wave of the pandemic in India, paediatricians pointed out the need for curated healthcare facilities such as dedicated children’s hospitals or nursing homes for dealing with respiratory diseases in children—as the existing medical setups are often geared to serve adults (Das &

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Chitravanshi, 2021). At the same time, extensive clinical trials are needed to find out the efficacy, dosage, and potential side-effects of COVID-19 drugs for children. There is also a need for an increase in the number of paediatricians and paediatric nurses to cater to the needs of children if a crisis arrives. For developing nations, such facilities need to percolate to the non-urban facilities, such as the primary healthcare centres, block-level hospitals and district hospitals. In addition, since COVID care is primarily home-based, there is need for extensive training of general physicians, nurses, and caregivers in providing nursing to children at home, to take the pressure off the formal healthcare system and to provide the needed interventions in case of an emergency. Preventive care in case of infectious diseases goes beyond vaccines. Physicians across the world has emphasized on developing healthy immune systems in children and adults alike, through healthy eating and regular exercise. In India, there has been emphasis on the efficacy of traditional medicines such as home-based Ayurvedic solutions to boost the immune system. Again, UNICEF has launched multiple advisories targeted at primary caregivers to know the symptoms for COVID in children and the best practices of preventive and curative care (e.g. Ahmad, 2020). There is an increased need for emphasis on such preventive measures, so that children stay healthy and naturally immunized against COVID-19 and other potential infections. In addition, there needs to be regular communication popularizing the use of masks, hand sanitization and social distancing, through the use of child-friendly media, such as simple pamphlets and posters in regional languages, animated videos, songs and small skits, involving popular film stars or sports persons.

Bridging the Privilege Gaps: Social and Financial Securities for Children The far-reaching impact of the COVID-19 pandemic on the security of children and youth from disadvantaged backgrounds necessitates focused interventions to close the gaps in the safety net provided by social security measures. In India, the first wave of the pandemic was accompanied by the migration of labourers across the nation with their families, as jobs became uncertain in their places of work. Post-lockdown, most of these labourers migrated back to their places of work. This instability is likely to have proven particularly jeopardizing for children of migrant workers, for whom it meant a complete disruption of education, healthcare and social network. It also drew attention to multiple problems such as the restrictions of access to the benefits of the Public Distribution System, only in one’s home state. The Government of India has since then adopted and put increased emphasis on several flexibility measures such as One Nation, One Card scheme, enabling access of the Public Distribution System benefits from any part of the country, and Direct Benefit Transfer to the accounts of the beneficiaries—the positive effects of which are likely to percolate to the children in the families (MoneyControl News, 2021b). Similar interventions

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are needed in the field of primary healthcare, nutrition, education and training, so that there is less slippage and the intended child beneficiaries have access to the interventions. For instance, the close-down of the Midday Meal programme with the closure of schools in India has necessitated alternative means through which the same benefits may be provided to the children, even when schools are closed. There needs to be extensive assessment of the current situation of deprivation when it comes to children from disadvantaged backgrounds when it comes to the impact of the pandemic and need-based interventions to address the specific problems before they further escalate.

Education and Skill Development When it comes to education, the problem is twofold. One is the problem of access that creates an enormous digital divide between children coming from different strata of the society. The resulting gap has reached scary proportions in many nations, with many children having regressed to a point of forgetting even the basic reading, writing or mathematics skills they were proficient in prior to the pandemic. There needs to be further emphasis on focused interventions to close this digital divide—through provision of digital devices, high-speed Internet and electricity in the remotest corners of a country, so that children do not miss out on learning opportunities. At the same time, the challenge remains for developmentally backward, differently abled and special children, who, despite access to digital contrivances, are less equipped to learn online without personalized face-to-face adult attention. Hence, there needs to be concentrated efforts to reopen schools in a safe plan, perhaps in a staggered method, so that those in critical need of offline education can return to school. Meanwhile, it may be worthwhile to explore opportunities to train primary caregivers and parents in best practices of home-schooling, so that the child may receive structured and engaging educational interventions from the security of the home. Infotainment and educational programmes on television and radio which are more accessible than digital technology to average homes can also bridge the gap in learning to some extent. Given the enormity of the problem, there is a critical need for public–private partnership when it comes to school level education and primary vocational training. The government needs to collaborate with corporate bodies for funds and management knowhow, and the grassroot NGOs and self-help groups for curated knowledge interventions that are community-driven and locally sourced. There have been several instances in India, where the environmental constraints of small classrooms have made teachers move to open-air teaching, using building walls as blackboards. Such innovative interventions need to be recorded and scaled up so that no child is left behind while the world combats with the pandemic. A relatively less talked-about problem is the curation of teaching and training methods and syllabi from the old Normal to the virtual and hybrid classrooms. Much of the syllabus, evaluation methods and teaching pedagogy is geared to physical

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classrooms, leading to adjustment problems as schools shifted online. There needs to be an increased emphasis on training of trainers in digital education practices such as online educational activities, use of social media platforms such as WhatsApp and Facebook for out-of-class engagement with learners, proctored examinations and online evaluation. The syllabi too need to be remodelled to cater to online delivery, learning through simulations rather than hands-on practical classes—interventions that are particularly critical when it comes to physical sciences and technical and vocational education.

Mental and Social Well-Being of Children What often gets ignored in the quagmire of issues is the mental health and social adaptiveness of the children. Mental health of children remains a poorly understood issue across nations, more so in the developing countries of the world. Developmental issues due to growing up in restricted households in lockdowns may often be misinterpreted as simple indiscipline or non-serious childish tantrums and ignored until it is too late. One ray of hope in the situation is the role of family. Research increasingly indicates to be essential in building strength and resilience in children. Idoiaga et al. (2020) reported that children, even when living in lockdown, reported feeling ‘safe, calm and happy with their families’. It is critical to train parents and primary caregivers to detect the signs of developmental problems and mental health issues in the child early on, so that professional help may be sought. Information, Education, and Communication (IEC) efforts may also target primary caregivers, equipping them with basic interventions at home that may address such problems at a personal level. At the same time, there is a need for interventions to promote mental wellness practices such as yoga, meditation, physical exercise, and offline hobbies such as gardening, pets, painting, and music. specifically targeted at children. Such efforts may help guide children to spend their time productively. To have time off from the online media, activity boxes and reading books are also becoming popular pastimes among children. There is also an increased need for quality entertainment targeted at children in the form of feature films, plays, books, and animation films. A related question is that of physical and sexual violence against children, particularly when they are away from school from a prolonged period, where they could have sought help from teachers, school counsellors and other responsible adults. In a June 2020 report, WHO recommended training of home delivery staff, domestic help, and other service providers who may be visiting people’s homes, to watch out for signs of child abuse and neglect and report to police if need arises. Similarly, healthcare workers and community service providers need to periodically visit families with children, to meet the child in person, assess his or her physical and mental well-being, and detect signs of abuse, if any. Additionally, details of child helplines need to be readily available and accessible to children so that they could seek help

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whenever necessary (World Health Organization, 2020b). IEC on social media, television, and other media need to be targeted to the primary caregivers as well, so that they could detect the early signs of abuse and take preventive measures before further harm is done (Kumar et al., 2020). UNICEF, for instance, recommended parenting programmes and mental health resources for caregivers to equip them with mental health issues of children during the pandemic (PTI, 2021). The permanent mark that COVID-19 has left in the life of children with deceased parents also requires focused intervention. Hills et al. (2021) recommend investment in foster care, kinship care, adoption, and empowerment of surviving caregivers to assist in fulfilling the financial and emotional needs of bereaved children. There is also an urgent need of developing databases of such children and providing them state-sponsored assistance until they reach adulthood.

Digital Training The threat is real, when it comes to overexposure to the adult world, owing to increased access to digital media and the Internet. Hence, primary caregivers need extensive training, through IEC messages, focused communication from schools, or from other governmental sources, in the best practices of digital use and the importance of supervision when a child is accessing the internet (Ferrara et al., 2021). Awareness needs to be built about the presence of sexual predators or financial scammers online, who particularly target vulnerable individuals such as young children. Children and their caregivers alike need to be taught the dangers of hacking and phishing online, the warning signs of a suspicious message, and the potential implications of sharing photographs, personal details and personal opinions online. Parents need to be taught about supervisory practices, child lock on devices and other best practices to prevent unchaperoned access of a child to the digital world. Children, on the other hand, need to be taught, in child-friendly methods, about the protocols of internet behaviour for children and ways to sense danger.

Conclusion The pandemic, one may hope, is not here to stay for long. With rapid advances in vaccinations, medications, and development of some level of herd immunity, COVID19 pandemic may soon turn into what has been termed as an endemic, a seasonal affliction of a non-fatal nature. However, the impact it is leaving on the social and financial fabrics of human society will rise into prominence, once the world attempts to return to the Old Normal. The generation that is spending its formative years in the throes of the pandemic is likely to see privilege gaps that are far starker than before, if interventions are not made immediately. At the same time, the world may be standing on the threshold of another global pandemic, which would force the population back

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to social isolation and its associated trauma. This is even more reason why the world must strive to learn from the lessons of the COVID-19 pandemic and the impact it is leaving on the most impressionable part of the human population—the children. With concentrated, knowledgeable, and empathetic efforts to address the situation of the child in the pandemic, it is likely that the future generations shall emerge from the first global affliction of the new century stronger than ever before.

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Ferrara, P., Franceschini, G., Corsello, G., Mestrovic, J., Giardino, I., Vural, M., & PettoelloMantovani, M. (2021). The dark side of the web—A risk for children and adolescents challenged by isolation during the novel coronavirus 2019 pandemic. The Journal of Pediatrics, 228, 324– 325. Harvard Health Publishing. (2021). Coronavirus outbreak and kids: Advice on playdates, social distancing, and healthy behaviors to help prevent infection. Retrieved from https://www.health. harvard.edu/diseases-and-conditions/coronavirus-outbreak-and-kids Hillis, S. D., Unwin, H. J. T., Chen, Y., Cluver, L., Sherr, L., Goldman, P. S., & Flaxman, S. (2021). Global minimum estimates of children affected by COVID-19-associated orphanhood and deaths of caregivers: A modelling study. The Lancet, 398(10298), 391–402. Holiday, S. (2021). Where do the children play… in a pandemic? Personal observations of US children’s social learning of preventative health through embodied experiences while shelteringin-place. Journal of Children and Media, 15(1), 81–84. Idoiaga, N., Berasategi, N., Eiguren, A., & Picaza, M. (2020). Exploring children’s social and emotional representations of the Covid-19 pandemic. Frontiers in Psychology, 11, 1952. India Today (2021, September 15). Covid-19 cases among children rising, national average over 7%. India Today. Retrieved from https://www.indiatoday.in/science/story/covid-19-cases-among-chi ldren-rising-national-average-over-7-1853107-2021-09-15 International Telecommunication Union. (2017). Measuring the information society report (Vol. 1). Retrieved July 1, 2021 from https://www.itu.int/en/ITU-D/Statistics/Documents/publications/mis r2017/MISR2017_Volume1.pdf Jena, P. (2020). Impact of pandemic COVID-19 on education in India. International Journal of Current Research, 12, 12582–12586. Kesharwani, A. (2020). Do (how) digital natives adopt a new technology differently than digital immigrants? A longitudinal study. Information & Management, 57(2), 103170. https://doi.org/ 10.1016/j.im.2019.103170 Kumar, A., Nayar, K. R., & Bhat, L. D. (2020). Debate: COVID-19 and children in India. Child and Adolescent Mental Health, 25(3), 165–166. Lee, J. (2020). Mental health effects of school closures during COVID-19. The Lancet Child & Adolescent Health, 4(6), 421. Mahapatra, A., & Sharma, P. (2020). Education in times of COVID-19 pandemic: Academic stress and its psychosocial impact on children and adolescents in India. International Journal of Social Psychiatry, 0020764020961801. Moneycontrol News. (2021a, May 18). COVID-19|Initiatives announced by state govts for children who lost both parents to pandemic. Retrieved from https://www.moneycontrol.com/news/ india/covid-19-initiatives-announced-by-state-govts-for-children-who-lost-both-parents-to-pan demic-6908451.html MoneyControl News. (2021b, July 20). Explained: What is one nation one ration card scheme. Retrieved from https://www.moneycontrol.com/news/india/explained-what-is-one-nation-oneration-cardscheme-7194501.html Pandit, D., & Agrawal, S. (2021). Exploring challenges of online education in COVID times. FIIB Business Review, 2319714520986254. Peper, E., Wilson, V., Martin, M., Rosegard, E., & Harvey, R. (2021). Avoid Zoom fatigue, be present and learn. NeuroRegulation, 8(1), 47–47. PTI. (2021, March 5). Covid-19 pandemic impacted health, psychosocial well-being of children in India: UNICEF. The Hindu Business Line. Retrieved from https://www.thehindubusinessline. com/news/variety/covid-19-pandemic-impacted-health-psychosocial-well-being-of-children-inindia-unicef/article33994310.ece Roy, A. (2021, July 21). Severity of future Covid-19 waves on kids speculatory, says top paediatrician. The Hindustan Times. Retrieved from https://www.hindustantimes.com/india-news/sev erity-of-future-covid-19-waves-on-kids-speculatory-says-top-paediatrician-101626866462574. html

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Sambuli, N., & Magnoli, S. (2019, April 29). What is digital equality? An interview with Nanjira Sambuli. World Economic Forum. Retrieved July 1, 2021 from https://www.weforum.org/age nda/2019/04/digital-equality-interview-nanjira-sambuli/ Saxena, R., Vashist, P., Tandon, R., Pandey, R. M., Bhardawaj, A., Gupta, V., & Menon, V. (2017). Incidence and progression of myopia and associated factors in urban school children in Delhi: The North India Myopia Study (NIM Study). PloS One, 12(12), e0189774. Scheerder, A., van Deursen, A., & van Dijk, J. (2017). Determinants of Internet skills, uses and outcomes. A systematic review of the second-and third-level digital divide. Telematics and Informatics, 34(8), 1607–1624. https://doi.org/10.1016/j.tele.2017.07.007 Sellaraju, S. N. (2021). Mental health crisis among children: A parallel pandemic. Indian Journal of Social Psychiatry, 37(1), 10–13. Sen, A. (2021, April 30). The pandemic has hit our children hard. How can we take care of them? The Indian Express. Retrieved from https://indianexpress.com/article/opinion/columns/the-pan demic-has-hit-our-children-hard-how-can-we-take-care-of-them-7295941/ Thaker, T. (2022, January 24). Production ramp up delayed Zydus Cadila’s vaccine launch, roll out likely soon. The Economic Times. Retrieved from https://economictimes.indiatimes.com/ind ustry/healthcare/biotech/pharmaceuticals/zydus-vaccine-launch-likely-to-be-delayed-due-to-iss ues-at-plant/articleshow/89084487.cms? The Economic Times. (2022, January 20). COVID-19 vaccination for children below 15 yrs to begin after scientific evidence: Centre. Retrieved from https://economictimes.indiatimes.com/ news/india/covid-19-vaccination-for-children-below-15-yrs-to-begin-after-scientific-evidencecentre/articleshow/89021447.cms? The Hindu. (2021a, July 21). Pandemic orphaned 1.2 lakh in India, over 10 lakh globally, says Lancet report. Retrieved from https://www.thehindu.com/news/national/119000-indian-childrenlost-caregivers-to-covid-during-first-14-months-of-pandemic-says-report/article35438967.ece The Hindu. (2021b, July 25). The Centre tells States to identify children orphaned by COVID19. Retrieved from https://www.thehindu.com/news/national/pm-cares-centre-tells-states-to-ide ntify-children-orphaned-by-covid-19/article35528695.ece The Indian Express. (2021, January 26). Little girl thinks everything is a hand sanitiser station, and an adorable video goes viral. Retrieved from https://indianexpress.com/article/trending/trendingglobally/little-girl-thinks-everything-is-hand-sanitiser-stations-7158299/ The Times of India. (2021, April 4). Andhra Pradesh: Children with autism hit hard during pandemic. Retrieved from https://timesofindia.indiatimes.com/city/visakhapatnam/children-with-autismhit-hard-during-pandemic/articleshowprint/81890311.cms UNFPA. (2020, March). Impact of the COVID-19 pandemic on family planning and ending gender-based violence, female genital mutilation and child marriage. Retrieved from https://www.unfpa.org/resources/impact-covid-19-pandemic-family-planning-and-endinggender-based-violence-female-genital UNICEF. (2020a, March). COVID-19 and children: UNICEF data hub. Retrieved from https://data. unicef.org/covid-19-and-children/ UNICEF. (2020b, July). Immunization coverage: Are we losing ground? Retrieved from https:// data.unicef.org/resources/immunization-coverage-are-we-losing-ground/ UNICEF. (2020c). How many children and young people have internet access at home?: estimating digital connectivity during the COVID-19 pandemic. UNICEF. Retrieved July 1, 2021 from http://saruna.mnu.edu.mv/jspui/bitstream/123456789/8093/1/How%20many%20children% 20and%20young%20people%20have%20internet%20access%20at%20home%3F%20%3A% 20estimating%20digital%20connectivity%20during%20the%20COVID-19%20pandemic.pdf UNICEF. (2020d, October). What have we learnt? Findings from a survey of ministries of education on national responses to COVID-19. Retrieved from https://data.unicef.org/resources/nationaleducation-responses-to-covid19/ UNICEF & Save The Children. (2020). technical note: impact of COVID-19 on child poverty. Retrieved from https://data.unicef.org/resources/impact-of-covid-19-on-multidimensi onal-child-poverty/

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UNICEF. (2021a, March). COVID-19 and school closures: One year of education disruption. Retrieved from https://data.unicef.org/resources/one-year-of-covid-19-and-school-closures/ UNICEF. (2021b, May). COVID-19 confirmed cases and deaths: Age- and sex-disaggregated data. Retrieved from https://data.unicef.org/resources/covid-19-confirmed-cases-and-deaths-das hboard/ Van Deursen, A. J., Helsper, E., Eynon, R., & Van Dijk, J. A. (2017). The compoundness and sequentiality of digital inequality. International Journal of Communication, 11, 452–473. World Health Organization. (2020a). COVID-19 Parenting—Keeping it positive. Retrieved from https://www.who.int/publications/m/item/covid-19-parenting-keeping-it-positive World Health Organization. (2020b). Addressing violence against children, women and older people during the COVID-19 pandemic: Key actions, 17 June 2020 (No. WHO/2019nCoV/Violence_actions/2020.1). World Health Organization. World Health Organization. (2021, February 2). India shares vaccination and clinical research know-how for countries to customize and adapt. Retrieved from https://www.who.int/india/ news/featurestories/detail/india-shares-vaccination-and-clinical-research-know-how-for-countr ies-to-customize-and-adapt Xiang, M., Zhang, Z., & Kuwahara, K. (2020). Impact of COVID-19 pandemic on children and adolescents’ lifestyle behavior larger than expected. Progress in Cardiovascular Diseases, 63(4), 531.

Chapter 15

Unfolding Children’s Agency in Ensuring Child Protection Virgil Mary D. Sami

Introduction Agency is defined as being able to make choices and decisions to influence events and to have an impact on one’s world. The basic concept of agency is that people do not merely react to and repeat given practices. Instead, people have the capacity for autonomous social action, during which they intentionally transform and refine their social and material worlds, thereby taking control of their lives (Kangas et al., 2014). The person who is able to shape the surrounding social structures is said to have agency (Crowhurst & Cornish, 2020). Agency is an inalienable feature of human knowing-being-doing—though it is not a ‘given’ and instead, it has to do with the socially transformative, practically productive and collaboratively inventive ways of how human life is organised within the socio-historical dynamics of human communities. Thus, agency is foundational to human life yet, nonetheless, it has to develop as we develop our capacities for participation in and contribution to community life with the help of collectively invented cultural tools suited for agentive knowing-being-doing (Stetsenko, 2019). Children’s agency is the children’s right to make choices and decisions, and capacity to initiate their own learning. It implies children’s capacities to act constructively on their own behalf and on behalf of others in a broad range of family, school and societal contexts. (Emma & Leon, 2018). United Nations Convention on the Rights of the child (UNCRC) brought about a paradigm shift in the perspective on children. Children are not just objects who belong to their parents or adults in training. Rather they are human beings and individuals with their own rights. (https://www.unicef.org/ child-rights-convention/what-is-the-convention). UNCRC recognises and affirms the rights of children to form their opinion, express views and contribute to decisions on issues concerning them. Children are social actors they have agency (Abeb, V. M. D. Sami (B) Arunodhaya Centre for Street and Working Children, 19/9/2 Bazaar street, Royapuram, Chennai 600013, India © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_15

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2019). This chapter intends to highlight the need to unfold children’s agency and how it would contribute in ensuring child protection. Child protection is ending all forms of violence against children, create an environment that facilitates positive development of children and empowering children with knowledge and access to protect themselves from abusive and violent situations. Child protection is not just responding when abuse or violence happens but it calls for building systems and mechanisms to protect children. Every failure to protect children has negative effects that continue into their adult life and also hold back a country’s national development (Save the children, 2013). Violence, abuse, neglect and exploitation negates the rights of children to survival, development and participation. Inadequate care and protection kill children threaten well-being and stop children from reaching their potential. It is a major driver of inequity and hinders economic growth (Emily, 2013). Children’s right to protection is enshrined in the United Nations Convention on the Rights of the Children (UNCRC) adopted in 1989. It bestows children with the right to be protected from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse (Art. 19), illicit transfers and illegal adoption (Art. 11), protection of children deprived of his or her family environment (Art. 20), protection of children seeking refugee status (Art. 22), protection of mentally and physically disable children (Art. 23), protection from economic exploitation and from performing any work that is likely to be hazardous or to interfere with the child’s education, or to be harmful to the child’s health or physical, mental, spiritual, moral or social development (Art. 32), to protect children from the illicit use of narcotic drugs and psychotropic substances (Art. 33), to protect children from all forms of sexual exploitation and sexual abuse (Art. 34), protection from abduction of, the sale of or traffic in children for any purpose or in any form (Art. 35), protect children against all other forms of exploitation prejudicial to any aspects of the child’s welfare. (Art. 36), protection from torture or other cruel, inhuman or degrading treatment or punishment (Art. 37). Children’s right to be protected from violence and exploitation is further reiterated in the Sustainable Development Goals (SDGs) with time-bound targets and a monitoring framework. A commitment has been made by the international community to achieve SDGs by 2030, which opens up an opportunity to protect children. SDGs 5, 6, 8 and 16 have specific targets related to child protection in eliminating all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation: Eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation, take immediate and effective measures to eradicate forced labour, end modern slavery and human trafficking and secure the prohibition and elimination of the worst forms of child labour, including recruitment and use of child soldiers, and by 2025 end child labour in all its forms and significantly reduce all forms of violence and related death rates everywhere, end abuse, exploitation, trafficking and all forms of violence against and torture of children. It is more than 30 years since the UNCRC was adopted, and there are only nine more years to achieve the SDG targets which are set for 2030. The adults who have

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the responsibility of taking measures to provide a safe and protective environment for all children have failed in their duty. Various reports and statistics continue to present a dismal picture with increasing incidents of violence and abuse against children. Starting from the period of conception, children are exposed to a myriad of violence and abuse. The skewed sex ratio at birth (SRB) favouring male children reveals a clear discrimination against the girl children. Increasing figures on malnourishment, school dropouts, child marriages, child sexual abuse, female genital mutilation, child labour stand as silent witness to the continued exploitation of children. Technological developments have further aggravated the abuse of children through online and digital media. The annual report of UNICEF ‘The state of the World’s Children 2019’—focusing on Food and Nutrition, reports that 149 million children aged under 5 still suffer from stunting and almost 50 million from wasting; 340 million children suffer from the hidden hunger of deficiencies of vitamins and minerals; and rates of overweight are rising rapidly. ‘End of Childhood report 2018’ by save the children indicates that 1.2 billion children are at the risk of an early end to their childhood due to poverty, conflict and discrimination against girls. It is estimated that every year 12 million girls marry before the age of 18 (UNICEF, 2019). A total of 152 million children—64 million girls and 88 million boys—are in child labour globally, accounting for almost one in ten of all children worldwide. Nearly half of all those in child labour—73 million children in absolute terms—are in hazardous work that directly endangers their health, safety and moral development. Children in employment, a broader measure comprising both child labour and permitted forms of employment involving children of legal working age, number 218 million (International Labour Organisation 2017). Some 15 million adolescent girls aged 15–19 years have experienced forced sex in their lifetime. About 10% of world’s children are not legally protected from corporal punishment. Over 1 in 3 students aged 13–15 experience bullying worldwide. Roughly, 3 in 4 children between the ages of 2 and 4—around 300 million are regularly subjected to violent discipline by their caregivers (UNICEF, 2014). An estimated one billion children—or one out of two children worldwide—suffer some form of violence each year. In addition to its immediate harms to individuals, families and communities, violence against children has pernicious, lifelong effects that undermine the potential of individuals, and when aggregated across billions of people, may impede economic development (Child Rights Now, 2020).

COVID-19 and Child Protection COVID-19 started in 2019 spread throughout the world making WHO to declare it as a global pandemic. It is not just a health pandemic, it has triggered a pandemic situation in other aspects such as hunger, malnutrition, health, poverty, education, mental health and more so a pandemic of child protection. The number of children who succumbed directly to COVID-19 infection is not very high but the indirect

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impact on the children is enormous. Children may not be the face of the pandemic but they have been affected indirectly with a long-term impact on their development. COVID-19 mitigation efforts taken by different governments such as school closure and lockdown have impacted the lives of children to a great extent making them more vulnerable to exploitation. Some silver linings in the protection of children are seeing a reversal trend as is revealed in the incidents of lower number of immunisations, higher rate of malnourishment, increase in child poverty, the learning crisis due to school closures, increasing number of child labour and child marriages. The pandemic has put at stake children’s right to survival, development, protection and participation. The measures used to prevent and control the spread of COVID-19 have led to disruptions to families, friendships, daily routines and wider community dynamics. These have had many harmful consequences for children’s protection, well-being and development (The Alliance for Child Protection in Humanitarian Action, 2020). COVID-19 pandemic has exacerbated the vulnerability of children. Child poverty has increased, closure of school has denied education to children leading to an increase in child labour, closure of school has also denied children of their mid-day meals which has led to hunger and malnutrition, children have no access to general health facilities, missed out on vaccination exposing them to more health hazards, violence and abuse against children has recorded an increase, has denied the children with disability the access to special training and treatment. Though COVID-19 pandemic has affected the whole globe and all categories of people, the impact of the pandemic has laid bare the inequality in the society in terms of access to health services and the ability to cope up with the situation. The marginalised and the vulnerable population is further pushed into a vulnerable situation. Young people will carry the societal and economic costs from the COVID-19 crisis for years to come, and subgroups of children and adolescents in vulnerable circumstances may carry an inordinate burden (UNICEF, 2020c). UNICEF Annual Report 2020 Responding to COVID-19 observed that the pandemic has reversed the progress on the key measures of childhood leaving children confronting a devastating and distorted new normal. The number of children in monetarily poor households is estimated to have risen by 142 million by the end of 2020. Disruptions in food systems and health and nutrition services could leave 44 million children hungry. An additional 1.2 million children under 5 years of age could die over a 12-month period in low- and middle-income countries as a result of the worst-case estimates of disruptions to health services and rising malnutrition. Around one-third of countries faced declines of 10% or more in service coverage for routine immunisations, outpatient care for childhood infectious diseases and maternal health services compared to 2019. An estimated 43% of all children (349 million) who are below primary school entry age need child care, but do not have access to it (UNICEF, 2021b). ‘COVID-19 a threat to progress against child marriage’ released by UNICEF on International Women’s Day 2021 issues a warning that child marriages may increase by 10 million in the next decade due to COVID-19 (UNICEF, 2021a). The global girlhood report 2020 by Save the children gives an estimate that 500,000 more girls

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risk being forced into child marriage and as many as one million more are expected to become pregnant in 2020 as a result of the economic impacts of the COVID-19 pandemic. Closure of schools, economic burden due to lockdown and the possibility of lower marriage expenses are contributing towards a rise in instances of child marriage (Save the Children, 2020). Confinement within the house and lower chance of contacting help services have led to an increase in violence against children within the family setting. Loss of source of income, isolation, fear of coronavirus and the resultant anxiety increased the stress level of parents exposing the children to an abusive and violent situation and conflict between parents/caregivers. 1.8 billion children live in the 104 countries where violence prevention and response services have been disrupted due to COVID19 (UNICEF, 2020d). COVID-19 pandemic and societies’ response to it has had a dramatic impact on the prevalence of violence against children and is likely to have long-lasting negative consequences (World Health Organisation, 2020). Nationwide school closures disrupted the learning of 90% of students worldwide. Marginalised children suffer the heaviest burden. Some 463 million young people were not able to access remote learning during school shutdowns. Previous shutdowns demonstrate that children who are out of school for extended periods, especially girls, are less likely to return (UNICEF, 2020f). Apart from learning and education children missed out on a nutritious diet, health monitoring, games and outdoor activities, friendship, interaction with teachers and many such things needed for their all-round development. For children with disability who were benefiting from the inclusive education, the closure of school is a slide down their progress. Children who participated in a documentation ‘Voices of children on COVID-19 and lockdown’ carried out by Forum for Promotion of Child Participation—Tamil Nadu (FPCP) expressed that school provided happiness and fun, schools provided a safe place and sense of inclusiveness, schools protected them from abusive and alcoholic parents and schools provided food (Forum for Promotion of Child Participation, 2020). I miss my school and playing with my friends, Teachers at my school conducted special classes for children like me and took special care to fulfil our daily needs. My friends at school were very helpful and did not discriminate against me. In school I forget all my problems and enjoyed myself. Due to lockdown, I am unable to meet my friends and teachers. I am bored sitting at home and doing nothing. I am eagerly looking forward to the start of the next academic year. Voice of a CPMR (Cerebral Palsy and Mental Retardation) child, boy, 12 years, Chennai.

The closure of schools also strengthened and concretised the inequality and the unjust social systems. Online classes created a digital divide revealing the inequality and vulnerability of the marginalised and underprivileged. SDG Watch—Tamil Nadu (a network in Tamil Nadu, India) conducted a study on impact of COVID-19 on education and learning crisis. The study conducted in September 2021 in 15 districts of Tamil Nadu with 1546 children revealed that only 12% had access to mobile phones and among those who had access to online learning most children (37.5%) spend less than an hour for classes with 31.55% spending about 1–2 hours for online learning. The survey also revealed that 40% had no access to any kind of reading materials in the home environment. Lack of access to online classes, no suitable

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learning environment at home and low level of education of parents lead to a loss in learning skill among the underprivileged children. UNICEF report presents that one-third of the school children has been unable to access remote learning while their schools were closed (UNICEF, 2021b). UNESCO high-level ministerial meeting held in March 2021 observed that over 100 million additional children will fall below the minimum proficiency level in reading as a result of the health crisis (UNESCO, 2020). Economic hardship and school closure have pushed many children into labour force. Child labour: global estimates 2020, trends and the road forward released by ILO and UNICEF on World day against child labour 2021 warns that globally 9 million additional children are at risk of being pushed into child labour by the end of 2022 as a result of the pandemic At the start of 2020, prior to the outbreak of the COVID-19 pandemic, 160 million children—63 million girls and 97 million boys—were in child labour, or 1 in 10 children worldwide. Seventy-nine million children—nearly half of all those in child labour—were in hazardous work directly endangering their health, safety and moral development. At present, the world is not on track to eliminate child labour by 2025. COVID-19 crisis is making this target even harder to reach, with many more children at risk of being pushed into child labour (ILO and UNICEF, 2021). A study conducted by campaign against child labour in Tamil Nadu reported a big jump in the proportion of working children from 28.2 to 79.6% because of the impact of COVID-19 and school closure (Ramamurthy, 2021). The pandemic situation exacerbated the existing discrimination. The street dwellers, dalits and the tribals found the pandemic situation increasing the discrimination against them. Government is telling people to stay indoors to protect themselves from the disease. It is possible for people who have a house but for people who are homeless how is it possible to maintain social distancing? People have started discriminating against us because we are not able to maintain personal hygiene and social distancing. I feel so low. (a street dwelling child girl, 14 years, Chennai, Tamilnadu, India) We belong to the scheduled tribe community and we face discrimination regularly and more so during these times. For instance, the sanitation workers do not spray disinfectant regularly in our village, but in nearby town they spray disinfectants on a regular basis. Our village people are not able to afford to buy mask, sanitizer. Even some individuals who are proving relief materials hesitate to come to our village because they think we are unhygienic. (Voice of a 14 years old tribal girl from Tiruvallur, Tamilnadu, India).

The lockdown which is a major mitigation measure taken by the governments affected the economic status of the children especially the marginalised and the underprivileged. The casual labourers and unorganised workers in the informal economic activities lost their jobs and wages. The number of children in monetarily poor households is estimated to have risen by 142 million by the end of 2020 (UNICEF, 2020e). In India, according to the report submitted by National Commission for Protection of Child Rights (NCPCR) to the Supreme Court as many as 30,071 children were orphaned, lost a parent or abandoned mostly due to the pandemic.

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COVID-19 pandemic situation with its mitigation efforts such as closure of school, lockdown, stay at home has caused much distress and confusion among the children. Staying within the four walls of the houses sometimes as small as 100 sq. ft.2 placed great stress on the children. Added to it the presence of alcoholic fathers, domestic fight among parents affects them psychologically. Many times, the parents who are pressurised by the economic situation release their stress on the children. Illness of parents and the subsequent quarantine creates lot of fear among the children. During the documentation on the voice of children many children mentioned about the fear of the virus, whether it will infect them, their parents. The news on the media increases the fear and pressure on the children and triggers adverse psychological consequences on the children. Everyday I hear that so many people have died around the world. But many people have overcome the virus and become healthy. We hardly hear positive news. In my house, news channel is always on and it brings us a lot of negativity and fear. (Voice of 16 years old girl, Chennai, Tamilnadu, India). Every day they are telling new information about the virus on the news, They say that corona virus is affecting even without any symptoms. So we are more confused and afraid. (Voice of 17 years old girl, Chennai, Tamilnadu, India).

COVID-19 pandemic with its mitigation measures like lockdown, quarantine and school closure has widened the online space and children are drawn into it for learning, socialising and entertainment. Online games and social media have become the means for connecting with friends and relatives during the time of lockdown. It makes them more vulnerable to online abuse exposing them to cyberbullying, risky online behaviour and sexual exploitation. The measures to contain and respond to the pandemic have further increased the risks of physical, sexual and emotional violence against girls, boys and children with different gender identities (Child Rights Now, 2020). Pandemic has exacerbated and brought to the forefront the systemic and deeply entrenched economic and societal inequalities that are among the root causes of human trafficking (United Nations Office on Drugs and Crimes, 2020).

Unfolding Children Agency: Child-Centred Approach in Recovery The U.N. Committee on the Rights of the Child warns of the grave physical, emotional and psychological effect of the COVID-19 pandemic on children and calls on states to protect the rights of children through exploring alternative and creative solutions for children to enjoy their rights, ensuring that the existing inequalities are not exacerbated, provide for nutrition, water, health care and sanitation.Protect children especially those who are put into a vulnerable situation and provide opportunities for children’s views to be heard and taken into account in decision-making processes on the pandemic (UN Committee on the Rights of the Child, Geneva, 2020).

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A child-centred approach unfolding children’s agency needs to be adopted as the recovery strategy to protect children during this pandemic and prevent a ‘generational catastrophe’. A child protection approach that places children at the centre— upholding child rights principles, reaching the most vulnerable and with adequate funding—is essential for all children, girls and boys, to be able to access and receive the support and services they need in these difficult times (Child Rights Now, 2020). It means looking at things from the child’s perspective, allowing them to participate in planning activities and events within the society. Children and young people are not helpless victims or passive beneficiaries; rather, they develop strategies to overcome hardships and circumstances and have much to contribute towards societal change (Cuevas-Parra & Stephano, 2020) . Children are not passive receivers; they are agents of change. Enabling children to participate will unfold their agency, develop their personality, build leadership, analytical skills and defend themselves and other children to protect themselves. Listening to the voice of children will enrich the understanding of adults and add new perspective in developing policies and schemes and legislations and in allocation of budget. The UNCRC places the Right to Participation as one of the basic rights of children along with the right to survival, development and protection. It greatly acknowledges children as rights holders, asserting their right to express their views and opinion, participate in decision-making process and play a role in the process of social change. The Convention calls upon the need to consult with children and not just consider them as recipients of adults’ decisions. It also calls upon the duties of the adults to provide needed information and build up the capacity of the children so that they can make informed decisions with awareness on the consequence and the impact of the decisions taken. Child participation should not remain at the level of tokenism or led by adults. It should transform into a process where the issues are identified by children, decision on action is taken by children, adults listen and support the initiative of children. Right to participation envisages enhancing the capacity of children through access to information, enabling children to form their opinion and express it, facilitating child-led organisations, creating space for children to voice their opinion and views on issues concerning them, adults capacitated to listen to the voice of children, respect and recognise their views and opinion and take them into consideration in formulating policies and schemes.

Access to Information and Capacity Building For children to participate effectively, they should have the needed information to take the right decision. UNCRC Article 17 ensure that the child has access to information and material from a diversity of national and international sources, especially those aimed at the promotion of his or her social, spiritual and moral well-being and physical and mental health. Access to information is crucial for enabling children to exercise their right to participation effectively. Traditionally children have been

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denied knowledge on protecting themselves from abusive situation and the mechanism to challenge these situations. Information is decisive in decision-making, and hence, it is imperative that children are equipped with necessary information which will enable them to form opinion on issues concerning them, take informed decision and have the confidence to voice their opinion. Simultaneously, the capacity of the children should be developed to enhance their skills and abilities to put into effect the information and knowledge received by them.

Forming Opinion and Expressing Them Access to information and capacity building is the pathway for children to take decisions concerning issues that will have an impact on them. Children have to form their opinion on issues concerning them. Without the right to express their views, they cannot claim their rights. UNCRC Article 12 assures the child who is capable of forming his or her own views the right to express those views freely in all matters affecting the child, the views of the child being given due weight in accordance with the age and maturity of the child. Decisions that are fully informed by children’s own perspectives will be more relevant, more effective and more sustainable (Lansdown, 2011).

Child-Led Organisations UNCRC Article 15 provides for the rights of the child to freedom of association and to freedom of peaceful assembly’. CRC General comment no. 12 states that children should be supported and encouraged to form their own child-led organisation and initiatives which will create space for meaningful participation and representation. Though children can participate, express their view as an individual, a collective voice has more say. Child-led organisation provides space for children to participate in an effective and meaningful way. Hart A. Rogers Ladder of participation places genuine participation on the other rungs of the ladder starting from assigned but informed and moving on to consulted and informed, adult initiated shared decisions with children, child-initiated and directed and ending with the stage of child-initiated shared decisions with adults (Roger, 1992). Child-led organisations reflects the meaningful participation of children.

Creating Space A protective and child-friendly space should be created where children can express their views freely on issues concerning them either individually or collectively.

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Creating space not only implies the physical space, but also structural space and attitudinal space. Structural space should be—at the level of family, school, community, governance and policymaking bodies. Structures are needed at different levels to enable children to participate. Thirdly space also implies attitudinal space—attitude of adults are open to listen to the voice of children, overcoming the myths that children have no knowledge or power to take decision, should not be burdening children, if we give them voice, they will become unruly or dominate us. Such attitude should give way to an attitude of respecting the views of children. Adopting of policies, to enable child participation to be systemic.

Adults Listening to Children Child participation calls for a profound and radical reconsideration of the status of children and the nature of adult/child relationship (Lansdown, 2011). Adults have a major responsibility in child-led initiatives. There is the need to unlearn many long-held notions and established concepts. The traditional belief that adults are the providers, they know what is best for the child has to give way to believing in children’s agency, listening to children, respecting and recognising their opinion and taking it into consideration in making decisions concerning them. It implies a transfer of power-transforming children from being passive receivers to agents of change. This has to happen at all levels starting with family, school, community, society and governance structures. The notion that adults are the providers, they know what is best for the child has to give way to the active engagement with children by listening to their views and opinion and respecting them will lead to new insights in developing legislations, policies, budget allocation and services. Effective participation leads to the realisation of other rights in the UNCRC. When children views are respected, it leads to better decisions being taken for individual children. Participation of children in the process of decision-making builds up the capacity of children to exercise their personal autonomy and be part of the decisions that affect them not only now but, in the future, also. When the views and opinion expressed by children are listened to and taken seriously by adults, children are protected from situations of abuse, violence, threat or injustice. Children are less cynical, more optimistic and more flexible in their approach to the future and capacity for change (Lansdown, 2005a; b). Enabling children to participate will unfold their agency, develop their personality, build leadership, analytical skills and defend themselves and other children to protect themselves. Listening to the voice of children will enrich the understanding of adults and add new perspective in developing policies and schemes and legislations and in allocation of budget.

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Case Study of Child-Centred Recovery: Experience of Arunodhaya Confederation of Arunodhaya Children Sangams (CACS) is a child-led organisation facilitated by Arunodhaya based in Chennai, India. CACS emerged from the child labour elimination project of Arunodhaya. Children who were rescued from child labour and mainstreamed to formal schools were engaged in discussion on child rights. This led to the idea of forming a children association in 2001. Over the past twenty years, CACS has emerged as a strong child-led organisation unfolding children’s agency in ensuring child rights. During COVID-19, Arunodhaya adopted a child-centred approach involving the child-led organisation—CACS in identifying the need, conceptualising the activities and implementing it. Arunodhaya provided the support and guidance requested by the children. The following interventions were carried out by the children. CHILD-CENTRED COVID-19 RECOVERY—Experience of Arunodhaya Situation analysis and need identification

Conceptualising activities

Implementation of activities

Role of adult organisation

Identified children who Developed criteria needed provision for identification of support and cash the most deserving support Suggested things to be included in the provision kits to meet the needs of children and adolescents

Need to create awareness in the community on COVID-19 precautions and vaccination

Distributed provision Mobilised provision kit and cash support to kit and cash support needy families getting the support from adult Materials to meet the organisation needs of children such as nutrition powder, grains, healthy snacks and sanitary napkins were suggested by children Songs, stories, dialogue to create awareness on COVID-19 precautions such as hand washing, wearing of mask, physical distancing and vaccination communicated through social media

Communicated information to members in their community through social media—WhatsApp, YouTube, Facebook and Instagram

Provided training in developing videos and messages to be posted on social media. Developed awareness on online safety

(continued)

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(continued) Situation analysis and need identification

Conceptualising activities

Implementation of activities

Role of adult organisation

Need to address learning crisis

Proposed starting of learning centres. Providing textbooks,

Child-to-child education initiatives were done with older children teaching the younger children. They shared their books with other children

Provided support with volunteers to conduct classes in small groups and virtual volunteering. Arrangements were made to provide Tablets and mobile phones for group learning. Virtual volunteers were mobilised to conduct session on spoken english, maths and science subjects

Need for counselling support to children in distress

Identified children/adolescents who needed counselling

Referred children and adolescents for counselling

Provided counselling to the needy children and adolescents

Need to initiate action on child exploitation such as child labour, child marriage

Taking initiative to stop child labour and child marriage

Spoke to the families and children going for work. Got support for them to stop work and continue their studies. Stopped child marriages with the support of Childline. Prepared videos on child protection and posted it on social media to create awareness in the community

Provided support to the children

Provision kit and cash support were provided to the most deserving children. The felt need of the children were identified and addressed with the involvement of the children. Child-to-child initiatives were taken in organising the learning centres that prevented the learning crisis. Child protective initiatives by children protected children from abusive and exploitative situations.

Conclusion COVID-19 is a dynamic and uncertain disease: it will not necessarily stay in the recovery stage but, in many communities, it will force children, families and child

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protection actors back to the response stage and then again back to recovery (The alliance for child protection in humanitarian action, 2020). Without coordinated, global action to prevent, mitigate and respond to the effects of the pandemic, the consequences for children now, and for the future of our shared humanity, will be severe (UNICEF, 2020f). A child-centred approach should be adopted by listening to the voice of children and young people and including them in decision-making. Children and young people are active, competent social actors who can make decisions and influence their environments (Cuevas-Parra & Stephano, 2020). Protection measures are more effective if children are actively involved in their development and can decide which measures are best to be applied (United Nations Committee on the Rights of the Child, 2018). The existing children’s platforms from grassroot level to national and international level should be consulted and their opinion and views elucidated and become part of the strategies developed to mitigate the effects of the pandemic on children. The closure of school has affected 1.5 billion children. Learning of 91 per cent of students worldwide has been disrupted. Some 463 million young people were not able to access remote learning during school shutdowns (UNICEF 2020f). The closure of school has not only disrupted the learning process but it has had an impact on the nutrition, health, social life and holistic development. Governments have to take the measure of reopening schools with precautionary measures. Special efforts should be taken by school teachers and child protection mechanisms to bring all children back to schools. There lures the threat of children from marginalised and underprivileged community being drawn into child labour, child marriage or trafficked. It is essential to identify these children and initiate measures to bring them back to school. The school closure has caused a learning crisis, hence once the school reopens children should be facilitated to recollect their past learnings and then move ahead. An assessment of the learning level of children should be conducted and remedial measures organised. Counselling services should be organised to enable the children to come out of their psychological stress caused due to the fear of COVID-19 and its repercussions. Early childhood care and education (ECCE) was drastically affected due to COVID-19 depriving the children of nutrition, growth monitoring, immunisation and health care. Activation of ECCE centres is needed to provide care and protection to children of 0–6 years. The quarantine efforts and the lockdown measures adopted by governments to control the epidemic have triggered economic distress pushing more families into poverty denying their right to an adequate standard of living. The number of children living below their national poverty lines expected to soar by 140 million by the end of the year (UNICEF, 2020f). Children from these families are greatly exposed to the risk of being pushed into child labour, child marriage and trafficked. Social protection measures including cash transfers, income generation and job opportunities should be extended to families of children at risk of exploitation and abuse.

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Children with disability have been forgotten in this COVID-19 pandemic. Even the minimum services that they had through inclusive education, home and communitybased rehabilitation have been completely dismantled. This has reversed even the slight progress made by these children and has pushed them to a more distress situation. Special education and trainings should be made available to these children. Hospitalisation, isolation or death of parents due to Covid-19 resulting in loss of parental care will heighten the risk of children to violence and abuse. These situations may lead to trafficking of children or illegal adoption. It is very essential to identify these children and provide immediate alternate care and protection. The increased need of digital technology during the period of pandemic as the means of communication and learning has placed the risk of children being exposed to online abuse. Spending more time on virtual platforms can leave children vulnerable to online sexual exploitation and grooming, as predators look to exploit the COVID19 pandemic (UNICEF, 2020b). Children should be trained and made aware of online safety and empowered to protect themselves. Reporting mechanisms should be in place and policies framed to prevent online abuse. Though children have not been affected directly in the initial period, there are speculations that there are more probabilities of children getting infected with coronavirus in the subsequent waves. Governments should prioritise availability of health services to infected children and vaccines to protect children. COVID-19 has thrown an array of challenges to child rights (UNICEF, 2020f). COVID-19 protocols such as isolation, stay at home and lockdown placed a barrier on the vulnerable and abused in reaching out to helpline or social services. Incidents of child abuse and violation of child rights were under-reported during the times of the pandemic. Quarantine measures and the closure of schools have pushed children into a more precarious situation exposing them to an exploitative and abusive situation. Child labour, child marriage, child abuse and violation of child rights are on the increase. Proactive measures should be taken to make the child protection services active and accessible to the marginalised and vulnerable population. Child protection mechanisms should be strengthened with additional resources, trainings and given priority. Child protection workers should be considered as front-line workers and provided all facilities to work in a safe environment. They should be acknowledged as a critical part of the COVID-19 response for children (UNICEF, 2020d). Child protection should be an integral component of all COVID-19 response and rehabilitation plans and schemes.

References Abeb. T (2019). Reconceptualising children’s agency as continuum and interdependence. Social Sciences, 8(3), 81. https://www.mdpi.com/2076-0760/8/3/81 Child Rights Now. (2020, June). Ending violence against children and COVID-19. Crowhurst, P., & Cornish, L. (2020). Factors in agency development: A supervisory teaching perspective. Australian Journal of Teacher Education, 45(9). https://doi.org/10.14221/ajte.202 0v45n9.2

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Cuevas-Parra, P., & Stephano, M. (2020). Children’s voices in the time of COVID-19 continued child activism in the face of personal challenges. World Vision International. Delap, E. (2013). Protect my future. Why child protection matters in the post—2015 development agenda. Emma, S., & Leon, K. (2018). Children’s agency in the family, in school and in society: implications for health and well-being. International Journal of Qualitative Studies on Health and Well-being, 13:sup1. https://www.tandfonline.com/doi/full/https://doi.org/10.1080/17482631.2019.1634414 Forum for Promotion of Child Participation (FPCP), Tamilnadu. (2020). Covid-19 Pandemic & Lockdown. FPCP. Hart, R. (1992). Children’s participation: From tokenism to citizenship: UNICEF. Human Rights Watch. (2021). “I Must Work to Eat” Covid-19, Poverty, and Child Labor in Ghana, Nepal, and Uganda, Human Rights Watch. International Labour Organisation & UNICEF. (2017). Global estimates of child labour: Results trends, 2012–16, ILO. International Labour Office & UNICEF. (2021). Child labour global estimates 2020 trends and the road forward. ILO. Lansdown, G. (2005). The evolving capacities of the child. Florence, UNICEF. Lansdown, G. (2005a). Can you hear me? The Right of Young Children to Participate in Decisions Affecting Them. Bernard van Leer Foundation. Lansdown, G. (2011). Every child’s right to be heard a resource guide on the UN committee on the rights of the child General comment no. 12. Save the children UK. Marjaana et al. (2014). Kangas Students’ agency in an out-of-classroom setting: Acting accountably in a gardening project. Learning, Culture Ad Social Interaction, 3(1). https://www.sciencedirect. com/science/article/abs/pii/S2210656113000731 Ramamurthy, V. (2021). Covid-19 reversing the situation of child labour—A rapid survey in Tamilnadu. Campaign Against Child Labour—Tamilnadu and Puducherry. Roberton, T., et al. (2020). Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study. Lancet Glob Health, 8(7), E901–E908. https://www.thelancet.com/journals/langlo/article/ PIIS2214-109X(20)30229-1/fulltext#seccestitle10 Save the children. (2013). Save the children’s child protection strategy 2013–2015 making the world a safe place for children. Save the children. Save the children. (2020). The global girlhood report 2020. Save the children. Stetsenko,A (2019) Radical-Transformative agency: Continuities and contrasts with relational agency and implications for education. Frontier Education, 4, 148. https://www.frontiersin.org/ articles/10.3389/feduc.2019.00148/full The alliance for child protection in humanitarian action. (2020). Protection of children during the Corona virus pandemic (V.2). The Economic Times, News. (2021, June 07) https://economictimes.indiatimes.com/news/india/ over-30000-children-orphaned-lost-a-parent-or-abandoned-due-to-covid-19-ncpcr-tellssc/art icleshow/83308281.cms?utm_source=contentofinterest&utm_medium=text&utm_campaign= cppst UNESCO. (2020). COVID-19 impact on education. https://en.unesco.org/covid19/educationres ponse UNICEF. (2014). A statistical snap shot of violence against adolescent girls. UNICEF. UNICEF. (2019). The state of the World’s children 2019. UNICEF. UNICEF. (2020a). Covid-19 and its implications for protecting children on line. UNICEF. UNICEF. (2020b). Rethinking screen-time in the time of COVID-19. UNICEF. UNICEF. (2020c). Impacts of pandemics and epidemics on child protection lessons learned from a rapid review in the context of COVID-19.UNICEF. UNICEF. (2020d). Protecting children from violence in the time of COVID-19: Disruptions in prevention and response services. UNICEF.

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UNICEF. (2020e). Protecting the most vulnerable children from the impact of coronavirus: An agenda for action. https://www.unicef.org/coronavirus/agenda-for-action UNICEF. (2020f). Averting a lost COVID generation. UNICEF. UNICEF. (2021a). Covid-19 a threat to progress against child marriage. UNICEF. UNICEF. (2021b). Responding to COVID-19: UNICEF Annual Report 2020. UNICEF. United Nations Committee on the Rights of the child. (2018). Day of general discussion (DGD) protecting and empowering children as human rights defenders. United Nations Committee on the Rights of the child, Geneva. (2020). https://tbinternet.ohchr.org/ Treaties/CRC/Shared%20Documents/1_Global/INT_CRC_STA_9095_E.docx United Nations office on drugs and crimes (UNODC). (2020). Impact of the Covid-19 pandemic on trafficking in persons—Preliminary findings and messaging based on rapid stocktaking. UNODC. World Health Organization. (2020). Global status report on preventing violence against children. World Health Organisation.

Chapter 16

Children in Armed Conflict: Concerns for Safety and Measures Towards Well-Being Raveena Kousar and Subhasis Bhadra

Introduction Childhood is the most critical stage of human life. Children continue to absorb a great amount of information from their experiences and environment. Early childhood experiences have profound impacts affecting health, behaviour, learning, social relationships and their earnings as an adult (Dyussenbayev, 2017). An optimal and conducive environment supports brain development, whereas a non-conducive environment exerts a negative impact on brain development. Consequently, the victim’s life not only gets affected in the short term but in the long term too (World Health Organisation, 2018). It is a valuable time for growth and development. Hence, in this period, an atmosphere should be created in which children should breathe free from fear, feel safe from any violence, exploitation and other types of social evils (Bellamy, 2005). Contributing financially and morally in the early years is one of the greatest investments a state can make to eliminate the vicious circle of poverty, achieve prosperity and create the human capital needed for economic development. Around 1.61 billion children of the globe live in conflict-affected economies, while approximately 426 million children living in the conflict zones in 2019. Africa had the highest number of children living in armed conflict (Ostby et al., 2020). Afghanistan, Syria and Somalia were the countries with the highest conflict intensity in 2019. The United Nations stated that a total of 10,173 children have been confirmed to have been murdered (4019) and maimed (6154) (The Secretary-General, 2020). In May 2021, an intensive conflict erupted between Israel and Palestine. At least 242 Palestinians including 66 children and 38 women have died due to the intensification of hostilities in Gaza, while over 1900 people have been injured. Nearly 12 people, including two children, have lost their lives and hundreds of injuries in Israel. About 77,000 Palestinians have been displaced from their native homes and taken shelter R. Kousar · S. Bhadra (B) Department of Social Work, School of Social Sciences, Central University of Rajasthan, Bandarsindri, Kishangarh, Ajmer, Rajasthan, India © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_16

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in schools of the United Nations Relief and Works Agency (ReliefWeb, 2021). In 2019, in Afghanistan, 3149 children were killed and maimed. In such conflict prevailing states and terrible zones, children often faced frequent problems like no access to school, nutrition, health and sports facilities. It deteriorated their health and other well-being aspects of their life (Schmidt, 2018). The brutal destruction of armed conflict is equally devastating to the public facilities which children require to survive, develop and grow such as educational and health infrastructure, homes, playgrounds, crops and animals. In 2019, the United Nations, while disclosing the statistics of the same, confirmed that 927 attacks were carried out on schools (494), on hospitals (433) and on protected areas in which vulnerable people were targeted. The countries that faced the highest number of attacks were the Syrian Arab Republic, Palestinian, Afghanistan and Somalia (ReliefWeb, 2021). In humanitarian crises, children’s protection, healthy development and well-being are all jeopardised. Posttraumatic stress disorder (PTSD), anxiety, depression and behavioural and psychosomatic complaints are common among children who have been exposed to military conflict, which stay for longer period after cessation of conflicts. This chapter examines the impact of armed conflict on children and different policies and strategies that are adopted for the rehabilitation of the children to facilitate protection and well-being. With special reference to the children living in Jammu and Kashmir’s border conflict-affected zone, the chapter has formulated a few recommendations to facilitate well-being for the children affected by war and armed conflicts.

Impact of Armed Conflict on Children In the UN General Assembly, the most wide-ranging assessment of the human rights of children and armed conflicts is discussed. The statement tabled by Grace Michael on the impact of armed conflict has diverted the world’s attention to this critical vulnerable group. This report has presented the real picture to the millions of children who have been killed, injured and permanently disabled, forced to witness and take part in horrifying atrocities due to armed conflict. The Security Council has identified and condemned the six grave human rights violations against children, namely brutal assassination and injury of children, the recruitment of innocent children as soldiers, kidnapping of children, sexual violence against children, attacks on schools or hospitals and the disowning of humanitarian access (Kadir et al., 2018).

Direct Effect on Right to Life In the twenty-first century where dignified life is being assured, at the same time, children are the direct victim due to conflict like situations. About 25,663 violations against children have been reported in the year 2019. Syria, Yemen, Afghanistan and

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Somalia were the most affected countries. Moreover, Afghanistan continued to be the worst country for children, with a sixty seven per cent increase in self-annihilation bombs and complex outbreaks. On the other hand, in West African country Mali, many child fatalities were confirmed, with 91 per cent of them occurring in the Mopti province. Increased violence in Myanmar’s Rakhine State caused in three times increase in child casualties. About 25% of the people are killed by improvised explosive leftovers of war (The Secretary-General, 2020). Explosions caused injuries, shockwave and shearing injuries, penetrating trauma, burns and crush injuries. Contamination injuries from explosive device are common due to a lack of medical facilities. During the explosion, heat, flames, gas and smoke caused quaternary injuries, including burns, inhalation injury and suffocation (Champion et al., 2009; Kadir et al., 2018). Machine gunfire, rockets and explosives, including cluster bombs, dropped from aeroplanes, killed or injured many children. In 2004, a study was conducted in Iraq and found that air strikes caused extremely violent deaths of women and children (Roberts et al., 2004). A study was conducted to analyse war-related injuries among children treated at hospital during the wars in Croatia (1991–1995) and Bosnia and Herzegovina (1992–1995) found that most of the children were injured by shelling, bombing, and remaining explosive devices. Nearly forty per cent of the children developed permanent disability (Terzic et al., 2001). In Baghdad, a study was conducted to estimate injuries caused during a period of 11 years of conflict found that 46% of the victims were children and 80% of the injuries resulted in a permanent disability due to damaged health system and lack of health workers (Lafta et al., 2015). Around 5400 doctors migrated from Iraq every year during conflict (Burnham et al., 2011). About 28.6% of health care infrastructure have been damaged, and shortages in substantial medications, blood screening and medical disposable were reported during the armed conflict in Libya (Daw et al., 2016). A study on the Syrian crisis found that refugees with disabilities have an increased risk of developing new medical conditions due to untreated chronic disease (Humanity and Inclusion, 2014). In 2015, Security-General’s report on children and armed conflict indicated that around 9000 injuries were verified in Palestine, and about 1000 of those injuries lead to disabilities. It highlighted concerns about children and adults with disabilities, including violence, risk of abandonment, lack of access to essential services and exclusion from social support systems. The Security Council has also addressed the need to support the reintegration of mine victims with disabilities and ensure the protection of persons with disabilities from violence (The Security Council, 2015). Article 38 of the CRC imposed an obligation to ensure protection and care for children, but the children who are caught up in conflict have fallen well short of its purpose. Protecting the right to survive requires that every child has access to health and food. As of November 2020, around 9.3 million people were devoid of food security, an increase of more than 1.4 million from the previous year and the most significant amount since the war began in Syria (Internal Displacement Monitoring Centre, 2020). The above incidents clearly indicated that the war and armed conflict severely violated the children’s rights in different parts of the globe. Rights associated with

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security, integrity and basic necessities to live were torn apart as children lived through insecurities without basic facilities and became victims of intended harm and abuse. The rights related to economic, social and cultural protection were equally denied as schooling was disturbed, lived as refugees or internally displaced persons (IDP) in temporary shelters, relief camps and lost parental care or opportunities to inherit property. Similarly, the children were devoid of civil and political rights, often separated from family, lost their essential documents and freedom to enjoy a happy, nurturing childhood.

Psychological Health Problem Stability in life matters the most, especially when it comes to psychological wellbeing because it has great potential to channelise one’s activities towards growth and development. Due to the armed conflicts in any part of the world, the first thing that emerges is psychological trauma, which further leads to many health-related disorders. Witnessing a family member being harmed or killed and having a home shelled or demolished can have a negative impact on a child’s mental health and lead to behavioural and emotional issues. In Palestine, according to an estimate, children witnessed friend being killed 23–49% or close relatives killed 3–16%, people being killed by rockets 75%, the bombardment of other homes by airplanes and helicopter 51–71% and hearing shelling of the area by artillery 92% (Thabet et al., 2008; Dimitry, 2012; Thabet et al., 2009). The study of Macksoud and Aber (1996) found that children had experienced six different types of war traumas and 15 per cent had experienced 10–20 traumas due to conflict in Lebanon. Psychological and social distress manifests wide range of emotional, cognitive, physical and behavioural and social problems (Hassan et al., 2016). Children exposed to the ongoing Israeli-Palestinian conflict had the highest prevalence of post-traumatic stress disorder, ranging from 21 to 44.6% (Slone & Mann, 2016). Various studies reported increased anxiety among conflict-affected children, and they displayed the number of problematic behaviours such as nervous, tense and quickly startled, as well as intense reactions, panic and developing new anxieties (Basu & Dutta, 2010; Sadeh et al., 2008). A study was conducted to examine the effects of armed conflict on mental health of children in Thailand reported that 42.1% of the respondents had at least one behavioural emotional problem and 30.5% has shown high risk of developing PTSD (Jayuphan et al., 2019). Such psychological and emotional problems have a long-term impact on the children and even in adulthood, severely restricting their growth potential.

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Children Recruitment Children are actively recruited and forced to fight in armed conflict. Using children in armed warfare is the worst kind of child labour and a human rights violation. International labour Organisation Convention No. 182 defines “forced or compulsory recruitment of children for use in armed conflict as the worst form of child labour” The Optional Protocol to the Convention on the Rights of the Child on the engagement of children in armed conflicts outlaws the recruitment of children under the age of 18 into armed conflicts, whether voluntary or forced. (International Labour Organization, 2014). Child labour is widely condemned at the international, regional and national level yet children continue to be involved in armed conflicts. Nearly 7747 children at the age of 6 and above were verified by the United Nations Security Council to be recruited and used in 2019 (The Secretary-General, 2020). It is further reported that the majority of these children were under the age of 15 and 40%of them were girls. In Afghanistan, 64 children were recruited by Taliban, Afghan National and local Police, pro-government militia in 2020. In the Central African Republic, 208 children in the ages of 11–17 years were recruited and used in 2019. In 2019, 601 children were recruited, and 30% of whom were under the age of 15 at the time of recruitment. The United Nations confirmed the recruitment and usage of 215 children between the ages of 9 and 17 in Mali (189 boys and 26 girls). In Somalia, it was reported that 1442 boys and 53 girls were recruited and used, with some children as young as eight years old (The Security Council 2020). Many illegal armed groups recruited children by force, kidnapping and abduction. It is a common practice around the world wherever child soldiers are found. Press Ganging is one of the common forms of forced recruitment where armed force groups visit public places, such as schools and streets, to capture children who have come across (Madubuike-Ekwe, 2005). In Northern Uganda, between 5000 and 8000 children were kidnapped from their schools to serve as child soldiers from 1995– 1997 by the Lord’s Resistance Army (LRA) (Relief Web, 2003). Similar incidents are still quite common all over the world in different conflict-affected countries. Sexual abuse of these children is quite common, and the girls are used as sex-slaves or pushed into forced marriage. Severe forms of exploitation and harassment are used to socialise them with the violence as a regular event of living as a soldier. Such perpetrated violence is used to break down their traditional value system and further to cut their opportunity for the children to return home. Sexual abuse and exploitation increased the incidence of STD/AIDS and a considerable amount of psychological trauma (Alfredson, 2001; Park, 2006).

Displacement Displacement is part of ongoing conflict and also one of the most significant humanitarian challenges. The devastation is such that people have to leave all their home,

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livelihood, earning, belonging and native places due to threats to their physical security. People often leave their home to be safe and adopt some other livelihood strategy, but being displaced is no assurance of being safe or attaining a sustainable livelihood. Indeed, the fact of being displaced can generate additional risks and vulnerabilities and in many cases struggle to meet even basic survival needs (Bradley, 2017). In Iraq, an acute humanitarian crisis was created due to war and armed conflict, and acute insecurity caused in the largest humanitarian refugee crisis in the Middle East. Around 4.4 million people have been internally displaced, and 2 million people have settled in other countries as refugees. Nearly 920,000 people have been displaced from their homes since the commencement of the military campaign in 2016. Syrian government forces launched a catastrophic assault in the northern governorate of Idlib, displacing 960,000 people. It was the largest displacement event since the war began in 2011 and accounted for over half of the 1.8 million people recorded displacement nationwide. (Internal Displacement Monitoring Centre, 2020). Conflict and natural catastrophes caused 40.5 million new IDP in 149 countries and territories. In 2020, highest IDP were recorded in Sub-Saharan Africa, the Middle East and North Africa. In previous years, most of the protests took place in the DRC, Syria and Ethiopia. Conflict has erupted in Mozambique’s northern province of Cabo Delgado since 2017, one of the poorest and most marginalized in the country. The crisis triggered 584,000 new displacements in 2020, more than seven times the number in 2019. More than 669,000 persons were internally displaced (Internal Displacement Monitoring Centre, 2021). About 23 million children under the age of 18 were internally displaced worldwide with considerable impacts on their housing, education, health and security and loss of income of their parents, as per the report of Internal Displacement Monitoring Centre (2021).

Schools and Education Conflict has impacted the education of the children. Education is the basic right and should not be compromised in any situation including emergency. In all the conflictaffected areas, often schools have been closed due to targeted attacks, damage and military use of school buildings. In 2019, attacks on schools increased dramatically in the Sahel region of African continent. According to UNICEF, violence forced more than 3300 schools to close or become non-operational in Burkina Faso, Mali and Niger by the end of the year 2019, affecting 650,000 children and 16,000 teachers (UNICEF, 2020). In 2019, the United Nations reported 433 attacks on hospitals and 494 attacks on schools. The occupied Palestinian Territory, the Syrian Arab Republic, Afghanistan and Somalia have recorded the most attacks on schools and hospitals nearly doubled internationally over the year. In Democratic Republic of Congo (DRC), approximately 180,000 primary school aged children are out of school because of fear of violence. Schools, students and teachers are often seen as the direct targets of violent conflicts to instil fear among the common people. At least 335 people were killed in the massacre at Beslan’s School by Chechen terrorists

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and others, including over 150 children. In December, Taliban militants attacked a school in Peshawar, killed 141 people, including 132 children (BBC, 2014). Since 1993, 25% of all primary school teachers in Burundi have been murdered or fled (Fountain 2000). Direct attacks on teachers and students killed the most teachers and students in Afghanistan, Cameroon, Palestine, and the Philippines (GCPEA, 2020). Educational facilities and educational administration buildings are frequently targets of violent conflicts and military attacks. Since 1993, 20 per cent of all school buildings in Burundi have been destroyed due to the violence. About 2665 schools were either shuttered or destroyed in Mozambique (Seitz, 2004). Classes were held in basement shelters, open areas, and garages, many of which lacked adequate infrastructure and amenities, making it dangerous for children to attend school. According to the Global Coalition to Protect Education from Attack (GCPEA, 2020), Yemen had approximately 7300 incidents of direct attacks on schools, with an average of one attack on education per day between 2015 and 2019. Attacks on schools were most frequent in the Democratic Republic of Congo (DRC) and Yemen, with over 1500 incidents reported. In 2018, approximately 100 schools in Afghanistan were attacked with explosive devices, fire, and other forms of violence while serving as polling sites during the national election. (GCPEA, 2020). After being shot in 2012 for challenging Taliban restrictions on female education, Yousafzai, 19, became a global icon of the fight for girls’ education. Attack on Malala became a voice to stop violence against education system and promote peace through the recognition of Nobel Peace prize in 2014 (NEWS18, 2014).

Safeguard and Provision for the Well-Being of Children Living in Armed Conflict Areas Child well-being is an outcome not an input. Thus, a lot of systematic planning, policy formulation, legislative actions, interventions and active engagements, commitments and willingness of different stakeholders are most essential.

International Legal Framework International law tries to mitigate war’s inherent inhumanity by establishing acceptable behaviour standards during war and conflict. The laws attempt to provide “guidance regarding the moral boundaries of the exercise of power in situations that most exclusively generate excess” (Maher, 1989). The primary goal of international law in the realm of armed conflicts is to protect and assist victims of armed wars. Children are among the most vulnerable victims of armed conflicts. The international community has developed and recognized several international organizations to provide neutral

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aid in and observe international disputes in order to restrict deviations from acceptable human behaviour norms (Lee-Koo, 2018). These organizations contribute to an “environment of international accountability” by codifying international standards that apply to conflict-affected countries. Since the Russian Revolution of 1917, the International Committee of the Red Cross (lCRC) has supported victims of conflicts. The international community’s goal of protecting children is rooted in traditional non-combatant protection as defined in the 1949 Geneva Convention, which was established to protect the innocent civilian population. In the 1970s, a demand to safeguard children through international legal tools arose. Thus, the Protocols of 1977 amended the Geneva Convention to apply to children particularly. Graca Machel’s report, “Impact of Armed Conflict on Children,” published in 1996, highlighted children’s issues and armed conflict firmly on the international political agenda (Machel, 1996). Since then, it has inspired extraordinary action, including establishing international standards, the passage of multiple Security Council resolutions and the appointment of a Special Representative of the Secretary-General for Children and Armed Conflict (SRSG CAAC). In 1989, world leaders came together to make a landmark commitment to children’s rights and their protection. The Convention on the Rights of the Child is far more than a human rights convention for children’s protection and fulfilment of their rights. It is the recognition that all children, especially those impacted by armed conflict, have human rights and must be treated as people who can act as change agents by exercising their rights. It is the most ratified human rights treaty, and it covers the entire spectrum of human rights. It provides equal significance to children’s civil and political rights and their economic, social and cultural rights (United Nations General Assembly, 1989). It was drafted in 1979 and adopted in 1989 by the United Nations General Assembly (1989). It is at the heart of the international legal framework for the protection of children in conflict and a guiding source of operative principles and standards for the children and conflict mandate. The United Nations Security Council Resolution 1216 of 1999 was another significant international development. The United Nations Security Council highlighted grave concern about armed conflict’s detrimental and widespread effects on children. It also severely condemns the killing and maiming of children, as well as sexual assault, kidnapping and forced displacement, and child recruitment and usage in armed conflict. The resolution called upon all parties to adhere to their international law particularly the Geneva Conventions (1949) and the obligations under the Additional Protocols of 1977 (UNSCR, 1999). In 2005, the Security Council passed Resolution 1612, which established a monitoring and reporting mechanism for grave violations against children in armed conflict. It directed the Special Representative to collect timely, accurate, objective, and reliable information as appropriate to support the protection and reintegration roles of the National government. It asked to report to the General Assembly, the Security Council and the Human Rights Council on the progress achieved and to discuss the challenges faced by the children in armed conflict. The establishment of the Security Council Working Group on children and armed conflict was also a pivotal event by the Security Council resolution 1612 provided a unique framework for engaging the Security Council on the issue of

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children affected by conflict regularly and bridging the gap between political action at the highest level and action in field. International Labour Organisation’s “Worst Forms of Child Labour” Convention (1999) was another significant development on the international level. It establishes the first international standard of 18 years as the minimum age for child recruiting. The most recent milestone in this area is the Optional Protocol to the Convention on the Rights of the Child on the Use of Children in Armed Conflict, which a UNHCHR working group adopted in 2000 (Plattner). Over the last decade, states, civic society, the United Nations (UN) and others have highlighted the impact of armed conflict on children, but accountability efforts rarely result in concrete advancements in children’s security and well-being. The Children in Armed Conflict Responsibility Framework (Freedson et al., 2015a; b) is a practical tool for promoting accountability for significant international law violations perpetrated against children in armed conflict (CAC accountability) at international, national, regional and regional local level. The key objective is to advance accountability for serious violations against children by redressing past violations and preventing future violations. A significant gap exists in preventing and redressing severe abuses committed against children in armed conflict (Freedson et al., 2015a; b). UNICEF established the concept of the protective environment as a tool to direct international and national actors’ programmatic work in support of children’s protection. The paradigm identifies a number of factors that safeguard children from risks and vulnerabilities. It recognizes the need for direct actions to reduce threats, such as peace processes that decrease civilian populations’ exposure to military action. The commitment of the government and capacity, legislation and enforcement, children’s life skills knowledge and participation and capacity of families and communities are the some key elements for creating and strengthening a protective environment around children. Each provides a foundation for enhancing child protection; however, their combined actions improve the effectiveness of protection (Landgren, 2005). The Framework for the Protection of Children was prepared in consultation with states, partners, communities and children themselves by the United Nations High Commissioner for Refugees (UNHCR). It is recognising the significance of children’s protection and the developing knowledge and proficiency in the global child protection sector. The framework expands UNHCR’s understanding of and commitment in child protection. It outlined six objectives that highlight UNHCR’s commitment to protect and fulfil the rights of children and practical help on how to achieve them. The framework adopts a systems approach to child protection, incorporating measures for duty bearers at all levels—family, community, national and international—to mitigate and respond to child protection challenges (United Nations High Commissioner for Refugees (UNHCR), 2012). The Minimum Standards for Child Protection (CPMS) by UNHCR (The Alliance, 2019) have been developed to guide all humanitarian actors in improving child protection in their work by developing common principles for those who are working in child protection, maintaining coordination among humanitarian actors and improving the value and accountability of child protection. The CPMS was first released in 2012 to address the need for a uniform framework and agreement on minimum quality

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guidelines across child safety in humanitarian operations. The 2019 Edition incorporates the most recent research, experience and best practises into the original manual. These standards laid down ten principles, and few of them are survival and development, children’s participation and strengthen child protection systems (The Alliance, 2019). The Sphere Project came out with a Humanitarian Charter, and a set of minimum principles are published together as a Handbook. It was first published in 2003 for use in humanitarian response planning, execution, monitoring and assessment. Protection concerns give rise to four main Protection Principles: avoid further harm, ensure people’s access to impartial assistance, protect from physical and psychological harm, and assist people in claiming their rights and remedies. These principles reflect the more serious threats that people experience in times of conflict or disaster in the context of humanitarian assistance (The Sphere Project, 2011). The Inter-Agency Network for Education in Emergencies (INEE) handbook contains 19 standards each having important actions and guidance notes. The handbook’s goal is to improve the quality of educational planning, response and recovery by increasing access to safe and relevant learning opportunities and ensuring accountability in delivering these services. The INEE Minimum Standards Handbook directs on establishing a high-quality, well-coordinated humanitarian response, which includes meeting catastrophe victims’ educational rights and needs through efficient and effective systems (INEE, 2012).

Child Protection at National Level In January 1950, the Indian Constitution came into effect, including provisions for children’s development, protection and survival. These are found in the Constitution’s Parts III and IV, which deal with “Fundamental Rights” and “Directive Principles of State Policy,” respectively. Numerous laws, policies and programmes are being introduced for the welfare of children. The Central Social Welfare Board (CSWB) was established in 1953 to aid volunteer agencies in the organization of welfare programmes for children, women and other disadvantaged groups. During the First Five-Year Plan, the Board aided 591 child welfare organizations. Furthermore, in 1955, the Indian government adopted the Protection of Civil Rights Act and ratified the International Labour Organization (ILO) Convention 1919 on the minimum age of employment in factories. A Committee on Child Care was also established, and its recommendations led to the establishment of a comprehensive Family and Child Welfare Scheme (1967) provided integrated services to children in villages as well as basic training for women in childcare including health education and nutrition. The National Policy for Children (1974) regarded children as the nation’s incredibly significant asset and said that it is the responsibility of the state to nurture them. The National Children’s Board (1974) was established to plan, review and coordinate services and programmes to fulfil children’s need (Bhakhry, 2006).

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The Integrated Child Development Services (ICDS) started in 1975 and is regarded as one of the world’s largest outreach programmes. The scheme adopts a multi-sectoral approach to child well-being, integrating health, education and nutrition interventions and is delivered at the community level through a network of Anganwadi centres (AWCs) (Baig, 1979). The year 1979 is significant for child welfare and development. The United Nations General Assembly declared the year 1979 to be the International Year of the Child (IYC). In order to honour the IYC, India developed a National Plan of Action. The core theme was “Reaching the Deprived Children” (Bhakhry, 2006). In September 1985, a distinct Department of Women and Child Development was established in the Ministry of Human Resource Development to address child development issues. It was upgraded as a separate Ministry in 2006 and named as Ministry of Women and Child Development. It now tackles problems impacting children that were previously handled by the Ministry of Social Justice and Empowerment. The Government of India also passed the Child Labour (Prohibition and Regulation) Act, 1986. The National Policy on Child Labour was declared in 1987 having the action plan for tackling the problem of child labour. The government has introduced Child Labour (Prohibition and Regulation) Act in 1986. The National Policy on Child Abuse and Neglect was enacted in 1987. The Juvenile Justice Act of 1986 was enacted to address the problem of abandoned children and children in conflict with the law. According to the Right of Children to Free and Compulsory Education (RTE) Act of 2009, every child has the right to a full-time elementary education, which constitutes constitutional legislation envisioned under Article 21 A. This Act mandates that all children aged six to fourteen get free and compulsory education in a neighbourhood school. Under the Commission for Protection of Child Rights (NCPCR) Act 2005, the National Commission for Protection of Child Rights (NCPCR) was established as a legislative body under the Ministry of Women and Child Development in 2007 to protect, promote, examine and defend child rights in the country. The Protection of Children from Sexual Offenses Act (POCSO) was passed in India in 2012. It is comprehensive sexual abuse legislation that broadens the scope and range of sexual offences, mandates abuse reporting and establishes criteria for victim examination (Seth & Srivastava, 2017). The National School Safety Policy (2016) strives to create a safe learning environment for children in which all students, their teachers and other stakeholders in the school community are safe from any risk of natural threats.

Situation of Children in Border Conflict Areas of Jammu and Kashmir The Union Territory Jammu and Kashmir has been experiencing conflict since Independence of India and Pakistan. Border remains sensitive. Martinez (2002) described four kinds of the border, and the Alienated border is one where borders operate

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in extremely unfavourable conditions, including warfare and political disputes. The characteristics of Jammu and Kashmir resemble the alienated border. Such a border is extremely vulnerable and highly sensitive. Uncertain threat to life, frequent displacement and unavailability of services are faced by the local people. Since the independence of both countries ignited the dispute on this land which became an unresolved issue. Even more, vulnerability has risen in these areas. People living near the International Border and the Line of Control have been subjected to a near-constant state of conflict. There has never been a time when weapons have been silent. There has been sporadic shelling and firing, creating an atmosphere of unpredictability and uncertainty. The residents living along the border were relieved when a formal ceasefire was announced in 2003. However, the ceasefire has been repeatedly breached, and the border situation remains unsettled. The year 2020 has recorded the highest number of ceasefire violations from the last 16 years (Ghosh, 2020). People living near the border have been displaced regularly. In 2018, over 76,000 villagers shifted to safer places due to intense firing at the border (The Economics Times, 2018). Most people preferred to shift their relatives’ homes instead of relief camps organized by the administration (Kousar & Bhadra, 2021). Many people’s homes and shelters were destroyed during the firing and shelling, and animals were killed. In 2020, eleven persons were killed in several ceasefire violations along the Line of Control, including five security forces officers (LoC) (FirstPost, 2020). As a precautionary measure for the safety of the students, the district administration decided to close all 67 schools along the Line of Control in the Nowshera area, which was the worst hit by cross-border shelling (The Quint, 2018). Around 25 schools in the affected districts have been instructed to remain closed due to ceasefire violations along the Line of Control (LoC) (Zee News, 2017).

Way Forward Child protection and their well-being is paramount for the overall development of the nation. Tremendous work has been done at the International, national, regional and local level for the protection of their rights. Despite having all measures, the children are still not protected, and their rights have been violated at all levels. Strong commitment and strict regulation at the international level should be there to protect the children’s rights. Conflict of any form could not be tolerated. It is critical to find a viable, just and fair political settlement solution which can serve as a prerequisite for ensuring a peaceful society. Most of the conflict-affected areas like Myanmar, Azerbaijan-Armenian and Kashmir military-driven peace process have been initiated. Major emphasis is given on the negative peace instead of positive peace. Such a process does not sustain for a longer period and conflict arises again. It is necessary to focus on the root causes and address the peace process according to that. Peace process is an important means, yet they cannot create sustainable peace on their own. The worldwide community would not only assist in the development of

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an agreement and the shaping of a process, but also facilitate the process of settling the longer-term difficulties of national identity construction, system transformation and addressing inadequate governance. An effective peace process must give the opportunity to all stakeholders in a society to be heard and address their concerns as part of the process. Conflicts have various dimensions; thus, many ways must be taken in the efforts to achieve peace. Identifying key stakeholders, creating meaningful involvement and linking important issues are important for achieving inclusiveness. Building peace is impossible without involving individuals in positions of power and authority to ensure that the process is legitimate and that the outcomes are translated into institutional change. Northern Ireland’s peace process is an example to showcase the ideal form of peace process to a great extent. The peace process included attempts to negotiate and help not only at the highest levels of government but also at lower levels and across civil society. It was estimated that 60 per cent of the achievement was due to civil society’s ability to negotiate, educate, create new concepts and create a platform for people of opposing communities together. Fitzduff (2017) emphasized that “civil society can do a lot of the difficult work that political and military parties cannot do themselves.” It is further stated that direct interaction with the community people will develop into the kinds of discussions which are needed in terms of developing a peace process (Rausch & Luu, 2017). Peace-building initiatives can be extremely successful when they thoroughly evaluate the conflict, fulfil the needs of the local population and bridge gaps between conflicting parties.

Conclusion Child protection is an important area of the United Nations at all times, but it becomes a critical concern during armed conflict due to increasing vulnerability and eroding societal support. Continuous conflict has created a psyche of fear and keeps them away from enjoying a prosperous life. There is a strict need of an hour to protect the children from such vulnerability and create a safe place for a bright future. Peace process should be initiated in conflict-affected areas with the proper involvement of important stakeholder and people participation. The community should be given the opportunity to contribute to the creation or transformation of institutions and power structures, as well as to the strengthening of the rule of law, justice and security.

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UNSCR. (1999). Resolution 1261 the children and armed conflict. United Nation Security Council. Retrieved from http://unscr.com/en/resolutions/doc/1261 World Health Organisation. (2018). Nurturing care for early childhood development—A global framework for action and results. Geneva: World Health Organisation. Zee News. (2017, July 22). Ceasefire violation in LoC, J&K school damaged in heavy shelling by Pakistani troops. Retrieved from https://zeenews.india.com/jammu-and-kashmir/ceasefire-violat ion-in-loc-jk-school-damaged-in-heavy-shelling-by-pakistani-troops-2025875.html

Chapter 17

Sexual Abuse of Male Children: Current Status and Future Directions P. Swathisha and Sibnath Deb

Introduction: What Is Child Sexual Abuse? Child sexual abuse (CSA) is a broader term which refers to an adult or adolescent uses a child for sexual stimulation. It is one among the many types of child maltreatment alongside physical abuse, emotional abuse and neglect. It is a violation of the child rights and their wellbeing. Child sexual abuse not only includes touch but also forced watching of sexual activity or pornography, invading privacy, making sexual comments also comes under the same (Napier-Hemy, 2008). There are many definitions used worldwide for CSA. For example, United States Centre for Disease Control and Prevention (CDC) defines child sexual abuse as “any completed or attempted sexual act, sexual contact with or exploitation (i.e. noncontact sexual interaction) of a child by a caregiver” (Murray et al., 2014). According to WHO, CSA is “the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violates the laws or social taboos of society. Child sexual abuse is evidenced by this activity between a child and an adult or another child who by age or development is in a relationship of responsibility, trust, or power, the activity being intended to gratify or satisfy the other person’s needs. This may include but is not limited to: the inducement or coercion of a child to engage in any unlawful sexual activity; the exploitative use of a child in prostitution or other unlawful sexual practices; the exploitative use of children in pornographic performances and materials” (cited in Murray et al., 2014). Child sexual abuse is considered a form of violence against children because the adult exerts power and superiority to use a child for his or her sexual gratification P. Swathisha (B) Department of Applied Psychology, Pondicherry University, Puducherry, India S. Deb Rajiv Gandhi National Institute of Youth Development, Sriperumbudur, Tamil Nadu, India © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_17

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(Castro et al., 2019). CSA usually applies to people under the age of 18. It varies from non-contractual sexual acts such as making sexual comments, forcing to be naked, capturing children’s nudity, to forced sex, genital contact and commercial sexual exploitation (Murray et al., 2014).

The Magnitude of Male Child Sexual Abuse: What Does Statistics Says There is always a tendency in society to see the female gender as a victim. Because of this, there is a deep-rooted notion that sexual assault victims will be females, which surprisingly is not corroborated by evidence. The magnitude of sexual abuse against males is alarmingly high worldwide. CSA against girls is reported at a higher rate than that of boys. The reason for this difference could be multiple. The number of studies focused on the posttraumatic effects of CSA among men is far fewer than those on women (Kanmerdsiri et al., 2020). One in six men are sexually abused in Australia (Healthy WA, n.d.). Research evidence suggests a prevalence of 14–16% of sexual abuse among male population before the age of 18 (Briere & Elliot, 2003; Cook & Ellis, 2020; Dube et al., 2005). A national survey conducted by the Centre for Disease Control and Prevention (CDC) in the United States in 2015 found that nearly 4 million men in the United States had been victims of sexual violence just in the previous year. Also, more than 2 million of those men were subjected to unwanted sexual contact, and more than 800,000 disclosed that they were “made to penetrate” another person (Brown, 2021). According to the Crime Survey for England and Wales (CSEW), in the year 2017, till March, 20% women and 4% men experienced sexual assault since the age of 16 (Zehra, 2020). The actual prevalence rate is difficult to obtain due to under-reporting of cases (Castro et al., 2019; Turmel & Liles, 2015). According to the 2006 World Report on Violence against Children, about 150 million girls and 73 million boys were exposed to CSA in 2002, with 1.2 million of them being trafficked. 1.8 million children are exploited through prostitution or pornography. In the United States, a population-based sample of face-to-face interviews with more than 34,000 adults found that 10% of respondents, 25% of whom were men, admitted experiencing contact CSA before 18 years (Murray et al., 2014). Two recent meta-analyses comprise 65 and 331 articles, respectively, estimated a prevalence of 7.9 and 7.6% of boys being sexually abused. These studies found that Africa is having the highest rate of incidents, while Europe and Asia are having a lower prevalence rate (Murray et al., 2014). The World Health Organization gives a higher estimate for males, reporting that 5–10% of men reported a history of childhood sexual abuse, even though most studies have been conducted in developed countries. Among the prevalence studies conducted in developing countries, such as Peru, Namibia and United Republic of Tanzania, the findings indicate 20%, 3.6% and 13.4%, respectively. An analysis of

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childhood sexual abuse surveys from twenty-one countries reported that prevalence rates ranged from 3 to 29% of male children compared to 7–36% of female children. A survey found that the countries with a high prevalence of male child sexual abuse are 19% in Austria, 13% in Costa Rica, 29% in South Africa and 15% in Spain (Stemple, 2009). When it comes to the Indian context, in a study conducted by the Ministry of Women and Child Welfare, supported by the United Nations Children’s Fund, save the children and Prayas in 2007 to find out the magnitude of child abuse in India, they found that 53.22% of the participants faced one or more forms of sexual abuse; among them, the percentage of male children was 52.94 and of female children was 47.06% (Subramanyan et al., 2017). Dariwala, a filmmaker, conducted a study among 160 men and found that 71% of the participants were subjected to sexual abuse during childhood. Among them 84.9% did not report the abuse. The primary reasons for not reporting were shame (55.6%), followed by confusion (50.9%), fear (43.5%) and guilt (28.7%) (Chatterjee, 2018). While the data for sexual harassment of men and boys in India is almost non-existent compared to the United States, most of such cases are going unreported (Sundd et al., 2000). In 2018, the ministry of women and child development, India, argued for making the legislature gender-neutral for child abuse and taken a step for the in-depth exploration of the issue along with two Non-Gazetted Organizations (Chatterjee, 2018).

Why Is It Different? The Role of Gender Stereotypes Since society is aware of the sexual abuse of female children, male child sexual abuse is a public secret. The reason behind this phenomenon is the deep-rooted gender stereotypes. Since our society is a patriarchal one, it adversely affects males too. Male child sexual abuse is such an example. There exist a lot of myths about the sexual abuse of male children in association with gender stereotypes. There is a notion that men should not feel the pain; they should not be vulnerable because they are privileged to be the dominant gender in the patriarchal society. Toxic masculinity is described as “a social science concept that describes a narrow authoritarian type of ideas about the male gender role that defines masculinity as exaggerated masculine traits like being violent, unemotional, sexually aggressive, and so forth” (cited in Zehra, 2020). It is believed that men cannot be sexually assaulted because they are strong enough to attack the perpetrator. If a man/boy is subjected to sexual abuse, it is thought that the victim must be gay. Also, there is a misbelief that if a boy gets sexually abused, he will become gay in future. If the person is gay, there is a notion that they do not get raped, but they always ask for sex. It neutralizes the act as consensual sex instead of a sexual assault (Stemple, 2009). There is no scientific or research evidence for any of these claims, and a

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person can be subjected to sexual assault regardless of gender and physique. Sexual orientation does not influence sexual abuse and vice versa (Healthy WA, n.d.). Men are conditioned to see themselves as strong, tough and self-sufficient by society. Men even think that their masculinity is robbed through sexual abuse, making them “fake”. This is because their confidence might be grossly dependent on how “manly” they are (Hopper, 2021). Acknowledging feelings and disclosing vulnerabilities are violations of the existing masculine roles because weakness is a feminine trait. In short, being abused makes you less than a man, which makes the men perceive expressing emotions as a shame as a man, so they internalize it. They can ignore, downplay or overlook the connection between sexual assault and subsequent mental health problems. They will dissociate and fail to fully register or recall what has occurred (Cook & Ellis, 2020; Napier-Hemy, 2008). It acts as a barrier to seeking professional help. Undergoing sexual abuse means being sexually used or being dominated, vulnerable, overwhelmed and flooded by intense emotions, which are exactly opposite to the societal concept of an “ideal man”. Boys and men can be sexually abused regardless of how masculine they are and their sexual orientation (Hopper, 2021). Since it undermines their masculinity concept, boys feel difficult to confront it. According to Lipkins (2006), it is common in boys to remain silent even after getting assaulted; unfortunately, they fail to recognize that they are victims (cited in Brown, 2021). Boys who are raped or sexually assaulted face a particular kind of disbelief that the adults reinterpret it as a consensual act or blame the child for taking it too seriously. They dismiss it by using terms like horseplay, hazing, poking, roughhousing, but not as a sexual assault or rape (Brown, 2021).

Nature of the Abuse The vast majority of male rape victims claim they were raped by another male, but a huge number of male victims of other forms of sexual assault say they were raped by a female (Stemple & Myer, 2014; Stemple et al., 2016; Zehra, 2020; Brown, 2021). In addition, research evidence points to the significant prevalence of female perpetrated sexual victimization against men and occasionally against women. These findings are strong enough to justify directly rethinking long-held stereotypes about sexual victimization and gender (Stemple et al., 2016). Also, male victims abused by a female tend to under-report or incorrectly report the gender of the perpetrator to a greater extent because it creates more threat to masculinity ideals (Stemple et al., 2016). Research indicates that the age of onset of the abuse can vary from early childhood to adolescence. The predators are known in most cases, such as parents, siblings, relatives, neighbours, religious priests and teachers, including males and females. In some cases, strangers also found to be the abusers. Many of the victims have been abused by more than one person and more than once (Lisak, 1994; Kanmerdsiri et al., 2020).

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Some studies pointed out that one-third of the male predators of CSA were victimized for CSA in their childhood (Finkelhor, 1979; Senn et al., 2012; Worling, 1995). When a male is victimized for sexual abuse, most probably, it occurs in childhood, but it does not mean there is no probability in adulthood. A history of sexual abuse is present in the majority of the sexual offenders who target male children. The possible reasons are said to be physiological arousal and social learning. For example, when a boy masturbates by imagining the abuse and get aroused, he might feel that he gets aroused by boys. Also, they tend to model their offender in abusing boys; however, there is a scarcity of research to fully explain the process (Worling, 1995).

Risk Factors Some of the risk factors associated with male child sexual abuse are given below: Family Dynamics: It is found that violence in the family environment has a strong relationship with the abuse of male children. Dysfunctional or broken family due to constant physical violence between the parents, divorce or separation, or parental death, substance abuse of parents are seen in the history of the victims of male child abuse (Lisak, 1994). Children living with either parent or step-parents are more likely to get sexually abused than children living with both biological parents (Sedlak et al., 2010). Age: Most of the boys are getting sexually abused under the age of 12 years. More than a quarter of the children subjected to sexual abuse under 12 are boys, and 8% of those abused between 12 and 17 years are boys (Snyder, 2000). Prison Settings: Sexual violence against men and boys continues to flourish in detention settings such as prisons (Stemple, 2009). Armed Conflict Situation: Being in an armed conflict situation is a risk factor for a boy (like a girl) to be subjected to multiple human rights violations, including sexual abuse. Reports from southern Sudan say that boys held as slaves by the military have been subjected to sexual abuse by government soldiers, including violent gang rape. Most of them are undergone rape more than once by multiple perpetrators (Stemple, 2009). Religious Settings: Religious settings provide a high chance of getting a boy to be sexually abused, mostly by priests. Many sexual abuse scandals reported all over the world from occur in the context of organized religious settings (Stemple, 2009). Hazing: Hazing is a humiliating, intimidating or demeaning practice towards a new member of a group to incorporate them. Sometimes it endangers the health and/or safety of those involved. Research suggests that as part of hazing, many children are getting sexually assaulted (especially in the case of boys) in schools and sports institutions (Jeckell et al., 2018; Lipkins, 2006).

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Socioeconomic Factors: Children from low socioeconomic backgrounds and living in rural areas are more at risk of getting sexually abused. Some studies identified race and ethnicity as also important factors in predicting the same. For example, African American, Hispanic children are more prone to sexual abuse (Sedlak et al., 2010). Carson et al. (2013) found that sexual exploitation and abuse are strongly linked to poverty, affecting families of all socioeconomic and religious backgrounds. Poverty, overcrowding, extended family living arrangements, an abundance of street children, and a lack of recreational opportunities in families are all variables that facilitate CSA (cited in Belur & Singh, 2015).

Long-Term Effects of CSA in Males Child sexual abuse (CSA) may significantly impact boys’ and men’s long-term mental health (Fondacaro & Holt., 1999). It highly differs from person to person depending upon multiple factors. Even though not all men with a history of CSA develop psychopathology (Easton, 2014). The major long-term effects of male child sexual abuse are the following:

Physical Problems The men who were sexually abused in their childhood tend to show several physical symptoms even after years. It includes frequent headaches, choking sensations, nausea, blurred vision, pain in the genitals, buttocks and back. (Napier-Hemy, 2008).

Psychopathology Research suggests that there exists a high probability of developing PTSD, depression, substance abuse, hostility, sleep disturbances and suicidal ideation (Lisak, 1994; Lisak & Luster, 1994; Fellitti et al., 1998; Widom, 1999; Romano & De Luca, 2001; Briere & Elliot, 2003; Dube et al., 2005, Allagia & Millington, 2008; Napier-Hemy, 2008; Brown, 2021). A study found that the physical force by the abuser contributes more mental distress along with the age of disclosure, childhood adversities and masculinity norms (Easton, 2014). Childhood trauma adversely affects the development of the child (Lisak, 1994). Experiences of flashbacks, anxiety and nightmares are also common. Many victims reported panic attacks, re-experience of trauma even after many years (Napier-Hemy, 2008).

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Emotional Problems Research found that high emotional disturbances are present among the men who got sexually abused in childhood, including excessive fear and anger outbursts. The people tend to have unsettling rage or suppression of anger. It is also observed that self-aggression, violent fantasies are commonly seen among the males who victimized to sexual abuse during childhood (Lisak, 1994; Napier-Hemy, 2008). Intrusive thoughts are common too. Intrusive images or affective intrusions, the sudden experience of panic, paralyzed and terrorized by fear, disorientation out of fear are also present (Lisak, 1994).

Doubt with Sexual Orientation It is found that confusion over gender identity, homophobia, denying the traumatic experience and negative self-image are also associated with CSA among males (Lisak, 1994). Men who have been sexually abused may have concerns about their sexual orientation; hence, their struggle intensifies with shame and self-blame (Cook & Ellis, 2020). During a sexual assault, some men may have an erection or ejaculate, leading them to conclude that this indicates they liked the encounter or that others may not believe they were sexually assaulted (Zehra, 2020). Issues with the perception of homosexuality are seen more in male children abused by males, and shame and humiliation appeared more frequently among the male children subjected to abuse by females (Lisak, 1994). Confusion over sexual identity, fear of being homosexual, obsessive hostility towards homosexuals were also observed among them(Lisak, 1994). It may affect friendships with other boys or men. They tend to believe that they are homosexuals if they had an erection during the abuse, but the fact is that the penis responds if they get stimulated in any way (Napier-Hemy, 2008).

Issues Related to Masculinity Rigid gender norms about masculinity affect the healing of trauma of abuse. Struggle to reconcile the conflict-struggle with non-masculinity endures for the whole life. It creates inferiority and worthlessness. Appropriately masculine men do not express vulnerability, pain or helplessness. It may emerge even before the onset of puberty. A fraction of men hyper-masculinizes themselves through the denial of the event. They overexpress the rage and follow hyper-masculinized lifestyles. In some cases, they tend to victimize others when they become adults. The majority of the men oscillate between these two poles of so-called non-masculinity and hyper-masculinity, while both result from unresolved conflicts (Lisak, 1994).

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Sexual Problems Some research indicated that sexual dysfunction is a long-term effect of childhood sexual abuse of males; since there is contradictory research evidence, it is yet to be explored (Brown, 2021). The difficulties with sexual functioning include low sex drive and erectile problems, which eventually affects self-esteem and sense of manhood and, in turn, interferes with intimate relationships (Turmel & Liles, 2015). Sexual intimacy will be frightening, evoking the feelings of trauma. Men who got abused by women found to be helpless during the sexual interaction with other women (Lisak, 1994). The problems may include premature ejaculation, painful erections, erectile dysfunction, premature ejaculation, lack of desire and obsession with sex (Napier-Hemy, 2008). Men who had previously experienced a sexual function problem were more likely to have a sexual function problem during the study period. Associations between previous experiences were also recorded and present sexual function concerns and a history of fast ejaculation and erectile dysfunction (Kanmerdsiri et al., 2020).

Problems Related to Self It is reported that feeling worthless about oneself is observed in the victims of male child sexual abuse. Loss of control over oneself, on physical being, on fate is common. A perception of having no self-efficacy and a feeling of helplessness is also identified (Lisak, 1994). They tend to develop a negative self-image and to internalize the “badness”. Perceptions of being unacceptable, non-loveable are also present in these men. They sometimes develop a sense of self-hatred for not preventing or fighting, and they tend to self-blame for inner badness. It leads to perceiving oneself as primarily responsible for the abuse (Lisak, 1994; Turmel & Liles, 2015). Sometimes it leads to self-harm and harming others (Napier-Hemy, 2008).

Problems with Interpersonal Relationships Men who undergone sexual abuse in childhood tend to develop a series of interpersonal problems such as primarily lack trust, intimacy, problems with physical touch and difficulty in expressing emotional needs. Lack of trust evokes feelings of betrayal and abandonment, especially towards parents because they tend to believe that parents failed to protect them (Lisak, 1994). When they become parents, these factors aggravate, and problems with parenthood, in turn, affect their child’s development. Some men become extremely protective of their children, and some remain unexpressed (Lisak, 1994; Turmel & Liles, 2015). When it comes to intimate partner relationships, some men tend to have one night stands or short-term relationships

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because long-term relationships remind them about the trauma, powerlessness due to the inability to trust (Napier-Hemy, 2008). They tend to feel they cannot be a good caretaker or intimate partner (Lisak, 1994). Some people experience isolation after a traumatic event. Feeling of alienation from peers due to the stigma attached to the child, disturbed sense of belongingness, intimacy issues, problematic relationships, chronic isolation, failure to validate the feelings and seeking help are present in such conditions. It leads to the development of negative schema about others. They sometimes feel an inability to connect with others expecting that others will hurt, others will not care (Lisak, 1994). They tend to have negative peer group relationships due to the profound insecurity around other children (Lisak, 1994).

Treatment and Mental Healthcare The dynamics of child sexual abuse is quite different from sexual abuse of an adult so that it is ineffective to handle in the same way. When it comes to therapy, male clients are more dissatisfied and tend to quit easily (Draucker & Petrovic, 1997; Weiss, 2016). Sociocultural factors, especially rigid gender norms, act as the major barrier to seek therapy or discontinuing it. So, the therapy should be slow and accept the fits and starts also breaks in between from the client’s side (Weiss, 2016). Even after the therapy, male clients have shown significantly less quality of life compared to their female counterparts (Lev-wiesel, 2008). Coping with the effects of sexual abuse is an important part of healing. An interpretive phenomenological analysis analysed the coping strategies of victims of sexual abuse. The investigators identified that healthy coping occurs by seeking support, cognitive engagement, optimistic thinking, self-acceptance and seeking meaning. It is also concluded that engaging in problem-focused coping strategies is better (Phanichrat & Townshend, 2010). A qualitative study identified six therapist characteristics that influence the clients positively are being informed about male sexual abuse, being connected to the client, informing the client about the therapeutic process, respecting the client and letting the client go at the right time (Draucker & Petrovic, 1997). From a developmental viewpoint, healing should take place to move forward from the trauma resulting from CSA. If the point is not properly addressed, it affects all kinds of relationships including parenthood. So, the impact of the effect of CSA on identity formation and relational health is an important thing to be considered by mental health professionals (Turmel & Liles, 2015). Men who engage in positive relationships are found to be having relational recovery (Kia-Keating et al., 2010). These men perceive long-term commitment and parenthood as a factor for establishing trust and relationships positively capable of leading a meaningful experience (Turmel & Liles, 2015).

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Legal Status Sexual abuse of boys is a barely addressed topic of the legislature in many countries. In many countries, laws only recognize girls as victims. A study conducted by the Economist Intelligence Unit with support from the World Childhood Foundation, Oak Foundation and the Carlson Family Foundation compared the laws in 40 countries found that the UK, Canada and Sweden are ranked best in dealing with the issue, while Pakistan, Egypt and Mozambique are in the bottom (Ratcliffe, 2019). In India, the Protection of Children from Sexual offence (POCSO) act implemented in 2012 to protect children from sexual assault, sexual harassment and pornography with the establishment of special courts to deal with it. The law ensures imprisonment and fine to the culprit depending upon the nature of assault (Ministry of Law and Justice, 2012). In 2018, an ordinance came to give capital punishment to culprits of sexual abuse of girls under 12 years. The Ministry of Women and Child Welfare proposed to amend the POCSO laws as gender-neutral (Times of India, 2018). Now, it acknowledges male children as a victim of sexual assault. The law identifies anyone under 18 as a child and increases the scope of including sexual assault other than penetrative sex also under the law (Mantri, 2021). In 2019, the POCSO Act amended in such a way that minimum punishment for aggravated and penetrative sexual assault on children below 16 years was increased from 10 to 20 years, which is extendable to life imprisonment or death. However, grooming is not explicitly recognized in POCSO. Grooming is defined as the act of creating and maintaining a relationship with a kid, whether in person or online, in order to facilitate either online or offline sexual interaction with the child. It is prohibited under section 67(b) of the Information Technology Act (Mantri, 2021). Unlike POCSO, other Indian laws about rape and sexual abuse are not genderneutral. They are made with a view that men are the culprit and women as the victim. Section 375 of the Indian Penal Code defines rape as an act committed by a man either through penetration of his penis, a part of the body, any external object to anybody orifice of a woman or having or forcing for oral sex against her will or without her consent or through getting consent forcefully. There may be several international treaties that address the problem and topic of male rape and sexual harassment, but there is currently no legislation in India that addresses these issues. A proposal to make gender-neutral rape laws in India was dismissed because it is not as common as female rape. When the situation arises, the authorities will consider it, determine and act accordingly (Zehra, 2020). A Public Interest Litigation seeking gender neutrality in offences such as rape, sexual harassment, outraging modesty, stalking and voyeurism was dismissed by the Supreme Court of India in 2018. However, gender-neutral sexual harassment legislation is urgently needed and should be enacted by the government to eliminate any inadvertent gender discrimination and provide equal protection for all genders (Sundd, 2020).

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Challenges in Management and Research While it is easy to recognize that future research is necessary in male child sexual abuse in order to direct policy and management in an evidence-based manner, there may be some challenges which has made it difficult to carry out and will still need to be addressed in order for research to happen. • Rigid Gender Norms: Since our society is a patriarchal one, gender norms are very rigid. Being a tough gender makes the male victims not admit or disclose that they got abused by another person. It leads to under-reporting. • Under-reporting: The magnitude of males getting abused in childhood or adulthood is yet to be known. Rigid beliefs about masculinity and associated issues lead the victim to remain silent. It is a barrier to understand the issue deeply and provide proper support to the victim. • Stigma: Sexual abuse itself is a matter of shame and stigma towards the victims and victim’s family, also a reason behind the silence of the victim. Especially when the victim is a male, there is a possibility of multiple stigmas about his gender, sexual orientation and the event. • Homophobia: There is a general notion that male children or men subjected to sexual abuse would be gay or develop into gay. Homosexuality is a matter of stigma in society; male child sexual abuse evokes a double shame on the victim and the family. • Delay in Taking Action by Judiciary: Delay in taking action by the judiciary also leads to the silence of the victim. They might feel unsure about getting justice and develop doubt about the judicial system. • Sampling Bias: There is a chance for bias in the sampling process for the research. Since it is a sensitive topic, and due to the hesitancy of the participant, randomization is difficult. Bias in sampling may adversely affect the results. • Recall Bias: Most of the research conducted in this area was done by collecting data from adults subjected to sexual abuse in their childhood. So, there is a high chance of having errors while recalling the previous event and related information. It can also adversely affect the results. • Problems with Definitions and Terminologies: Since CSA is an umbrella term, different studies operationally define it differently, affecting the exact prevalence and data. Especially the definition of age and operational definition of sexual abuse may vary from one study to the other. The methodological difference in studies also creates confusion when it comes to the comparison of regions. • Lack of Professional Training: The professionals who encounter male sexual abuse victims sometimes fail to treat them accordingly. This is because of the lack of in-depth understanding of the issue, which leads to the lack of tailor-made interventions. In addition, physicians and mental health professionals are often “not trained to recognize the consequences” of male child abuse and associated psychological issues (Stemple, 2009).

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Conclusion and Recommendations The incidence of male child sexual abuse is yet to be estimated properly. Male children and their families hesitate to open up and seek treatment or move legally on the assault due to several factors, including rigid gender norms, toxic masculinity and stigma. According to reports, 1 in 6 male children are subjected to sexual abuse by an adult, both male and female. It leads to several long-term effects throughout the child’s life, including psychopathology, interpersonal relationship issues, emotional problems, issues related to self, physical problems, confusion with sexual orientation and sexual problems. Even though therapeutic strategies exist, there is an unwillingness from the client’s side and a lack of specialized training from the professionals’ side. Therefore, it is important to understand the pitfalls in the existing body of knowledge about the issue and address the challenges to properly deal with the same. Some recommendations are given below: • Public Awareness: Sex and sex-related issues are still taboo in public. Giving awareness will facilitate the people to understand the issue in a better way. Also, it gives a chance to understand factual information and debunking the myths about the issue. It will help to identify more victims and facilitate disclosure. Also, use of pamphlets, notices, etc., for the same purpose is advisable. It helps to unleash the stigma associated with the same. • Gender-neutral Laws: It is a need of the hour to make our laws gender-neutral. It does not only help men and women also the queer community to disclose about the abuses. The laws have to be amended so that justice is ensured to the victims regardless of gender and take action as early as possible. In addition, it will increase the trust in the legislature so that more people may report the issue and come forward to fight legally. • Training for Mental Health Professionals: The mental health professionals also have to undergo proper training to deal with the issue separately because the expression and effect of sexual abuse in boys have much difference from that of girls. So, in order to deal with the issue specifically, more academic and practical training has to be given to the mental health professionals. • Training for Parents: Conducting awareness classes for parents by experts at the school level or local body level also will be beneficial. It helps them to understand “my child is not alone”. Also, training is to be given to parents to deal with their shock and the child’s reactions. The importance of reporting and how to report are also to be included in the parents training programme. • Sex Education: Proving sex education from childhood is a vital part of education. Sex is still a taboo word in the curriculum also so that children cannot understand what is proper and improper. It is advisable to begin compulsory sex education in all schools from primary classes. It should include childhood sexual abuse, and it will help the children identify good touch and bad touch. It makes them able to prevent the abuse up to an extent and in case it happens to report it. • Gender Education: Educating children and adults about the concept of gender and associated inequalities would help with fighting against male child sexual

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abuse. It helps to neutralize the notions of toxic masculinity and gender identity crisis due to sexual abuse. It also helps to fight homophobia. Research: Alike any other topic, research plays a vital part in acquiring knowledge about male child sexual abuse. To date, a few pieces of research are available in the literature about the same. Conducting more research will help understand the issue thoroughly, developing theoretical models, interventions and social policies. Accessibility to Mental Health Care: Mental health and counselling services should be made available to the children. It should be given free of cost so that people from low socioeconomic backgrounds also get access to the same. Ensuring Trauma Care from the Government Level: Government should take primary responsibility to make policies and laws against male sexual abuse. Also, ensuring treatment at the government level will make people get more access to the same. Funding Child Lines to Take Action: Child line is a government agency working with the welfare of children. Giving more funds to child lines and agencies will help conduct more awareness classes, research and expand their outreach. Use of Media and Social Media for Awareness: Social media can be used as a powerful tool to make awareness about male child sexual abuse. Creating videos, conducting surveys, providing statistics and all related information can be done and circulated to a large audience in a shorter period. It is more convenient in the digital age than conducting face-to-face awareness classes too.

References Alaggia, R., & Millington, G. (2008). Male child sexual abuse: A phenomenology of betrayal. Clinical Social Work Journal, 36, 265–275. https://doi.org/10.1007/s10615-007-0144-y Belur, J., Singh, B. B. (2015). Child sexual abuse and the law in India: a commentary. Crime Science, 4(26). https://doi.org/10.1186/s40163-015-0037-2 Briere, J., & Elliot, D. M. (2003). Prevalence and psychological sequelae of self-reported childhood physical and sexual abuse in a general population sample of men and women. Child Abuse & Neglect, 27, 1205–1222. Brown, E. (2021, February 22). Sexual violence against boys is a crisis. The Washington post. https://www.washingtonpost.com/magazine/2021/02/22/why-we-dont-talk-aboutsexual-violence-against-boys-why-we-should/ Castro, Á., Ibáñez, J., Maté, B., Esteban, J., & Barrada, J. R. (2019). Childhood sexual abuse, sexual behavior, and re victimization in adolescence and youth: A mini review. Frontiers in Psychology, 10(2018). https://doi.org/10.3389/fpsyg.2019.02018 Chatterjee, R. (2018, May 23). The mind-set is that boys are not raped: India ends silence on male sex abuse. The Guardian. https://www.theguardian.com/global-development/2018/may/23/ indian-study-male-sexual-abuse-film-maker-insia-dariwala Cook, J. M., & Ellis, A. E. (2020). The other #Me Too: Male sexual abuse survivors. Psychiatric Times, 37(4). https://www.psychiatrictimes.com/view/other-me-too-male-sexual-abuse-sur vivors Draucker, C. B., & Petrovic, K. (1997). Therapy with male survivors of sexual abuse: The client perspective. Issues in Mental Health Nursing, 18(2), 139–155. https://doi.org/10.3109/016128 49709010330

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Dube, S. R., Anda, R. F., Whitfield, C. L., et al. (2005). Long-term consequences of childhood sexual abuse by gender of victim. American Journal of Preventive Medicine, 28, 430–438. Easton, S. D. (2014). Masculine norms, disclosure, and childhood adversities predict long-term mental distress among men with histories of child sexual abuse. Child Abuse & Neglect, 38(2), 243–251. https://doi.org/10.1016/j.chiabu.2013.08.020 Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14, 245–258. Finkelhor, D. (1979). Sexually victimized children. The Free Press. Fondacaro, K. M., & Holt, J. C. (1999). Psychological impact of childhood sexual abuse on male inmates: The importance of perception. Child Abuse & Neglect, 23(4), 361–369. Healthy WA. (n.d.). Department of Health, Australia. https://healthywa.wa.gov.au/Articles/S_T/ Sexual-assault-information-for-men Hopper, J. (2021). Sexual abuse of boys. https://www.jimhopper.com/topics/child-abuse/sexualabuse-of-boys/ India Today. (2018, April 29). POCSO Act to soon become gender-neutral for justice to male child victims of sexual assault. https://www.indiatoday.in/education-today/gk-current-affairs/ story/pocso-act-to-become-gender-neutral-to-protect-male-child-victims-of-sexual-abuse-html1222789-2018-04-29 Jeckell, A. S., Copenhaver, E. A., & Diamond, A. B. (2018). The spectrum of hazing and peer sexual abuse in sports: A current perspective. Sports Health, 10(6), 558–564. https://doi.org/10. 1177/1941738118797322 Kamnerdsiri, W. A., Fox, C., & Weiss, P. (2020). Impact of childhood sexual assault on sexual function in the Czech male population. Journal of Sexual Medicine, 8, 446–453. Kia-Keating, M. K., Sorsoli, L., & Grossman, F. K. (2010). Relational challenges and recovery processes in male survivors of childhood sexual abuse. Journal of Interpersonal Violence, 25(4), 666–683. Lev-Wiesel, R. (2008). Quality of life in adult survivors of childhood sexual abuse who have undergone therapy. Journal of Child Sexual Abuse, 9(1), 1–13. https://doi.org/10.1300/J070v0 9n01_01 Lipkins, S. (2006). Prevent hazing: How parents, teachers, and coaches can stop the violence, harassment, and humiliation. Wiley. https://books.google.co.in/books/about/Preventing_Hazing. html?id=9EGDvHzGWjsC&redir_esc=y Lisak, D. (1994). The psychological impact of sexual abuse: Content analysis of interviews with male survivors. Journal of Traumatic Stress, 7(4), 525–548. Lisak, D., & Luster, L. (1994). Educational, occupational and relationship histories of men who were sexually and/or physically abused as children. Journal of Traumatic Stress, 7, 507–523. Mantri, G. (2021, February 12). What is the POCSO act and how is it used: A guide. The News Minute. https://www.thenewsminute.com/article/what-pocso-act-and-how-it-used-guide-143310 Ministry of Law and Justice, India. (2012, June 20). The protection of children from sexual offenses act [No. 32 of 2012]. https://wcd.nic.in/sites/default/files/POCSO%20Act%2C%202012.pdf Murray, L. K., Nguyen, A., & Cohen, J. A. (2014). Child sexual abuse. Child and Adolescent Psychiatric Clinics of North America, 23(2), 321–337. https://doi.org/10.1016/j.chc.2014.01.003 Napier-Hemy, J. (2008). When males have been sexually abused as children: A guide for men. VISAC (Vancouver Incest and Sexual Abuse Centre) sexual abuse information series. https://www.canada.ca/content/dam/phac-aspc/migration/phac-aspc/sfv-avf/sources/ nfnts/nfnts-visac-male/assets/pdf/nfntsx-visac-males_e.pdf Phanichart, T., & Townshend, J. M. (2010). Coping strategies used by survivors of childhood sexual abuse on the journey to recovery. Journal of Child Sexual Abuse., 19(1), 62–78. https://doi.org/ 10.1080/10538710903485617 Ratcliffe, R. (2019, January 16). Sexual abuse of boys often overlooked by state laws, global study warns. The Guardian. https://www.theguardian.com/global-development/2019/jan/16/sex ual-abuse-of-boys-often-overlooked-by-state-laws-global-study-warns

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Romano, E., & De Luca, R. V. (2001). Male sexual abuse: A review of effects, abuse characteristics, and links with later psychological functioning. Aggression and Violent Behaviour, 6(1), 55–78. https://doi.org/10.1016/S1359-1789(99)00011-7 Sedlak, A. J., Mettenburg, J., Basena, M., Petta, I., McPherson, K., Greene, A., & Li, S. (2010). Fourth national study of child abuse and neglect (NIS-4): Report to congress executive summary. U.S. Department of Health and Human Services. https://cap.law.harvard.edu/wp-content/uploads/ 2015/07/sedlaknis.pdf Senn, T. E., Carey, M. P., & Coury-Doniger, P. (2012). Mediators of the relation between childhood sexual abuse and women’s sexual risk behavior: A comparison of two theoretical frameworks. Archives of Sexual Behaviour, 41, 1363–1377. https://doi.org/10.1007/s10508-011-9897-z Snyder, S. N. (2000). Sexual assault of young children as reported to law enforcement: Victim, incident and offender characteristics. https://bjs.ojp.gov/content/pub/pdf/saycrle.pdf Stemple, L. (2009). Male rape and human rights. https://repository.uchastings.edu/hastings_law_ journal/vol60/iss3/3 Stemple, L., & Meyer, I. H. (2014). The sexual victimization of men in America: New data challenge old assumptions. American Journal of Public Health, 104(6), e19–e26. Stemple, L., Flores, A. R., & Meyer, I. H. (2016). Sexual victimization perpetrated by women: Federal data reveal surprising prevalence. Aggression and Violent Behaviour. https://doi.org/10. 1016/j.avb.2016.09.007 Subramaniyan, V., Reddy, P., Chandra, G., Rao, C., & Rao, T. (2017). Silence of male child sexual abuse in India: Qualitative analysis of barriers for seeking psychiatric help in a multidisciplinary unit in a general hospital. Indian Journal of Psychiatry, 59(2), 202–207. https://doi.org/10.4103/ psychiatry.IndianJPsychiatry_195_17 Sundd, S., Bhatia,D., & Bisht, D. (2020, September 25). Gender neutrality& Sexual harassment laws in India: An overview. https://www.mondaq.com/india/employee-rights-labour-relations/ 988146/gender-neutrality-sexual-harassment-laws-in-india-an-overview Turmel, C. P., & Liles, R. G. (2015). Understanding male childhood sexual abuse: Consequences and considerations. VISTAS online, American Counseling association. http://www.counseling. org/knowledge-center/vistas Weiss, R. (2016, June 2). Treating male survivers of sexual abuse. Psychology today. https://www. psychologytoday.com/us/blog/love-and-sex-in-the-digital-age/201606/treating-male-survivorssexual-abuse Widom. (1999). Posttraumatic stress disorder in abused and neglected children grown up. American Journal of Psychiatry, 156, 1223–1229. Worling, J. R. (1995). Sexual abuse histories of adolescent male sex offenders: Differences on the basis of the age and gender of their victims. Journal of Abnormal Psychology, 104(4), 610–613. https://doi.org/10.1037//0021-843x.104.4.610 Zehra, G. (2020, July 13). India’s silence on sexual assault of men and boys. https://blog.ipleaders. in/indias-silence-sexual-assault-men-boys/

P. Swathisha , a Ph.D. scholar of the Department of Applied Psychology, Pondicherry University has been carrying out her research on issues and challenges of commercial sex workers in Puducherry. She has published one book chapter and one article and attended a number of workshops and conferences. Prof. Sibnath Deb Ph.D. and D.Sc., is Director of Rajiv Gandhi National Institute of Youth Development (RGNIYD)—an institute of national importance, Sriperumbudur, Tamil Nadu, India. Prior to joining RGNIYD, he taught at the Department of Applied Psychology, Pondicherry University (A Central University), and at the University of Calcutta. During April 2009 to August 2009, Prof. Deb visited the School of Public Health, Queensland University of Technology (QUT), Brisbane, Australia as Visiting Faculty. Currently, he is also Adjunct Professor of the School of Social Justice, Faculty of Law, QUT, Australia. During 2004–2008, he served the International

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Society for Prevention of Child Abuse and Neglect (ISPCAN) as Councillor Member. He has 30 years of teaching, research, and administrative experience and has published a large number of research articles in leading national and international journals as well as in edited books. He has written eight books and edited six. Some of his latest books include (i) Disadvantaged Children in India: Empirical Evidence, Policies and Actions (Springer, 2020); (ii) Community Psychology: Theories and Applications (Sage, 2020); (iii) Social Psychology in Everyday Life (SAGE, 2019); (iv) Childhood to Adolescence: Issues and Concerns (Pearson, 2020); and (v) Positive Schooling and Child Development: International Perspectives (Springer, 2018). His research interests include child safety, students’ mental health, youth development and adolescent reproductive health. He has got three international and five national awards for his contribution in academics and research. In 2019, he received the “Visitor’s Award 2019” from Hon’ble President of India Sri Ram Nath Kovind for his contribution in the field of child protection and health psychology.

Part III

Child Rights, School Drop-Outs and Emerging Challenges

Chapter 18

Adoption: Right to Information Versus Right to Confidentiality Jagannath Pati

Introduction One’s identity is not just a crisis that a person undergoes in adolescence, but is a lifelong desire that cannot be satisfied by anything else. Growing up with a happy adoptive family or establishing one’s own family are not replacements for an adoptee’s right to knowledge of their origin. Lee Kyung-eun, Director of Human Rights, Beyond Borders

Children’s Identity Many people think of the issues that take place before and during an adoption, but fail to recognize that it is important to anticipate and understand the issues that may arise after you have brought a child into your family. Adoption is an emotional experience. It is also a physical, biological and psychological experience. Existing literature reveals that adoptees may begin experiencing the desire to seek information during adolescence but most do not begin an active search until adulthood. A person’s right to know her biological or genetic origins raises some of the hardest legal and ethical issues that we have had to face in the last decade or so. This question arises not only in the case of adopted children, but also in cases of abandoned or displaced children conceived by artificial insemination or born out of wedlock. It opens up, in the words of [leading international human rights lawyer] Geraldine van Beuren, “a whole Pandora’s Box—the principle of the best interests of the child and her right to know very often conflicts with other competing rights such as the mother’s right to privacy and autonomy and the rights of the adoptive parents.” (http://www. thehindu.com/opinion/op-ed/a-difficult-road-to-her-roots/article4562334.ece). J. Pati (B) Director (Programme) IC, Central Adoption Resource Authority, New Delhi, India © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_18

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The classic “Seven Core Issues in Adoption,” published in the early 1980s, outlined the seven lifelong issues experienced by all members of the adoption triad: loss, rejection, guilt and shame, grief, identity, intimacy and mastery/control. Others have built on these core issues. Adoption is a social, emotional and legal process through which children not being raised by their birth parents become full, permanent and legal members of another family. As such, adoption involves the rights of three distinct “triad members”: the birth parents, the child and the adoptive parents. Adoption is also a lifelong process. Ethical issues change over time as children who were adopted become adults and may choose to claim their right to know their genetic and historical identity. It is imperative that professionals working within adoption act ethically to ensure the rights of all the involved parties at all points in the process. In this section, find resources to help guide the professional’s ethical practice in all phases of adoption (https://www.childwelfare.gov/adoption/adopt_ethics). Adoption carries developmental opportunities and risks. Many adoptees have remarkably good outcomes, but some subgroups have difficulties. Generally, infant, international and trans-racial adoptions may complicate adoptees’ identity formation. Those placed after infancy may have developmental delays, attachment disturbances and post-traumatic stress disorder. Useful interventions include preventive counseling to foster attachment, post-adoption supports, focused groups for parents and adoptees and psychotherapy (Nickman et al., 2005). One of the most difficult, but normative, tasks faced by adoptive parents is talking with their child about adoption (Brodzinsky et al., 1992). Parental anxiety is usually tied to their uncertainty about how the child will react to this information and whether parent–child ties will be weakened. In addition, inquiring about the child’s adoption story will offer the clinician an opportunity to reinforce the thought of the adoptive parents to realize that their child is having a “whole life” that began, with a biological mother and father, as all lives do (Lifton, 1994; Nickman, 1985). Every human being cares about his/her family roots in order to acquire a personal identity as a sound basis for optimal development. The desire to know about one’s roots generally sets in during adolescence, or sometimes, even later. Adoption brings a radical change to the life of a child. It is therefore justified only in the cases where it serves the best interest of the child and provides him with genuine shelter. Adoption in a foreign country should only be an option when and if there is no viable alternative in the child’s country of origin (http://www.ssiss.ch/en). Positive identity development during adolescence, in general, is a complex process and may pose additional challenges for adolescents adopted from a different culture. Adoptive identity mediated the influence of racial socialization on psychological well-being, and ethnic affirmation mediated the influence of ethnic socialization on adoptees’ well-being. It is important to provide supportive counseling services for adoptees who are exploring their adoptive identity (Mohanty, 2013). The right to know one’s origins is guaranteed both by the International Convention on the Rights of the Child and by the Hague Convention. The Hague Convention, in particular, states that Countries of Origin of the children must guarantee access to their adoption files and therefore should keep all the relevant information concerning

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them. Hague Convention also lays down that the competent authorities shall ensure access for children to the relevant information with appropriate counsel. Whatever their origin (institution, foster family) or their age upon arrival might be, all adoptees need to build their own adoptive identity, understand what it means to be adopted and the circumstances that caused their adoption to happen. All needs encountered by adoptees in relation to their adoption status will require answers from their adoptive parents. On the other hand, adoptive parents frequently need help in order to understand their children’s behavior concerning adoption, as well as certain guidelines as to what would be the best way to address it. Krueger et al. (1997) explain that adopted persons naturally engage in an existential quest for the truth about their heritage, which can remain as a psychological longing or result in an active search. If adopted persons were not motivated to search, the adoption process would be simplified without loss and yearning for biological roots (Freundlich, 2000). To explain this need, Krueger et al. (1997) describe it as “a quest for authenticity, meaningfulness, and a sense of being, freedom, and belonging.” For an existential perspective, the quest for one’s worth, parents and origins is part of the quest for authenticity, meaningfulness, being and freedom. Most researching adoptees are women, and they generally seek their mothers (Moran, 1994). Adoptive men, in contrast, tend to seek their birth fathers (Pacheco & Eme, 1993). Children need some knowledge of their heritage to foster self-esteem later on in life. Long-term studies have shown that children whose heritage was celebrated in their adoptive families by and large grew up to be healthy, self-respecting adults (afabc website). There have been a lot of debates on the adoptive child’s search for his “Identity” and “Roots”—with its social, emotional and legal implications in national and international forums. In the Indian sociocultural context, this issue takes on a unique dimension. The right of the adoptee to search for his/her roots and identity is diametrically opposite to the birth mother’s right to secrecy and confidentiality of her identity. The “search” has serious repercussions on the emotional well-being of all the three integral corners of the adoption triad, i.e., the adoptee, the birth parent, and the adoptive parents. The concept of “children’s identity” tends to focus on the child’s immediate family, but it is increasingly recognized that children have a remarkable capacity to embrace multiple relationships, speak several languages fluently and enjoy a complex, multicultural world. From the secure foundation of an established family environment, children can enjoy complex and subtle relationships with other adults and with a range of cultures, to a much larger degree than may be recognized. Thus, the children’s best interests and sense of identity may be sustained without having to deny the knowledge of their origins, for example, after reception into State care, through “secret” adoptions or anonymous egg/sperm donations and so forth (Rachel & Peter, 2002). Name, nationality and family are only some elements of identity. Other aspects of identity include

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• The child’s personal history since birth—where he or she lived, who looked after him or her, why crucial decisions were taken, etc.? • The child’s race, culture, religion and language. An “unlawful” interference in this aspect of identity could include A person’s right to know one’s biological parents is well-entrenched in law, in most of the civilized countries around the world. Typically, the visiting adoptees look for information on their life prior to adoption to fill the void experienced in their lives. If handled well, to their satisfaction, it can lead to the closure of this sensitive issue, and they can move on with their lives. However, this must be done, keeping in mind the birth parent’s right to confidentiality as this is the commitment given to them at the time of relinquishment of their child, especially in the case of unwed mothers who desire anonymity because of the strong stigma attached to unwed parenthood. This is a very sensitive issue to be handled, keeping in mind the social taboos in the country of origin. Professional social workers of the adoption agency are equipped with techniques to handle such situations and not the activists having international connections generating funds for the purpose.

International adoptions present unique challenges in securing accurate and truthful background information and history on individual children. Differences in culture, language, terminology and the competence of medical resources all profoundly affect this process. The access to information and the quality and reliability of information vary widely from country to country. In countries where programs are wellestablished and sophisticated, child information can be very complete and available. This information is routinely updated by orphanages, institutions or hospitals that are all under the authority of appointed government ministries. The range of cooperation on the part of these authorities, however, is often irregular and inconsistent (http:// www.holtintl.org/ethics.shtml). It has been observed that rarely a biological mother goes back to the adoption agency to reclaim her surrendered child within the stipulated period. While searching for his/her birth parent, a child is sure to experience many difficult emotions. Fear, guilt, anger, anxiety and exhilaration—all may play a part. It has also been noticed that in most cases, foreign adoptive parents do help their adopted children gather more information about their biological parent and their country of origin. The right of the adoptee to search for his or her roots and identity is diametrically opposite to the birth mother’s right to secrecy and confidentiality of her identity. The “search” has serious repercussions on the emotional well-being of all the three integral corners of the adoption triad, i.e., the adoptee, the birth parent and the adoptive parents. The child’s best welfare and interest should be of paramount consideration in all questions relating to his/her adoption. Searching for birth family relatives is a sensitive and emotional process. The intent to search may be allowed only upon the personal request made by the adult adoptee or adopter. Minors who are interested in searching for their biological parent may be represented by their adoptive parents. The request must be made in writing to the particular foreign adoption agency, which processed their case, in association with the local adoption agency. The adoptive parents should respect the adopted child’s right to enjoy the reciprocal rights and obligations arising from the relationship of parents and child. The adoptee’s rights and those of his/her biological parents, on the one hand, as well as those of his/her adoptive parents on the other, can sometimes lead to conflict.

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It then becomes a matter of seeking solutions that respect the needs and rights of all concerned parties and with those of the child as a priority. Searching for roots may be treated as a natural emotional response. The contact between the child placed in adoption and its biological mother is a distant reality in India, as the biological mother hardly resides in the place/address given in the surrender deed due to social stigma. Getting to know more about the social background of the biological mother may be quite meaningful in the sense that it may yield positive results in terms of improved self-concept, self-esteem and ability to relate to others. Thus, the professional social worker can play a meaningful role through counseling and helping older adoptees in their search missions. For some, the interest in searching is a matter of intense curiosity. They seek a sense of connection to someone of similar genetic makeup. They want to know if their birth relatives look like they do, speak as they do or demonstrate similar gestures or body language. They want to know if they share similar characteristics, such as a dry sense of humor, athletic or musical abilities or an outgoing personality. For others, searching is important for their emotional development. Some adoptees have a desire to know and understand why their birth parents made an adoption plan for them. They want to know if their birth parents ever regretted their decision or missed them. Birthparents, on the other hand, wish to tell their birth children the reasons and circumstances for giving them up for adoption. Birthparents also wonder if the adoptive parents treated their child well and if the child has been happy. The adoptee has the basic rights and needs to search for his/her origin and identity, and hence, he/she should not be denied the opportunity to search and to know his/her roots. All agencies and authorities involved in the process should ensure the observance of confidentiality in matters related to the adoption. While non-identifying information, e.g., medical records, circumstances which lead to the adoption of the child (but not necessarily divulging the identity of concerned individual, etc.) may be made available to both adoptive parents/s and birth parents and the adoptee under 18 years old, identifying information, e.g., names, address, personal background, etc., can be shared only between and among the adult adoptee, adoptive parents and his/her birth parents and only if they give their written consent (Rachel & Peter, 2002). There is no research about the number of adoptees searching for their birth parents. While searching for the birth parent, a child is sure to experience many difficult emotions. Counseling in this area helps the adoptee to cope with his adoptive status. While some adoptees are quite comfortable with this knowledge, there are some who feel a sense of being “incomplete”, like the oft-quoted “missing link” or the “missing piece of the jigsaw” situation. The issue that often lurks in the mind of the adopted child is, “Why was I given up? Did my parents not love me and want me?” Counseling the adopted child and the adoptive parents with this issue helps to resolve many unarticulated problems. The whole question of “who is a parent?” is reflected upon, and children feel comfortable with the fact that parenting is far more than the biological process of birth. Experience has shown that there is no correlation between children who have a need to “search” for their biological “Roots” and their level of adjustment or security

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in their adoptive homes. Therefore, the belief that children who are happy and welladjusted do not have a need to search and vice versa is not necessarily true. The psychological need to know one’s roots or identity is found to be the most important reason as to why adoptees want to know about their biological parents.

Guiding Principles/Policies The Honorable Supreme Court of India has given the direction that it may not be desirable to give information to the child about its biological parents while the child is young as this might have the effect of encouraging his/her curiosity to meet its biological parents. But if after attaining the age of maturity, the child wants to know about his/her biological parents, it should not raise any serious objection. The child is not likely to be easily affected by such information at this stage, and in such a case, the foreign adoptive parents may in exercise of their discretion furnish such information to the child if they so think fit.

Adoption Regulations, 2017 Adoption guidelines/regulations framed by CARA and notified by the Government of India also affirm that confidentiality is required to be maintained regarding the child’s origin. If the right of a biological unwed mother, her confidentiality, is not maintained, most would prefer to abandon their child. This would mean putting the life of the infant in jeopardy, rather than legally relinquishing and ensuring its rehabilitation. In most cases, the biological mother moves on with her life and starts life afresh, after relinquishing her child. It would cause an upheaval in her already settled life if such information is divulged. Thus, her fundamental right to life and privacy needs to be protected. Since the production of the child is a mandatory requirement now before the Child Welfare Committee, the biological mother/parents need to visit the Committee not essentially the Specialised Adoption Agency for surrendering the child. Regulation 44. Root search. (1) In case of an orphan or abandoned child, information about his adoption, including the source and circumstances in which the child was admitted into the Specialised Adoption Agency, as well as the process followed for his adoption, may be disclosed to the adoptee by the Specialised Adoption Agency or the Child Welfare Committee, as the case may be 1.

In cases of root search by older adoptees, the agencies or authorities concerned (Authorised Foreign Adoption Agency, Central Authority, Indian diplomatic mission, Authority, State Adoption Resource Agency or District Child Protection Unit or Specialised Adoption Agency), whenever contacted by any adoptee, shall facilitate his root search.

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Persons above eighteen years can apply independently online, while children below eighteen years shall apply jointly with their adoptive parents to the Authority seeking facilitation of root search. If the biological parents, at the time of surrender of the child, have specifically requested anonymity, then the consent in writing of the biological parent(s) shall be taken by the Specialised Adoption Agency or Child Welfare Committee, as the case may be, before divulging information. In case of denial by the biological parents or the parents are not traceable in surrendered cases, the reasons and the circumstances under which the information is not being made available shall be disclosed to the adoptee. A root search by a third party shall not be permitted, and the agencies or authorities concerned shall not make any information public relating to biological parents, adoptive parents or adopted child. The right of an adopted child shall not infringe the right to privacy of the biological parents.

Regulation 45. Confidentiality of adoption records. All agencies or authorities involved in the adoption process shall ensure that confidentiality of adoption records is maintained, except as permitted under any other law for the time being in force and for such purpose, the adoption court order may not be displayed in any public portal.

United Nations Convention on Rights of the Child (UNCRC 1989) Relevant Articles: Article 2: All rights to be recognized for each child in jurisdiction without discrimination on any ground. Article 3(1): Best interests of the child to be of primary consideration in all actions concerning children. Article 7: Birth registration, right to name and nationality and to know and be cared for by parents. Article 8: Article 8 of the UN Convention on the Rights of the Child (CRC) notes that a child has a right to identity including a name, a nationality and family relations. Whenever a child is deprived of one of these elements, States have an obligation to restore the child’s identity speedily. This article of the Convention on the Rights of the Child concerns the children’s rights to identity and their rights to have such identity preserved or, where necessary, re-established by the State. Although article 8 only describes three aspects of identity—nationality, name and family relations—other articles, such as article 2 (nondiscrimination), article 16 (protection from arbitrary interference in privacy, family

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and home) and article 30 (right to enjoy culture, religion and language), should render unlawful most forms of interference in children’s identity. Article 20 also provides that children deprived of their family environment should where possible have continuity of upbringing, particularly with regard to their ethnic, cultural and linguistic background (Rachel & Peter, 2002).

Convention on Protection of Children and Cooperation in Respect of Inter-country Adoption—1993 Article 16 (2): It shall transmit to the Central Authority of the receiving State its report on the child, proof that the necessary consents have been obtained and the reasons for its determination on the placement, taking care not to reveal the identity of the mother and the father if, in the State of origin, these identities may not be disclosed. Article 30: (1) The competent authorities of a Contracting State shall ensure that information held by them concerning the child’s origin, in particular, information concerning the identity of his or her parents, as well as the medical history, is preserved. (2) They shall ensure that the child or his or her representative has access to such information, under appropriate guidance, in so far as is permitted by the law of that State. Article 30 of the Convention imposes on the Contracting States an obligation to preserve any information they have about the child and his or her origins. There is also an obligation to ensure the child has access to that information under certain conditions. Article 30 should be read in conjunction with Article 16 because the information referred to is required for the preparation of the report on the child that the Central Authority of the State of origin is to transmit to the Receiving State. Therefore, as a practical matter, it may be beneficial for States to include the retention of records as a duty of the same office that prepares the report on the child. States may also want to clearly determine and include within their laws, the length of time that records should be kept. The child’s right must be balanced against the right of birth parents not to have their identity disclosed to the child who is relinquished for adoption. For example, in some countries, an unmarried mother who had consented to the adoption might be later harmed by the disclosure of her past. Therefore, Article 30 does sanction some restrictions to the right of the child to have information, as access is only “in so far as is permitted by the law of that State.” Furthermore, States of Origin are permitted to withhold identifying information from the report on the child in accordance with Article 16(2). While Article 30 acknowledges the right of the child to discover his or her origins under certain circumstances, it is necessary to limit the possibility of misuse of personal data, which is disclosed during the adoption process. Consequently, the Convention establishes minimum safeguards by prescribing that the information on the child and the prospective adoptive parents should only be used for the purposes for which it was gathered or transmitted. These

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obligations and safeguards are also given emphasis through the requirements of Article 9(a) that Central Authorities shall take all appropriate measures to “collect, preserve and exchange information about the situation of the child and the prospective adoptive parents, so far as is necessary to complete the adoption.” Article 30(1) of the Hague Convention on Intercountry Adoption stipulates that competent authorities of a Contracting State shall ensure that information held by them concerning the child’s origin, in particular, information concerning the identity of his or her parents, as well as the medical history, is preserved. (2) They shall ensure that the child or his or her representative has access to such information, under appropriate guidance, in so far as is permitted by the law of that State.

Report and Conclusions of The Second Special Commission on The Practical Operation of The Hague Convention of 29 May 1993 on Protection of Children and Co-operation In Respect of Intercountry Adoption (17–23 September 2005) Para 109: Many experts stated that personal information had to be retained in the files in order for the adopted children to have future access to the information on their origins. Currently, more and more adopted children are looking for information on their origins. In the same manner, more and more biological parents sought information on the whereabouts of their adopted children. It was said that the gathering of as much information as possible was important to guarantee the best interests of the child as adoption is a lifelong experience and every piece of information could be important for the adoptee. Countries of origin should be encouraged to collect information about birth parents, such as a photograph, or a gift to present to their children, for the future benefit of the adoptee. As more and more adoptees search for their biological families, it is important to have long-term policies and procedures for the preservation of information. Para 110: Not all States had the same notion of confidentiality. It was agreed that a child had a right to information on his/her own background. The right of the child to obtain information about his or her origins derives from the right to know his or her parents as provided for in Article 7(1) of the UN Convention on the Rights of the Child. But the right of adopted children to information did not have to infringe the biological parents’ right to privacy. Information would not be made public, but only supplied to the adopted child. Furthermore, factual information, such as age, health and social circumstances, could be given without disclosing the names of the parents. In many countries, the disclosure of information is based on the mutual consent by the adult adopted child and the biological parents. Para 111: However, it was stated that the child’s right must be balanced against the right of birth parents not to have their identity disclosed to the child who is relinquished for adoption. For example, in some countries, an unmarried mother who had consented to the adoption might be later harmed by the disclosure of her

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past. Therefore, Article 30 does sanction some restrictions to the right of the child to have information, as access is only “in so far as is permitted by the law of that State.” Furthermore, States of Origin are permitted to withhold identifying information from the report on the child in accordance with Article 16(2).

UNICEF’s Position Adoptees should be able to access basic information on their birth parents (which, moreover, can be of great importance in regard to health issues) that does not enable the latter to be identified. This information would normally be contained in the report on the child prepared prior to the authorization of the adoption. Such access must be accompanied by appropriate counseling and guidance. The obvious implication of this is that adequate records be preserved for a long period (at least 50 years, according to the 2008 European Convention on the Adoption of Children which is yet to enter into force). To the extent that both parties freely consent to identification and that this is deemed to be in conformity with the interests of all concerned, UNICEF encourages the establishment of procedures that will enable this to happen under appropriate conditions. UNICEF does not believe that such initiatives can be justified by reference to CRC Article 7 (right to know one’s parents), given the nature of adoption, its consequences in terms of family ties and the fact that the child’s parents are therefore those who adopted him or her (UNICEF Guidance Note on Inter-country Adoption in the CEE/CIS Region, Sept. 2009).

Understanding the Surrendering Process It is important to understand the surrendering process of a child before the Child Welfare Committee, competent authority for children in need of care and protection and is located at the district level in each State in the country. In India, abandoned and surrendered children are placed in adoption following due process of law. First of all, a child has to be legally free for adoption, and for such a process, the involvement of CWC is mandatory. A reconsideration period of 60 days is given to the surrendering mother/parents during which can reclaim the child, if not the child can be declared legally free for adoption.

Adoption Regulations 2017 “7. Procedure relating to a surrendered child. (1) A parent or guardian wishing to surrender a child under subsection (1) of section 35 of the Act, shall apply to the

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Child Welfare Committee in the Form 23 of Juvenile Justice (Care and Protection of Children) Model Rules, 2016. 1.

2. 3.

4.

5.

6.

7.

8.

9.

10.

11.

12. 13.

For parents or guardians who are unable to give an application, due to illiteracy or any other reason, the Child Welfare Committee shall facilitate the same through the legal aid counsel provided by the Legal Services Authority. The Deed of Surrender shall be executed as per Schedule V. If the surrendering parent is an unmarried other, the Deed of Surrender may be executed in the presence of preferably any single female member of the Child Welfare Committee. If a child born to a married couple is to be surrendered, both parents shall sign the Deed of Surrender and in case one of them is dead, death certificate is required to be furnished in respect of the deceased parent. If a child born to a married couple is to be surrendered by one biological parent and the whereabouts of the other parent are not known, the child shall be treated as abandoned child and further procedures in accordance with regulation 6 of these regulations shall be followed. In case of a child born out of wedlock, only the mother can surrender the child and if the mother is a minor, the Deed of Surrender shall be signed by an accompanying adult as the witness. If the surrender is by a person other than the biological parents who is not appointed as a guardian by a court of law, the child shall be treated as abandoned child and further procedures in accordance with regulation 6 shall be followed. The Specialised Adoption Agency and the Child Welfare Committee shall ensure that a copy of the Deed of Surrender is given to the surrendering parents or person. The details of the child along with his photograph shall be entered online in the Child Adoption Resource Information and Guidance System by the Specialised Adoption Agency within three working days from the time of receiving the child. To discourage surrender by biological parents, efforts shall be made by the Specialised Adoption Agency or the Child Welfare Committee for exploring the possibility of parents retaining the child, which shall include counseling or linking them to the counseling center set up at the Authority or State Adoption Resource Agency, encouraging them to retain the child and explaining that the process of surrender is irrevocable. The Specialised Adoption Agency and the Child Welfare Committee shall ensure that the surrendering parents or the legal guardian is made aware that they can reclaim the surrendered child only within a period of sixty days from the date of surrender. Due regard shall be given to the privacy of the surrendering parents and the surrendered child by the authorities and agencies involved in the process. No public notice or advertisement shall be issued in the case of a surrendered child.

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14.

In case the surrendering biological parent has not claimed back the child during the reconsideration period, the same shall be intimated by the Specialised Adoption Agency to the Child Welfare Committee on completion of sixty days from the date of surrender. The reconsideration period for the biological parents is specified in subsection (3) of section 35 of the Act and no further notice shall be issued to the surrendering parents. The Child Welfare Committee shall issue an order signed by at least three members declaring the surrendered child as legally free for adoption after the expiry of sixty days from the date of surrender, in the format at Schedule I. The Child Study Report and Medical Examination Report of the surrendered child shall be prepared and posted in the Child Adoption Resource Information and Guidance System by the Specialised Adoption Agency, within ten days from the date the child is declared legally free for adoption, in the format at Schedule II and Schedule III of these Regulations, respectively. The Child Study Report and Medical Examination Report shall be made available in English (apart from the local language) and the District Child Protection Unit shall facilitate the Specialised Adoption Agency in uploading the Child Study Report and Medical Examination Report in Child Adoption Resource Information and Guidance System, in case the Specialised Adoption Agency is facing any technical difficulty. Strict confidentiality shall be maintained in cases of all documents pertaining to biological parents in all circumstances unless the surrendering parents have expressed their willingness for divulging the same. The surrender of a child by an unwed mother before a single woman member of the Child Welfare Committee shall be considered as surrender of the child before the Committee as envisaged under section 35 of the Act, and her right to privacy has to be protected. The surrender of a child before the Child Welfare Committee shall be in camera. The surrender of child or children by the biological parents for adoption by the step-parent shall be before the Child Welfare Committee, for adoption, on the ground of emotional and social factors as envisaged under subsection (1) of section 35 of the Act, in the format given at Schedule XXI.”

15.

16.

17.

18.

19.

20.

21. 22.

Feedback from Recognized Adoption Agencies in India 1. 2.

More and more adoptees are visiting Adoption Agencies from where they are adopted to know about their birth background. Typically, the visiting adoptees are looking for information on their life prior to adoption to fill the void experienced in their lives. If handled well to their satisfaction, it can lead to the closure of this sensitive beginning of their lives. However, this must be done, keeping in mind the birth parent’s right to confidentiality as this is the commitment given to them at the time of relinquishment

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of their child, especially in the case of unwed mothers, who desire anonymity because of the strong stigma attached to unwed parenthood. The social implication of “uprooting” the birth parent’s family life (which includes children born subsequently through marriage) needs to be considered seriously in the Indian context. Some adoptees manifest a compelling need to know the name and address of the birth parents or even meet them. This can only be done after taking permission from the birth family and implies contacting the birth family before disclosing any information. This should only be done by the adoption agency which was responsible for the relinquishment and subsequent adoption. If the biological parents are traced, their desire to meet or not to meet their relinquished child must be respected. However, if it is possible to bring the parents and the relinquished adoptee together, it should be done discreetly and sensitively in the agency from where the adoptee was placed. This is to be done only by a senior and experienced social worker of the concerned adoption agency that placed the child in adoption. The information should be conveyed in person and not via correspondence or email. This means the adoptee should visit the particular adoption agency from where they were adopted. As far as possible, relevant information can only be given to the adoptee if he or she is an adult, 18 years of age and above. When background information is sought by adoptees even before they are 18 years, in such cases, counseling by a professional social worker is highly recommended, keeping in view the sensitivity of such information. As far as possible, the adoptee must be accompanied by his/her adoptive parents, and only non-identifying information can be given. Third-party searches undertaken by adoptees or foreign adoption agencies need to be discouraged. It is a personal issue between the adopted child and the Indian agency, and the records maintained are confidential.

Older Adoptees Must Know 1.

2.

Children or adults in inter-country adoption face unique challenges in locating birth parents. Each country has its own laws governing information access. In addition, there is great variation in record-keeping practices across countries and cultures, and in many cases, searchers will find that no information was ever recorded, that records were misplaced, or cultural practices placed little emphasis on accurate record-keeping. In case of an abandoned child, one has a remote chance of finding one’s biological mother. In case of surrender by an unwed mother, there is very less chance also to be reunited with the biological mother as the unwed mother mostly gives a false address or does not stick to the address given at the time of surrender.

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In India, we have hardly come across cases of root search in domestic adoptions. In cases of inter-country adoptions, the child-placing agency is the best beginning point for an international search. The foreign accredited agency or the central authority should be able to share the name and location of the Indian adoption agency, perhaps, the names of caregivers, attorneys or others involved in the placement or adoption. The agency, or its counterpart abroad, may be able to provide specific information on names, dates and places. They also may be able to offer some medical history, biographical information on parents and circumstances regarding the adoption. One must remember that one has been surrendered or abandoned by his/her biological mother for a better life, respectable in all sense. Therefore, a child is welcome to find relevant information of his/her social background, but it should not lead to a tragic end. Unlike western culture, here in India, if the biological mother’s family comes to know that she had a child before her marriage, she might invite the wrath of her husband and in-laws. Therefore, a child is strongly advised to have the help of the particular adoption agency in India, while he/she gets adopted. It is advised not to take the help of a third person and keep away from the media or press who may not put the child’s situation correctly. There are two points of view regarding what should be done in such a situation. Particularly in India, the adoptive parents usually wish to keep the matter secret. At present, many agencies promote the view that when the child grows up, information may be given regarding the birth mother’s social background, circumstances and reasons for surrender, etc. However, the identity of the mother is not revealed for protecting all t concerned in the adoption triad. Adoption agencies in India have a sealed and confidential record system. There is no access to the relinquishment document, and it remains a property of the Court. It has been observed that rarely a biological mother (unwed mother) turns back to an adoption agency to reclaim her surrendered child within the stipulated period. While searching for the birth parent, a child is sure to experience a plethora of difficult emotions, including fear, guilt, anger, anxiety and exhilaration. It has also been noticed that in most of the cases, particularly foreign adoptive parents do help their adoptive children to gather more information about their biological parents and their country of origin. Older adoptees must be aware of the fact that third-party search would be dangerous and it may lead to utter frustration. Counseling in this area helps the adoptee to cope with his or her adoptive status. There are some adoptees who are quite comfortable with this knowledge and there are some who feel a sense of “void”. Counseling the adopted child and the adoptive parents of this issue aims to resolve many unarticulated problems. It is not easy for a mother to let her child go. She may not be well-educated, but the act of relinquishing the child shows that she has respect for human life. Roots search is the natural desire or instinct of the child to find out answers to burning questions and find out who their biological parents or family were. Root search should be completely the choice of our child, but they should have that choice to have a closure to the past and grappling questions. Someone has rightly said, “Genetic roots or past does not define our identity and is just a

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minuscule part of us. It is the human values we develop, our talents and our confidence that makes us whole part of our identity.”

Conclusion Whenever there is a question of adoption, and in particular about inter-country adoption, all the different elements that constitute the identity of the child, including not only name, nationality and family relations, but also cultural environment, must be taken into account. These elements are fundamental for the construction of the child as a unique person with their own internal and external characteristics which belong to them alone and enable them to answer at least partially the most basic existential question: “Who am I?”. It is widely accepted among adoption professionals today that parental preparation, education and support are crucial for the stability of an adoption and for the long-term emotional well-being of all family members. Every adoption is meant to be permanent and last forever, as children need permanency in order to thrive as they mature into adulthood. Most of the adopted children have benefited, while there are few cases of adjustment issues. This also happens with biological families, so also in domestic adoptions. At present, many agencies promote the view that when the child grows up, information may be given regarding the birth mother’s social background, circumstances and reasons for surrender, etc. However, the identity of the mother is not revealed for protecting all concerned in the adoption triad. The recognized adoption agencies should provide independent advice, counseling and support to anyone approaching for background search of his/her adoption. The Child Welfare Committee (CWC) is the competent authority which is involved at the pre-adoption stage, is required to handle the issue very sensitively and should refer the matter to the particular adoption agency, in case approached by an older adoptee. Furthermore, the Committee should not disclose any information without professional assistance. Efforts to contact the biological mothers/parents may create a fear in the minds of the biological parents, especially the unwed mothers, who may, out of fear of their identity being revealed, abandon the children and dump them in garbage bins rather than relinquish them to adoption agencies. Central Adoption Resource Authority is in the process of streamlining modalities required for root search of older adoptees. In open adoptions done under Hindu Adoption & Maintenance Act, 1956, there is no such issue of knowing the roots as the adoptive parents and the biological parents know each other, but in cases of adoptions completed under the Juvenile Justice Act, 2015 (now amended in 2021) which are known as closed adoptions, there is need of setting a protocol to support root search for older adoptees.

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References Brodzinsky, D. M., Schechter, M. D., & Henig, R. (1992). Being adopted: The lifelong search for self . Anchor Books, Doubleday. Freundlich, M. (2000). Adoption and ethics: The market forces in adoption (Vol. 2). Child Welfare League of America. Guidelines Governing the Adoption of Children. (2011) http://www.adoptionindia.nic.in Hague Convention on Inter-country Adoption. (1993). (http://www.hcch.net/index_en.php?act=con ventions.text&cid=69) Krueger, M., Jago, J., & Hanna, F. J. (1997). Why adopted persons search: An existential treatment perspective. Journal of Counseling and Development, 75. Retrieved December 2, 2006, from the Psychology and Behavioral Sciences Collection database. Pandey, L. K. Union of India case of 1982, Supreme Court of India website. Letter to CARA from Maharashtra based adoption agencies on root search. (2010). Lifton, B. J. (1994). Journey of the adopted self: A quest for wholeness. Basic Books. Mohanty, J. (2013). Ethnic and racial socialization and self-esteem of Asian adoptees: The mediating role of multiple identities. Journal of Adolescence, 36(1), 161–170. https://doi.org/10.1016/j.ado lescence.2012.10.003 Moran, R. A. (1994). Stages of emotion: An adult adoptee’s post reunion perspective. Child Welfare Journal, 73, 249–260. Nickman, S. L., Rosenfeld, A. A., Fine, P., MacIntyre, J. C., Pilowsky, D. J., Howe, R. A., & Sveda, S. A. (2005). Children in adoptive families: Overview and update. Journal of the American Academy of Child and Adolescent Psychiatry, 44(10), 987–995. https://doi.org/10.1097/01.chi. 0000174463.60987.69 Nickman, S. L. (1985). Losses in adoption: The need for dialogue. Journal of the American Psychoanalytic Study of the Child, 40, 365–398. Pacheco, F., & Eme, R. (1993). An outcome study of the reunion between adoptees and biological parents. Child Welfare, 72, 53–64. Rachel, H., & Peter, N. (2002). Implementation handbook for the convention on the rights of the child. UNICEF, USA (http://www.holtintl.org/ethics.shtml) Report and Conclusions of the Second Special Commission on the Practical Operation of the Hague Convention of 29 May 1993 on protection of children and co-operation in respect of intercountry adoption (17–23 September 2005). The Case for Transracial Adoption (afabcwebsite). United Nations Convention on Rights of the Child. (UNCRC 1989). UNICEF guidance note on inter-country adoption in the CEE/CIS region, September 2009. 159.

Chapter 19

Misuse of Internet Among School Children: Risk Factors and Preventative Measures K. Jayasankara Reddy

and G. Balasubramanian

Introduction The Internet has become an inseparable and indispensable part of everyday life, beginning at home, in the classroom, and in the workplace due to its multiple benefits and ease of access. The Internet connects people from all around the world. Individuals can now interact with their friends, family, relatives, and other connections residing in various places across the globe through social media platforms including Facebook, Twitter, and Instagram. Since the beginning of Internet technology, the number of consumers has grown exponentially and continuous to grow rapidly than ever before. For example, India ranked second globally in terms of Internet usage, with roughly 500 million users as of June 2018, up from 481 million in December 2017 and was projected to reach 730 million by 2020 (Maheshwari & Preksha, 2018). Since the COVID-19 pandemic outbreak, which compelled the Government of India to impose temporary lockdown measures to prevent the infection from spreading further into the public, the majority of businesses and organisations have transitioned their operations to a digital platform. Schools and other educational facilities across the country were forced to shift from traditional offline classroom learning to online delivery over the Internet thereby establishing a safe environment for academic activities. All school-aged children, beginning with kindergarten, would attend virtual classes using a variety of digital devices such as laptops, tablets, and smartphones. According to a recent study, children as young as two years old were using Internet-enabled devices such as smartphones, gaming consoles, and tablets within the initial week of Internet access (Nakayama et al., 2020), and the age of first exposure to such devices is

K. Jayasankara Reddy (B) · G. Balasubramanian Department of Psychology, CHRIST (Deemed to be University), Bengaluru, India e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_19

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constantly lowering (Park & Park, 2021). This would imply that there was a substantial increase in Internet penetration and Internet-enabled devices compared to the prepandemic era. A study on Internet use post-COVID-19 pandemic lockdown confirms that average use of the Internet increased to 13 from 9% (Narayan Subudhi, & Palai, 2020). During this period of lockdown, the Internet serves as a benefit, connecting everyone to the rest of the world while maintaining physical distance and residing at home. People can easily interact with one another and with the rest of the world through Internet communication tools, which promote the seamless operation of both personal and professional activities. Working from home, adjusting work hours, and so forth helped to streamline the flow of activities and responsibilities. Online meetings, such as video conferencing, teleconferencing, and online chat, enable offices, institutions, and other corporate organisations to operate more efficiently. Simultaneously, the Internet has enabled people to connect with those who are physically separated from their homes, families, relatives, and friends by reducing physical distance with digital nearness. Despite being a ground breaking innovation in the world of communication, the Internet also has an unhealthy side, as several individuals use it for Internet pornography, gambling, Internet video games, cyberbullying, and cybercrime. For parents, they may be unaware of the extent to which their children engage in Internet activities. As a result, schoolchildren may increase their non-educational Internet use, which may result in harmful use and consequent mental health concerns (Chen et al., 2021).

Misuse of Internet (MOI) The rise in Internet use has been accompanied by an increase in public concern over misuse of Internet resulting in psychological concerns known as Internet addiction (Brenner, 1997; Young, 1998a, 1998b) or pathological Internet use (Davis, 2001) or Internet dependence (Scherer, 1997). This article considers the use of the term Misuse of Internet (MOI) to remove the stigma associated with the term “addiction.” MOI indicates immoderate or unrestrained obsessions, longings, or actions related to use of Internet and further resulting in debilitation or discomfort (Weinstein et al., 2014). Additionally, it is described as Internet use that results in psychological, interpersonal, academic, or occupational concerns in an individual’s life. (Beard & Wolf, 2001). According to existing definitions of “general internet use,” it is defined as the use of the Internet in a manner that has no detrimental influence on any area of an individual’s quality of life. Hence, it was difficult to establish what constituted normal Internet use since it would vary among generations, times, technological trends, and evolution (Murray et al., 2021). Additionally, scientific comprehension of MOI has lagged media attention, owing to problems in defining the illness, doubt regarding its real occurrence, and the variety of methodological approaches used to further examine the condition (Aboujaoude, 2010). Despite this, a growing body of evidence demonstrated conclusively that the Internet has the capacity to cause significant psychological harm (Aboujaoude, 2010; Spada, 2014).

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Diagnosis In the 1990s, academic inquiry into harmful use of the Internet grew in scope with the release of Young’s (1996) and Griffiths (1995) clinical case studies. Adolescents and middle-aged individuals in these studies, all spent a lot of time online and reported various mood symptoms like despair, anxiety, and irritability after their Internet access was turned off, which is congruent with a withdrawal effect. A review of evolving conceptualisations of problematic Internet usage reveals the multifaceted and poorly defined links involving substance abuse, impulse control problems, and obsessive–compulsive disorder. All of these disorders have indeed been compared to problematic Internet use. Griffiths categorised harmful use of Internet as a subgroup of psychological addictions when a spectrum of disorders shared key addictive characteristics such as heightened awareness, euphoria, endurance, withdrawn, discord, and regression (Griffiths, 1995). Young (1996) established the very first set of signs and symptoms for problematic Internet use centred on the DSM-IV criteria for substance dependence, recognising the clinical resemblance between MOI and substance addiction. Subsequently, MOI was associated as an impulse control disorder, with the guidelines of DSM-IV for compulsive gambling serving as the suggested diagnostic criteria for Internet addiction (Young, 1998b). The growing awareness of the potential harms and public health implications of problematic Internet usage had resulted in the recommendation to incorporate criteria for MOI in the DSM-5, yet it was not included (Spada, 2014). Nonetheless, several researchers and field experts have maintained that MOI is a distinct psychopathological entity, frequently asserting that it is a behavioural addiction (D’Angelo & Moreno, 2020; Ko et al., 2009; Potenza, 2006; Spada, 2014; Widyanto and Griffiths, 2006) or impulse control disorder (American Psychiatric Association, 2000). The latter also shared characteristics of addictive behaviour. Centred on this line of reasoning, following diagnostic criteria necessary for a probable identification of MOI as a behavioural addiction: (1) heightened Internet use is frequently accompanied by a loss of sense of reality as well as an inability to comprehend basic motivations; (2) withdrawn, when the Internet use is restricted leading to state of anger, depressed, anxiousness, irritability, and tension; (3) endurance, including the frequent requirement for upgraded computer hardware, additional software, or hours of use in excess of what was intended; (4) harmful consequences, involving quarrels, deception, low academic or vocational accomplishment, social isolation, and exhaustion. Additionally, unhealthy consequences also extend to mild to moderate physiological ailments such as dry eyes, impaired eyesight, loss of sleep, exhaustion, and Musculo—skeletal pain (Chou, 2001; Liu & Potenza, 2010).

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Risk Factors The risk factors for MOI among school students are numerous and complicated. Based on the COVID-19 pandemic, the rise of digital activities has escalated the vulnerability to the possible consequences of MOI. Interestingly, a study confirms that the number of Internet users is increasing, while the age group of Internet users is reducing (Wang & Cheng, 2019). Additionally, the study discovered that students of different genders engaged in significantly different degrees of MOI based on their reported Internet activity preferences. Different Internet activities posed varying levels of risk of MOI for male and female students. The following insights elicit the key aspects that contribute to MOI. (i)

Family and School Factors Stressful early childhood experiences predispose individuals to react violently to stress, which contributes to the development of psychological problems and maladaptive behaviours. A traumatic home environment with high degree of family dysfunction would influence maladjustments, which further develops an inability to regulate emotions and challenges a healthy self-development leading to unfavourable coping mechanisms. Hence, parenting methods, familial situations, and parental usage of online media may all have an effect on children’s detrimental Internet use. Family plays a critical impact in children’s psychological development and wellbeing. When families are in a state of conflict, problem behaviours are more likely to occur (Wang et al., 2011). Children who had a higher level of conflict with their parents refused to comply with their parents’ monitoring, including the regulations imposed for Internet use. Maternal depression is counterproductive to the child’s growth and psychological wellbeing. (Gjerde et al., 2017; Oh et al., 2021). Severe maternal depressions in formative years do have an influence on persistent behavioural issues in middle childhood. Depression in mothers is strongly associated with a lack of educational involvement, a lack of bonding, and negligent parenting style (Sohr-Preston & Scaramella, 2006). Toddlers and pre-school children are more exposed to media than those mothers, who do not suffer from chronic depression. When child neglect is a consequence of maternal depression, coupled with the child’s MOI, the child’s behavioural problems can be exacerbated (Oh et al., 2021). MOI is related to negative school-based interactions (Hayixibayi et al., 2021). Inadequate relationships with peers, teachers, and other school personnel have resulted in an avoidance of uncomfortable face-to-face encounters in school settings. The risk factors also include incidents of cyberbullying, cybercrime, physical or verbal abuse by teachers, a child’s undesirable behaviours, challenges adjusting to the new school setting, academic burnouts, constant pressure to achieve centum results, high expectations by oneself, and significant caretakers to increase academic performance. Present-day online learning may offer a space for children to socially isolate themselves from the virtual classroom.

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(iii)

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According to attachment theory, classroom interactions may be associated to MOI (Catalano et al., 2004). When it comes to predicting mental health outcomes, this theory emphasises the importance of emotional connectedness and a sense of security with one’s relationship with significant others. Different terminologies have been used to represent emotional connectedness with others in the school-based empirical research. These terms include student’s participation, perceived academic environment, perceived school satisfaction, and school connectedness, among others. (Hayixibayi et al., 2021). Digital Media Exposure Young children are more exposed to digital media, which have the drawback of emphasising one-way communication and enthusiasm at the expense of fostering supportive relationships. (Oh et al., 2021). Early media exposure can have a negative impact on a child’s linguistic development as well as their social development (Zimmerman et al., 2007). Exposure to media including social networking sites also has potential risks of MOI, maladaptive behaviours, executive function deterioration, inhibitory control, and decisionmaking, particularly when confronted with cues of harmful Internet use and interpersonal difficulties from early childhood and continues to present in further developmental stages (Aydın et al., 2020; Gentile et al., 2010; Pichardo et al., 2021). As a result, the American Academy of Pediatrics advises parents to limit screen time for their children below the age of two (Brown, 2011). Genetics Genetic and other biological determinants of human behaviour, such as ontogenetic characteristics and early childhood experiences, and their biological ramifications and implications for learning experiences, are among the earliest predisposing variables. However, substantial research has confirmed the influence of genetic factors during the early adolescence or high school students. Although just a few studies have predicted genetic influence on early to middle childhood, the findings are inconclusive and warrant further investigation. Comorbidities

Attention-Deficit Hyperactivity Disorder (ADHD) ADHD is one of the most common mental health concerns among children, ADHD symptoms include inattention (inability to maintain concentration), hyperactivity (excessive movement that is inappropriate for the situation), and impulsivity (rapid acts that occur in the moment without thought) (American Psychiatric Association, 2017). Numerous ADHD symptoms, such as excessive movement, trouble remaining still for extended periods of time, and short attention spans, are also frequent in young children. In children with ADHD, hyperactivity and inattention are significantly more than usual for their age, resulting in distress in functioning at home, school, or with friends. There were significant associations between the severity of ADHD symptoms and the intensity of MOI among children (Morita et al., 2021; Restrepo et al.,

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2020; Yen et al., 2007; Yoo et al., 2004). Additionally, recent research found that the prevalence of ADHD, specifically in the dimensions of lack of attention and impulsivity, may be a substantial risk factor for MOI. In children with ADHD, changes in the quality/quantity of task engagement, as well as a preference for short-term gratification and situations over delayed ones, result from cognitive and motivational dysfunction (Sonuga-Barke, 2002). Also, it has been noted that children with ADHD have a proclivity for stimulus seeking (Antrop, 2002). The Internet also provides evolving and changing, multimodal stimuli as well as immediate gratification with little latency. As a result, Internet use may be an excellent match for metacognition aspects of ADHD. The implication is that children with MOI may spend far more time playing online games than doing different activities, because games are the most appealing and instantly pleasurable experiences, and they are all available online. Furthermore, Internet use may function as a substitute activity for children with ADHD who lack social competence, emotional challenges, and enjoyment in their daily lives.

Autism Spectrum Disorder (ASD) ASD is a neurodevelopmental disorder that impairs an individual’s ability to comprehend and interact with others, resulting in difficulties with social interaction and communication (Mayo Clinic, 2018). Additionally, the disorder involves restricted and repetitive behavioural patterns. The terminology “spectrum” refers to the wide range of ASD-related clinical manifestations. ASD typically manifests in early childhood and leads to difficulties functioning in society, such as social and academic difficulties. Oftentimes, children exhibit autism signs during the first year. A small percentage of children appear to develop normally during the first year, but subsequently regress between the ages of 18 and 24 months when they acquire autism symptoms (Mayo Clinic, 2018). ASD comprises disorders that were once recognised as distinct, such as Autism, Asperger’s syndrome, childhood disintegrative disorder, as well as an unidentified type of pervasive developmental disorder. Some people continue to refer to ASD as “Asperger’s syndrome,” which is widely considered to be on the milder end of the spectrum. Several studies have proven the existence of a positive relationship between ASD and MOI, including gaming disorder. (Mazurek & Wenstrup, 2013; Murray et al., 2021; Paulus et al., 2020; Restrepo et al., 2020). Children with ASD frequently struggle with face-to-face interpersonal relationships due to their difficulty comprehending social cues. Anecdotal studies indicate that these individuals may find Internet interactions to be less demanding in terms of emotional, social, and temporal constraints. These individuals frequently expressed a sense of freedom online and a sense of increased equality with their peers (Benford & Standen, 2009). The sense of independence came with the risk of losing control. Not only do these children struggle with social connection and communication, but they frequently engage in confined

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and repetitive behaviour. This proclivity for obsessing over extremely narrow interests may make it harder for these individuals to disconnect from video games (Engelhardt & Mazurek, 2013). Moreover, when parents reported having no constraints on their child’s video game use, there was a notably strong association between in-room access to a video game system and defiant behaviour (Engelhardt & Mazurek, 2013). It is probable that this obsession with highly specific hobbies may extend to increased Internet use. Given the allure and security that online gaming and Internet use provide for individuals with autism, it stands to reason that ASD populations may be more prone to developing problematic behaviours when interacting with such technologies. Previous research and evaluations have established a link between autism and electronic media exposure, with individuals with ASD devoting more time watching television, playing online games, and using the Internet more frequently (Murray et al., 2021).

Photosensitive Epilepsy Epilepsy is characterised as two or more episodes of seizures, but a seizure is a singular incident. Photosensitive epilepsy is a well-characterised condition in which seizures are caused by flashing lights or sequences of alternating light and dark (Epilepsy Society, 2021). It affects a small percentage of people who have epilepsy. Electroencephalography can be used to demonstrate this proclivity by utilising intermittent photic stimulation (IPS) at varying frequencies. Individuals with or without epilepsy may experience disorientation, discomfort, or illness as a result of flashing or patterned effects. This does not always imply that individuals suffer from photosensitive epilepsy (Epilepsy Society, 2021). Flickering sunshine has long been recognised to cause seizures in some people. Gowers a well-known English physician who specialises in epilepsy initially described photic-induced seizure in a toddler who suffered seizures in intense sunlight in the late 1800s (Brna & Gordon, 2017). However, as the television, video, and computer gaming sagas developed, advanced technologies became a more prevalent trigger. Photosensitive epilepsy is more prevalent in children and adolescents (up to 5%) with age ranging from 5 to 19 years, while it is less prevalent beyond the age of 20 (Epilepsy Society, 2021; Quirk et al., 1995;). Another study verifies the 1/4000 prevalence of photosensitive epilepsy and indicates that the incidence of photosensitivity varies significantly, spanning from 0.5–9% of the non-epileptic population. (Tychsen & Thio, 2020). The same paper discusses the factors that affect the incidence rate, including diverse populations, varying IPS methodologies, and differing definitions of photosensitivity. Even though children with generalised epilepsy are at greater risk of developing photosensitive epilepsy, those with focal epilepsy, such as occipital epilepsy, are equally vulnerable (Ferrie et al., 1994; Martins da Silva & Leal, 2017; Padmanaban et al., 2019). Generalised tonic–clonic, absence,

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and myoclonic seizures are all manifestations of photic-induced seizures, although myoclonic seizures being one of the most prevalent (Padmanaban et al., 2019). Both eyelid myoclonia with absence epilepsy (Jeavon syndrome) and progressive myoclonic epilepsy are marked by photic-induced myoclonic seizures. (Martins da Silva & Leal, 2017; Padmanaban et al., 2019). Rushton (1981) documented the phenomena of video game-induced seizures for the first time. Since then, additional cases of epileptic seizures believed to be related to video games have surfaced (Brna & Gordon, 2017; Bureau et al., 2004; Ferrie et al., 1994). In 1997, Japanese children with seizures were correlated with the television anime “Pokemon,” revealing a substantial correlation between these seizures and very long wavelengths of monochromatic light. Photosensitive individuals may be sensitive to geometric patterns, particularly stripes, and to specific colours, particularly alternating red and blue, as well as a mixture of these stimuli (Bureau et al., 2004). Such combinations were to blame for the seizures due to the television anime. Recognising this vulnerability for people with photosensitivity resulted in the implementation of stringent broadcasting regulations in a number of countries. In recent years, the popularity of the self-portrait, called the “selfie,” has surged. The word “selfie” refers to a snapshot of oneself captured with the forward-facing lens of a smartphone or webcam. The popularity of selfie photographs for instant messaging, Twitter, Instagram, Facebook, Snapchat, and regular photography has risen dramatically over the last decade. Due to the widespread use of this means of social communication, it may pose a risk to those with photosensitive epilepsy, especially in low-light conditions (Brna & Gordon, 2017). The perils of taking selfie-images in high-risk situations, such as while riding a motorcycle or while driving a car, or while posing with firearms, have been extensively evident. However, individuals with photosensitive epilepsy may have significant problems because many phone cameras use a pulsating flash to eliminate red eye preceding to take a snapshot in a dark situation with the use of long-wavelength red light (Brna & Gordon, 2017).

Depression Children suffering from depression are more inclined to become involved in the online world in an effort to avoid reality and seek relief. Positive association between MOI and depressive symptoms among children is highlighted by some of the studies (Kremer et al., 2014; Lim & Nam, 2018; Morita et al., 2021). Depressed children are more likely to engage in harmful online activities to avoid from unpleasant feelings. High involvement in the online world has possible unhealthy outcomes, such as reduced daily activities, excessive daytime sleep, anger, social network defamation, low self-confidence, and online bullying (Kremer et al., 2014; Morita et al., 2021). As a result, in children, MOI may worsen depressive symptoms.

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Social Anxiety According to researchers, children suffering from social anxiety use online relationships to compensate for unsatisfactory interpersonal relationships (Esbjørn et al., 2020). This may be the case in children who suffer from depression. The privacy offered by the Internet encourages the socially anxious to involve in low-risk social interactions online. Also, earlier studies, however, did not take into account comorbidity with ADHD, ASD, or depression (Restrepo et al., 2020). As a result, earlier links between MOI and anxiety may have been due to co-occurring disorders.

Preventative Measures Evidence addressing healthy media use in this modern era does not support a onesize-fits-all strategy, yet certain recommendations are highlighted to decrease the MOI among school children and hence achieving compelling health outcomes. Parenting in the Internet world, especially post-COVID-19 pandemic outbreak, has been considered one of the most difficult tasks. Parents are conflicted, uncertain, and concerned about their function as a mediating force to help children in eliminating MOI in the early formative years. On this line of concern, parents may need to set a standard screen time for the children. Screen time is described as time spent idle or proactive on screen-based activities, based on the context as well as the goal of the activity, such as leisure, homework, or socialising (Throuvala et al., 2021). Recent guidelines recommend a transition away from purely restrictions and limitations (i.e. time limits) and into a balance of active techniques (examining personal liberties, danger, and security concerns) and conditional regulations (time-bound) (Throuvala et al., 2021). Notably, the French Academy of Pediatrics made several recommendations (Picherot et al., 2018). Parents may view a situation more objectively and without malice. Maintaining a policy prohibits the use of digital devices such as cell phones, tablets in bedrooms. Conserving time without the use of digital gadgets during breakfast, lunch, bedtime, and family time is essential. Ensuring parental control of digital use and, finally, eliminating a sense of isolation is most needed. Approaches that incorporate proactive and constraining mediation measures, as well as holistic management, healthy parenting, and exercise habits, are some of the recommendations. Importantly, parents or significant caretakers may need to maintain a continuing discussion with children about online citizenship and safety, which involves treating others with respect both online and offline, preventing cyberbullying, being cautious of online solicitations, and avoiding interactions that might jeopardise personal privacy or safety (American Academy of Pediatrics, 2016). Parents stressed the importance of schools in educating students and fostering discussion with children about screen time problems. Digital education was viewed as a new impediment to classroom teaching, but also as an emerging prospect and new educational area. Quite precisely, this means that schools can operate as

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information and guidance centres for both students and families, complementing parental efforts to promote appropriate Internet use among children. Training and interventions for school personnel can indeed be undertaken under the supervision of competent academicians and consulting firms. Collaboration between specialists such as physicians, mental health experts, as well as school counsellors is essential to develop standards and support training and development needs for virtual learning and prevention strategies (Throuvala et al., 2021). The content should be appropriate for different stages of a child’s development, with an even dynamic equilibrium of upsides and downsides of technology to counteract the prevalent prejudice against Internet use. Importantly, media literacy awareness is necessary at all levels of education since it goes beyond online safety to address psychological implications, foster depth of understanding and learning of social communication, and promote accountability. This can also include information that emphasises skills development (i.e. emotional wellbeing, healthy attitudes, and compassion), research reports, narratives, and practical and engaging activities (Throuvala et al., 2019).

Conclusion and Recommendations Given the extent to which technology permeates individuals’ daily activities, this chapter highlights that a child may be vulnerable to problematic Internet use. Following the COVID-19 pandemic outbreak, studies have revealed an increase in the global population of Internet users. Online education has become the new norm. Although Internet technology has multiple benefits in a variety of contexts, it also has significant negative consequences that may affect a child’s cognitive abilities, emotional development, social competence, and physiological health, among others. This would obstruct the child’s healthy developmental growth much more. Additionally, co-occurring disorders among children may complicate the implementation of specific psychological interventions. There is a need for culturally relevant studies on Internet use, as it varies across society. There is no precise time period for Internet use that should be considered harmful. As a result, extensive study is required to fully understand the detrimental Internet usage behaviours. New policy recommendations and initiatives for healthy Internet use that are applicable across the nation and by various stakeholders are urgently needed.

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Chapter 20

School-dropout Scenario in India and Impact of the Right of Children to Free and Compulsory Education Act, 2009 Vimala Veeraraghavan Abstract Education is essential for every child to gain knowledge, develop better understanding about life to deal with various challenges in life and to become a responsible and productive citizen. However, a large number of children in India either do not get the opportunity for study or become school dropout at an early stage because of various reasons. The scenario of school dropout is quite disturbing in developing countries like India as compared to industrialised countries. This chapter focuses on the role of the Right to Education Act 2009 (alternatively known as The Right of Children to Free and Compulsory Education Act, 2009) in ensuring education for all children in addition to discussing the research-based evidence on school dropouts and various reasons behind it. The chapter also discusses categorywise school-dropout rate in India during 2015–2020 at primary, upper-primary and secondary levels. A comparative picture of school dropout rate at different levels before and after the enactment of The Right of Children to Free and Compulsory Education Act 2009 is presented indicating positive impact of the Act. Finally, the chapter focuses on various preventive measures for controlling school dropout in India through creating a positive and safe school environment, organizing teachers training for quality teaching and involving parents and larger community in various developmental programs of schools. Keywords Student · Right · School · Dropout · Education · India · RTE Act · 2009

Introduction The impact of any policy becomes visible at the ground level after a few years of its effective implementation. Now, the time has come to check the effectiveness of the RTE Act which is also known as The Right of Children to Free and Compulsory Education Act, 2009, examining the latest data from the reliable source concerning school dropout at different levels in India. V. Veeraraghavan (B) Emeritus Professor, Psychology and Education, Apeejay Stya University, Gurgaon, India © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_20

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The RTE Act has been superimposed on Sarva Shiksha Abhiyan, the flagship program of central and state government for attaining the goal of universal elementary education. The program has been in implementation for more than a decade and doubtless has had a good impact on enrollment. What the RTE Act seeks is to introduce right-based approach so that every child’s right can be enforced through legal means with a grievance redressal procedure and an appeal to National and State Commission of Children for Protection of Rights. It also makes it legally obligatory on the part of various authorities of the government, state and local levels, to provide requisite number of schools and appoint teachers according to norms, ensure that the teachers are sufficiently qualified, provide defined minimum physical facilities in all the schools, simplify admission procedures and ensure the transaction of curriculum on desired lines. It also gives important voice to parents and local community in the management of the school. In particular, the RTE Act pays special attention to the quality of education provided in the school. In fact, according to a distinguished educationist, Section 29 of the RTE Act is the heart and soul of the Act. This section stipulates that the curriculum for elementary education will take into account the following: (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k)

Conformity with the values enshrined in the Constitution All round development of the child Building up of the child’s knowledge, potentiality and talent Development of physical and mental abilities to the fullest extent Learning through activities, discovery and exploration in a child-friendly and Child-centered manner Medium of instruction shall as far as practical be in the child’s mother tongue Making the child free of fear, trauma and anxiety and helping the child to Express views freely Comprehensive and continuous evaluation of the child’ s understanding of Knowledge and his or her ability to apply the same.

The above provisions should be read with rules prescribing that the teacher shall maintain a file containing a pupil’s cumulative record which shall be the basis for awarding the certificate for completion of elementary education. The requirement that the teacher shall maintain a cumulative record for every child arises also from the stipulation in Section 30 of the Act that no child shall be required to pass any board examination till completion of elementary education and that every child completing the elementary education shall be awarded a certificate. The RTE Act, therefore, places a great responsibility on the teachers and has very high expectations from them. To facilitate the performance of their duties, the Act provides for the appointment of specific number of teachers in accordance with prescribed student–teacher ratio, filling up of all vacancies in teacher positions within stipulated time, prescribing of minimum qualifications and teacher eligibility tests for appointment of teachers and training programs of pre-service and in-service and provision of various academic support services. The rules also requires teacher participation in curriculum formulation, development of syllabi, training modules and text book development. The Act prescribes inter alia that the teacher shall be

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regular and punctual, conduct and complete curriculum within the specified time, assess the learning ability of each child and supplement additional instructions if required and hold regular meetings with parents and appraise them about regularity and progressive learning and other relevant information about the child. Attention has been drawn to the above provision to show that if the RTE Act has to succeed in its objectives, much greater attention is required to training of teachers particularly to improve their ability to adopt flexible teaching learning method, evaluation and assessment to meet with the greater diversity among student population, the high expectation of the Act and the responsibility imposed on them. The Teacher Eligibility Test as now in force is intended to ensure that teachers have sufficient subject matter competence. But, what is needed is not only subject matter competence but a great deal of ability in transacting the curriculum in the classroom and in working with the parents and the community to ensure that the individual student’s needs are met adequately. It calls for a sea change in the perspectives and practices of teaching. To quote from a recent document of the Ministry of HRD on Framework for implementation of the RTE Act, “Abhiyan” in the year 2009, “in-service training for teachers should be provided every year so as to enable them to continuously upgrade their knowledge and teaching skills and work toward a shift in their understanding the practices of teaching and learning in the following manner”: From 1 Teacher directed, fixed designs

To Learner centric flexible processes

2 Learner receptivity

Learner agency, participation in learning

3 Knowledge as “given,” fixed

Knowledge as constructed, evolving

4 Learning as an individual Act

Learning as a collaborative, social process

5 Disciplinary focus

Multidisciplinary educational focus

6 Assessment judgmental, mainly through competitive tests for ranking through narrow measures of achievement leading to trauma and anxiety

Assessment for learning, self-assessment to enhance motivation, through continuous non-threatening processes, to record progress over time

Let us now take up the school-dropout scenario in India and see how the RTE can deal with the same.

The Phenomenon of Dropouts The difficulty in estimating the number of dropouts is also clear from a recent report of NUEPA (2012a) on Education for All. The report cites the following figures: • Census Figures of 2001 estimated out of school children at 32 million or 28% of the age group 6–14 years in that year.

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• SRI IMRB Report of 2005 (an independent survey) estimated the number at 13.5 million or 6.94% (4.34% in urban areas and 7.8% in rural areas). • SRI IMRB Report of 2009 estimated the number 8.1 million in 2009, that is, 4.2% of the children in the age group 6–14 years. • National Sample Survey (66th round) estimated the non-attending children at 14.25 million children. NUEPA Report concludes that although estimates of out of school children in the age group 6–14 years using different sources of data provide varying figures, all the estimates do indicate that the number of out of school children in India has declined substantially during the last few years. Moreover, this decline in the percentage of school children is across gender and all social categories. For girls, it has decreased from 7.9% in 2005 to 4.6% in 2009. For SC population, it has (Source National Curriculum Framework 2005, p. 110) decreased from 8.1% in 2005 to 5.9% in 2009. The decrease is more noticeable in rural areas where the percentage of school children dropped from 7.1% in 2005 to 4.4% in 2009. The definition of non-attending children in NSS survey refers to non-attendance during a particular period which is different from enrollment data in official figures. NUEPA’s Report Education For All (2012a) gives an overall dropout rate for Classes I–VIII at 42.7% in 2007–2008 (43.7% for boys and 41.3% for girls). It also indicates that the retention rate at the primary level (Class V) has increased from 53% in 2001 to 74% in 2009. The retention rate up to Class V estimated by NUEPA through its annual DISE 2011 document that shows a retention rate of approximately 75% up to Class V. The retention rate shows the number of children surviving up to Class V out of a given cohort. The terms out of school children may include dropouts as well as irregularly attending children. Not all children who fail to reach Class V would be dropouts as some may continue to attend lower classes which in the future will decline due to non-detention policy. Whatever the definition and method of statistical compilation, the fact remains that a substantial number of children fails to achieve the learning goals set for universal elementary education up to Class V and Class VIII, as was pointed out in Pratham study given below.

Research Evidence on Dropouts There are several factors responsible for school dropout, and it varies from state to state and individual child. However, lack of interest in studies, poor supervision by parents, poverty, distance of school, poor communication facilities, poor quality of education and failure in examinations are some of the frequently cited explanations for dropping out of school (Pratinidhi et al., 1992). However, traditionally, the reason for non-attendance and dropout of children has been attributed to (i) physical accessibility of schools, (ii) lack of facilities in

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schools, (iii) transport arrangements, (iv) absence of teachers, (v) absence of facilities at school, (vi) poverty and socio-economic conditions of children leading to employment of children as income earners in various occupations, (vii) social factors based on caste and gender, (viii) lack of education particularly among mothers, (ix) poor teaching and learning in the schools and (x) inappropriate teacher behavior. Despite the economic and social progress over the last few decades, the above causes are still very much in operation as can be seen from some of the recent research studies and programs. A brief summary of conclusions of these studies is given below. A study in Delhi by Sajjad et al. (2012) suggests the reasons for dropout as under: (i) (ii) (iii) (iv)

Abysmal quality of education (22%) Poverty in households (34%) Helping in household chore (25%) and Supplementing family income (18%).

The study suggests conditional cash transfer program as in Mexico and Brazil where cash support is extended to poor families, conditional on children attending schools and going to clinic for check-up. Although the study recognizes such a program, it may be difficult to implement in a populated country like India. In its annual status of education report ASER rural (2009) released in the year 2010, Pratham, the well-known NGO tried to get reliable estimates of the status of children schooling and basic learning (reading, writing and math ability) at district levels. The survey recorded the household and village characteristics, education of fathers as well. The analysis was based on 29 districts covering children 3–16 years of age. Children aged 5–16 years were assessed on reading tasks, arithmetic tasks, English tasks, etc. The report observed that among children in the age group of 6–14 years, the dropout had come down from 4.3% in 2008 to 4% in 2009. School girls had dropped from 7.2% in 2008 to 6.8% in 2009. Over 50% of 12 year olds are enrolled in schools. Only 25% of all rural children in Class V could read simple sentences. Of these, over 80% could understand the meaning of the sentences. By Class VIII, 60% of all children could read a simple sentence. In all the North Eastern states, except Tripura, Goa, Himachal Pradesh and Kerala, more than 80% of children in Class VIII could not read simple sentences fluently, but they could understand the meaning. It was found that the percentage of children taking paid tuition increased in every class in both private and government schools. The incidence of tuition in Bihar and Orissa was high. This very large numbers of the government school children taking tuition (more than 33% in Class I to 50% in Class VIII) is indeed significant. Water was available in 75% government primary schools, and usable toilets were found in over 50% government schools. In Classes 1–2, more than 70% children could read letters of words except in Tamil Nadu (62%) and UP (68%). In Classes 3–5, more than 50% children could read the level 1 set or more, except UP and Jammu & Kashmir. In other words, the Pratham study highlights the inadequate learning attainment in language and maths. However, using another methodology of assessment, the

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NCERT has been able to give a more positive report on the attainment of language and maths abilities in children. Uma (2011) in a study on reasons for the rising school-dropout rates in rural India has stated on the basis of a study that 50% of children who join Class I dropout by Class VIII. With each successive class, students quit in large numbers. By Class V, every third kid has dropped, and by Class VIII, every second kid dropped out of school. The net enrollment ratio for Classes VI–VIII was reported as 54%, that is, only 54% of all children in this age group were enrolled. This meant that 44 million children in this age group did not go to school. For Classes I–V, the net enrollment was 97% leaving out 4 million children. In a study conducted by her drawn on 154 rural girl students, she found the following reasons for children dropping out of the school: (1) (2) (3) (4) (5) (6) (7) (8)

Child not interested in studies Parents not interested in studies Financial constraints Unable to cope To work for wage/salary Participation in other economic activities Attend to domestic duties Facility for study does not exist in the nearby town.

The main reason for dropping out in her study was found to be financial difficulties for both boys and girls. About 31% boys and 13% girls also reported that they were just not interested in further studies. Twenty-eight percent (28%) girls said that their families and relatives did not approve of their further continuation of their studies. Parents wish to discontinue children’s education was cited as the most important reason (29% for all age groups). About two-fifth (42%) of girls were pulled out of school by their parents so that the girls could look after their siblings (53%). For boys, the reason given was to help in family occupation (57%) and the perception that education will not be helpful in the future (42%). The research study concludes that there is a great need for literacy drive among parents, vocational training for skills for income generation and continuing education. Gouda and Sekher (2014) carried out a study to examine the factors responsible for school dropouts in India analyzing the National Family Health Survey 3 data. Findings disclosed that “only 75% of the children in the age group 6 to 16 years were attending school during 2005–2006, while about 14% never attended the school and 11% dropped out of school owing to various reasons. School-dropout rate was high among the children belonging to Muslim, Scheduled Caste and Scheduled Tribe families during the same period. Parental educational background was found to be associated with children school dropout. The dropouts among the children belonging to illiterate parents were four times higher than that of the literate parents. It was also observed that if parents were not working, the possibility of dropout among their children was relatively high.” Authors emphasized on improving the economic condition of the poor people along with their educational level to change the scenario of school attendance.

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In addition, child developmental factors like autism, mental retardation, learning disability, attention-deficit hyperactivity disorder (ADHD) and severe health problems like congenital and cardiac problems play a contributing role behind school dropout across the world (Patel & De Souza, 2000). Latest data of UNESCO as of 2019 indicate that about 1.1 lakh schools in India are running with a single teacher. Madhya Pradesh has maximum schools with a single teacher. Now, one can imagine the situation about teaching and learning process in those schools that is one of the main reasons for school drop outs in India. Further, the same study reported that 7.7%, pre-primary, 4.6% primary and 3.3% upper-primary teachers are not qualified teaching. During the COVD-19 lockdown, the teaching and learning process in those schools and other rural and government schools was very poor. A large number of teaching posts at the school levels are lying vacant for a long period and the states where the situation is worse in terms of vacancy include Uttar Pradesh (3.3 lakh), Bihar (2.2 lakh) and West Bengal (1.1 lakh) (Source: Gohain, Oct. 6, 2021). In terms of infrastructure facilities, teaching and non-teaching manpower and quality education, there is a wide gap between rural and urban schools. There is an urgent need to improve the infrastructure of government schools especially in the rural areas and recruit qualified teachers for every school to ensure quality education and equal opportunity of education for every child of the country. In order to attract children to school, extra-curricular activities like games and sports, music and arts play an important role. During childhood, children get maximum pleasure out of games and sports and playing with other children. These facilities are either missing or not much encouraged by the school authorities resulting in disinterest in attending the schools for some children. Facilities for vocational and special education are also missing in most of the schools in India. It also emphasizes the need for greater awareness of gender justice and women’s empowerment, if Right to education is not to remain as a mere paper exercise. Another study on school dropout in rural setting, Govindaraju and Venkatesan (2010), has cited Census Figures to show that while 96% of children enrolled in primary school by age of 10, 40% would have dropped out. While some 3 crore children do not go to school, 8.5 crore children are dropouts. The reasons for dropping out may be failure in academics, non-availability of schools and inaccessibility of schools, pushing out due to teachers, behavior/school environment and financial problems. Based on the study, they have classified the reasons for dropout under the following categories: (i) child-centered, (ii) parents-centered, (iii) teacher-centered and (iv) environmentcentered and have analyzed the reasons under these four categories. Neglect, poor or lack of interest in teachers, fear of teachers, misbehavior by teachers, irregular classes, poor teaching, overtly strict discipline, discrimination, cruelty or punishment meted out by teachers, absence of teachers, lack of female teachers are listed under teacher-centric causes. Poor interest or neglect, over freedom and affection of parents, giving up parental responsibilities, denial of school for female children, gambling, alcoholism and other vices, death of a parent, parent discord and illiteracy are among the parent-centric causes. Transient or prolonged illness, accidents, disabilities, handicapped child, early menarche or marriage of the child, age of the child, disinterest in studies, distraction

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in play or games, inferiority feelings, problem behaviors in child, poor academic performance, preference to go for work and earn money, fear of punishment by teachers, love affairs, perception that there are no job opportunities after studying, pride and ego are among the child-centric factors. Caste factors, poverty in family, tradition, change of school or medium of instruction, influence by television or mass media, drought or famine in the village, tribal life, frequent shifts or migration of family, poor home background, distance from school, poor school maintenance, absence of toilet facilities in school, intimidating system of examination are among the environment-centric reasons. The author’s conclusion is that the empirical evidence suggests three major clusters, viz., parent, teacher student with significant differences in relation to gender, occupation and educational status of teachers, the SES and education of parents and gender of the dropout students themselves. Another program in Samashtipur by SDPP (2012) analyzes an intervention program organized in consultation with the Bihar government in 13 blocks of Samashtipur district. The intervention includes an early warning system (to check student absenteeism) and recreation and enrichment activities to make the school more attractive. This includes life skills, arts, crafts, sports and games, storytelling and engaging teachers and volunteers in the above. The program also proposes to measure the following outcomes: (i) school dropouts, (ii) engagement in school, (iii) progression in school and (iv) the student, teacher and parent attitude. The report of status and trends by NUEPA (2012b) emphasizes that the RTI Act requires the government and the local authorities to ensure that the child belonging to the weaker sections, disadvantaged groups, etc. is not discriminated against and prevented from pursuing and completing elementary education on any ground. The approaches to ensure inclusion of all children in elementary education include special initiative for enhancing educational access for disadvantaged and weaker sections of the community. It also states that area-intensive and target group initiatives including assessment of educational status of specific social and cultural groups, alternative schooling opportunity for special group such as out of school children and support, community-based innovative and experimental projects by voluntary agencies are important aspects of the initiative to bridge gender and social gap in education. It also emphasizes the importance of early childhood care and education and meeting the learning needs of young people and adolescents generally improving the levels of adult literacy to achieve the objectives of UEE. It has several recommendations for bridging gender gap and promoting gender equality as well as for improving educational quality and student learning.

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School Dropout Rate During 2015–2020 in India at Primary, Upper-primary and Secondary Levels Available data pertaining to category-wise school dropout at primary, upper-primary and secondary levels of the last five years are presented in Table 20.1. Some of the common trends are observed. First, school dropout at primary level is found to be higher among boys as compared to girls during 2015–2020, while at the upperprimary level, the picture is revised, i.e., dropout was more among girls than that of boys during the reporting periods. Again at the secondary level, dropout rate was more among boys except 2016–2017. When we compare the dropout rate in terms of levels of school dropout, it has been observed that a maximum number of students become dropout at the secondary level, irrespective of gender with minor variation. School dropout rate increases when children go to upper class, i.e., at secondary level. Further review of school-dropout rate category-wise of Indian children provides a clear trend, i.e., it is the highest among children belonging to Scheduled Tribe (ST) category, followed by the children from Scheduled Caste (SC), Other Backward Caste (OBC) and general categories. The concentration of different categories of population in different states and union territories varies. Some states are having more OBC population, while another state has more concentration of SC population. In-depth review of state and union territorywise school dropout rate of children during 2019–2020 at three levels reflects the same picture. In some states and union territories like Andaman and Nicobar Islands, Nagaland, Odisha, Sikkim and Nagaland, the rate of school dropout among children of SC category was more. For example, in Andaman and Nicobar Islands, the maximum population belongs to SC category, and the school-dropout rate of these children at primary and upper-primary levels were 97.35% and 96%, respectively. Similarly, in Sikkim 0.92, 8.90 and 30.91% children become dropout at primary, upper-primary and secondary levels. In Arunachal Pradesh, the scenario is totally different. School-dropout rate was more among general and OBC category children at all levels. At the same time, in Manipur, the highest number of children belonging to ST category became school dropout, i.e., 13.76, 7.49 and 19.78% of children at primary, upper-primary and secondary levels. In Tamil Nadu and Tripura, the dropout rate among ST category children was more at all levels. It was 32.34% for Tamil Nadu and 34.65% for Tripura at secondary level.

School Dropout Rate at Different Levels Before and After the Enactment of the Right of Children to Free and Compulsory Education Act 2009 Comparison of school dropout rate at primary, upper-primary and secondary levels before and after the enactment of The Right of Children to Free and Compulsory

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Table 20.1 School dropout rate in India during 2015–2020 2015–2016

Primary level

Upper-primary level

Secondary level

category

Girls

Boys

Total

Girls

Boys

Total

Girls

Boys

Total

• General

2.16

2.74

2.47

2.42

1.81

2.1

13.15

12.85

13.0

• OBC

2.79

3.25

3.02

5.29

3.68

4.47

19.79

20.31

20.07

• SC

3.28

3.62

3.46

6.42

5.25

5.82

21.00

21.28

21.15

• ST

4.18

4.29

4.24

9.64

9.7

9.67

26.28

26.27

26.27

Total

2.89

3.31

3.1

5.21

4.1

4.64

18.75

18.93

18.84

• General

1.62

2.28

1.96

1.69

1.38

1.53

15.9

15.13

15.49

• OBC

1.7

2.27

1.99

4.26

2.42

3.31

22.94

23.12

23.04

• SC

2.52

2.85

2.68

4.5

3.48

3.98

23.54

23.87

23.71

2016–2017

• ST

3.91

3.96

3.94

8.6

8.69

8.64

27.15

27.85

27.51

Total

2.07

2.56

2.32

4.09

2.97

3.51

21.50

21.47

21.49

• General

1.53

2.25

1.91

3

2.74

2.87

14.81

15.07

14.94

• OBC

3.62

3.88

3.75

6.22

4.51

5.35

19.3

19.77

19.54

• SC

4.73

4.98

4.85

7.14

6.07

6.59

21.47

22.05

21.77

• ST

3.48

3.82

3.66

6.14

5.95

6.04

21.36

22.9

22.14

Total

3.33

3.68

3.51

5.57

4.49

5.02

18.66

19.16

18.93

• General

3.62

3.61

3.61

2.78

2.27

2.51

13.03

13.37

13.21

• OBC

4.18

4.54

4.37

5.6

4.22

4.89

17.38

19.26

18.38

• SC

4.9

5.41

5.16

6.48

5.62

6.04

18.97

21.32

20.2

2017–2018

2018–2019

• ST

5.23

5.72

5.48

6.46

6.89

6.69

23.38

26.4

24.93

Total

4.3

4.59

4.45

5.14

4.26

4.68

17.05

18.68

17.9

• General

0.30

0.68

0.5

0.07

0

0

10.25

11.58

10.94

• OBC

1.01

1.58

1.3

3.49

2.19

2.82

15.43

17.46

16.49

• SC

1.62

2.00

1.82

4.14

3.39

3.75

17.39

19.81

18.64

• ST

3.45

3.9

3.69

5.65

6.15

5.9

22.49

25.51

24.03

Total

1.22

1.67

1.45

2.96

2.22

2.58

15.05

17.01

16.07

2019–2020

Source National Informatics Centre (NIC), Ministry of Electronics and Information Technology (MeitY), Government of India

Education Act 2009 gives a clear picture about the efficacy of the law. Data indicate that the school dropout rate at primary level has decreased from 27.85 in 2008–09 to 3.1% in 2015–16 in a gap of six years. Further, it has come down to 1.45 in 2019–20. At the primary level, dropout rate is more among boys during the last five consecutive years. At the upper-primary and secondary levels, a similar trend has been observed.

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For example, at the secondary level, school dropout rate has decreased from 54.2% in 2008–09 to 18.845 in 2015–2016. In 2019–20, it has further gone down to 16.07%. Like primary level, school dropout rate is higher among boys than that of girls at secondary level. Interestingly, the situation is reversed at upper-primary level, i.e., it is more among girls than boys.

Prevention of Dropouts and Needs of Inclusive Schools RTE has stipulated that all children should be admitted to schools without screening which means children with poor academic performance will also be admitted which indicates the need for inclusive education and inclusive schools. The term “inclusive schools” refers to one that encourages every child, irrespective of its socio-economic background, gender or academic ability, achieves its fullest potential through diverse teaching and learning styles appropriate to children (Doran, 2011). Many of the classroom practices and procedure including assessment method and relationship between children and parents may need to be modified to achieve the above goals of inclusion. While children with high abilities should always be encouraged, attention should also be given equally to the poor performing children so that the causes of poor performance are understood, and the children are assisted to overcome their learning difficulty. Some of these difficulties may arise due to early upbringing or socialization or the lack of it and will need cognitive, emotional and behavioral interventions. Some of these children may have special need, and the teachers should identify these special needs and assist in provision for education of the same. For all these, the school or the local cluster of schools should be able to provide for aptitude, interest and personality tests as an aid to learning. This will help all children and not the only poor performing children. In a recent paper, Ricconuini et al. (2012) stated that cognitive behavior intervention (CBI) can be taught in a series of 10 or more classes. It can be taught to students by general and special education teachers, school psychologists or behavior specialists in one-to-one, small group or large group instructional format. Although the specific cognitive and behavioral component may vary, a variety of instructional techniques can be used including mentoring by teacher and peer modeling, role play and behavioral rehearsal. A decade ago, in another study on guided learning, Dash and Khan (2001) demonstrated the impact of guided learning on cognitive performance of children. They concluded that school instruction should capitalize on the potential development level of students using dynamic assessment methods. A common instructional theme in using CBI to reduce aggression and dropout was that the students were exclusively taught strategy and appropriate behavior response by the teacher. The instructional design teachers included multiple models, frequent opportunities for guided practice, plenty of corrective feedback, positive reinforcement, independent practice and specific generalization strategies. Additionally, it would be helpful if teachers monitor students’ progress by observing and recording student behavior across various settings. When students do

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not make progress, teachers provide additional model, feedback and opportunities to practice.

Motivational Climate of Schools In view of the high expectations in school from the teachers, the Act specifically prohibits deployment use of teachers for non-educational purposes except for decennial population census, disaster relief duty or duties relating to elections to local authority, state legislature and parliament. Since there are many elections, teachers perhaps must be exempted from election duties as well. Also, teachers are involved in supervising construction and other similar non-academic works which need to be prohibited. The intention is that teachers should have sufficient time to discharge the responsibilities expected of them. The training arrangements are also intended to help them in this regard. But, little attention seems to have been paid in raising their motivational and leadership levels in schools. Professionals in Psychology, Management and Education who have worked on organizational and institutional climate have to be involved in raising the motivational climate and in teacher training programs. This involvement has to be at the level of the schools, clusters of schools, at the block and district level, state and national levels. Without raising the school’s climate, motivational level and commitment of teachers, it would be impossible to make a success of the RET Act implementation. This commitment and motivation can come only through a person-oriented organizational approach. To quote from a recent report in Ireland, “to create a positive student behavior schools must develop in a consistent and sustained way the person oriented dimension of their organization. They must display high level of emotional intelligence, that is, the ability to empathize, to motivate, to build supportive alliances, to persist and to show warmth and acceptance.” Again to quote further from the report, “The teachers and other adults in the schools have to influence student behavior through their thinking, their actions and their feeling. There should be an effective leadership of the school and in the larger school it means distributive leadership which means wide involvement of staff in a range of school processes and their empowerment for the purpose. Recent research on school leadership points out that successful leaders set directions, develop people and redesign their organizations and in the process also actively involve all the staff members. This means they develop shared vision and group goals, set high performance expectations, provide individual support and intellectual and emotional stimulation, set examples and promote collaborative and participative relations with parents and community.” The leadership practices in schools that have above average enrollment of challenging students are specifically referred to in the Irish report (DES Publication, 2006). These are (i)

Constantly managing tensions and problems relating to particular circumstances and context of the schools.

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Coping on a daily basis with unpredictability and conflict while retaining the core values of the school. Personal and professional values that place human needs before organizational needs, that is, to be people oriented. Sharing decision-making with others through staff empowerment. To see their jobs not as desk job but as people-centered enterprise.

The leaders of the school are especially aware of the importance of building positive relations with students, teachers and parents. They do this through a process of trust and empowerment and engaging other students and parents in dealing with decision-making. The link between teachers’ learning and behavior is fundamental to all good practice. The teachers play a pivotal role in fostering classrooms that are conducive to quality teaching and learning. Where there is good teaching and learning, behavior difficulties would be considerably reduced especially if teaching and learning are tailored to the capacity and interest of the students. Apart from the pedagogic skills, the teachers should develop the capacity to build positive and mutually respectful relation with students and others. The pastoral care function of the teachers and the school is as important as the academic function, and when conflicts occur either with teachers or with parents or students, the adults concerned do not insist on their “pound of flesh.” Schools should be centers of reconciliation and not places for power struggle or for holding out or to triumph over some other person especially over a vulnerable student. For children and young people with emotional and behavioral difficulty, inclusion means (i) (ii) (iii) (iv) (v) (vi) (vii) (viii) (ix)

Maximizing their access to and engagement with social and educational setting appropriate to their needs and aspirations Providing environment where they experience a personal sense of security Respect and being valued Supportive relationship Sharing their life with positive adult role models Clear, humane and flexible boundary settings Successful achievement boosting their self-esteem Opportunities to obtain academic and vocational qualifications Chance to develop and exercise personal responsibility.

Raising Motivational Level of Students If RTE Act has to succeed, the school has to aim at improving the motivation level of the students. If the motivation of students for learning improves, it should have the beneficial impact on the motivation of the teachers as well. Many studies have been made on the issue of motivation for learning, and psychologists make a distinction between intrinsic and extrinsic motivation (Mukunda, 2009). The more intrinsic the

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motivation is (that is something from within rises for accomplishing certain goal), greater will be the impact or achievement in learning. Evolutionary psychologists believe that for certain kinds of knowledge, there is this intrinsic motivation arising from the Rights of Children, no matter from which socio-economic or family background the student comes from. However, for other kinds of knowledge which are essential to acquire from the school, there has to be a certain measure of extrinsic motivation, that is, a system of reward and punishment which in the school context would mean non-physical penalties of various kinds and also appropriate praise rewards and recognition. In a recent book (Mukunda, 2009) on (“What did you ask at school today—A handbook of child learning,” 2009), it is stated that “there are many possible reasons for the lack of intrinsic motivation among school children: emotional or physical insecurity and ill health, evolutionary constraints, a lack of perceived control over the learning process, the misuse of reward, irrelevant of material and difficult level of work, the classroom environment and most importantly teacher behavior and student beliefs.” She cites Maslow’s hierarchy of needs to say that only when the needs at the base of the pyramid are met, the child will be motivated to learn. “If the child is hungry and anxious or unloved, he will not be intrinsically motivated to achieve competence in the school. When a child goes through an emotionally shaky patch (family or peer related), school performance suffers immediately. A teacher who wants learning to happen has no alternative but to involve himself with the student’s emotional life.” The main objective of the teacher and of the school in its various practices is to encourage the intrinsic motivation of the students and use praise and reward system and occasional punishment system as well to ensure that classrooms and schools function in an orderly manner, and children are motivated to learn and observe the codes of behavior which is a powerful way of inculcating the democratic and humane values inherent in our Constitution.

Teacher Training In-service and pre-service training programs for teachers presently seem to give little attention to capacity building for teachers in these vital areas. Moreover, the extreme diversity in the student’s background has to be managed by the new paradigm of teaching learning processes with great flexibility and with links to career and vocational skills. All this requires effective use of principles of interpersonal as well as educational psychology. The syllabus of teacher training institutes must incorporate materials on testing for aptitude, interest and personality and their application under varying local circumstances and contexts. Psychological assessment and counseling-based thereon could also help reduce non-attendance and dropouts. The in-service training programs must incorporate sufficient knowledge both theoretical and applied in psychological tests and assessment and counseling. Even at the level of recruitment of teachers, it is necessary to provide for aptitude test before they are

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appointed, as teaching is one profession which requires a certain measure of commitment to children and interest in educational activities, without which the teachers will be unsuccessful despite their subject knowledge. The teachers must be proficient in identification of learning difficulty, in assessment and evaluation, in behavior guidance, enhancing motivation of children as well as interacting with parents and community.

Parental and Community Involvement Section 21 of the Act provides that the government schools and aided schools should constitute a school management committee consisting of elected representatives of local authority, parents or guardians of children and teachers. Three-fourth of this committee is to consist of the parents or guardians. This does not mean that the school principal and the school work under the control of the parent as the government and aided schools are working under designated authority of the government. The main purpose of the school management committee is to prepare and recommend school development plan and monitor the working of the school. The principal and teachers of the school should develop positive and cooperative relation with the school management committee and use it as a source of strength for the school in achieving its objectives and resolving many day to day problems. Since some of the parents of the poor and marginalized sections of the society may not be able to be in touch with the school, some volunteers, NGOs and representatives of the school managing committee could act as a bridge in order to ascertain the difficulties of the children who are not attending school regularly and those who have other problems. The school management committee and NGOs can be of assistance in providing special training program particularly in regard to vocational and life skills. In conclusion, India is a vast country, and we would be dealing with approximately 200 million children across Classes I–VIII. They are distributed across rural and urban areas with vastly different economic, social and geographical situations. The policy prescription should provide for sufficient flexibility and delegation of authority to decide on academic and other practices most conducive to getting the best results of quality education for every single child and developing its potential. The RTE Act seeks to make the common citizen and every one aware of the Rights of Children and provide for the enforcement of these rights through monitoring redressal of grievances and appeal to National Commission for Protection of Rights. It seeks to ensure while there is flexibility in the delivery of education according to local requirements and needs, sufficient resources are provided to ensure adequate basic facilities, sufficient number of teachers and ensure that there is universal acceptance of basic approach to quality education and one that is child-friendly and promote the growth of children and give meaning to their life and also enable them to make a living. It recognizes that life and vocational skills are important, and children should learn both within the school and community, but at the same time, the Rights of Children

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to their childhood should not be deprived by forcing them into child labor especially in prohibited activities. It is also the responsibility of the school that along with academic reform envisaged in the RTE Act, there are also sufficient opportunities for children to develop their vocational and work skills and life skills in general according to the emerging opportunity. It is the special responsibility of the school to provide for the development of these skills in school in a guided manner whether in family occupation or, otherwise, so that at the end of elementary education, children may choose their career in appropriate manner. The biggest impact of RTE Act may come, if effectually implemented through the enforcement of provisions for grievance redressal and monitoring especially as Section 31 of the Act clearly states that NCPCR (National Commission for Protection of Child’s Rights), and their state counterparts are responsible for monitoring the Rights of the Child. According to the Ministry of HRD’s document framework for implementation of RTE Act for implementation, the NCPCR will have to look at children’s rights in two domains: (i) children out of school and (ii) children in school and monitor every aspect of the Act including the reservation of 25% of admission of the weaker section in private school. Thus, for the first time, the government authority responsible for delivering educational services becomes accountable to an expert neutral agency set up by the government for protecting the rights of children. This, in the medium and long terms, it will have a major impact in ensuring educational provision and quality.

Conclusion and Recommendations In fine, it might be stated that the RTE Act ensures quality education for each child up to Class VIII. Another objective of the Act is to reduce non-attendees and dropouts in the age group of 6–14 years, so that every child goes to school. Latest data indicate the positive impact of RTE Act, i.e., school dropout rate at all levels has gone down significantly over a period time after the implementation of the RTE Act. However, there is a need to open more schools in the rural areas, recruit more teachers, arrange special training for them for acting as motivating teachers, ensuring uninterrupted midday meals, free uniforms and text books should be provided on regular basis. Teachers who are trained in the traditional system of teaching have to make a paradigm shift to meet the new responsibilities and methods of teaching. This requires capacity building, without which the dropouts and non-attendees will now become non-learners within the school and thus will be worse off. This capacity building calls for teachers with new approaches to teaching and learning, more emphatic to the needs of individual children, more capable of interacting with the parents and committed to the goal of developing the potential and livelihood opportunities of all the children—especially the non-performing children. However, the extreme diversity in the background of students and their background has to be managed by new paradigms of the teaching learning processes with links to vocational options and requires the effective use of the principles of psychology. For instance, after the admission of students, a psychological test for aptitude and interest

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could be administered. The syllabus of the teacher training institutes (TTIs) must incorporate material on the psychology of children who dropout and/or non-attendees as well as children who create problems in the classroom during and after teaching. The TTIs must incorporate knowledge of psychology and practice in these areas. At the level of recruitment, teachers may be given a teacher aptitude test before they take the entrance examination for TTI admissions, and only those who have the aptitude for teaching may be admitted to TTI. Apart from the know-how of differential styles of teaching to suit the needs of children, it is necessary to make them proficient also in evaluation, identification of learning obstacles and in motivation, behavior and guidance of children as well as in interacting with parents. Support from the parents of the children and community is essential for effective implementation of RTE Act. In addition, the following steps are suggested for improving the situation: There is a need to carry out a multi-centric study to examine the barriers for school attendance in different states and union territories of the country where the school dropout rate is still high as discussed above. • Local administration should pay special attention to ensure reservation of 25% seats for the disadvantaged children in every school. • Ensure admission of all the minor children in school and supporting their families so that a child does not become a school dropout because of poverty and other causes. • Periodic monitoring of infrastructure facilities, teachers’ regular attendance to school in rural and semi-urban areas and quality of teaching are also essential to ensure better functioning of the schools in the rural and semi-urban areas.

References Dash, M., & Khan, F. (2001). Impact of guided k-learning on the cognitive performance of low and high achievers. Psychological Studies, 46(1–2), 14–20. DES Publication. (2006). School matters. The report of the task force on student behavior in second level schools. SESS.ie/documents-and-publications/otherdes. Doran, J. (2011). Inclusive education framework. Bangor University, USA. Govindaraju, R., & Venkatesan, S. (2010). A study on school dropouts in rural settings. Journal of Psychology, 1(1), 47–53. Gohain, M. (2021, October 6). 1L schools in India run with just one teacher each: UNESCO study. The Times of India, Chennai, Vol. 14, No. 327, p. 1. Gouda, S., & Sekher, T. V. (2014). Factors leading to school dropouts in India: An analysis of national family health survey-3 data. IOSR Journal of Research & Method in Education, 4(6), 75–83. Mukunda, K. V. (2009). What did you ask at school today?—A handbook of child learning. Harper Collins Publishers. National Sample Survey Organization (NSSR) Report. (2009–2010). 66th Round. NCERT. (2005). National curriculum framework (2005). NCERT. NUEPA. (2012a). Education for all: Status and trends. NUEPA. NUEPA. (2012b). Elementary education in India progress towards UEE. NUEPA.

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Patel, V., & De Souza, N. (2000). School dropout: A public health approach. National Medical Journal of India, 13, 316. Pratinidhi, A. K., Kurulkar, P. V., Garad, S. G., & Dalal, M. (1992). Epidemiological aspects of school drop-outs in children between 7–15 years in rural Maharashtra. Indian Journal of Pediatrics, 59, 423–427. Ricconuni, P., J., Loujeania, W. B., Antonis, K., & Dalun, Z. (2012). Cognitive behavioral interventions: An effective approach to help students with disabilities stay in school. Effective interventions in dropout prevention: A practice brief for educators. Sajjad, H., Iqbal, M., Siddiqui, M. A., et al. (2012). Socio economic determinants of primary school dropouts: Evidence from south east Delhi, India. European Journal of Social Sciences, 30(3), 391–399. SPDD. (2012). School dropouts in Cambodia, India, Tajikistan and Timor-Leste. School dropout prevention Pilot Program. Creative. Uma, R. R. (2011). Reasons for rising school dropout rates of rural girls in India—An analysis using soft computing approach. International Journal of Current Research, 3(9), 140–143.

Chapter 21

Child Mental Health in the Milieu of Online Education K. Jayasankara Reddy, Bhuvana Manohari Nataraj , and Sukriti Pant

Introduction The coronavirus disease 2019 (COVID-19) pandemic caused massive disruption globally. Its arrival in countries across the world threw entire governments into disarray, and most countries’ budgets for the fiscal year were re-routed to the healthcare sector to keep up with the sheer number of people that were getting infected by the virus. Amidst such a situation, many countries’ education systems saw massive crises, with schools remaining shut all through the first wave of the virus. In order to combat the learning losses, schools turned to online learning, a method that had earlier seen success in times of disasters like earthquakes (Baytiyeh, 2018). Overnight, classrooms moved online, with teachers now teaching through computer devices and online classrooms like Zoom and Google Meet, while students were studying through phones and other devices. Whether the teachers or students were prepared for this sudden change did not prevent this sudden shift. Online education has now become ubiquitous, and is here to stay even beyond the time of pandemic (Dhawan, 2020). Even with graded return to normalcy, and gradual opening up of society, online mode will continue to flourish and augment the educational process. The pandemic and lockdown period has also given rise to a number of researches and thinking about the advantages, challenges, policy-level changes, and methodologies of online education. The impact of this on various stakeholders like families, teachers, educational institutions, and children need to be understood in order to arrive at possible K. J. Reddy (B) · B. M. Nataraj Department of Psychology, CHRIST (Deemed to be University), Hosur Road, Bengaluru, Karnataka 560029, India e-mail: [email protected] B. M. Nataraj e-mail: [email protected] S. Pant School of Education, Azim Premji University, Bengaluru, India © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_21

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strategies which will aid in planning and preparation for the future. In that light, this chapter examines the impact of online education on the mental health of children and adolescents (herein referred to as children), and explores ways and means to support and enhance it in the current milieu.

Mental Health and Children World Health Organization (WHO) holds that mental health is an integral aspect of overall health, and is necessary for promoting physical health (Prince et al., 2007). Mental health of children and adolescents needs to be made a significant consideration because, globally, around 10–20% of this group face mental health issues (Kieling et al., 2011). In considering addressing mental health issues, it is important to take into account prevention of mental health problems, and promotion of mental wellbeing alongside treatment (Shastri, 2009). While it is important to consider the mental health of children at any time, it is imperative that further attempt is made in this direction during periods of unprecedented change in society, such as effected by the pandemic and large-scale lockdown. Childhood and adolescent is also an important developmental stage of human beings, where adverse events can lead to physical and mental impacts that last a lifetime (Kutcher & Venn, 2008). Besides, over half of mental health issues have their onset during adolescence (Kessler et al., 2005). One of the significant changes that was brought forth, which can have immediate and long-term impact on children, is the shift to online mode of education.

Online Education Online education has its history as early as the arrival of communication technology. With the introduction of the World Wide Web, it came into educational usage more and more (Harasim, 2000). Online education can be classified based on the proportion of content delivery in the traditional mode versus online (Allen & Seaman, 2010): for a course to be deemed online, at least 80% of the content had to be delivered online, with typically little face-to-face interaction. Blended or hybrid courses were those where the content delivered through online mode was between 30 and 79%, with features such as facilitated discussions, and some face-to-face interaction. There were also “web-facilitated” courses, which were courses that made use of web-based technology like learning management systems like Moodle and Google Classroom, but rely mostly on face-to-face interaction. Traditional courses were those which were delivered in person, through written and oral delivery, with no use of technology. Harasim (2000) identifies these as fully online mode, mixed mode, and adjunct modes of delivery. She also categorises online education on the basis of the domains or the environments in which learning happens: group communication is where many communicate with many, place-independent is learning that can happen in any place,

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asynchronicity or learning that can happen at any time, text-based, and computermediated messaging. Hrastinski (2008) explains asynchronous learning as something that takes place even when the learning community members are not online at the same time through discussion boards, support network, emails, and other forms of communication, and allows for flexible learning. He contrasts it with synchronous learning where the learning community is online at the same time, happening in real time, and it allows for greater interaction among the participants and makes them feel like part of a community. Despite the presence of online modes of education prior to the COVID-19 pandemic, the society-wide lockdowns ensuing the COVID-19 pandemic thrust the online mode of education from its niche to become a global phenomenon. The sudden requirement for online education placed a number of challenges on the educational system including the administrators, teachers, students, families, and technological and logistic services.

Challenges Faced by School Administration Challenges arose for school administration primarily from three sources—students, staff members, and parents (Ahlström et al., 2020). Communication, accountability, and interpersonal relationships were found to be the primary areas of attention with regard to teachers (Brelsford et al., 2020). Teachers perceived effective communication to be characterised by being “proactive, frequent, collaborative, flexible, accurate and transparent”. Problems in communication were marked by reactivity, delay, contradictions, and insensitivity. Periodic meetings with various departments, relying on multiple channels of communication instead of only on email or traditional modes of communication, effective use of social media platforms, transparency from the leaders, and a willingness to listen and acknowledge challenges went a long way in improving communication challenges. However, overload of information and instruction, not checking for breakdown in communication up and down the hierarchical structure, not being aware of ground realities and grass-roots level problems created hurdles for clear communication. Ways to keep up effective communication channels are important to sustain support to the teachers (Kafa & Pashiardis, 2020). Accountability is required to ensure that individuals are aware of their roles and responsibilities, and are working towards fulfilling them. Healthy accountability was allowed for through flexibility, cooperation, healthy monitoring and evaluation, and the like. However, exertion of control, being punitive, lack of support, and unclear instruction hampered accountability. It was also reported that attributes like care, trust, and respect facilitated interpersonal relationships among the teaching and learning communities, and the lack of them impedes interpersonal relationships. With regard to students, the school administration has the challenges to ensure a positive school climate and equity of access to education (Ahlström et al., 2020).

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Challenges Faced by Teachers The pandemic and the lockdown propelled the teachers into the world of online teaching in a very short span of time. One of the important aspects that was affected was student engagement, which can have an impact on teacher’s job satisfaction (Kengatharan, 2020). The need for rapid upskilling in terms of information and communication technology also posed a challenge for the teachers as they were required to do this in a short span of time, especially compounded by the uncertainty surrounding the pandemic (Nuangchalerm et al., 2021). While a huge portion of teachers agreed that online teaching was a viable option especially during the time of pandemic, a large proportion of them also reported having challenges with developing online course content, and with online course delivery. Poor internet connectivity was also an infrastructural challenge they faced when teaching online (Hassan et al., 2020). Student disruptive behaviours during online classes also proved to be demotivating for teachers. The low attention span of students, and their inability to stay in place or be distracted adds to further demotivation for teachers (Khanna & Kareem, 2021). The workload of teachers significantly increased during this period, which further added to their difficulties (Kadwa & Alshenqeeti, 2020). Related to this is the disruption in work–home balance due to online teaching, which had an impact on the quality of life of teachers (Lizana & Vega-Fernadez, 2021).

Challenges Faced by Parents While parental burnout is a concern even during normal times, the round-the-clock presence of children can further contribute to it. Besides affecting the mental health of parents directly, it can also lead to neglect and abuse of children (Griffith, 2020). Online education can be impacted because of parental resistance towards it as well. This resistance could be caused by perceived inefficacy of online instruction, poor self-regulation of children, and lack of knowledge in supporting children during online instruction (Dong et al., 2020), which could further hamper teachers’ efforts. Inability to meet children’s social interaction needs, increased screen time, decreased physical activity, and disrupted sleeping pattern of children were also causes of concern for parents (Harjule et al., 2021; Misirli & Ergulec, 2021). Many parents also reported that their engagement was required for their children’s online education, which further added to their daily burden, while some parents had to depend on others to fulfil this need as they had jobs and other responsibilities (Garbe et al., 2020; Joseph et al., 2021).

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Technological and Logistical Challenges Talesra (2020) in her chapter titled “Educational Responses to the Pandemic in India” states that the switch to online classes could successfully be carried out by very few private schools in India. In a country with over 15 lakh schools, and over 8 lakh of these schools being government and government-aided schools (Department of School Education and Literacy, 2020), where access to basic facilities is often a challenge, a device for every child in a home, and access to good quality internet was a barrier that most homes could not overcome. Problems like devices being shared among siblings, lack of good quality internet, frequent power cuts, and devices that needed constant charging were also challenges that came to the fore in these times (Kasinathan, 2021). Online education caused disparity in access, and only some children were able to access learning. Annual Status of Education Report (ASER) Center (2021), states that about 70% of rural households surveyed during the first wave of COVID-19 pandemic reported that their children were engaged in some kind of learning activities throughout the week, with materials like textbooks and worksheets. Less than 20% of children were able to access learning programmes online, or on television or radio. In such a scenario, where an extended absence from the classroom will most certainly lead to learning loss, when students do return to online classes, they will find peers possessing greater academic abilities than they do. According to a study carried out by Atherley (1990), student self-concept has been linked to their perception of their level of academic ability. This means that students who have faced extended absences could develop self-concept issues due to accessibility challenges.

Challenges Faced by Children With most of the school day being spent online, students’ interaction with peers and teachers is limited to classes through a screen. Very different from an offline classroom, an absence of physical interaction could lead a student to quickly feel disconnected from their class, which might lead to a sense of loneliness and feeling alone, despite being virtually surrounded by their entire classroom. Studies done long before the pandemic became our present reality, like Donohue et al. (2007) and Cerniglia (2011) have shown that learning online can often be an isolating experience, and it leaves students with the sense that they are unable to build meaningful relationships with their peers. Harjule et al. (2021) also observed that 78% of parents felt that in the long run, sustained online education could lead to decreased socialisation and interaction ability in their children. Classes shifting online due to the pandemic, have brought another new challenge into students’ lives, namely, managing their screen time. With the pandemic, activities for recreation and leisure have also shifted online, along with regular schoolwork and hence, a huge portion of their day is now spent staring at a screen. Of the 784

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parents interviewed by Harjule et al. (2021), 71% of parents felt that their children were not learning faster than they would studying in a traditional, offline classroom. 72% of the parents also felt that the online mode of learning has had a negative impact on the health of their children. An increase in screen time was attributed as one of the factors that had an impact on children’s health. Numerous studies talk about the impact of excessive screen time on children’s sleep levels (Magee et al., 2014; Nathanson and Fries, 2014; Parent et al., 2016). Increased screen time also puts children at risk for depression (Liu et al., 2016), suicidal tendencies (Oshima et al., 2012) and ADHD-related behaviour (Lo et al., 2015). A study conducted by Lau and Lee (2020) with 6700 parents of kindergarten and primary school students found that nearly 67% of kindergarten parents and 85% of primary school parents felt that their children encountered difficulties in completing school-assigned tasks. The difficulty with the highest rating was “children’s lack of focus and interest”. 9% of kindergarten children and 14% of primary school children were able to complete assigned tasks on their own; the rest required parental assistance. Along with placing demands on parents’ time, this situation also calls into question the parents’ academic readiness in supporting their child with school-related tasks. For children with parents that are not very educated, this is yet another hurdle that online learning poses. Increase in screen time has also led to “Zoom Fatigue”. Researchers have found that looking at screens for hours has promoted something called semitasking—while people are trying to pay attention to multiple devices, they are doing so with lesser amounts of attention (Peper et al., 2021). Students have also reported an increase in physical problems like backache, sore neck, shoulder strain, eye strain, and headaches. Constantly sitting in front of a screen prompts passive listening, which further dulls the student’s ability to actively participate in the class. The absence of non-verbal cues like facial expressions and body language makes it more difficult to process lessons effectively, since a huge portion of communication between the teacher and student, and between students, is limited due to the online mode of learning (Peper et al., 2021). Furthermore, constantly sitting in the “screen posture” activates something called the “fear posture”, which triggers our threat detection and response system, commonly known as the fight–flight–freeze response (Lautenbach & Randell, 2020). So, children complaining that they feel uncomfortable sitting for online classes may not just be an issue of body, but also mind! Interactive activities that were possible in physical classrooms are now restricted and cause challenges especially for young children to stay engaged (Khanna & Kareem, 2021). When students do try to actively engage with their teachers, they may face an absolutely unprecedented challenge—they are able to view themselves. A feat that has been rarely experienced before, students are now able to see themselves as they participate in classes online. This could lead to excessive self-evaluation, especially in adolescents, and children may also develop low self-esteem issues because of the increasing distance between the actual self and the ideal self (Atherley, 1990).

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Children with Special Needs and Online Education Online education can pose certain challenges to children with special needs. Parents of children with additional support needs and disability in Scotland reported challenges in accessing online resources, and some were hampered by digital access. Some of the challenges they faced came from the learning material being made for use in larger groups, and parents had to adapt the material for use with their children (Couper-Kenney & Riddell, 2021). Sometimes the support and instructions from the teachers were sufficient, which further compounded the problem for parents in helping their children with special needs (Trzci´nska-Król, 2020). However, online education also has proved useful for these children as it allows for asynchronous mode of learning, which aids in learning at their own pace. Further, bullying and other behavioural issues arising out interaction with peers have reduced (Tonks et al., 2021; Trzci´nska-Król, 2020). In order for the online transition for children with special needs to be effective, it is imperative that certain allowances and advances be made like providing assistive technologies to support the existing information and communication infrastructure, increasing access and mobility, and creating and advancing adaptive learning methods (Cahapay, 2021). The challenges faced in the educational system by the various stakeholders deserve considerable deliberation when discussing mental health of children, due to the direct and indirect role they play in the well-being of children. While taking into account the challenges, one needs to also examine the benefits of online education and the rapid strides that have been made in this space.

Benefits of Online Learning The multi-modal of nature of online education, like the availability synchronous and asynchronous modes, comes with a number of advantages. Those learners who find it difficult to keep up with the pace of lessons will be able to learn at their own pace. Those students who experience anxiety and difficulty in participating in classroom discussion have more opportunities to be heard through online message board discussions. Furthermore, social interaction and connection needs can also be met through live sessions and synchronous classrooms. Thus, online mode of education has the bandwidth to accommodate the needs of individual learners (Igbokwe et al., 2020). Dhawan (2020) has explored the usefulness of online education especially in times of disasters and unprecedented situation in various regions, much like what the world faced with COVID-19 pandemic. Various information and communication technological tools and services enabled the continuation of education in those situations, with little to no disruption in some situation; in other situations, it enabled returning to learning much sooner than would have been possible otherwise. With the global pandemic having thrust teachers and students into online educational mode even in

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middle- and low-income countries, it has led to a certain level of preparedness which did not exist before. Additionally, online learning offers relative flexibility to students and teachers in terms of time and location. This, then, enables greater reach and access to those who find it difficult to come to a physical classroom. Hybrid classes offer further inclusion in that, it allows for interaction between learners who are physically present, and those that are virtually present. This level of flexibility allows for creating more inclusive education. In terms of media and resources, teachers who initially relied mostly on chalk-and-talk method, have begun to explore and embrace diverse multimedia tools that are available to enhance their teaching. Besides, the teachers have also been pushed to think creatively to increase student engagement, and enhance classroom environment (Khanna & Kareem, 2021). Deci and Ryan (2008) discuss the importance of autonomy in developing intrinsic motivation in the self-determination theory they proposed. Online education requires an individual to develop self-regulation in the areas of goal orientation, self-efficacy, self-management, and willingness to seek help, all of which will allow them to develop autonomy (Lynch & Dembo, 2004). While this may be difficult for younger children, self-discipline, self-learning, learning to set goals and manage time not only will add to developing these skills, but will also help the learners take ownership of their learning process. Taking into account the challenges posed by the sudden thrust into online education, the advantages that this mode of education offers, and incorporating the insights and the experience gained during and before the pandemic, we can draw out certain strategies to optimise the use of online education for now and posterity.

Strategies for Effective Online Learning While online learning continues for most students across the world, we have seen that the challenges seem to far outweigh the benefits. However, even though this is the case, we are still in the midst of the pandemic, and (as on 25th October 2021) with only half of the country vaccinated against it, and vaccines for children in the testing stage, the reopening of schools is still a matter of debate and discussion. The challenges faced in the educational system by the various stakeholders deserve considerable importance when discussing mental health of children, due to the direct and indirect role they play in the well-being of children. Hence, it becomes imperative that steps are taken to better the learning that children are receiving right now, in order to ensure that quality learning continues. Any strategies that are drawn to address child mental health must include ways to address the numerous challenges that have been listed out. Here are some strategies that could be adopted to better a student’s online learning experience.

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Increasing Effectiveness of Online Engagement Kearney et al. (2012), through their study, proposed a framework to analyse the usage of mobile devices in learning. Personalisation, authenticity, and collaboration are the three pedagogical aspects of learning modules put forward, and when implemented by teachers in designing their course can lead to better learning outcome and student engagement: • Personalisation—When learners access activities that are customised for them, it helps them develop a sense of ownership over the content they are accessing. This, in turn, also helps them control the pace of learning, thus leading to relaxed, more confident learners. • Authenticity—When learners have access to modules that are contextualised, they are able to involve themselves in real-life situations, which will help them find greater relevance in the content that they are studying. • Collaboration—When the varied forms of content that the learner is accessing help them start conversations and feel connected, their interest in engaging in online learning increases. These connections could be between the teacher and the learner, the learner and another learner, or the learner and the teacher. A study carried out by Yates et al. (2020) with high school students in New Zealand, using the framework proposed by Kearney et al. (2012) found that students valued the agency they received through online learning classes, preferring to decide on their own the amount of time they would like to devote to subjects and assignments. However, only 10% of these learners preferred learning at home. They wanted agency in learning, but preferred it in offline classes. Students also liked that their lessons were either relevant to what they can see around them, like activities related to the COVID-19 pandemic, or activities that made use of the students’ immediate environments, like science experiments with objects around the house, or coaching their siblings for a physical education class. They found using social media tools like messaging and videoing platforms helped them study better in small groups, and also preferred classes where they could engage in synchronous collaboration, like the teacher planning activities where students could dress up as per a theme and come to class, or having karaoke sessions after the lesson was over. However, despite all these positives, 67% of the participants still preferred collaboration exercises in offline classes, since they found it difficult to participate online, where classmates would often mute themselves and turn their videos off, and engaging with them would be a challenge. Participants also identified certain pedagogical practices that they felt helped them in online classes, like discussions in classes, clear communication, receiving feedback, and interactive activities. They felt comfortable in online classes when the classes simulated a physical, offline class environment.

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Creating Safe Spaces in Online Classes As we have seen in the previous sections, the absence of non-verbal cues and the depersonalisation of online classes has a huge role to play in the disinterest of a student. Sometimes, synchronous online learning can ignore individual learner needs and styles of learning. For example, certain students may need more time to answer a question, or may need a question framed differently in order to better understand it. When these needs get frequently ignored, the student may feel excluded and as a result, disengage from the classroom. In such situations, the teacher can, through some simple methods, try to bring the learner back into the classroom. By establishing a space where the student can express their needs, wants and emotions, the teacher is helping the student feel connected to the classroom, and to their peers. These safe spaces in online classrooms can create a “learning environment conducive to open communication, free from intimidation, fear or discrimination” (Brown, 2011, p. 66). This exercise also helps the teacher identify what their learners need from the classroom space, thus helping them effectively plan future lessons to address these needs. This can be introduced into lessons through the Whiteboard feature on Zoom, where the teacher can ask students to think about one thing they want to take away from a lesson, and write it down on the whiteboard. The whiteboard can also be used to express what students are feeling, or share a sentence of gratitude towards someone in the classroom. Students can also be put into smaller breakout rooms depending on how much time they would need for activities, and these rooms will also help them connect with peers that have similar learning needs.

Intentional Communication Cerniglia (2011) in her paper, talks of how she conducts online classes with future teachers. One of the techniques that she uses to build relationships with her students is the skill of intentional communication. In online classes, most children raise doubts or ask questions through the chat feature. Even in answering something as brief as a doubt, teachers who address students by name, or refer to their prior work are able to forge a greater bond than teachers who don’t. Owing to the impersonal nature of the forums that are being used for such classes, the mindfulness of a teacher towards their students’ emotions can go a long way. Deng (2021) finds that learners’ emotional engagement further contributes to a positive learning experience. Recalling a previously asked doubt while solving a current one, or asking after a child’s family, even matter-of-factly, helps students feel more connected to the classroom and the teacher. Cerniglia (2011) talks of intentional communication through carefully worded emails that nurture her students’ abilities. A technique she swears by to make students feel more connected to her is addressing them by name. Simple, yet effective!

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Conclusion The COVID-19 pandemic, while can be classified as a disaster, has caused societies to push the boundaries and explore possibilities. The field of education was not left behind in this challenge. The sudden onset and the ensuing closure of society forced the entire education system—administration, teachers, parents, and learners—out of their comfort zone, to learn, upskill, and adapt quickly to new ways and medium of learning. While there were challenges, disparities, infrastructural insufficiencies, and knowledge gaps, we are also left with massive learning and experience. Capturing and cataloguing such experience is essential to continue to charter new paths and prepare ourselves further. This chapter looked specifically at the challenges posed by the sudden shift to online education from the perspectives of school administration, teachers, parents, and the learners themselves. It also looked at theories, practices, and research that exist on learning in general, and online learning specifically, and consolidated lessons and learning that will be useful for those engaged in the education system. While the authors recognise that the list is not exhaustive, their hope is to lay the groundwork for further thinking and development in this direction. Conflicts of Interest We have no conflicts of interest to disclose.

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Part IV

Rights of Vulnerable Children

Chapter 22

Child Rights in the Era of HIV/AIDS Seema Sahay

Introduction Every seven minutes, an adolescent is killed by an act of violence.

The United Nations defines adolescents as persons aged 10–19 years, and youth as persons aged 15–24 years. Grouped together, ‘children and adolescents’ represent those aged 0–19 years. With children stepping into the challenging age of adolescence, there are a gamut of new experiences and new challenges. Violence, abuse, gender-based violence and intimate partner violence can take different forms as children grow up. Children become more and more vulnerable as their vulnerabilities increase in layers of various forms and contexts such as neglectful families, different sexual orientations and of course the disabilities. Digitalization and the dependence on social media during COVID-19 pandemic have added another layer of vulnerability. Children are becoming more and more vulnerable to the outside forces hitherto unknown. UNICEF reports every 7 minute, an adolescent boy or girl is killed by an act of violence; over 130 million boys and girls have been bullied at school; over 15 million adolescent girl aged 13–15 years have experienced force sex in their lifetime (UNICEF, 2019). The UN Convention on the Rights of the Child (CRC) is the most complete statement of children’s rights ever produced and provides explicit recognition of all children as full rights holders. The Convention on the Rights of the Child of 1989 (United Nations, 1989) defines precisely the term ‘child’: […] a child is any human being below the age of eighteen years unless, under the law applicable to the child, majority is attained earlier.

The League of Nations adopted the Geneva Declaration of the Rights of the Child (1924), which enunciated the child’s right to receive the requirements for normal S. Sahay (B) ICMR-National AIDS Research Institute, Pune, India e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_22

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development, the right of the hungry child to be fed, the right of the sick child to receive health care, the right of the backward child to be reclaimed, the right of orphans to shelter, and the right to protection from exploitation (League-of-Nations, 1924). The Convention on Rights of the Child was adopted on November 20, 1989, by General Assembly Resolution 44/25. CRC General Comment No. 20 (2016) on the implementation of the rights of the child, Para 4, provides specific recognition of empowerment as an essential component of the human rights-based approach: …[the General Comment] provides guidance to States on the measures necessary to ensure the realization of the rights of children during adolescence… and highlights the importance of a human rights-based approach that includes recognition and respect for the dignity and agency of adolescents; their empowerment, citizenship and active participation in their own lives; the promotion of optimum health, wellbeing and development; and a commitment to the promotion, protection and fulfillment of their human rights, without discrimination.

Almost all countries except the USA and Somalia ratified this convention. In 1974, the Government of India adopted a National Policy for Children, declaring the nation’s children as ‘supremely important assets’ but children are still vulnerable. Being minors, they do not have a voice in the adult world and the need for their voices to be heard is generally not considered by the adults. India gave accession to Convention on Rights of the Child on December 11, 1992, with the following declaration: While fully subscribing to the objectives and purposes of the Convention, realizing that certain of the rights of child, namely those pertaining to the economic, social, and cultural rights can only be progressively implemented in the developing countries, subject to the extent of available resources and within the framework of international cooperation; recognizing that the child has to be protected from exploitation of all forms including economic exploitation; noting that for several reasons children of different ages do work in India; having prescribed minimum wages for employment in hazardous occupations and in certain other areas; having made regulatory provisions regarding hours and conditions of employment; and being aware that it is not practical immediately to prescribe minimum wages for admission to each and every area of employment in India-the Government of India undertakes to take measures to progressively implement the provisions of Article 32, particularly paragraph 2(a), in accordance with its national legislation and relevant international instruments to which it is a State Party.

All children can be rendered vulnerable by the particular circumstances of their lives, especially (a) children who are themselves HIV-infected; (b) children who are affected by the epidemic because of the loss of a parental caregivers; and (c) children who are most prone to be infected or affected (United Nations, 2003). One fundamental issue in the human life cycle is about one’s rights. A child, however, is devoid of one important right: ‘right to be born.’ This is a complex problem and philosophers, policymakers, physicians, social scientists and activists have not come up with an answer. A child born to an HIV-infected parent and carrying infection is again a question about his/her right. Very limited literature is available on ‘responsible parenthood.’ With pandemic AIDS, the world has witnessed human rights issues pertaining to reproductive health of women, health of vulnerable populations, and rights of high risk groups. Rights of HIV-infected children are the missing

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component from this bunch of ‘rights.’ Salisbury aptly expresses this problem, ‘the secrecy and stigma that still surround HIV and AIDS make it difficult for HIV-affected children and youth to benefit as fully as they might from policies and programs that provide more generic types of care and assistance (Salisbury, 2000).’ Under international law, children have two types of human rights: (1) (2)

Fundamental Rights of Adults Special human rights that are necessary to protect them during their minority years such as the right to life, the right to a name, the right to express views in matters concerning the child, the right to freedom of thought, conscience and religion, the right to health care, the right to protection from economic and sexual exploitation, and the right to education.

The International Convention on the Rights of the Child in the year 1989, for the first time legally recognizes fundamental rights of a child. The purpose of the United Nations Convention on the Rights of the Child (UNCRC) is to outline the basic human rights that should be afforded to children. The UNCRC covers the cultural, social, economic, and political rights of children and is guided in interpretation and implementation by four principles: • • • •

Non-discrimination The best interest of the child The maximum survival of the child, development of the child Consideration of children’s opinion in matters that affect them.

The UNCRC consists of 41 articles which define children’s rights to life, to survival, freedom of expression and belief and to protection from exploitation. The practical relevance of the CRC for children’s health and well-being, and particularly for public health, is not understood. UNCRC is among the most potent tools available to respond to and increase the significance of pediatrics to contemporary disparities and determinants of child health outcomes. There are four broad classifications of these rights. These four categories cover all civil, political, social, economic, and cultural rights of every child: • Right to Survival: A child’s right to survival begins before a child is born. According to the Government of India, a child’s life begins after twenty weeks of conception. Hence, the right to survival is inclusive of the child rights: to be born or not to be born, right to life, right to minimum standards of food, shelter and clothing, to be able to benefit from appropriate health care, and the right to live with dignity. • Right to Protection: A child has the right to be protected from neglect, exploitation, and abuse at home, and or elsewhere. • Right to Participation: A child has a right to participate in any decision making that involves him/her directly or indirectly. There are varying degrees of participation as per the age and maturity of the child. • Right to Development: Child has the right to all forms of development: emotional, mental, and physical. Emotional development is fulfilled by proper care and love

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of a support system, mental development through education and learning, and physical development through recreation, play, and nutrition. • Empowerment as Right: As the child grows and attains adolescence, empowerment becomes their right. Empowerment is multidimensional, and it is defined as ‘A personal journey during which an adolescent (age 10–19), through increased assets and critical awareness develops a clear and evolving understanding of themselves, their rights and opportunities in the world around them, and through increased agency, and voice and participation, have the power to make personal and public choices for the improvement of their lives and their world.’ Adolescents must feel empowered to realize their rights. They must be prepared with the knowledge and skills to encounter a new world as they attain adulthood. They need to learn to develop a sense of self-worth and become a quality part of the communities by linking with communities and individuals. Toward empowerment the following excerpt from a qualitative research interview is apt, Awareness generation becomes very important. First they [/adolescents/] need to know their rights. Then they [/adolescents/] need to know in case there is a problem and there is discrimination or denial of the rights then where do they [/adolescents/] need to go? And, who needs to help them ? … it will be very difficult for adolescents to go to a court. (HCP-PO-08)

HIV-Infected Children Adolescents need protection from harm on the one hand and support to make independent decisions and act on them on the other. Access to correct counseling and optimal health care is essential for their well-being. While alluding to the rights of the children, an even more complex situation arises because of HIV epidemic. The burden of HIV in the child population is disproportionately affecting adolescents, particularly adolescent girls. According to UNICEF report in 2017, 430,000 (confidence interval: 260,000–620,000) new infections occurred worldwide among children and adolescents up to 19 years of age; an estimated 3 million children are living with HIV/AIDS with estimated 130,000 deaths due to HIV/AIDS were reported in this age group (UNICEF, 2018). With increased availability of pediatric ART, more children born with HIV survive into adolescence and adulthood (Edmonds et al., 2011; Palladino et al., 2009; Sahay, 2013). The new HIV infections are declining at a significantly faster rate among young children than among adolescents. Based on current trends in HIV incidence, ART coverage and PPTCT coverage, the annual number of under-five HIV infections is expected to decrease by 45% between 2018 and 2030 (UNICEF, 2018). The focus of treatment has thereby changed from management of a severe debilitating disease to more longterm care with challenges such as maintaining treatment success, management of chronic comorbidities, supporting adherence to life-long therapy, prevention of HIV drug resistance, and finally transitioning children from pediatric program to adult HIV program (Haubrich et al., 1999; Volberding & Deeks, 2010; Wood et al., 2004). The case is not the same for adolescents. In many countries, new infections have been decreasing too slowly or are even showing signs of increasing. Assuming continued

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scale-up of ART and PPTCT coverage, along with continued reductions in HIV incidence, new HIV infections among adolescents are projected to be reduced by 23% between 2018 and 2030. This report indicates an alarming trend. The cumulative number of children and adolescents newly infected with HIV between 2018 and 2030 will be 3.7 million. They would need services and treatment in future. Considering the socio-behavioral nature of the disease, growing to be adolescent with HIV has various developmental issues that add to the complexity of adolescence. HIV presents an example of the way in which the UNCRC helps shift attention from a biomedical approach to another perspective toward social, cultural, and economic determinants of risk and survival. If the protection of human rights is seen as a societal precondition for human well-being, then the promotion and protection of these rights is enmeshed with promoting children’s protection from HIV. This chapter deals with the needs of HIV-infected children, adolescents, and young adults. The ensuing discourse focuses on the impact that HIV makes on this young population. It also discusses needs and rights issue taking examples from literature. Some of the real-life examples are reported from a qualitative study that explored the issues of HIV-infected children and adolescents. Human rights relevant to HIV/AIDS identified in Universal Declaration of Human Rights (UDHR) treaties include the right to non-discrimination and equality, to health, to liberty and security of the person, to privacy, to seek, receive and impart information, to marry and found a family, to work, and the right to freedom of movement, association and expression. All these rights have particular importance in the context of HIV/AIDS and would imply that no person can be discriminated against on the basis of one’s HIV status. India made a landmark act ‘The Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Act, 2017. ACT NO. 16 OF 2017’ (Gazette, 2017). This Act is supposed to provide for the prevention and control of the spread of Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome and for the protection of human rights of persons affected by the said virus and syndrome and for matters connected therewith or incidental thereto. There are special provisions for HIV-infected and affected children as follows: Section 2(c) defines child affected by HIV means a person below the age of eighteen years, who is HIV positive or whose parent or guardian (with whom such child normally resides) is HIV positive or has lost a parent or guardian (with whom such child resided) due to AIDS or lives in a household fostering children orphaned by AIDS. Section 16 provides for the Protection of property of children affected by HIV or AIDS: The Central Government or the State Government, as the case may be, shall take appropriate steps to protect the property of children affected by HIV or AIDS for the protection of property of child affected by HIV or AIDS. The parents or guardians of children affected by HIV and AIDS, or any person acting for protecting their interest, or a child affected by HIV and AIDS may approach the Child Welfare Committee for the safekeeping and deposit of documents related to the property rights of such child or to make complaints relating to such child being dispossessed or actual dispossession or trespass into such child’s house.

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Explanation: For the purpose of this section, ‘Child Welfare Committee’ means a Committee setup under the Juvenile Justice (Care and Protection of Children) Act. Section 18 lays down provision for women and children infected with HIV/AIDS. The central government shall lay down guidelines for care, support, and treatment of children infected with HIV/AIDS. • Without prejudice to the generality of the provisions of sub-section (1) and notwithstanding anything contained in any other law for the time being in force, the central government, or the state government as the case may be, shall take measures to counsel and provide information regarding the outcome of pregnancy and HIV-related treatment to the HIV-infected women. No HIV positive woman, who is pregnant, shall be subjected to sterilization or abortion without obtaining her informed consent.

Key Findings In studies conducted in India and Africa, adolescents wanted greater access to HIV, reproductive and sexual health education, information on how to protect themselves, privacy and confidentiality in service sites, and better control over disclosure of their HIV status to others (Mburu et al., 2013; Sahay et al., 2013). Gender disparities are a part of the HIV scenario. Around 30 teenagers aged 15–19 were newly infected with HIV per hour in 2017, according to a new UNICEF report. Women in East and South Africa are on an average infected with HIV five to seven years earlier than men, with the risk especially high between the ages of 15 and 24 (Dellar et al., 2015). The HIV-infected children not only suffer from the infection, but the family and parental care is also limited. The social nature of the disease renders the family ‘self-conscious,’ sometimes hyper-vigilant and over protective, leading to restrained childhood among children who might be infected. The affected children shoulder many responsibilities of the adult and therefore child-headed households emerge. The socio-psychological outcomes for children are multiple, viz. discontinuation of education; having parents who have infection and may not be able to work can lead children to engage in child labor, and many children lose their parents and siblings. Overall effect is ‘debilitating social status’ and exploited childhood resulting in adolescent and young adults with ‘fragile and vulnerable’ mental health and of course physical health.

Rights of Child Belonging to Disadvantaged Group (INDIA) includes: Measures to prohibit and eradicate discrimination, harassment, and victimization of children from disadvantaged groups.

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Eliminating discrimination in relation to the admissions process including denying or limiting access to any benefits of enrollment or through segregation in separate study, sports, playground, canteen areas, or any other amenities provided by the school. Protection from financial extortion or forced expenditure. The guarantee that private schools will allocate a minimum of 25% of places in each class to children from disadvantaged groups. Special mechanisms are available for complaints of discrimination.

Legal-India’s Response to Rights of Children Infected with HIV On May 5, 2017, India’s Supreme Court held that children living with or affected by HIV (that is, children who are HIV positive and children who are HIV negative but whose parent[s] is/are HIV positive) should be afforded protected status and included as a ‘child belonging to a disadvantaged group’ under India’s Right of Children to Free and Compulsory Education (RTE) Act (2009) (Writ Petition, 2014). The extension of protected status to children living with or affected by HIV means that they are now entitled to special protections and measures, under the terms of the RTE Act.

Parents’ Role Toward Realizing the Rights of Child Parents or guardians play an important role in the life of their child. However, as adolescence peeps in, social communications become veiled as parents do want to communicate about puberty, reproductive health and as simple as menstruation is a prohibited topic. Moving forward to equitable gender norms is a challenge. A healthcare provider in a study conducted among HIV adolescentsin India said, right to information, it has to be... they should be informed inside out of everything especially when they are asking questions and certain things we have to give anticipatory guidance. (HCP-AP-18) …similar rights like right to education, right to freedom of every sort of facility in the community which a normal child gets. Right to education is a must and right to work also. Right to health care should also be there. (HCP-PD-05)

Parents have an important role in delivering interventions. The environment of silence around puberty is so strong that it is impossible for them to help adolescents’ access interventions such as the human papillomavirus (HPV) vaccine and reproductive and adolescent sexual health education (ARSHE). Parents, therefore, need to be

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engaged, convinced of its value and supported, and their fears should be addressed upfront through scientific agencies. Similarly, there is a need to build competence and empathy in teachers, healthcare workers, and social workers.

HIV Testing: One’s Right Joint Nations Program report in 2017 showed that undiagnosed and untreated HIV among adolescents results in substantial mortality, and the data shows higher mortality among adolescent population as compared to children and adults living with HIV (Slogrove et al., 2017; UNAIDS, 2017). According to the United Nations Children Fund report in the year (2016), the adolescent age group was the only one group for which AIDS-related mortality did not decline between 2000 and 2015 worldwide. In fact, AIDS-related mortality among adolescents more than doubled during this time period. Their right to HIV testing and prevention access is crucial. Even though it is a challenge, one needs to speak about Pre-exposure prophylaxis (PrEP) and condoms for this population. Structural interventions and reforms need to be devised to bring in access to RSH services for the adolescents. It will be prudent to note that healthcare providers would need to familiarize themselves with consent and assent processes in the country/state. If routine HIV testing of at least 16–18 years old adolescents is allowed in the country, conversation around PrEP and condoms and prevention option is liable to begin and help in protecting adolescents, if they are assessed at high risk.

HIV Care and Treatment: Right as Adolescent Researchers pointed out a lack of age disaggregated data which further leads to no specific care of adolescents infected with HIV. Unmet needs of transitioning from pediatric to adult HIV care in existing settings were the major gap in the program as reported by Verma and Sahay (2019). Transitioning requires an awareness of basic differences between adolescent and adult HIV care models. In addition, the need for parental consent for minor adolescents undermines their right to access HIV prevention care and treatment. Empowerment of adolescents to demand and access health services is not visible at all. Adolescents are often considered to be under the responsibility of adults, with limited control of information or decision making on their HIV status.

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Disclosure: Debating on Rights Issue Denying older children information about their HIV status violates the child’s right to information and privacy, and the child’s right to voluntary, confidential HIV counseling and testing. It also compromises the child’s ability to participate in his or her own medical care, an important part of the right to health. Older children and adolescents are reaching a level of physical and emotional development that can lead to sexual activity and sexual transmission risks. Generally, laws assume that parents act in the best interests of the child. The law might thus support a parent’s decision regarding disclosure. But the law recognizes that in certain circumstances, and for various reasons, parents may not act in their child’s best interest. According to the principle of parens patriae, protection of the child’s welfare outweighs the parents’ right to refuse medical treatment for the child. However, whether parents have a right to refuse disclosure of diagnosis to a child is unclear. Children have the right to health information under the Convention on the Rights of the Child. If children are not told about their status but are mature enough to understand and appreciate it, their right to health and information may have been violated. However, many stakeholders have raised voices for disclosure as right for protection of the child itself: I think they should be informed about what is in them because it is their fundamental right. We should know that it’s not like it was something which could not affect them…They should know about it in order for them to prepare themselves. May be not at a very mature stage but a little earlier…Because they would be responsible, so I guess it should be told because first, it is their fundamental right and second, even also for the well-being of others surrounding them. [PQO-I-UAD-22]

In India, there are no guidelines available for disclosure of HIV status to minors. Sometimes organizational rules are followed and children step into the ‘adult’ world unprepared. Orphanages are allowed to keep only minors and hence girls after 17 years of age are turned out. Plight of such minors in the ‘big world’ is bewildering as seen in the excerpt from a focus group discussion below: Until 17 years, the girl was permitted to stay in the hostel, up to 18 years for a boy. This has to be cancelled and should be abolished by the Government. A girl was thrown out after 17 years and today also a hostel has thrown a girl outside. After all she is on medicines, ART- antiretroviral therapy-medicines for HIV. But till she became 17 years of age, what that institute has taught her? Only and only to consume medicines…In the end when we enquired about the girl, then she responded that she had relations with her friend, and then we discussed with them [/girl and her friend/] about everything, they asked us what is HIV? …But up to 17 years of girl’s age, she was not taught… But the organization by rule and Child Welfare Committee (CWC) rules, had thrown her out of the hostel. [FGD of NGO representatives]

Even the uninfected adolescents of today who are aware of their rights, feel strongly about the rights of their HIV-infected counterparts. To them, knowing one’s status is his or her right. An adolescent talks about it eloquently about the right of both infected and uninfected adolescents in the following interview:

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##Facilitator## THEN ACCORDING TO YOU IF A CHILD IS INFECTED THEN, WHETHER WE HAVE TO TELL ABOUT HIS OR HER HIV STATUS TO HIM OR HER OR NOT? ##PQO-I-PD-22## I think they should be informed about what is in him. ## Facilitator ## AND WHY? ##PQO-I-PD-22## Because it is their fundamental right. We should know that it’s not like it was something which could not affect them. They should know about it in order for them to prepare themselves. Maybe not at a very mature stage but a little earlier… Because they would be responsible, so I guess it should be told because, first because it is a fundamental right and second even for the well-being of others surrounding them.

Here, the adolescent talks about an important issue of preparing the HIV-infected child for prevention of secondary transmission. He is showing acceptance for his infected peer but feels strongly for his right and right of uninfected ones who should not acquire HIV inadvertently because the infected adolescent was unaware of the infection or unaware of the protection methods. The principles of human rights, as stated in the Convention on the Rights of the Child about what are the ideal characteristics of the person making disclosure regarding HIV status to the child (3), provide guidance: The choice must be made in the best interests of the child.

Stigma and Discrimination AIDS-related stigma and discrimination refers to prejudice, negative attitudes, abuse and maltreatment directed at people living with HIV/AIDS at home, in their local community, in schools or at healthcare facilities. Disclosure also entails a critical repercussion of stigma. Stigma contributes to children’s psychosocial problems independent of their orphan status and other key demographic factors. Disclosure/stigma are associated with a child’s psychosocial well-being (e.g., self-esteem, positive future expectation, hopes for future, and perceived control over the future). ##PQO-I-AUD-28## They behave with them normally prior to HIV infection but when they come to know that he has got AIDS then all say that if he has got this [/HIV/], then we can also get it [/HIV/]. If he shows ignorance then we can also get that [/infection/], so they start to ignore him; so close friends also start to behave wrongly that time. ##FC## THEY START TO IGNORE AND THEN START TO BEHAVE WRONGLY MEANS WHAT? HOW? ##PQO-I-AUD-28## They don’t allow to come near, don’t let him touch them, they don’t go with him, and don’t talk properly with him etc.

The consequences of stigma and discrimination are wide-ranging: being shunned by family, peers and the wider community, poor treatment in health care and education settings, an erosion of rights, psychological damage, and a negative effect on the success of HIV testing and treatment. The right to be treated equally is part of the United Nations Convention on the Rights of the Child.

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Exploitation Orphans of parents who have died from AIDS are particularly vulnerable and many survive in child-headed households. Many of them turn to crime, drugs, or to the streets in order to survive. Affected children experience an early end to their childhood since they are required to become heads of households, drop out of school, work, raise younger siblings and care for sick parents and other ill family members. With relatives, they become unpaid willing workers as we hear a very young HIV-infected orphan girl living with her relatives speak about her daily routine: ##PQM-I-AD-31## Because, what happens, my aunt, she has small children, so leaving her small children on me ….I make very big contribution means, do such, so much of the work that I become light and feel like weightless [/too much of work makes her feel faint/] means now, today such situation is at home that without me not a single work is done. On everybody’s lips from morning till I go to sleep. It is = Suman* [/fictitious name to maintain confidentiality/] = would do this!= Suman = do that. = Suman = did you do this! = Suman = did that! = Suman = get water, = Suman = bring tea and what not…. [/ Suman is beckoned all chores from morning till night/] Routine means, it is very busy this much, since getting up in the morning, now where we live is on the ground floor, are four rooms, two bedrooms, one kitchen, one hall. And this much, 12 people live. Means that sweeping, cleaning all rooms, keep clean etc. then to help all in work, if anyone say something do that, this only is my routine, to see all at college, parlor [/she works at beauty parlor also/], then eat and sleep, this is the routine.1

The right of a child-NOT TO BE EXPLOITED-! Furthermore, they experience greater poverty as a result of the loss due to sickness of other wage earners in the family. These losses affect all of the children in a household and, where infection rates are high, affect entire communities. With no adequate care and support, children experience losses in health, nutrition, education, affection, security, and protection. They suffer emotionally from rejection, discrimination, fear, loneliness, and depression.

Discontinuation of Education The first thing that happens to an infected or affected child is the break in their education. Either the parents are too sick, impoverished, and thus, they are unable to continue with the child’s education or the child is stressed/sick and discontinues education. An HIV-infected adolescent tells: ## PQM-I-AD-26##: He [/his father/] was not working. He became very sick over here. Then father made a phone call to us. He said to my mother that, now I don’t have a guarantee of my health, so you can take our son, daughter and go there [/village/]. And my school was closed that year. Mother has been told that she has it too [/HIV infection/].

1

Fictitious name.

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Right to Recreation and Good Life Our study also showed a strict social control upon girl child who was perinatally infected: ## PQM-I-AD-26## ‘Then… Then… I [/Suman/] am thinking about it, the girls will say to me, your father does not allow you even for the Dandiya [/a folk dance form which is innocuous, common traditional and fun filled/], how can you go outside [/for any other fun activities/]? Thus Suman laments again: I get disturbed over there [/because of above taunts from friends and because she knows she will not be allowed to have fun/]. Another HIV infected girl who again was perinatally infected showed her helplessness and bitterness towards her father who had brought HIV in family: ##PQM-I-AD-31##, ‘One thing is always in my mind, that I was also entitled to live one beautiful life. I am living but one black spot is there, that I have HIV. Have AIDS that should rest in my life…I feel this. It was also my right to live a healthy life. But because of my father that life is not possible. That was my right and that I lost.

Our study showed the positive support of uninfected adolescents who seem to be aware that most of the infected adolescents are the ‘hapless’ victims of the situation. They did not seem to stigmatize their infected counterparts, reminding us about the innocence of young minds. The situation reminds of the verse from Henry Vaughn’s couplet (Vaughan, 1621–1695). Happy those early days! when I Shined in my angel infancy. Before I understood this place Appointed for my second race.

Marriage and sexual partnerships are the issues that are emerging as matter of concern for infected, affected, and uninfected adolescents. Why can’t I marry like a normal child? Why don’t I have a boyfriend or girlfriend? Sir, since I am now 18 years old, I will start going out, so if I get married, then will it be ok?

The HIV-infected adolescent forces the civil societies to understand the needs of the adolescent which is his/her right as a human being. The situation entitles for bringing in structural changes with in-depth perceptions of social norms pertaining to the institution of marriage in the society.

The PPTCT Program as Right of the Child Article 17 of the United Nations Convention on the Rights of the Child (3) states that every child should have, ‘access to information and material from a diversity

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of national and international sources, especially those aimed at the promotion of his or her social, spiritual, and moral well-being and physical and mental health.’ The transmission of HIV from an HIV positive mother to her child during pregnancy, labor, delivery, or breastfeeding is called mother-to-child transmission. In the absence of any interventions, transmission rates range from 15 to 45% but this rate can be reduced to levels below 5% with effective interventions. Prevention of parent-to-child HIV transmission (PPTCT) is a critical, cost-effective, healthcare intervention. This programme was started in India in the year 2002 to offer HIV testing to every pregnant woman (universal coverage) in the country. The PPTCT of HIV transmission under NACP involves free counselling and testing of pregnant women, detection of HIV positive pregnant women, and the administration of ART to HIV positive pregnant women and prophylactic ARV drugs to their infants to prevent the mother to child transmission of HIV. India is a signatory to the Joint United Nations Programme on HIV and AIDS (UNAIDS) goal of Elimination of Mother to Child Transmission (EMTCT) of HIV by 2020. The Prevention of Parent to Child Transmission (PPTCT) programme is being implemented under NACP to achieve the EMTCT goal. Almost 2.45 crore HIV tests among pregnant women were conducted in 2019–20. PPTCT should continue to be considered a priority in terms of humanitarian principles and human rights, since it will protect children born to HIV positive parents from undue suffering and death. This is also in accordance with the obligation of the State Parties to the Convention on the Rights of the Child to ‘recognize that every child has the inherent right to life’ and to ‘ensure to the maximum extent possible the survival and development of the child’ (Article 6). In addition, the uninfected infants would not need a ‘cost’ for the life-long care and treatment. Preventing pediatric cases is less costly than caring for children with HIV/AIDS, especially if Highly Active Antiretroviral Therapy (HAART) is used (WHO, 2004). If children are to be protected from HIV, the expansion of PPTCT programs must be complemented by increased provision of pediatric treatment. This is expensive, yet there are humanitarian, equity, and children’s rights arguments to justify the prioritization of treating HIV-infected children (Tolle et al., 2013). The PPTCT program respects the right of the child to survival, development, and health. In India, approximately 49,000 women living with HIV become pregnant and deliver each year. While the government of India has made progress increasing the availability of prevention of parent-to-child transmission of HIV (PPTCT) services, only about one-quarter of pregnant women received an HIV test in 2010, and about one-in-five that were found positive for HIV received interventions to prevent vertical transmission of HIV (Madhivanan et al., 2014).

Discussion The HIV epidemic has not only been straining resources but it has created newer issues of children’s rights to survival, development, and protection. As suggested by Jones, the universal discourses on the concepts of risk and rights may be an inadequate

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basis for addressing the health and social needs of especially marginalized children and that targeted social action to tackle the processes of marginalization is also needed (Jones, 2009). Our study indicates four prominent rights areas in the context of HIV among children and adolescents: (1) (2)

Parental communication on RSH issue Abandoned/orphaned: Major issue is that of ‘Right to inheritance.’

(3)

Vulnerability: HIV-infected children/adolescents become vulnerable at the family level. Most of the time, either the parents are sick or dead and the ‘Right to education’ gets undermined immediately. This is a leading problem when the household becomes a child-headed household or children get exploited by the persons who have given them refuge.

(4)

Attitude: The attitude of the family changes and without any fault of the young ones, their ‘Right to marry’ and their ‘Right to recreation’ is emasculated. Children get emotionally exploited but anger and strain are evident among children/adolescents.

A review of 23 studies showed educational disadvantages among children affected by AIDS in various educational outcomes, including school enrollment and attendance, school behavior and performance, school completion, and educational attainment (Guo et al., 2012). Discontinuation of education of HIV-infected and an affected child is a matter of concern. In a study conducted in China as well, stigma and discrimination puts a dent into right to education of HIV/AIDS-affected children in rural China (Qin et al., 2013). It has thus been observed that HIV undermines a child’s possibilities for exercising the rights to education, health and autonomy, as guaranteed in international treaties such as the Convention on the Rights of the Child. It is important to build the capacities of parents and guardians. The inheritance of children who have lost their parents should be addressed. Access to education must be guaranteed to these children as education would also reduce their vulnerability. There is discomfort about adolescent sexuality, which contributes to legal and social barriers to the provision of ARSHE. For strong advocacy, ARSHE needs to be placed on national agendas, and strategies need to be put in place to build community support for ARSHE. Studies have shown that ARSHE does not increase sexual activity, sexual risk-taking behavior or rates of HIV or other STIs (Fonner et al., 2014; UNESC, 2018; Shepherd et al. 2010). At the programmatic level, challenge is the failure to involve young people living with HIV (YPHIV) in the planning, designing, implementation, and evaluation of programs aimed at meeting their needs including sexual and reproductive health. Research shows that young people prefer services that are offered by their peers and also those that revolve around their ideologies (Baryamutuma & Baingana, 2011). Policies aiming at protecting and fulfilling the rights of men and women living with HIV to parenthood should thus be comprehensive enough to address the continuum of care from pregnancy to infant and child care, to provide means of integrating sexual and reproductive health interventions with HIV/AIDS care and to mitigate

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AIDS-related stigma and discrimination. In India, PPTCT is a successful program but it focuses mostly on mother and child as dyad and the father is excluded. Focusing on the couple, the individual or the set of adults who are responsible for raising a child, rather than seeing only the woman or the infant as the unit of care, can be an innovative programmatic advance toward meeting the parenthood rights and needs of people living with or affected by HIV. Some areas of concern are the discrimination faced by orphaned children of HIV/AIDS parents, lack of funding or utilization of funds in giving treatments, unsafe healthcare practices, and lack of attention to HIV/AIDS among children in health policy. Child affected by AIDS needs medical treatment, counseling, support from extended families, and other non-institutional care, and help with medical care for parents so as not to create debt and need for engaging children in labor. Labor exploitation remains hidden at foster families and homes. As part of an attempt to help children living with HIV/AIDS, UNICEF in collaboration with national organizations and the Government of India have put children on the agenda of the National AIDS Control Plan 9. The aim is to prevent parent-to-child transmission of the disease, and provide care and medical treatment to children infected with HIV/AIDS. Disclosure of HIV diagnosis to children is the unmet need in this whole scenario. No guidelines are available for disclosure to children but disclosure has emerged emphatically as the right of the children. There is growing evidence of the benefits of disclosure and with the increasing population of children and adolescents on ART, the disclosure of HIV diagnosis is kept on hold until older childhood and beyond (Wiener et al., 2007). One guideline for children up to 12 years has recently been introduced by WHO (2011), but feasibility in cultural settings needs to be tested cautiously. Sexually active children, most often older adolescents, who know their HIV status can choose to use protection during sex and other risky activities. When sexually active people do not know about their status, they are at risk of spreading HIV. The American Academy of Pediatrics stressed that a ‘conspiracy of silence’ may isolate children from potential sources of support and undermine trust between adults and children. Health workers in Kenya have found that disclosure before adolescence is preferable, as adolescents often react badly to disclosure. Children have the right to age-appropriate information about their HIV status. Governments around the world need to create sound policies on supportive ways to disclose HIV status to children and adolescents as more children worldwide are tested for HIV and have access to antiretroviral treatment (ART). Policymakers need to be acutely aware of the questions and nuances involved pertaining to HIV disclosure. Tensions arise if the child is psychologically and cognitively, but not legally old enough to be told. The staff may then arguably, from a purely ethical perspective, be supported in disclosing, but legally be unable to disclose. Hence, policymakers could consider broadening the concept of emancipated or mature minors so that clinicians can discuss the infection with offspring, even if parents object. Considering the regional variations in India, the state laws could also become more uniform and allow for the development of national guidelines that are more universally applicable.

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Conclusion In order to support children living with HIV, there is a need for advocacy for greater vaccine access, for promoting children’s right to education, right to healthcare access to protect children. Prioritize adolescents in the context of the HIV epidemic. It is well-known that failure to ensure children’s rights creates opportunities for HIV infection. At the same time, HIV/AIDS creates opportunities for the violation of children’s rights. Advances in the realization of children’s rights, including the implementation of the United Nations Convention on the Rights of the Child (UNCRC), are necessary to stem the growth of the AIDS epidemic.

Recommendations and/or Implications Age stratified policies and a program for adolescents and young adults is an emerging gap. Policies should be drafted specifically for this vulnerable population. India has already provided legally a status of ‘disadvantaged group’ to the HIV-infected and affected children, and they have been given special rights. The structural interventions need to be formulated in the context of these rights. Multicomponent interventions, especially those that include community mobilization and women empowerment strategies, have the potential to improve a range of adolescent sexual and reproductive health outcomes. HIV prevention programs should be mobilized. The PPTCT program is the right of the unborn child of an infected mother/parents. Expanding and strengthening the PPTCT program should be considered the right of the child in the HIV context. Responsible parenthood/responsible guardianship are required to bring up HIV-infected children. Male and family involvement in the PPTCT program would help bring in the required change in the responsible parenthood. Ambient environment for disclosure of HIV diagnosis to children/adolescents is critical as with success of ART program, developmental issues of adolescence and young adults also emerge. Mainstreaming HIV-infected children with their uninfected counterparts calls for far larger and broader structural interventions where communities inclusive of families and other stakeholders need to become responsible for the ‘generation growing with HIV’ and struggling to survive and thrive.

References Baryamutuma, R., & Baingana, F. (2011). Sexual, reproductive health needs and rights of young people with perinatally acquired HIV in Uganda. [review]. African Health Sciences, 11(2), 211– 218. Dellar, R. C., Dlamini, S., & Karim, Q. A. (2015). Adolescent girls and young women: Key populations for HIV epidemic control. Journal of the International AIDS Society, 18(2, suppl. 1), 19408. https://doi.org/10.7448/IAS.18.2.19408. Accessed June 16, 2018.

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Edmonds, A., Yotebieng, M., Lusiama, J., Matumona, Y., Kitetele, F., Napravnik, S., & Behets, F. (2011). The effect of highly active antiretroviral therapy on the survival of HIV-infected children in a resource-deprived setting: A cohort study. PLoS Medicine, 8(6), e1001044. Fonner, V. A., Armstrong, K. S., Kennedy, C. E., O’Reilly, K. R., & Sweat, M. D. (2014). Schoolbased sex education and HIV prevention in low- and middle-income countries: A systematic review and meta-analysis. PLoS ONE, 9(3), e89692. Gazette. (2017, April). The gazette of India. The human immunodeficiency virus and acquired immune deficiency syndrome (prevention and control) Act, 2017 No. 16 of 2017. Ministry of Law and Justice, Government of India. https://lms.naco.gov.in/frontend/content/4%20HIV%20A IDS%20Act.pdf. Accessed on September 27, 2021. Guo, Y., Li, X., & Sherr, L. (2012). The impact of HIV/AIDS on children’s educational outcome: A critical review of global literature. [review]. AIDS Care, 24(8), 993–1012. https://doi.org/10. 1080/09540121.2012.668170 Haubrich, R. H., Little, S. J., Currier, J. S., Forthal, D. N., Kemper, C. A., Beall, G. N., Johnson, D., Dubé, M. P., Hwang, J. Y., McCutchan, J. A., California Collaborative Treatment Group. (1999). The value of patient-reported adherence to antiretroviral therapy in predicting virologic and immunologic response. AIDS, 13(9), 1099–1107. Jones, A. (2009). Social marginalization and children’s rights: HIV-affected children in the Republic of Trinidad and Tobago. Health and Social Work, 34(4), 293–300. https://doi.org/10.1093/hsw/ 34.4.293 League-of-Nations. (1924). Geneva declaration of the rights of the child of 1924 adopted September 26, 1924. League of Nations Official Journal, Special Supplement, 21. Madhivanan, P., Krupp, K., Kulkarni, V., Kulkarni, S., Vaidya, N., Shaheen, R., & Fisher, C. (2014). HIV testing among pregnant women living with HIV in India: Are private healthcare providers routinely violating women’s human rights? BMC International Health and Human Rights, 14(1), 7. Mburu, G., Hodgson, I., Teltschik, A., Ram, M., Haamujompa, C., Bajpai, D., & Mutali, B. (2013). Rights-based services for adolescents living with HIV: Adolescent self-efficacy and implications for health systems in Zambia. Reproductive Health Matters, 21(41), 176–185. https://doi.org/10. 1016/S0968-8080(13)41701-9 Palladino, C., Bellón, J. M., Jarrín, I., Gurbindo, M. D., De José, M. I., Ramos, J. T., et al. (2009). Impact of highly active antiretroviral therapy (HAART) on AIDS and death in a cohort of vertically HIV type 1-infected children: 1980–2006. AIDS Research and Human Retroviruses, 25(11), 1091–1097. https://doi.org/10.1089/aid.2009.0070 Qin, J., Yang, T., Kong, F., Wei, J., & Shan, X. (2013). Students and their parental attitudes toward the education of children affected by HIV/AIDS: A cross-sectional study in AIDS prevalent rural areas, China. Australian and New Zealand Journal of Public Health, 37(1), 52–57. https://doi. org/10.1111/1753-6405.12010 Sahay, S. (2013). Coming of age with HIV: A need for disclosure of HIV diagnosis among children/adolescents. JAID, 1, 1–7. https://doi.org/10.1155/2013/161085 Sahay, S., Nirmalkar, A., Sane, S., Verma, A., Reddy, S., & Mehendale, S. (2013). Correlates of sex initiation among school going adolescents in Pune, India. Indian Journal of Pediatrics, 80(10), 814–820. https://doi.org/10.1007/s12098-013-1025-8 Salisbury, K. M. (2000). National and state policies influencing the care of children affected by AIDS. [review]. Child and Adolescent Psychiatric Clinics of North America, 9(2), 425–449. https://doi.org/10.1007/s12098-013-1025-8 Shepherd, J. Kavanagh, J., Picot, J., Cooper, K., Harden, A., Barnett-Page, E., Jones, J., Clegg, A., Hartwell, D., Frampton, G. K., Price, A. (2010). The effectiveness and cost–effectiveness of behavioural interventions for the prevention of sexually transmitted infections in young people aged 13–19: A systematic review and economic evaluation. Health Technology Assessment, 14(7), 1–206, iii–iv.

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Slogrove, A. L., Mahy, M., Armstrong, A., & Davies, M. A. (2017). Living and dying to be counted: What we know about the epidemiology of the global adolescent HIV epidemic. Journal of the International AIDS Society, 20(Suppl. 3), 21520. Tolle, M. A., Phelps, B. R., Desmond, C., Sugandhi, N., Omeogu, C., & Jamieson, D. (2013). Child survival working group of the interagency task team on the prevention and treatment of HIV infection in pregnant women, mothers and children. Delivering pediatric HIV care in resourcelimited settings: Cost considerations in an expanded response. AIDS, 27, S179–S186. https://doi. org/10.1097/QAD.0000000000000105 UNAIDS. (2012). Global statistics: More than 35 million people live with HIV. http://www.unaids. org/en/media/unaids/ UNAIDS. (2017). Ending AIDS: Progress towards the 90–90–90 targets—Global AIDS update. Joint United Nations Programme on HIV/AIDS. UNCF. (2016). For every child to end AIDS: Seventh stocktaking report, 2016. United Nations Children’s Fund. UNESC. (2018). Revised edition: International technical guidance on sexuality education—An evidence-informed approach. United Nations Educational, Scientific and Cultural Organization. UNICEF. (2014). The children: HIV/AIDS. Picture in India. Retrieved November 3, 2014, from http://www.unicef.org/india/children_2358.htm UNICEF. (2019). Adolescent safety and protection. Press Release. https://www.unicef.org/adoles cence/protection. Accessed on September 25, 2021. United Nations. (1989). Convention on the rights of the child (Vol. 1, Chap IV). Human Rights. United Nations. (2003). Convention on the rights of the child (1989). HIV/AIDS and the rights of the child. United Nations Children’s Fund. (2018, July). Women: At the heart of the HIV response for children. UNICEF. United Nations Educational, Scientific and Cultural Organization. (2018). International technical guidance on sexuality education—An evidence-informed approach (Rev. ed.). Vaughan, H. (1621–1695). The retreat. Verma A, & Sahay S. (2019). Healthcare needs and programmatic gaps in transition from pediatric to adult care of vertically transmitted HIV infected adolescents in India. PLoS ONE, 14(10), e0224490. https://doi.org/10.1371/journal.pone.0224490. PMID: 31661535; PMCID: PMC6818794. Volberding, P. A., & Deeks, S. G. (2010). Antiretroviral therapy and management of HIV infection. [Research support, N.I.H., extramural review]. Lancet, 376(9734), 49–62. https://doi.org/ 10.1016/S0140-6736(10)60676-9 WHO. (2004). Strategic framework for the prevention of HIV infection in infants in Europe. Copenhagen. WHO. (2011). Guideline on HIV disclosure counselling for children up to 12 years of age. Wiener, L. S., Battles, H. B., & Wood, L. V. (2007). A longitudinal study of adolescents with perinatally or transfusion acquired HIV infection: Sexual knowledge, risk reduction self-efficacy and sexual behavior. [Research support, N.I.H., Intramural]. AIDS and Behavior, 11(3), 471–478. https://doi.org/10.1007/s10461-006-9162-y Wood, E., Hogg, R. S., Yip, B., Harrigan, P. R., O’Shaughnessy, M. V., & Montaner, J. S. (2004). The impact of adherence on CD4 cell count responses among HIV-infected patients. [Research support, non-U.S. Gov’t]. Journal of Acquired Immune Deficiency Syndromes, 35(3), 261–268. https://doi.org/10.1097/00126334-200403 Writ Petition. (2014). NAZ foundation versus Union of India. Writ Petition (C) No. 147 of 2014. https://www.right-to-education.org/sites/right-to-education.org/files/resource-att achments/SC%20order%20%20dated%205.5.2017.pdf. Accessed on September 27, 2021.

Chapter 23

Evolving Trend of Adoption Against the Pedestal of Maltreatment and Child Rights Violation Nilanjana Sanyal

Introduction A home in a socio-emotional flavor is adorned with the presence of a child. It is just not the conjugal intimacy of two adult individuals that constitutes the frame of a family structure; it is rather the etching of a place marked by the existence of a child with all his/her nuances that typifies the ambience of a family life. Children are just not the extensions of their parents in physical terms; they are the bearers of their values and the podium to reflect on the stylized parenting they receive in life. Parent–child interaction thus pays a heavy toll on the future growth of a child, creating positive or negative ripples in the basic “present” life context. The precious presence of children is so heavily felt by most couples that a home without a child is felt as a groove that needs mending. The process might be going for “adoption”. A child, be it any biological or an adopted one, being contextually available, is expected to fill up the empty hearts of wanting-to-be parents. The expected scenario is healthy family flow with glowing emotional bonding and felt security and warmth therein. But at times, reality poses different and difficult pictures through its crude lenses. The resultant experience being the fact that it is not all the roses to have in a family through the existence of a child, the thorns are hurting at times. DeVooght et al. (2011) showed that although children of all ages can be victims of abuse or neglect, infants and children are particularly vulnerable. Federal data on child maltreatment from the National Data System (NCANDS) show that young children are more likely than older children to be reported to child protective services (CPS) for suspected abuse or neglect and are more likely than their older peers to be determined victims of maltreatment by CPS. The data consistently show that child victims most frequently experience maltreatment in the form of neglect (with more than 78% of all victims) in Federal Fiscal Year (FFY) 2009 experiencing neglect (DHHS, 2010). Children aged five and younger are N. Sanyal (B) Department of Psychology, University of Calcutta, Kolkata, India © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_23

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at an even greater risk for neglect than older children: Almost 80% of all maltreatment victims in the younger age group experienced neglect in FFY 2009, compared to two-thirds of children aged six and older. Further, data on child fatalities consistently show that the youngest children (aged five and younger) are at greater risk of death as a result of abuse or neglect, with 87% of all child maltreatment fatalities in FFY 2009. Children less than a year old comprise 46% of all child maltreatment fatalities.

Maltreatment of Children The data furnish a new conceptual frame of maltreatment of children of every age through abuse or neglect, being intentional or unintentional. The Federal Child Abuse Prevention and Treatment Act (2010) required states to develop minimum definitions of child abuse or neglect. The act states that abuse or neglect is “any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation or an act or failure to act which presents an imminent risk of serious harm”. In addition to this federal law, some states define specific types of abuse or neglect, such as emotional abuse, medical neglect, sexual exploitation and abandonment. Despite persistent media headlines about extreme cases of child abuse and neglect, the public remains largely uninformed about the developmental status of children affected by this tragic problem. The immediate markers of abuse and neglect are obvious—bruise and battered bodies and in its most severe form death. However, research has shown that child abuse and neglect—collectively known as “child maltreatment”—are also associated with a broad array of less visible negative outcomes that may emerge at different stages of children’s lives (Chalk et al., 2002). Sensational stories of child abuse and neglect have become an all too frequent feature of news reports across the country. Research allows us to move beyond the headlines to get a better grasp of this pressing social problem. Child neglect is the most common form of child maltreatment. More than half (58%) of the substantiated cases of child maltreatment involve child neglect. Additionally, about 36% were victims of other forms of maltreatment, such as abandonment or threats of harm. Regarding consequences, hundreds of research studies and agency reports have consistently reported negative outcomes from abuse and neglect for many children (English, 1998; Howe, 2005). Taken together, this evidence suggests that abuse and neglect are associated with both short- and long-term negative consequences for children’s physical and mental health, cognitive skills and educational attainments and social and behavioral development. What is not yet certain, however, is the extent to which these effects are caused by the child’s experience with abuse and neglect or the presence or absence of other factors in the child’s developmental experiences. Child neglect can take many forms and can stem from a range of underlying conditions affecting families. These can include mental health issues, substance abuse disorders, issues involving domestic violence and poverty. The federally supported

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Child Welfare Information Gateway, provides this definition, “neglect is frequently defined as the failure of a parent or other person with responsibility for the child to provide needed food, clothing, shelter, medical care or supervision, such that the child’s safety, health and well-being are threatened with harm” (DeVooght et al., 2011). Within the framework of the present article, the focus would be on mental health issues of adopted children, being the by-product of maltreatments of parents oozing out their own personality problems, expectations regarding parenthood and total lack of identifications of biological parenthood itself. The presentation will take help of certain case studies as noted in psychotherapeutic situations.

Adoption: The Alternate Parenthood Context Owing to physical or psychosocial problems, prospective couples really cannot manage to conceive a child yet cry for a baby in life tremendously—their only alternate way out is to adopt a baby. According to Nagera (2006), people adopt because of the following reasons: a. b. c. d.

Kindness to accommodate a poor or abandoned child in life; Cannot conceive at all; In order to save the bitter marriage, having a buffer through an adopted child; Going to design a companion for an already existing child (biological or not).

Adoption first became a legal status and process for transferring parental rights from biological parents to substitute parents in 1926. Prior to that, the practice of babies and young children being cared for by extended family members or strangers probably goes back to the beginning of human time. At its inception, the legal framework for adoption was designed for the placement of babies with adoptive parents. The law was designed to ensure: • That adopted parents were suitable to care for a baby, and that this was not a financial transaction but a child-centered process. • The anonymity of the birth parents, particularly the birth mother, was preserved, and the baby was given a new identity. The expectation was that in post-adoption, there would be no further contact between the child and its birth family. It was common practice for the adoptive child not even to be told that they had been adopted. Anonymity protected the birth mother from the shame of motherhood out of wedlock, the adopters from the embarrassment of infertility and the child from the stigma of illegitimacy.

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From Attachment Theory to Understanding Trauma of Adopted Children in Infancy by Bowlby In his later works, Bowlby postulated the existence of “an internal psychological organization with a number of highly specific features, which included representational models of the self and of attachment figures” (Bowlby, 2005). This concept made sense of the patterns of behavior that children were displaying not only in adoptive families but in foster homes. The template for attachment that they were displaying in the substitute families was the template that had been learned in a dysfunctional birth family. This attachment behavior or attachment strategy can be seen as adaptive in the context of pathologized parent–infant relationships. In “normal” functional substitute families, it was mal-adaptive. Bowlby had made the link between poor mother–infant attachment relationships and the development of “delinquent” behavior in adolescence (Bowlby, 1944). His followers had refined and developed his theory and identified different attachment styles that children develop depending upon the quality and form of that primary attachment relationship between mother and infant (Main & Solomon, 1986). These attachment styles have been defined as secure, insecure–ambivalent, avoidant and disorganized (Howe, 2005). The work of Bessell van der Kolk (2005) and Perry (2006) helped us recognize that PTSD in childhood was really only applicable to children who by and large have had “good enough” attachments to primary carers, but had subsequently suffered single traumas. For children who have experienced multiple trauma and who also had insecure attachment relationships, their whole development was impacted from birth through infancy by repeated “relationship” or “ambient” trauma. This phenomenon has subsequently been given the title of “Developmental Trauma”. This syndrome has been researched and defined by Child Traumatic Stress Network Task Force (2003) in the following fashion: Developmental Trauma Disorder by Bessel van der Kolk in the Psychiatric Annals (2005) A. Exposure

Multiple or chronic exposure to one or more forms of developmentally adverse interpersonal trauma (e.g., abandonment, betrayal, physical assaults, sexual assaults, threats to bodily integrity, coercive practices, emotional abuse, witnessing violence and death) • Subjective experience (e.g., rape, betrayal, fear, resignation, defeat, shame) (continued)

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(continued) Developmental Trauma Disorder by Bessel van der Kolk in the Psychiatric Annals (2005) B. Triggered pattern of repeated dysregulation Affective in response to trauma cues • Somatic (e.g., physiological, motoric, medical) • Behavioral (e.g., re-enactment, cutting) • Cognitive (e.g., thinking that it is happening again, confusion, dissociation, depersonalization) • Relational (e.g., clinging, oppositional, distrustful, compliant) • Self-attribution (e.g., self-hate, blame) C. Persistently altered attributions and expectancies

• • • • • •

Negative self-attribution Distrust of protective caretakers Loss of expectancy of protection by others Loss of trust in social agencies to protect Lack of recourse to social justice / retribution Inevitability of future victimization

D. Functional impairment

• Educational – Familial – Peer – Legal – Vocational

Grueling assessment, long waiting lists, exasperating bureaucracy and considerable expense are some of the common stories or challenges that the prospective adoptive parents experience in the process. But, there is a presumption that the day these parents finally take a child into their arms is the first day of the “happily ever after” dreams for both sides. But, that really is a dream and is not realistic. Too many possible complications may come in the way in the source format being: • • • • A.

Coming from the parents Coming from the child Coming from the interaction Coming from development. Coming from the Parent

There is a common notion that if a child is picked up from an orphanage and put in a decent family, he/ she will thrive and develop as per Archer and Burnell (2003) of the UK-based “Family Futures” which specializes in providing therapeutic services for children who have experienced early trauma. Unfortunately, reality shows that love does not always conquer all. Hence, in adoption situations, the “attachment issues” turn to be a primary problem among many. The older they are when placed in a family, the deeper the problem is likely to be. Consequently, it has been noted that children who receive poor early parenting have every aspect of their development being impaired or impacted to varying degrees by that early traumatic experience. It

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has been shown that their brains develop differently from those who are encouraged to develop a secure, loving attachment to a principal carer—usually their mother (Archer & Burnell, 2003; Monahon, 1993). It is not just that they find it difficult to form secure attachment to their parents, they also have problems with problemsolving and cognitive processing and also with sensory motor development. Unless adoptive parents know about the issues and receive appropriate professional help where necessary, they are parenting on “faulty foundations,” says Archer and Burnell (2003). The problems are just not there in the initial stage of settling in a family, in adoption, long-term issues can re-emerge at various later life stages, particularly in adolescence. In parenthood, most parents draw on their experiences of being parented when raising a family. But, adopted children may need different forms of parenting to help with feelings that biological children of their age would not have. They need a parent to help them to make a transition from babyhood to an autonomous child of middle childhood; otherwise, regressive modes have deep patches in their behavioral mode. Usually, children with attachment issues can become overly self-assured and pseudo-independent, or they become frustrated and intolerant, often quite aggressive, or they are very compliant and quiet. None of these coping strategies that the child has developed works in the long run, and “re-parenting” is needed to make up for what that child has missed. Additionally, it has been found that human-to-human touch releases oxytocin, a feel-good hormone, and it is a process that happens all the time between biological parents and babies. In adoption, if by any chance, the death is noted in the context, relevant fearful experiences regarding touch take place in the child’s mind. Touch seems to be the essential element in bonding with people with pleasure (Archer & Burnell, 2003). Typical emotional inadequacy is evident in most adoptive parents. They are found to be slow in looking for help for the child or for their relationship, because they may not want to admit that they are having difficulties. Faced with a child who would just not stop crying or tantruming, adoptive parents can feel a huge sense of shame. They seem not to have the visceral confidence that they know their child, and the experience can be quite harrowing. The behavior they are dealing with in their children includes extreme mood swings, aggression, poor performance at school, low self-esteem and sometimes stealing and self-harming behavior. In fact, prospective adoptive parents need to know that it is not going to be an easy task for them. Their resilience would need to stand firm to confront the demand. B.

Coming from the Child

Children come into new families with pathological ways of relating, and they at times pathologize the new family. Situationally, it is not the parents who are a risk factor; it is the child who may be the risk factor. They endanger the marriage, endanger the mental health of parents, and possibly the potentiality of the child could not be utilized in the desired ways in the family owing to his/her own constitutional factors like low intelligence, impulsivity, poor psychiatric history.

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Coming from the Institution

Most frequently adopted children are found to have poor identification with their parents. A constant search, even in fantasy for one’s own parents, prevents them from having a healthy bond with the adoptive ones. They become verbally abusive, retaliate at every juncture of advice, have displaced rage on them from the nonavailable biological parents. Adopted girls in a reactive mode become promiscuous and conceive illegitimate children. Boys become vandals, abuse drugs, remain asocial and can be quite destructive to adoptive parent’s property. D.

Coming from the Development

Adopted children have two sets of parents, biological and adoptive. They can denigrate and idealize them at will. Because of this, the mechanism of splitting is highly facilitated in them with negative consequences for development (Freud, 1909). Similarly, their oedipal orientations suffer injury for the same reason. The splitting in them turns two sets of parents into four sets: • • • •

A denigrated bad set of biological parents; An idealized set of biological parents; A good idealized set of adoptive parents; A bad denigrated set of adoptive parents.

They feel frustrated in any way and react negatively. Navigating a balanced developmental chart and a welfare system for them then becomes a major challenge. The theoretical roots of analysis of such a situation need little elaboration at this point (Fig. 23.1). The system of developmental trauma can also be summarized as follows (Fig. 23.2). Similarly, a neuro-physiological psychotherapy approach to working with children who are fostered or adopted showed the necessity of healthy attachment to overcome the difficulties posed by developmental trauma (Burnell & Vaughan, 2012; Vaughan et al., 2016).

The Hand-On Scenario of Adopted Children: Excerpts from a Few Psychotherapeutic Case Studies 1.

Riyance, a four-year-old, very frail child has been brought to the clinic with following complaints; • The child is restless and has difficulty in going off to sleep; • He needs to be bribed to make him follow any instructions; • He eats very fast, has frequent outbursts of temper tantrums, especially with the mother; • Likes to draw father’s attention which is usually unresponded;

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Affect the brain-body relationship

May result in impairment in cognitive and affective regulation

Fig. 23.1 Trauma graph. Source Author

Residue of early trauma affecting the personality of the child

Deficit in brain development and executive functioning

Developmental trauma

Challenged cognitive conditions

Dysfunction in affect regulation

Fig. 23.2 Challenges in development of young children due to adoption. Source Author

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• Gets very aggressive at times.

2.

The background history reveals that he was from a starved mother, who just after giving his birth, died of malnutrition. The father abandoned the child instantly. Through a home, he had been placed into a well-to-do family with a professor father and a working mother. The mother, being beautiful, was too narcissistic and did think that her beauty would be spoiled in conceiving a child. The husband seemed to be reluctant in close bonding with the wife but cooperated with her in adopting the child and in looking after the household chores. The child seemed to be a victim of maltreatment. A helping assistant was hired to look after the child during the day time, but the mother did try her best to take care of him. In the process, she developed a peculiar guilt thinking that she is not up to the expected level of being his mother, maybe she is depriving him of the quality of love that his natural mother could have given him. She was always worried about his food and was constantly offering him food to compensate for whatever may be his deprivation with her. While trying to help the child in any habit formation, she always felt shaky, thinking that she might be coxing him to do it. The father attended him physically at times, but very rarely attended him psychologically. Their inadequate, inconsistent and irresponsible parenting was no doubt inking the maltreatment issue for their child. Shaon, a girl of seven years, was brought to psychotherapy for her attention deficit in studies, stubbornness, non-compliant attitude to family members, dislike toward studies and going to school, constant T.V. watching habits, lying and extreme regressive speech. The family backdrop revealed her adoptive mother was approaching 40 years of age, father’s age was 44 yrs. Both of them were graduates. The father worked in a private company; the mother was the home maker. The mother was brought in an extended family with a widow mother-in-law and a spinster sister, elder to her husband. The husband had strong inclinations toward them, and all three of them used to criticize her for almost everything. The couple’s life was at stake; they constantly fought with each other. Both the members revealed an obsessive–compulsive personality pattern with extreme rigidity in their self-opinionated ways in life. They could not conceive in a natural way and hence opted for adoption. Shaon was conceived as a bridge between them, but very soon they started fighting over their caregiving roles. The child was the victim of family conflicts, clashes, even parents fighting physically, abusing each other in high pitches and not being allowed by the mother to spend time with the grandmother or aunt. Ultimately, the couple got separated from the mother-in-law and sister-in-law and started their home in a new locality with the daughter. She was sent to school. But, they found her to be absent-minded and not at all interested in studies. She was keen on watching T.V. even at the cost of receiving thrashings from the parents. To the therapist, she seemed to be a bright girl who used all her potentialities in manipulating a situation or condition to fulfill her instant pleasure-seeking habit format. Her defense was that of having regressive speech, but she seems to be aware of the minute details of the situation. On her second day of visit, feeling quite assured

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with the therapist, she opened her mind saying, “I don’t like my parents, they fight a lot between them, beat me up regularly, force me to obey them always and take out their own anger on me. I can’t study, I watch T.V. to forget all my miseries. Can I be sent somewhere else? I like to be away from these two human beings”. Her emotional plight is an instance of maltreatment. A six-year-old boy, Rohit, has been brought into the clinic with a concentration problem, mother-teasing and extreme demanding nature. He was an adopted son of a reputed medical practitioner and a homemaker mother. Unfolding his mind, he gradually revealed the fact that he feels something amiss in the family. He always wanted to see the mother in stripped-off condition in order to see how he was born out of her. He had some confusion regarding father too whom he found to be unrealistically possessive and protective about him. At the age of 6, he had been given two tutors to teach him, and he was showered with gifts and toys from the father on a regular basis. Mother was restrictive a bit for which she was constantly abused by the father. His little mind put a query in front—“Is there anything unnatural regarding my birth? I do not feel comfortable here”. Taking the child much away from normal developmental course is another angle of maltreatment meted out to them at times. A 9-year-old Shreya had the problems of poor academic grade, problem of enuresis, nail biting, unusual hankering for money and electronic gadgets, a special lesbian friendship with a girl of two years older than her. She was the adopted daughter of an affluent business father and was a student of a very posh school in Kolkata. She was described as an Internet addict and was in a habit of constantly using her mobile for text messaging. Therapeutic interviewing was difficult with her initially. Gradually she narrated her plight saying her mother was an extremely prying type and complained about her to the father that resulted even in shoe-beating her. She had been criticized by both of them for not being beautiful in looks, good in studies and in terms of not being obedient. Her friend seemed to offer her the emotional cushion which she was not ready to part with. The discourse with the parents revealed their mentality saying, “She is not the type we wanted to have. Neither can we accept her, nor can we abandon her. Even her body features seem repulsive to us”. Barring details is not it good enough to conceptualize what maltreatment means? Three-and-a-half-year-old Reshma came with her mother to the clinic. The child was having seizure disorder and was unusually hyperactive. The homemaker mother of an engineer husband found it very difficult to accept the child with her problem. She said, “To me, the child seems to be a problem, an emotional burden, a time consumer, a robber in terms of my free life. I just want her to get removed to someone else or die”. The father’s version was that the child was brought to fill up the void of his wife in terms of time and emotions. The contrast between the dreamt child and the child in reality painted the canvas of maltreatment for her.

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The Mental Frame of Maltreating Parents: A Few Salient Points In the mental frame of maltreating parents, especially the mother, certain noteworthy psychological points seem to be: • Infertile mothers’ design and expectations at times do not match the reality of the situation—they instantly become reactive in terms of open irritation and rejection. • Motherhood or parentage is a heavy task, carrying out which, successfully can bring enormous joy and fulfillment. But, the process needs a lot of resilience and patience to bear the common hazards of developmental tasks. One needs to be totally mentally prepared to combat any errands there. • Children are not decorative elements in life. Life follows unfolding of growth in hazardous sequential stages, and one needs to offer balanced “holding” there. • Children are not your canvas to put your designs on it. They are living beings having their potentialities as well as vulnerabilities to grow in a stylized manner. • If children are required to follow their parents, parents need to be the stable role models. • Psychoanalytically, mothers or caregivers are called “containers” in life. In order to contain (the child) in a container (mother or parent), the container must be clean to assure its quality preservation. • Mother’s/father’s infertility may be the outcome of wrong parenting received and hence poor identification with the roles. Before opting for adoption, one needs to rectify the situation through self-correcting therapeutic processes. • Being a parent is difficult, accepting the challenge and confronting it need maturity to carve progression in life. Maltreating a child is a wrapping on the defects of the parents. One needs to acknowledge it.

Indicators for Child Maltreatment Traditional indicators for child maltreatment prevention programs raise thorny ethical, methodological and empirical issues and have significant validity problems. To inform the design of maltreatment prevention program evaluation, it is recommended that there should be a combination of indicators that measure risk and protective factors for child maltreatment along four dimensions: • • • •

Parenting capacity Substance use Financial solvency and Family conflict.

In addition, Centre for Study of Social Policy (CSSP) indicators in two other areas: child well-being and home and community. Indicators of child well-being should address the domains of physical health, education and cognitive development and

398 Table 23.1 Domains and concepts for assessment of child development prevention programs

N. Sanyal Domain

Concept measured

Child well-being

Health Education and cognitive development Social and emotional well-being

Home and community factors

Home safety Social connectedness

Child maltreatment

Parenting capacity Substance use Financial solvency Family conflict

social and emotional well-being. Among several dimensions of home and community factors, indicators include domain of home safety and social connectedness (Ross & Vandinere, 2009) (Table 23.1). There are many reasons why reliable and valid indicators of child maltreatment do not exist. Maltreating a child can result in civil or criminal actions that have severe repercussions for parents and children. In addition, parents labeled as abusive or neglectful of their children bear a heavy social stigma. These qualities undermine direct observation aimed at detecting maltreatment—parents can be expected to avoid maltreating their children in the presence of a researcher or therapist. In adoptive family situation, two most important factors that need consideration are: • Parenting Capacity This has many dimensions, including parenting skills, parenting knowledge of child development and parent mental health. Strong parenting capacity can be a protective factor against maltreatment, while weak parenting capacity can be a risk factor. Some parents, especially young parents or parents going for adoption, may not have had the opportunity to practice parenting skills or learn about child development. This appears especially true when parents have not experienced modeling of appropriate parenting behavior (Shireman, 2003). Mental health problems can also hamper parenting capacity, resulting in an increased risk of child maltreatment (Barth, 2003). Parenting knowledge of child development is a protective factor for child maltreatment—and a lack of knowledge is a risk factor that can contribute to parenting practices that are not developmentally appropriate. Three approaches to using indicators of parenting capacity in evaluating child maltreatment prevention programs include measuring the existence of screening and service access, directly observing parenting and parent self-reports. • Family Conflict and Discipline Practices Nurturing parenting is a protective factor for child maltreatment. The use of nonviolent and non-aggressive methods for resolving conflicts between partners and for disciplining children, for example, are protective factors. Conversely, aggressive

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methods for resolving conflicts, including threatening and abusive language as well as physical confrontation and punishment, are risk factors. Because witnessing violence between parents or a parent and a significant other is traumatic for children, it can be considered child maltreatment even when children are not physically harmed (Putnam, 2001). The selection of specific indicators and how they are operationalized may vary across evaluations, depending partly on available resources. Though challenging, rigorous assessment of maltreatment prevention programs is critically important. In the complex matrix of family problems from multidimensional sources, placing increasing stresses on families and threatening the resources available to support the family in terms of financial as well as socio-emotional, it is particularly important to invest in effective programs to deal with child maltreatment. Thus, the vulnerability of infants and young children to abuse or neglect and the significant toll of maltreatment on the very young child underscore the critical importance of early and effective interventions that support and strengthen their families and ensure that these children are protected and nurtured. At the same time, reduction in the incidence of abuse or neglect among these very young children holds the promise of substantial government savings, befitting children and families as well as society as a whole. The selection of specific indicators and how they are operationalized may vary across evaluations, depending partly on available resources. Though challenging, rigorous assessment of maltreatment prevention programs is critically important. In the complex matrix of family problems from multidimensional sources, placing increasing stresses on families and threatening the resources available to support the family in terms of financial as well as socio-emotional, it is particularly important to invest in effective programs to deal with child maltreatment. In fact, India has been a major supporter of child’s rights and CRC, but still it has not been able to achieve or eradicate child-related basic issues. Consistent efforts are needed in right direction. Securing child rights is not the matter to be dealt with at the policy level, people have to be mobilized to this cause. The role of psychologists stands very high there.

Child Right Violation Violation of the rights of children represents a common occurrence in many parts of the world. These violations take the form of torture, cruel, inhuman or degrading treatment, excessive work and labor, sexual abuse and slavery. The Universal Declaration of Human Rights (UDHR) (1945) contains important provisions for children, although emphasis is upon protection and non-discrimination rather granting specific, independent rights to a child as a person. Article 25(2) of the declaration provides that motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection. As far as children’s rights as a distinct category of human rights is concerned, the real impetus was provided with the adoption of the United Nations General Assembly

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Declaration on the Rights of the Child in 1959. The convention came into force in September, 1994. It is the most valuable treaty in the armory of human rights law with which to protect and defend the rights of children the world over. The basic thrust of the convention is that the child has independent rights, and the primary focus of the convention is to operate in, “the best interests of the child”. According to Van Bueren (1999), the convention is essentially about what she terms as the “four Ps”. These are: • The participation of children in decisions affecting their own destiny; • The protection of the children against discrimination, destiny and all forms of neglect and exploitation; • The prevention of harm to children; and • The provisions of assistance for basic needs. While accepting the realities of parental influences and rights and duties of the wider family, the article is nevertheless reticent in dealing with situations where the interests, directions and guidance of parents that are not “appropriate” or “consistent” with the evolving capabilities of the child. To bring out the best in each child, the rights of a child to be protected against all forms of abuse and violence are as follows (Rehman, 2003): • The right to special care if disabled; • The right to adequate nutrition and care; • The right to learn to be useful member of society and to develop individual activities; • The right to be brought up in a spirit of peace; • The right to a name and nationality; • The right to affection, love and understanding; • The right to be among the first to receive relief in times of disaster; • The right to protection against all forms of neglect, cruelty and exploitation; • The right to free education and to full opportunity for play and recreation; • The right to enjoy these rights regardless of race, color, sex, national or social origin. Thus, keeping in mind the common rights of children in any set up and considering the scenario of various possible maltreatments meted out on them at times, certain alternate emotional moves on the part of parents are required to have a frame for common reference.

Solution-Oriented Emotional Moves of Adoptive Parents: Helping a Child to Settle Advice for parents returning home with an adopted child includes: • Keep the house hassle-free and physically quiet;

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• Limit the number of toys and equipment available to the child to enroot him in the family realistically. Too much stimulation can cause overwhelming reaction; • Seek support from other parents who have older adopted children, to get a sense of what things are going to be like; • Expect that the child is going to need a lot of time settling at night; • Try to get as much information as possible from the care home as to the child’s typical habits like eating, sleeping. • It is better if one of the parents is available on a one-to-one basis for the child for at least a couple of years, after coming into the home; • One should remain prepared for temper tantrums as they are the single media of expressing anxiety; • Be prepared for the child’s physical rejection of parents through pushing the parent away. Time and consistent support alter the situation; • Professionally monitor child’s development with experts on the subject; • Use remedial techniques like psychotherapy, counseling, parental guidance when things do not move smoothly; • Provide on-going supportive and preventive services such as parents group, marriage counseling. Apart from the offered solution orientations to adoptive parents, certain policybased approaches need to be followed to combat maltreatment effects on adopted children. • Possible adoptive parents must go through rigorous psychotherapeutic interviews to open up their emotional files behind the desires for adoption; • Personality profiles of such parents need to be mapped out with projective techniques; • They need to be counseled to heal up their emotional patches before finally taking the decision of adoption; • Data need to be collected regarding the couples’ socio-emotional basic reaction patterns; • Follow-up interventions in the family after adoption are required to verify the comfort level of the adopted child. Summarily, the prospective parents must be mentally prepared to accommodate the child in their lives and be equipped enough to deal with the hazards of the normal developmental course to see a bright future of their own family profile.

An Evolving Trend in Adoption at the Moment Of late, a newly developed trend in adoption attempts can be noticed in society, which spontaneously seems to envelop the child being adopted with warmth, love and care in an emotionally almost intact family. This emergent trend seeks to eradicate the bitter memories of maltreatment of adopted children and policy-wise attempts to

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provide them safety and security. To elaborate on this trend, conceptualization may be done in the following fashion. It may be noted that the picturization of a complete family has at least three pillars: the father, the mother and children. In such a context, the missing of any of these three pillars makes the framework incomplete with a hollow in the emotional pattern. The third pillar, if missing, creates a vacuum in the fold of parenting. To fill up such a void, many couples willingly opt for “adoption” of a child—the last cog in the wheel of a fulfilling coupling bond. Hence, the root point in adoption is the need of the couples to fill up an emotional void. Couples have faced varied resistances from extended family members, relatives, neighbors and other members of their social group, whose personal considerations have stigmatized the process of adoption. However, despite such hurdles, a trend of legal adoption of a child by couples not having biological issues was seen to emerge in the past. The process resulted in multivariate problems, with problems observed to emerge in a significant number of cases. The children initially welcomed in families with no kids could not fulfill the dreams of the restrictive parents, with the situation being further complicated when a biological child arrived. In such scenarios, the presence of the adopted child within the family was regarded as an intrusion. The adopted child was criticized and reprimanded over their childhood behavioral anomalies, ascribing the anomalies to their “bad blood”. The initial joy of welcoming a non-biological child had turned the family ambience filled with frustration, disappointment, non-acceptance of the situation, leading to the parents brooding over wrong decisions resulting in ultimate emotional rejection. From the psychological point of view, the adjustment anomalies are due to the emotional immaturity of potential adopting parents who severely lack psycho-educational maturity. The varied lines of differentiation between the biological issue and the adopted one trigger feelings of kinship with the biological issue with simultaneous rejection of the adopted child. A note of discord echoes through the forum of family life; the emotional frame of the adopted child is devastated; the presence of the later biological child gives rise to confusion; and a host of negative emotions plays on the minds of the adoptive parents. With the progress of time, the world has gone through changes of various kinds, with the dynamics of family life undergoing many metamorphoses. The adoption scenario has also seen the advent of educated, warm parents, whose handling techniques establish the fact that parenting is a noble role one plays. Such nobility results in bringing up children realistically, being full of warmth, trust, compassion, concern and having exchangeability of positive emotional frames. Such values are successfully transmitted between generations, with the healthy vibes of life resonating in society, ultimately refurnishing the world with bright, healthy mental tunes. In recent times, a great factual change is being observed in the “adoption platter” in recent times.

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The Wonder Work of Adopting Children by Parents Wearing Biological Issues on Their Sleeves The current social frame is witnessing a phenomenon of several young, educated, job-wise well-placed couples/parents having one or two children of their own opting to have an adopted child in the family. The mind-set of such parents has the “mantra” that “giving birth is not the only way of making a family”. The couples point out that their decision to adopt is purely driven by their desire to have a child and not because they want to do something “noble”. While they too want to enjoy the direct experience of having a biological child, the decision to have a follow-up of embracing an adopted child is to have a complete family frame (Aatif, 2019). To them, it appears they are bringing a child with whom they are emotionally and karmically bonded. This trend of radical change over the years has been possible because of the participation of many well-to-do couples having biological children in not only upper middle-class families of the society but also in many families of celebrities across the country. In other words, adoption is no longer the avenue to complete a family of a couple if they are childless because of varied reasons (Lizy, 2016; Sinha, 2006). This step is very encouraging and conveys important messages to the society at large. Couples or single parents are now opting for having a sibling for their biological child/children in the form of one or more adopted children (The Hindustan Times, 2017). This indicates a mentality of grown-up individuals to help children learn to share their affection as well as assets in life with others in a healthy manner and thereby help in developing healthy personalities in the long run. This is brought forward by gifting the biological children an adopted sibling and a mature sibling-relationship throughout life. In fact, many actors and actresses of the Indian film industry presently serve as role models in this arena. This interesting trend in adoption studied across the nation appears to have much impact on the socio-emotional environment of young children (Dhawan, 2015). Such a proactive attitude of adults seems appropriate to erase the stigma and taboo associated with rejection and abandonment of an adopted child and appears to be operative along different tiers of the society.

The Probable Conditions Behind Such Mind-Sets Economic venture-wise, the current work life of young couples is very stressful. They have extremely long working hours, target-oriented job set-ups that disrupt the normal flow of a family life to a great extent. The pressure to have a biological child is constantly present for Indian couples. To have the second issue seems more difficult for them, yet the desire to welcome another child, to give their biological one a partner to play with, to grow with, to learn sharing, to imbibe taking little bit of responsibility and to develop true sense of compassion and empathy and also to enjoy the presence of another child in life—they go for the option of adoption. Their actions result in carving out emotionally enriched lives for many orphaned,

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dejected, abandoned angels in reality. Modern society has many follies; however, a single change in the psychological perspective of healthy adoption practices seems to be the sparkling sunshine in the lives of so many unfortunate kids, to bathe in unforeseen emotional bliss.

Conclusion It needs to be comprehended that a childless life for a couple may often be a barren one. The presence of a child; be it biological or adopted adds meaning and flavor to one’s life. So, adoption should be accepted as the ikigai of issueless couples. Further, the emotionally attached couple looks for extension of the attachment in children. Medically or otherwise, being in a state of not having a child of themselves, adoption seems to be the window in their world to fulfill their dreams and yet at the same time help the abandoned child to have a complete life of his/her own. Children available for adoption often carry a history of rejection, possible stigma and varied other trauma linked to abandonment. The story is always that of suffering. If a new set of parents can ease this pain with the promise of a life devoid of the pain and suffering of the past, the burden of the whole world in this sector can be significantly reduced (Gangopadhyay & Mathur, 2021). Many parents or single parents of an adopted child feel that such children share karmic connections with them. Hence, within a short while of getting them and being absorbed in hands-on parenting, the fact that the child does not possess biological lineage is often forgotten. Adoption may be a medium of getting a child in one’s life, in the significant developmental fold of an adult being. The adoption of the task of being a parent and taking the responsibilities helps one in the completion of the circle of life. Such a life would be full of effort and understanding, with the positive practices automatically translating in an environment where child welfare and protection are ensured as opposed to the environment of abuse, neglect and desertion that the children need to leave behind. Emotionally healthy children can adorn families and carve their own niches in life through growing up to be good parents to other children, whether natural or adoptive.

References Aatif, S. M. P. (2019). The law of adoption in India: A critical analysis. Ljubljana, 74(1/2), 5– 31,137–138. Archer, C. & Burnell, A. (Eds.). (2003). Trauma, attachment and family permanence: Fear can stop you loving. Jessica Kingsley Publishers. Barth, R. (2003). Outcomes after child welfare services. Children and Youth Services Review, 22(9/10), 763–787. Bowlby, J. (1944). Forty-four juvenile thieves: Their characters and home life. International Journal of Psycho-Analysis, 25, 19–52, 107–127.

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Bowlby, J. (2005). A secure base. Routledge. Burnell, A., & Vaughan, J. (2012). Family future’s neuro-sequential approach to the assessment and treatment of traumatized children: Neuro-physiological psychotherapy (NPP). In W. Grosso (Ed.), Una casa per un po’—Esperienze di casa-famiglia. Quaderni di Psicoterapia Infantile. Borla. Chalk, R.; Gibbons, A., & Scampa, H. J. (2002). The multiple dimensions of child abuse and neglects: New insights into an old problem. Child Trend Research Brief. www.childtrend.org.May Child Abuse Prevention and Treatment Act. (2010). www.acf.hhs.gov/programs/cb/resource/cap ta2010 Child Traumatic Stress Network Task Force. (2003). In A. Burnell & J. Vaughan (Eds.), Family futures’ neuro-sequential approach to the assessment and treatment of traumatized children: Neuro-physiological psychotherapy (NPP). www.familyfutures.co.uk/wp-content/upl oads/.../family-futures-rationale DeVooght, K., McCoy-Roth, M., & Freundlich, M. (2011). Young and vulnerable: Children five and under experience high maltreatment rates. Early Childhood Highlights, 2(2). Dhawan, H. (2015). When it comes to adoptions, Indians prefer the girl child. The Times of India. DHHS. (2010). www.dhhs.tas.gov.au/about_the_department/.../annual_reports English, D. J. (1998). The extent and consequences of child maltreatment. The future of children: Protecting Children from Abuse and Neglect, 8(1), 39–53. In Guterman, N. B. (2001). Stopping child maltreatment before it starts: Emerging horizons in early home visitation services. Sage. Freud, S. (1909) Analysis of a phobia of a five-year old boy. In The pelican freud library (1977). Vol. 8. Case Histories (Vol. 1, pp. 169–306). Gangopadhyay, J., & Mathur, K. (2021). Examining lived experiences of infertility and perceptions toward the adoption of children in urban India. Adoption Quarterly, 1–19. Howe, D. (2005). Child abuse and neglect: Attachment, development and intervention. Palgrave Macmillan. Lizy, P J. (2016). Adoption as an alternative family system for childless couples in Kerela. Rajagiri Journal of Social Development, 8(1), 31–42. Main, M., & Solomon, J. (1986). Discovery of an insecure disorganized/disoriented attachment pattern: procedures, findings and implications for classification of behaviour. In M. W. Yogman & T. B. Brazelton (Eds.), Affective development in infancy. Ablex. Monahon, C. (1993). Children and trauma: A guide for parents and professionals. Jossey-Bass. Nagera, H. (2006). On adoption: Problems, successes and psychiatric consequences. University of South Florida. Perry, B. (2006). In A. Burnell & J. Vaughan (Eds.), Family futures’ neuro-sequential approach to the assessment and treatment of traumatized children: Neuro-physiological psychotherapy (NPP). www.familyfutures.co.uk/wp-content/uploads/.../family-futures-rationale Putnam, R. (2001). Bowlby alone: The collapse and revival of American community. Simon and Schuster. Rehman, J. (2003). International human rights law: A practical approach. Pearson Education. Ross, T., & Vandivere, S. (2009). Indicators for child maltreatment prevention programmes. Child Trends. www.childtrenddatabank.org Shireman, J. (2003). Critical issues in child welfare. Columbia University Press. Sinha, D. (2006). Infertility, adoption, and reproductive technologies: Challenges before the social work profession. Perspectives in Social Work, 21(2), 21–29. The Hindustan Times. (2017). More single women coming forward to adopt children in India, shows data. New Delhi, March 26, 2017. UDHR. (1945). Article 25 (2). Motherhood and childhood are entitled to special care and assistance. All children, whether born in/ out of wedlock, shall enjoy the same social prestige. Van Bueren, G. (1999). Combating child poverty-human rights approaches. HRQ, 21, 680. van der Kolk, B. (2005). In A. Burnell & J. Vaughan (Eds.), Family futures’ neuro-sequential approach to the assessment and treatment of traumatized children: Neuro-physiological psychotherapy (NPP). www.familyfutures.co.uk/wp-content/uploads/.../family-futures-rationale

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Vaughan, J., Mccullough, E., & Burnell, A. (2016). Neuro-physiological psychotherapy (NPP): The development and application of an integrative, wrap-around service and treatment programme for maltreated children placed in adoptive and foster care placements. Clinical Child Psychology and Psychiatry, 21(4). https://doi.org/10.1177/1359104516635222

Chapter 24

Rights of Children with Disability Prerna Sharma

Introduction Childhood is a time of opportunity and learning, in which even small positive change or development can generate long-term benefits into the future. Therefore, the care a child receives when he or she is young, as well as the manner in which his or her needs are met, has a remarkable impact on the child’s intelligence, personality, and social interactions through adulthood. Further, childhood is the most sensitive part of life for every human being. It is in this period of life that every individual grows up and develops, as well as becomes educated and adjusted to realities of life. The identity of the individual is formed during childhood. Human growth is often viewed in developmental stages, each one having some cardinal characteristics and so is the case with childhood. The consideration of their individual characteristics be it age, caste, class, gender, ability, or disability is of secondary significance. As everybody is equal before the Law, the rights provided under it should also be viewed in the same light. The United Nations Convention on the Rights of the Child (UNCRC) (1989), one of the most widely ratified international instruments, gives legal expression to the notion that children have independent human rights and those rights should be at the heart of all political, economic, and social decision making (UNICEF, 2001). This convention sets universal legal standards for the protection of children against discrimination, neglect, abuse, and exploitation, as well as guaranteeing them their basic human rights, including survival, development, and full participation in social, cultural, educational, and other endeavors necessary for their individual growth and well-being. All children are entitled to rights listed in the UNCRC, including children with disabilities. However, a large number of these children face discrimination, exploitation, and barriers in accessing services and entitlements in their day-to-day P. Sharma (B) Mumbai, India © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_24

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living. When compared with their peers without disability, they also encounter lack of equal opportunities, which impede them from attaining their innate potential. Children with disabilities are at a point where child rights and disability rights intersect. They belong to the constituencies of children and that of the population with a disability. Both the constituencies have specific conditions and circumstances that result in situations of disentitlements and invisibility. Therefore, children with disabilities are liable to face dual as well compounded difficulties. Inevitably, the very children who need these rights the most are unable, through personal and/or social circumstances, to use them. With respect to children with disabilities, the concerns are right to education, right to development, right to participation, right to be accepted as individuals in their own right with dreams, aspirations, the need to work and contribute meaningfully, to be accepted as they are, and to be able to access all public places. Further, they have a unique set of experiences, challenges, issues, and concerns, which are very specific to them due to their impairments. Hence, this chapter focuses on the determinants of experiences that “dis-able” the children with impairments. It draws attention to the concern about rights of children with disability in India in the context of the UNCRC.

Children with Disabilities Children with disabilities are those children who have an impairment leading to dysfunction in any part of their lives, hampering the fulfillment of their roles and responsibilities. In the Convention on the Rights of Persons with Disabilities (UNCRPD) (2006), children with disabilities are described as including those who have long-term impairments that, in interaction with physical, social, economic, or cultural barriers, may limit their ability to participate fully in society on an equal basis with others. Every child craves love, attention, recognition, and acceptance; however, from a very young age, children with disabilities internalize negative perceptions of society undermining their innate potential and self-esteem. Some children with disabilities may encounter a small number of barriers which they and their families can challenge and overcome, while many others can be identified to be at high risk of social exclusion. As a society, we are conditioned to viewing children with disabilities as having a range of deficits, rather than focusing on their strengths and abilities; this is a barrier in the way of fulfillment of rights of disabled children (Alkazi, 2002). It is nearly impossible to define the precise number of children living with a disability in the world because the concepts of both “impairment” and “disability” are defined differently according to cultures and contexts. India is home to millions of children living with a disability, with the Census of India (2001) reporting 2.19 crore (2.13%) of the total population of the country are persons living with disability. Of all persons living with disability, 78% (i.e., 1.67% of total population of the country) are children and young adults in the 0–19 age-group. Barely 50% of children with disabilities reportedly reach adulthood, and no more than 20% survive to cross the

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fourth decade of life (Census of India, 2001). One in every 10 children is born with or acquires a physical, mental, or sensory disability (Government of India estimates 2001). A World Bank report (2008), states that at least one in 12 households includes a member with a disability. Additionally, more than 75% of disabilities are preventable (Thukral, 2002).

Rights of Children with Disabilities in the Context of the UNCRC (1989) Human rights perspective in disability means viewing children with disability as subjects and not objects. It entails a shift from viewing this group of children as problems toward viewing them as holder of rights. The UNCRC, to which India acceded on December 2, 1992, provides a set of universal minimum standards of entitlement for all children. It establishes them as rights holders and insists on the recognition of children as actors in the exercise of their rights, and participants in all matters affecting them. According to UNICEF Innocenti Research Centre (2007), in spite of almost universal ratification of the UNCRC, and the social and political mobilization that led to the adoption of the UNCRPD, children with disabilities and their families continue to be confronted with daily challenges that compromise the enjoyment of their rights. Discrimination and exclusion related to disabilities occur in all countries, in all sectors of society, and across all economic, political, religious, and cultural settings. The shift in focus from the “welfare” to the “rights” approach is considered to be significant (UNICEF, 2007). The right approach means locating problems outside the children with disabilities and addressing the manner in which various economic and social processes can and should accommodate the difference of disability. It means including children with disabilities in all social, political, and economic processes in the manner any other citizen of the country might be expected to, this process is termed as “Inclusion.” The UNCRC was the first and only human rights instrument which contained a specific reference to disability (Article 2 on non-discrimination) and a separate article (Article 23) dedicated to special rights and needs of children with disabilities. It has very clearly and specifically mentioned children with disabilities with the intention of bringing these children as a constituency to be protected and accorded rights. Article 23 of the UNCRC is about recognizing children with disabilities as full human beings. This acknowledges that children living with a disability have the right to enjoy a full and decent life, in conditions which ensure dignity, promote selfreliance, and facilitate the child’s active participation in the community. Paragraphs 2 and 3 of Article 23 stress the fact that children with disabilities are entitled to special care. The emphasis is on special efforts to provide for the special care and special needs of children with disabilities.

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The priority needs, however, of children with disabilities are not special, they are basic as in the case of all children; children with disabilities need food, shelter, love and affection, protection, and education like all children do in order to achieve their inherent potential. The focus of the language used in the text is on the deficiency of the child with disability and the provision of special services to fill the deficiency. It draws instant attention to the fact of disability and highlights the inability of the child. It reinforces and is reinforced by the medical model of disability where disability is seen as a tragedy, and people with disabilities are treated as if they are its victims. The social model of disability is grounded in paradigm shift from welfare to rights based. Rather than identifying disability as an individual limitation, the social model identifies society as the problem and looks for fundamental political and cultural changes to generate solutions. According to this model, disability is not an attribute of an individual, but rather a complex collection of conditions, many of which are created by the social environment. Through this model, the collective responsibility is placed on the society to make the environmental modifications necessary for the full participation of people with disabilities in all areas of social life. The provisions in Article 23 are too limited to ensure the fulfillment and protection of the rights of children with disabilities. Article 2 not only requires governments to respect the equal rights of all children but also imposes active obligations on them to ensure that children are not discriminated against in exercising any of their rights. Offering children with disabilities different or lesser education simply because of their disability is a breach of Article 2. Segregated schooling experiences in special institutions, denial of admission to regular schools, absence of educational experiences in rural areas for children with disabilities, and exclusion from playing with all children on grounds of disability are examples of discrimination that children with disabilities face every day (Curtis, 2002; Human Rights Watch, 2013; IPSEA, 2007; SPLC, 2010). Article 3 states that in all actions concerning children, their best interests must be the primary consideration; adults frequently make decisions and take action in respect of children, ostensibly in their best interests, but are subsequently acknowledged to be on the contrary (UNICEF, 1989). As per Article 5 of the UNCRC, “it is the responsibility of parents and other caregivers to provide direction and guidance in accordance with the evolving capacities of the child.” In other words, as children acquire the competence to exercise rights for themselves, they are entitled to do so and should be encouraged and supported by their parents in that. However, children in all societies have a different legal status from adults. Autonomy involves the right of an individual to self-determination, including, e.g., the right to informed consent for treatment or refusal of treatment. The UNCRPD, therefore, needed to include additional measures to ensure their realization. Article 6 provides for the right to life, survival, and development, meaning that governments must ensure “to the maximum extent possible” the survival and development of children. This requires that children with disabilities, like children without disabilities, are provided with support, resources, and care necessary to promote

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the fulfillment of their potential. According to Puri (2002), children with disabilities in India are denied personal or economic security, health care, education, and basic needs necessary for their growth and development. Further, certain disabilities such as mental disability carry even greater stigma, hampering life chances, and opportunities for their growth and development. Article 12 provides that all children have the right to express their views on all matters of concern to them and to have those views taken seriously in accordance with their age and maturity. Too often, it is the silence and invisibility of children with disabilities that contributes to the persistence of discrimination against them, both as a group and as individuals. It is only through listening directly to the experiences of children with disabilities that adults gain awareness of the extent, nature, and impact of discrimination on their lives. The attitudes of overprotection by some parents, not seriously listening to the child, the tendency of the adults to infantilize or neglect by some others leads to the views of children with disabilities not being taken into account by the significant adults around them (Audit Commission for Local Authorities in England and Wales, United Kingdom, 2003; Taub, 2006). Article 13 follows from Article 12 in terms of the rights of children with disabilities to have access to information and freedom of expression as it states that the child shall have the right to freedom of expression; this right shall include freedom to seek, receive, and impart information and ideas of all kinds, either orally, in writing or in print, in the form of art, or through any other media of the child’s choice. Children with disabilities are often denied their human right to communicate their views. A study conducted by Sharma (2013) on rights fulfillment of children with disabilities in Mumbai revealed that only 34% of parents sought their children’s participation in decisions affecting them. Article 27 affirms the right of every child to a standard of living adequate for the child’s physical, mental, spiritual, and social well-being. There is considerable evidence that the standard of living of families with children with disabilities falls below the necessary standard to satisfy this right (Brewer et al., 2009; Royal College of Nursing, 2011). Moreover, the presence of a child with disability in a family leads to an increase in the demands on the existing resources, as there are additional medical bills to take care of or other aids or supports that need to be arranged. Article 28 recognizes the right of children to education and to be able to access it with equal opportunities. Ninety percent of children with disabilities in developing countries do not attend school (UNESCO, 2000). With respect to disability, inclusive education was perhaps the earliest issue recognized internationally as critical. This is one area where initiatives by the government of India have stressed the critical importance of universalizing education as well as covering all children, including children with disabilities. India has been a signatory to the Salamanca Declaration held in Spain on Education for All in 1992. The Persons with Disability Act, 1995 states that children with disabilities should, as far as possible, be educated in integrated settings. In the District Primary Education Program, launched in 1994, the district primary schools are responsible for all children, including children with disabilities. Article 29 directs governments to ensure that education leads to the development of child’s personality, talents, and mental and physical abilities to their fullest potential.

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The outcome of education leading to personality development is a far cry as access to quality education for children with disabilities in inclusive education settings itself is not available to the majority of disabled children. Article 31 identifies that children with disabilities have the right to take part in play and leisure activities, and to freely express themselves in cultural and artistic ways. It recognizes that resources remain tied up in segregated services rather than being used to help children with disabilities gain equal access to cultural, artistic, recreational, and leisure activities. According to Lansdown (2009), for children with disabilities the most acute sense of marginalization and social exclusion is felt in the field of play, leisure and recreational activities. The exclusion of children with disabilities from play and other structured forms of recreation can stifle both physical and mental growth. Articles 32 and 34 have given stress on governments to ensure the protection of children from economic and sexual exploitation and abuse. Research conducted by UNICEF indicates that violence against children with disabilities occurs at around rates 1.7 times higher than for their peers without disabilities. They are more likely to be victims of violence and sexual abuse. When compared with their peers without disabilities, children with disabilities encounter lack of equal opportunities, which impedes them from attaining their innate potential. Negative societal attitudes also expose children with disabilities to greater risk of violence, abuse, and exploitation (UNICEF EAPR, 2011). Research has revealed that children with disabilities more than other children are targets for sexual abuse because they lack the full capacity to flee the site of violence, defend themselves, or seek justice (Edelson, 2010; Smith & Harrell, 2013; Stalker & McArthur, 2012). Often sexual abuse of children with disability happens because of the widespread assumption that children with disabilities are asexual and hence unlikely to attract sexual attraction (Andrews, 2011; Rogers, 2005). They are also to be found working and/or living on the streets. The UNCRC has resulted in other significant areas of children’s rights being brought to the attention of the world community. Since its adoption in 1989, issues such as sexual exploitation of children, child labor, children in armed conflict, violence against children have been widely acknowledged as human rights issues demanding action. However, to date, no comparable interest has focused on the experiences of children with disabilities. According to Lansdown (2001), they remain largely invisible, hidden within families or institutions, and vulnerable to neglect of their economic, social, cultural, civil, and political rights. Some children have multiple disabilities and are often the most neglected and vulnerable children. On December 13, 2006, the United Nations General Assembly adopted a new UNCRPD as well as an Optional Protocol on the Rights of Persons with Disabilities. India signed the Convention on March 30, 2007, and it was ratified on October 1, 2007. The Convention includes specific provisions for children with disabilities referring to the respect for the evolving capacities of children and to their right to preserve their identities. It provides them with the same rights and freedoms as all children, with particular reference to the rights to be protected from exploitation, violence, and abuse; to express their views on all issues which affect them (Article 7) and to access to justice.

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Factors Leading to Disabling Experiences Lansdown (2002) reports that despite the explicit inclusion of disability as grounds for protection against discrimination in the UNCRC, and the provisions of Article 23, which specifically addresses the situation of children with disabilities, the reality for children with children with disabilities remains largely unchanged in most countries of the world. Children with disabilities can face further physical, attitudinal, policy, and practice-based barriers to full social participation, which may impact on their long-term aspirations and opportunities. Tuli (2002) argues that the pervasive tendency to underestimate the potential of children with disability leads to lack of recognition of their rights and hence their fulfillment. UNICEF Innocenti Research Centre (2007) has found that children with disabilities constantly face barriers to the enjoyment of their basic human rights and to their inclusion in society. Their abilities are overlooked, their capacities are underestimated, and their needs are given a low priority. Marta Santos Pais (2011), the special representative of the UN Secretary General on violence against children, states that life of children with disabilities is surrounded by stigma, discrimination, cultural prejudices and invisibility as well as heightened risk of neglect, violence, injury, and exploitation. She further states that children with disabilities are still viewed as curse, shame for the family, and misfortune for the community. These factors are further discussed below.

Societal Attitudes Disability brings with it many limitations. Physical limitations are those which can be worked with and worked around, but which limit nonetheless. Over and above the restrictions on mobility, there are other limitations in the area of choices and opportunities, which stem from political, economic, and attitudinal sources that are avoidable, and compound the original problems caused by physical disability. These limitations are societal attitudes, policies, and programs, as well as the resistance to accept, to include people with disabilities in mainstream society, which turn disabilities into handicaps. In most parts of India, irrespective of state, region, or religion, the disgrace of giving birth to a child with a disability is unanimous. Despite modern, human rights attitudes, the idea that a child with a disability is the result of anger of Gods, or ancestors, and the embodiment of sin in the family is widely prevalent. Endless research shows that parents of children with disabilities feel guilty and sometimes take the blame for the impairment on themselves (Austin, 2000; Gupta & Singhal, 2004; Kumar & Akhtar, 2001; Marshak et al., 1999; Olkin, 1999; Rangaswami, 1995; Seligman & Darling, 2007). In India, disability is still viewed in terms of a “tragedy” with a “better dead than disabled” approach, the idea being that it is not possible for children with disabilities to be happy or enjoy a good quality of life. Cultural

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beliefs about disability play an important role in determining the way in which the family perceives disability and the kind of measures it takes for prevention, treatment, and rehabilitation (Sen, 1988). There is also a very strong belief in metaphysical causation in India. One such instance is the belief in the theory of karma, which is often invoked to explain major life events, including the occurrence of disability. It has also been shown that people tend to accept their own disability as something which has resulted from their past karma or due to God’s will and thus often show low motivation to overcome the limitations (Alur, 2003; Berry & Dalal, 1996). A belief, in stark contrast, it is the duty of the “non-disabled” to give away food, money, and clothes in charity to those with disabilities, as a religious responsibility to attain mocha, the ultimate liberation (Ghai, 2000). Families, communities, and the medical profession often do not help parents to alleviate their guilt. Their attitude to the children and parents, in fact, makes the situation worse leading to stigma and social isolation. This stigma and guilt result in segregation of the child with a disability. So engrained is the prejudice that even the mother of a child with a disability faces humiliation and indignity (Thukral, 2002). These stigmatizing social attitudes have developed due to a wide psychological gulf of exclusion existing between those with disabilities and those who are able-bodied. It is recognized and acknowledged by the UNCRPD, which formally records that it is not “disability” that hinders full and effective participation of people with disabilities in society, but rather “attitudinal and environmental barriers” in that society. Such barriers and stigmatization underscore the imperative of keeping rights clearly articulated and eventually becoming entrenched in policy and legislative frameworks.

Stigma and Discrimination Children with disabilities suffer from discrimination based on society’s prejudice and ignorance which prevents their integration and full participation in the community. In addition, they often do not enjoy the same opportunities as other children because of the lack of access to essential service leading to their segregation and deprivation from rights entitlements. Stigma leads to children with disabilities often being condemned to social isolation, loneliness, lack of friendships, denial of a voice, and denial of opportunities to participate within society. Barnes (1991) states that type of discrimination encountered by children with disabilities is not just a question of individual prejudice but are institutionalized in the very fabric of our society. Institutional discrimination is a complex form of discrimination that operates throughout society. Institutional discrimination is evident when the policies and activities of all types of modern organizations result in irregularity between children with disabilities and children without disabilities.

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Abuse Often prevailing attitudes perceive the life of a child with a disability as being of less worth, less importance, and of less potential than other lives (Thukral, 2002). Therefore, children with disabilities are more vulnerable to all forms of abuse be it mental, physical, or sexual in all settings, including the family, schools, private and public institutions, and community at large. In the home and in institutions, children with disabilities are often subjected to mental and physical violence and sexual abuse as well as being particularly vulnerable to neglect and negligent treatment since they often present an extra physical and financial burden on the family (International Disability Alliance (IDA), 2010). School bullying is a particular form of violence that children are exposed to and very often, this form of abuse targets children with disabilities. The main reasons for their particular vulnerability include their inability to hear, move, dress, toilet, and bathe independently, increasing their vulnerability to intrusive personal care or abuse; those who have communication or intellectual impairments, may be ignored, disbelieved, or misunderstood even when they report abuse (Eastgate, 2011; Pownall et al., 2011). Parents or others taking care of the child may be under considerable pressure or stress because of physical, financial, and emotional issues in caring for their child, with studies indicating that those under stress may be more likely to commit abuse. Dalal and Pande (1999) investigated cultural beliefs and attitudes of a rural Indian community toward physical disability. The results revealed fatalistic attitudes and external dependence in families with children with disabilities.

Legislation and Lack of Actionable Policies Recognizing the needs of people with disabilities, the Directive Principles of State Policy laid down in the Constitution of India, the obligation of the government to provide assistance for children with disabilities. The National Policy for Children, 1974, has acknowledged the need of, and made provisions for, special treatment, education, and rehabilitation of children with disabilities. Similarly, the National Policy on Education, 1986 has made provisions for mainstream education of children with disability in regular, mainstream schools. The UNCRC and the World Summit on Children 1990 have influenced, to some extent, India’s policy of children. This led to the formulation of a National Plan of Action for Children in 1992, which calls for government departments, community, and society at large for greater participation for the welfare and development of children with disabilities. Provisions to integrate children with disabilities in the mainstream education system have been made in the District Primary Education Program since 1998. The National Plan of Action for Children (2005) has recognized children with disabilities as a special category to be provided with special conditions for their development.

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The National Trust Act aims to enable and empower persons with disabilities (mental retardation, cerebral palsy, autism, and multiple disabilities) to live as independently and as fully as possible. The Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995, assures free and appropriate education to all children with disabilities up to the age of eighteen. The Act can hardly be termed a rights-based legislation. This Act holds the State responsible for the education of all persons with disabilities until the age of eighteen and stipulates 3% reservation for them in government educational institutions or institutions supported by the government. Government schools are bound by law to provide admission to students with disabilities, and the law also stipulates that all public buildings, including educational institutions, be made accessible to everyone. In the 17 years since the Persons with Disability (Equal Opportunities, Protection of Rights and Full Participation) Act (1995) came into being, it has met with very little success even in matters as basic as ensuring a barrier-free environment and generating employment (Mehta et al., 2012). Very few organizations have been penalized for not providing barrier-free environments. In fact, this basic requirement is seen more as a voluntary gesture, and if an organization provides a ramp it’s touted as a praiseworthy achievement. No one considers the fact that, according to the Persons with Disability Act (1995), the provision is mandatory by law. There are several instances where children with disabilities are excluded or even barred from availing the facilities provided even under government run schemes or programs. A case in point is highlighted through a research undertaken by Alur (2003) on Integrated Child Development Scheme (ICDS), run by the government of India, for children from 0 to 6 years and their mothers. She found that children with disabilities were as a matter of routine excluded from availing the benefits through ICDS offered to the rest of the children. Due to ill-defined policy objectives during the policy formulation stage, policy remains silent on the issue, not clarifying that “all” includes children with disabilities as well. Implementation strategies for the inclusion of these children therefore are not worked out, which leads to noninclusion of children with disabilities from the program. Alur (2003) further states policy has been too long silent and ambivalent, with a tacit understanding among policy makers, that children with disabilities are not to be brought into the services of the ICDS due to the difficulties this inclusion may cause. Codes of practice, putting policy into action can only be done if a decision to include this group of children is taken and the resource allocation is made.

Gender Female children with disabilities are more likely not to survive, to be abandoned, discriminated against, excluded from education, deemed un-marriageable, and excluded from motherhood and general participation in their society. There is an over-representation of male children with disabilities in education (Sharma, 2007, 2013), both in special and mainstream schools. Due to differential gender-based

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role expectations, education is not considered a priority for female children with disabilities.

Dropout The rates for female children with disabilities are higher than for male children with disabilities. Poverty Disability is both a cause and a consequence of poverty (Sen, 2000). Majority of the world’s population of people with disabilities live in low-income countries and experience social and economic disadvantages and denial of rights. It is an established fact that families with members with disabilities are frequently the poorest and most marginalized. Poverty becomes one of the most serious barriers to accessing rights entitlements of children with disabilities. Singh agrees that children with disabilities are subject to multiple deprivations as they are generally from the low socio-economic groups and have limited or no awareness of their rights and entitlements. Food deprivation due to poverty has a direct negative bearing on the physical and mental development of children and even starvation deaths (Milteer et al., 2012; Schoufour et al., 2013). Nutritional deficiency disorders like vitamin A blindness, anemia, and goiter are common among poor children leading to disabilities (Rahman et al., 2013). Tuli (2002) states that a majority of children with disabilities are from rural and low-income homes, where immunization coverage is poor, malnutrition is widespread and maternal health is severely undermined by frequent childbirth. Injuries resulting from accidents are often not attended to in time, causing irreversible damage and disability in children. Family poverty may be more likely, and this is particularly the case where more than one family member is a person with a disability, if there are significant care (or child care) costs, and/or parents are unable to work in paid employment. Rogers and Hogan (2003) found that parents of children with disabilities experience increasing financial difficulties resulting from the needs for special equipment, special medical care, and special programs that are appropriate for each child and also families which include a child with a disability are more likely to slide down the economic scale. This may be for a number of reasons including, parental inability to access employment (e.g., due to unavailability of appropriate and affordable childcare); difficulties due to employers’ failure to recognize parental responsibilities for children with special needs; impairment, and disability-related costs; lack of information on, access to entitlements, and adequacy of benefits available for children with disabilities (Rogers & Hogan, 2003).

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Barriers in Education Education is a medium through which the futures of children are molded. India’s education system, on the whole, is designed for children without disabilities, as are most other services in the country. For children with disabilities, an attempt has been made to set up a parallel system of education by way of “special schools”. Although special schools do play a role in rehabilitation, they also keep children with disabilities away from the mainstream, and the mainstream away from children with disabilities. In fact, these institutions have helped push children with disabilities to the periphery where they grow up in a markedly different atmosphere compared to “normal” children. If children are educated differently, the differential treatment is ingrained in them making their future integration into mainstream society almost impossible. The government has provided legislative intent through the Inclusive Education Act, which makes it mandatory to include children with all kinds of disabilities. If one were to go only by the laws and policies regarding inclusion formulated in this country, there is ample reason to be optimistic. Since the 1970s, various Central Government schemes—especially those for Universalization of Elementary Education— have been advocating the inclusion of children with disabilities into the mainstream educational system. These include: • The Integrated Education for Disabled Children Scheme, launched in 1974, to admit children with disabilities in regular schools; • The District Primary Education Program, 1985, which acknowledges the fact that universalization of education is possible only if it includes children with disabilities; • The National Policy on Education, 1986, which promotes the integration of children with mild disabilities into the mainstream; • The Project Integrated Education for the Disabled, launched in 1987, which encourages all schools in a neighborhood to enroll children with disabilities; • The Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995, which recommends making changes in assessment and curriculum, and removing architectural barriers, to support inclusion. It also recommends providing free books and uniform for children with disabilities; • The National Trust for the Welfare of Persons with Autism, Cerebral Retardation and Multiple Disability, 1999, which recommends promotion of inclusive education; • The Sarva Shiksha Abhiyan (SSA, 2000), which pledges that the “SSA will ensure that every child with special needs, irrespective of the kind, category and degree of disability, is provided education in an appropriate environment”; • The Amendment to the Constitution in 2001, to make education a fundamental right for those in the 6–14 age-group, which covers children with disabilities;

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• The draft National Policy for Persons with Disabilities, which has a section on education, stating, “There is a need for mainstreaming of the persons with disabilities in the general education system through inclusive education”. It also mentions that children “learn best in the company of their peers”. Till date, however, there has been no move toward the inclusive concept or equal opportunities for education provided to children with disabilities. According to the National Sample Survey Organization (2002), a report on “Disabled Persons in India” states that 55% persons with disabilities were illiterate; a very large and unacceptable percentage. Children with disabilities are 4–5 times less likely to be enrolled in school and if they remain in school, they rarely progress beyond primary levels. The main barriers they face to access school include: lack of specialized teachers for both physically and mentally challenged children, absence of teacher training programs, absence of disabled-friendly infrastructure, including ramps, special chairs, and toilet facilities, as well as the mockery of adults and other children. The World Bank Report (2007) states that children with disabilities are five times more likely to be out of school than scheduled caste or scheduled tribe (SC/ST) children, and if they stay in school they rarely progress beyond the primary level, leading ultimately to lower employment and incomes. A study conducted by the National Centre for Promotion of Employment for Disabled People disclosed shocking facts of educational discrimination against those with disabilities. A survey of 89 mainstream schools across the country found that a mere 0.5% of the total number of students were those with disabilities, although the Persons with Disabilities Act (1995) recommends a reservation of 3% seats in institutions funded by the government. Eighteen of the schools surveyed acknowledged that they did not admit students with disabilities. Twenty percent of the schools polled were not aware of the 1995 Disability Act at all. In 2007, 12 years after The Persons with Disability Act (1995) was passed, a group of young volunteers for CRY (Child Rights and You) and Sruti Disability Rights Centre conducted a study in Kolkata to discover the gap between policy and ground reality on the issue of inclusive education. In an attempt to cover various aspects of inclusive education, the group sought an appointment with 65 schools in the city, of which only 30, including 16 government schools and 14 private schools, responded positively. Shockingly, the study revealed that 50% of government schools and 36% of private schools were not aware of the 3% reservation for children with disabilities. According to the study, students with disabilities comprised only 0.16% of government school students; private schools had a slightly higher percentage of 0.31%. The study also showed that 0% of the 65 schools in Kolkata that were visited had a ramp or any form of infrastructural facility for supporting education of children with disabilities within their buildings and environment (Sengupta, 2008). The recent introduction and adoption of the Right to Education Act, 2009, have advocated the right of children to free and compulsory education up to the age of 14 years. The Act incorporates a section on disadvantaged children, which also includes children with disabilities. While the Act mentions the inclusion of children

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with disabilities in the educational system, it does not provide mechanisms for implementation. According to a study conducted by Save the Children (2009), a tandem has developed between an acute lack of services for children with disabilities, attitudinal blocks of the larger society, lack of information among parents as well as service providers, and the missing convergence between various agencies. In a paper analyzing the situation of inclusive education facilities, Sharma (2009) identifies that legislation in favor of inclusion has also been supported by circulars issued by various state and central boards of education, such as the Central Board of Secondary Education (CBSE) and the Indian School Certificate Examinations (ICSE). The circulars list various concessions that children with disabilities can avail of. In a circular issued in May 2005, the CBSE states that children with disabilities should have “barrier-free access to all educational facilities,” and that students with dyslexia can study one language instead of two and any four of the subjects such as mathematics, science, social science, music, and painting, among others (Mukherji, 2010a). The ICSE provides extra time to students with disabilities to complete exams, as well as scribes, if required. The children can also choose from a number of subjects such as yoga and physical training (Mukherji, 2010b). Several state governments have similar policies for their boards, for instance, the Maharashtra board gives students with disabilities extra time during tests, provision for scribes, concessions while learning mathematics, and the option of studying one language less than what is otherwise mandatory. The high number of policies in support of inclusion, unfortunately, is in no way indicative of the current situation in the country since these have not been followed through to implementation. A glaring example of segregation in education is the existence of mainstream education for children without disabilities under the Ministry of Human Resource Development, and education for those with disabilities comes under the Ministry of Social Justice and Empowerment. This dichotomy in responsibility for education of children with disabilities and those without disabilities is the beginning point in discrimination in education of the two categories of children.

Protection of Rights of Children with Disability The rights-based approach views children as citizen entitled to all that has been promised to them under the constitution of India and the UNCRC. They are not to be viewed as objects of sympathy, benevolence, or charity. Applying the rights-based approach to children means putting children at the center recognizing them as rights holders and social actors. All children, especially children with disabilities, have a right to be protected by law from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment, or exploitation. Such protection should cover the relationship of the child with his or her parents, legal guardians, or any other person who has the responsibility for the care of the child. The UNCRC establishes duty bearers for guaranteeing children the enjoyment of their rights. The duty bearers

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are the state (Articles 2.2, 3.2, and 37), parents, legal guardians, and individuals responsible for children (Article 3.2); and institutions, facilities and services for the care and protection of the child (Article 3.2). These are duty bearers in the immediate vicinity of children, on who is the onus of meeting all the needs children with disabilities totally dependent on them. Parents play a dual role in the life of a child with a disability. One as mentioned above as duty bearers to make provisions for their child’s growth and development and the other as advocates seeking from the rest of the duty bearers (i.e., institutions, NGOs and the government at the local, state, and central level) services and provisions required by their children with disabilities, both as other children and the special requirements on account of their disabilities to bring them at par with children without disabilities. Since children are dependent on their parents, they are the most important people for the former’s successful growth, development, and learning. Parents are the best advocates for their children since they are most closely associated with them. They also have the maximum amount of knowledge regarding their children; knowledge that may not be available to others. Parents’ knowledge is the basis for their action toward seeking services and securing entitlements for their children. The source of parents’ knowledge is their perceptions and experiences with respect to the disability of their child. Parental perceptions ultimately lead to awareness of rights entitlements of their children, and it is expected that parents fulfill their responsibilities, which build a foundation leading to fulfillment of entitlements of their children. Another set of duty bearers are the government, at central and state levels as well as the machinery at level of local governance, responsible for provisions of services and opportunities for the children. The government has established the National Commission for protection of Child Rights and is also setting up the Commission for Rights of the Child at state level. The commission is responsible for formulating policies for state governments to adopt and put into practice, monitor, and evaluate. It is imperative for any legislation for persons with disabilities to impose obligations on governments to ensure that children with disabilities are equally protected. Most of the measures in place presently are largely inaccessible to children with disabilities (Huq et al., 2013; Kashyap et al., 2012). The Persons with Disability Act, 1995 does not touch upon the issue of protection of children with disabilities from any kind of violence, as it looks into providing measures for education and vocational training of children with disabilities and training of personnel working in the disability sector. Even the Juvenile Justice Act, 2000, does not provide for accessible complaint mechanisms for children with disabilities. Thus, the legislation should guarantee protection from any kind of abuse or economic exploitation and from any work that is likely to be harmful to their development or to interfere with their education, in any way. There is a need for prohibition of violence in all settings, including the home, family, schools, institutions, and the juvenile justice systems. The respective state governments must ensure that institutions providing care for children with disabilities are staffed with specially trained personnel who have been properly screened, according to appropriate standards, regularly monitored and evaluated. The government has set up a National Coordination Group on the Rights of the Child for implementation of child rights in the country, and has instituted a Chair

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on the theme of Protection of Child Rights as part of the 10 Rajiv Gandhi Chairs in Contemporary Studies in central and state universities. These mechanisms, however, are not functional. There is a need to ensure that all children with disabilities have easy access to courts and legal representation, and the lawyers as well as judges should be trained in dealing with children with disabilities. There should be a provision of age-appropriate facilities, i.e., access to sign language, access to information in accessible and ageappropriate forms, physical access to the courts, sufficient time made available to ensure the child fully understands the court procedures, videotaped interviews, and forms of questioning that promote children’s understanding and capacity to express themselves (Lansdown, 2009). Analysis of government reports to the Committee on the Rights of the Child reveals that mostly the only issues ever addressed by governments in respect of children with disabilities relate to education and social welfare, and other rights which include right to participate, to play, to information, to freedom from violence, to an adequate standard of living, and indeed, the right to life are rarely addressed (Lansdown, 2005). The lack of any policy or program for children with disabilities in India depicts that the situation is the same in India as well. It is imperative that any new legislation pays attention to children with disabilities in imposing obligations on governments to ensure that they are afforded equal respect for their rights. Another scenario which needs immediate attention is that large majorities of the adults, who have decision-making responsibility, implementation authority, monitoring jobs, and child rights and child development responsibility, are ignorant about rights of children in general and rights of children with disabilities in particular. Children are dependent on adults for their basic needs and fulfillment of rights. The lack of knowledge and information on human rights of children among the parents and significant adults affects policies and practical day-to-day lives of children with disabilities. The problem of adult illiteracy with respect to children’s rights is extensive, complex, and in urgent need of urgent resolution.

Children with Disabilities and COVID-19 COVID-19 is the new reality that each one of us has to face and battle today. We have achieved a lot of milestones in this journey because of the contribution of different sectors of our society. But there are many vulnerable populations in such a pandemic and children with disabilities constitute one of the most important of these. The situation is difficult for them because of the following reasons: (1) (2)

Children with disabilities have different degrees of care and medical needs as compared to children without disabilities. Their educational needs are to be addressed by various stakeholders like parents, teachers as well as the community. These cannot be taken care of in isolation.

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They are prone to stigmatization and neglect and hence the restrictions imposed because of the pandemic have the tendency to further aggravate the stigma and marginalisation.

According to UNICEF (2020) report on the needs of children with disabilities during COVID-19, these children are less likely to have access to sanitation requirements, more prone to medical problems like diarrhea, respiratory infections and fever as well as are less likely to have access to educational aids. All over the globe, there have been experiences of hindrances to services provided to children with disabilities. This is also because there have been no policy level revisions for these children in fighting against the pandemic. Without specific and well-spelt out measures, children with disabilities will lose in this war against COVID-19. There are sporadic initiatives that may be seen as examples to follow through in this situation. For example, UNICEF India has been working in collaboration with the government to widen the reach of education through its “Stay at home” initiative, screening of mini-educational videos for parents of the children with disabilities and training of special educators in the state of Gujarat. There are many challenges that children with disabilities are facing during the pandemic. Some of them are as follows: • Social distancing and isolation have forced the schools to be shut down for a long period of time. An alternate source of education has been found in the form of online classes. But these do not address the needs of children with disabilities who are getting assistive education in the form of special educators and other technologies that may not be affordable in a home environment (Patel, 2020). • Number of stressors has increased in their environment. Parents might be doing their best to look after their children with disability but confinement at home may result in negative emotions both in the parents as well as the children. Parents have to arrange for many tangible and intangible resources for children with disabilities in addition to the basic needs that anyway have to be looked after. They may not have the same level of expertise to handle all concerns of their children like a trained service provider has. This may cause them to experience added stress and result in a negative impact on children (Aishworiya & Kang, 2021). • Mental health issues have increased in children with disabilities especially anxiety and depression. These put a disadvantage on the progress that children with disabilities would have been making in school and home environments. • Accessibility to the services needed to adequately take care of children with disabilities has decreased. Achievement of developmental milestones is crucial for the healthy development of any child. Hindrance in the procedure may alter the lifelong consequences for them. Children with disabilities take extra time to achieve these goals. Disruption in accessibility to services further perpetuates the problem. There are various steps that can be taken to deal with the challenges faced by children with disabilities during this pandemic. Some of the recommendations are:

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• A multi-stage approach toward the problem is the need of the hour. First, a database on the problems being faced by these children needs to be established through evidence-based research. Then, these facts need to be incorporated into the current plan of tackling COVID-19 by all countries. This will ensure the adequate representation of service requirements of children with disabilities. • Schools should provide online clinics for these children. Sessions with special educators need to be emphasized on and need to be executed with the available technology. • Emergency care systems need to be in place and functional so that disruption in accessibility to the services has a reduced impact on the positive health of these children (Schiariti, 2020).

Conclusion and Recommendations Rights of children are matters of individual entitlements and their fulfillment depends upon social conditions and conducive environment. Children’s survival, development, and active participation are crucial to the progress of any society and it makes good sense to invest in the growth and development of children. Only the recognition of children as individuals with rights can pave the way for future action. In the absence of this, all efforts will be sporadic, addressing only some symptoms and not the root cause of the problems that affect the children of this country. All rights become meaningless if the circumstances in which children live make their realization impossible, as it happens most frequently with children with disabilities. It is important to recognize that all children, including children with disabilities, have within themselves a potential for their own development; however, this can only be realized in an environment where their optimal capacities can thrive. There is an urgent need to provide children with disabilities access to opportunities equally with other children and individuals with disabilities such that they can achieve their potential and become contributing citizens of the nation. An environment where children with disabilities are protected and nurtured needs to be established. Unless specific requirements for children with disabilities are recognized in ways which enable them to be included and to have equal access to the things their peers without disabilities take for granted, then they will continue to be denied access to their human rights. Disability and those with disabilities have to be integrated into everyday life. Segregation in special schools and institutions must be minimized; the issue of disability must consciously move beyond issues of special education and medical rehabilitation, and be mainstreamed into other discourses such as the economy, polity, entertainment, sports, fashion, and lifestyle. The language of special needs and vulnerable groups has to be replaced with less stigmatizing and more empowering terms like human rights and specific needs. Families have to be helped to overcome feelings of shame at having a child with a disability. Most important of all, children with disabilities have to be helped to acquire a positive sense of self,

24 Rights of Children with Disability

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self-confidence, and self-respect. Only when these are achieved will there be total inclusion and empowerment. Acknowledgements Author expresses her gratitude to Dr. Anjali Gireesan, Scientist-C of DRDO, for her support in revising the chapter with latest information.

References Aishworiya, R., & Kang, Y. Q. (2021). Including children with developmental disabilities in the equation during this COVID-19 pandemic. Journal of Autism and Developmental Disorders, 51(6), 2155–2158. Alkazi, R. (2002). Not less, just different: Children with mental impairment, in seen, but not heard: India’s marginalized, neglected and vulnerable children. Voluntary Health Association of India. Alur, M. (2003). Invisible children: A study of policy exclusion. Viva Books Private Limited. Andrews, E. E. (2011, May 20). Pregnancy with a physical disability: One psychologist’s journey. Spotlight on Disability Newsletter. American Psychological Association. Audit Commission for Local Authorities in England and Wales (United Kingdom). (2003). Services for disabled children: A review of services for disabled children and their families. Retrieved February 25, 2014, from http://www.audit-commission.gov.uk/SiteCollectionDocuments/AuditC ommissionReports/NationalStudies/Disabled-report.pdf Austin, J. F. (2000). The role of parents as advocates for the transition rights of their disabled youth. Disability Studies Quarterly, 20(4), 75–83. Barnes, C. (1991). Disabled people in Britain and discrimination: A case for anti discrimination legislation. C Hurst & Co. Publishers Ltd. Berry, J., & Dalal, A. K. (1996). Disability attitudes, beliefs and behaviors: A preliminary report on an international project in community based rehabilitation [Unpublished Manuscript]. Queen’s University. ICACBR, Kingston, Canada. Brewer, M., O’Dea, C., Paull, G., & Sibieta, L. (2009). The living standards of families with children reporting low incomes. Department for Work and Pensions (DWP). Retrieved June 7, 2014, from http://lx.iriss.org.uk/sites/default/files/resources/rrep577.pdf Census of India: Census Data Online. (2001). Office of the registrar general and census commissioner, India, Ministry of Home Affairs, Government of India. Retrieved July 9, 2014. http:// www.censusindia.gov.in Curtis, P. (2002, December 9). Disabled pupils face discrimination at school. The Guardian. http:// theguardian.com Dalal, A. K., & Pande, N. (1999). Cultural beliefs and family care of the children with disabilities. Psychology and Developing Societies, 11(1), 55–75. https://doi.org/10.1177/097133369901 100103 Eastgate, G. (2011). Sex and intellectual disability: Dealing with sexual health issues. Australian Family Physician, 40(4), 188. Edelson, M. G. (2010). Sexual abuse of children with autism: Factors that increase risk and interfere with recognition of abuse. Disability Studies Quarterly, 30(1). Ghai, A. (2000). Towards understanding disability. Psychological Studies, 45, 145–149. Gupta, A., & Singhal, N. (2004). Positive perceptions in parents of children with disabilities. Asia Pacific Disability Rehabilitation Journal, 15(1), 22–35. Human Rights Watch. (2013, July 15). China: End discrimination, exclusion of children with disabilities. Retrieved May 12, 2014, from http://www.hrw.org/news/2013/07/15/china-end-discrimin ation-exclusion-children-disabilities

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Huq, N. L., Edmonds, T. J., Baker, S. M., Busjia, L., Devine, A., Fotis, K., & Keeffe, J. E. (2013). The rapid assessment of disability–informing the development of an instrument to measure the effectiveness of disability inclusive development through a qualitative study in Bangladesh. Disability, CBR and Inclusive Development, 24(3), 37–60. https://doi.org/10.5463/dcid.v24i3.174 International Disability Alliance (IDA). (2010). IDA submission to the committee on economic, social and cultural rights day of general discussion on sexual and reproductive health rights, November 15, 2010. Retrieved June 27, 2014, from www.internationaldisabilityalliance.org IPSEA. (2007). School discriminated against disabled child by excluding him from swimming, club and school trip. Retrieved June 17, 2014, from http://ipsea.org.uk/News/News-archive/School-dis criminated-against-disabled-child-by-excluding-him-from-swimming-club-andschool-trip.aspx Kashyap, K., Thunga, R., Rao, A. K., & Balamurali, N. P. (2012). Trends of utilization of government disability benefits among chronic mentally ill. Indian Journal of Psychiatry, 54(1), 54. https:// doi.org/10.4103/0019-5545.94648 Kumar, I., & Akhtar, S. (2001). Rate of anxiety in mothers of mentally retarded children. Indian Journal of Psychiatry, 43, 27. Lansdown, G. (2001, September). It is our world too: A report on the lives of disabled children, for the UN general assembly special session on children. Disability Awareness in Action. Retrieved February 22, 2014, from www.daa.org.uk/uploads/pdf/It%20is%20Our%20World%20Too!.pdf Lansdown, G. (2002). Disabled children in South Africa: Progress in implementing the convention on the rights of the child, the international disability and human rights network. Retrieved June 12, 2014, from http://daa.org.uk Lansdown, G. (2005). Children’s welfare and children’s rights. In H. Hendrick (Ed.), Child welfare and social policy: An essential reader. The Policy Press. Lansdown, G. (2009). See me, hear me, a guide to using the UN convention on the rights of persons with disabilities to promote the rights of children. The Save the Children Fund. Retrieved June 15, 2014, from www.crin.org/docs/See_me_hear_final.pdf Marshak, L. E., Seligman, M., & Prezant, F. (1999). Disability and the family life cycle: Recognizing and treating developmental challenges. Basic Books. Mehta, K., Garware, M. V., & Deshpande, S. (2012). Identifying and implementing social infrastructure for social inclusion of people with disabilities in India. Aweshkar Research Journal, 13(1), 10–22. Milteer, R. M., Ginsburg, K. R., Mulligan, D. A., Ameenuddin, N., Brown, A., Christakis, D. A., & Swanson, W. S. (2012). The importance of play in promoting healthy child development and maintaining strong parent-child bond: Focus on children in poverty. Pediatrics, 129(1), e204– e213. https://doi.org/10.1542/peds.2011-2953 Mukherji, A. (2010a, February 4). Tough to integrate special students in ‘normal’ schools (p. 6). The Times of India, Mumbai Edition. Mukherji, A. (2010b, February 4). CBSE policy on special kids is proactive (p. 6). The Times of India, Mumbai Edition. National Sample Survey Organization. (2002). Disabled persons in India: NSS 58th round, ministry of statistics and programme implementation. Government of India. Retrieved November 31, 2011, from http://mospi.nic.in/rept%20_%20pubn/485_final.pdf Olkin, R. (1999). What psychotherapists should know about disability. Guilford Publications. Pais, M. S. (2011). Promoting rights of children with disabilities. Retrieved July 4, 2015. http://un. org/disabilities/documents/events/17june2011_marta_santos_pais.pdf Patel, K. (2020). Mental health implications of COVID-19 on children with disabilities. Asian Journal of Psychiatry, 54, 102273. Pownall, J. D., Jahoda, A., Hastings, R., & Kerr, L. (2011). Sexual understanding and development of young people with intellectual disabilities: Mothers’ perspectives of within-family context. American Journal on Intellectual and Developmental Disabilities, 116(3), 205–219. https://doi. org/10.1352/1944-7558-116.3.205 Puri, M. (2002). In E. G. Thukral (Ed.), The disabled child, children in globalizing India: Challenging our conscience. HAQ Center for Child Rights.

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Rahman, A. S., Sarker, S. A., Ahmed, T., Islam, R., Wahed, M. A., & Sack, D. A. (2013). Relationship of intestinal parasites, H. pylori infection with anemia or iron status among school age children in rural Bangladesh. Journal of Gastroenterology and Hepatology Research, 2(9). https://doi.org/ 10.6051/j.issn.2224-3992.2013.02.333 Rangaswami, K. (1995). Parental attitude towards mentally retarded children. Indian Journal of Clinical Psychology, 22, 20–23. Rogers, J. (2005). The disabled woman’s guide to pregnancy and birth. Demos Publishing. Rogers, M. L., & Hogan, D. P. (2003). Family life with children with disabilities: The key role of rehabilitation. Journal of Marriage and Family, 65(4), 818–833. https://doi.org/10.1111/j.17413737.2003.00818.x Royal College of Nursing. (2011). Health care service standards in caring for neonates, children and young people. Royal College of Nursing. Retrieved June 20, 2014, from http://www.rcn. org.uk Schiariti, V. (2020). The human rights of children with disabilities during health emergencies: The challenge of COVID-19. Developmental Medicine and Child Neurology, 62(6), 661. Schoufour, J. D., Mitnitski, A., Rockwood, K., Evenhuis, H. M., & Echteld, M. A. (2013). Development of a frailty index for older people with intellectual disabilities: Results from the HA-ID study. Research in Developmental Disabilities, 34(5), 1541–1555. https://doi.org/10.1016/j.ridd. 2013.01.029 Seligman, M., & Darling, R. B. (2007). Ordinary families, special children: A systems approach to childhood disability. Guilford Books. Sen, A. (1988). Psychosocial integration of the handicapped. Mittal Publications. Sen, A. (2000). A decade of human development. Journal of Human Development, 1(1). Sengupta, S. (2008). Out of sight out of mind, info change news and features. Retrieved September 18, 2010, from http://infochangeindia.org/200706156475/Agenda/Child-Rights-In-India/ Sharma, P. (2007). Rights of children with disability. Presented at the National Seminar on child rights, organized by Department of Social Work. Jamia Millia Islamia University. Sharma, P. (2009). Inclusive education: A right of children with disability. In Perspectives in social work (Vol. 24, p. 3). College of Social Work. Sharma, P. (2013). Rights entitlements of children with disability: Study of parents awareness in India, Mumbai. International Journal of Arts and Sciences, 6(3). CD-ROM. ISSN 1944-6934. Smith, N., & Harrell, S. (2013, March). Sexual abuse of children with disabilities: A national snapshot. Vera Institute of Justice. Retrieved June 12, 2014, from http://www.vera.org/sites/default/ files/resources/downloads/sexual-abuse-of-children-with-disabilitiesnational-snapshot-v3.pdf SPLC. (2010, July 28). Children with disabilities face discrimination in New Orleans Schools. Retrieved June 18, 2014, from http://www.splcenter.org/get-informed/news/splccomplaint-chi ldren-with-disabilities-face-discrimination-in-new-orleans-schoo SSA. (2009). Department of School Education and Literacy, Ministry of Human Resource Development, Government of India. Retrieved July 4, 2015. http://ssa.nic.in Stalker, K., & McArthur, K. (2012). Child abuse, child protection and disabled children: A review of recent research. Child Abuse Review, 21(1), 24–40. https://doi.org/10.1002/car.1154 Taub, D. J. (2006). Understanding the concerns of parents of students with disabilities: Challenges and roles for school counselors. Professional School Counseling, 10(1), 52–57. Thukral, E. G. (2002). Children in globalizing India: Challenging our conscience. HAQ Centre for Child Rights. Tuli, U. (2002). Breaking barriers: Physically challenged children in seen but not heard: India’s marginalized, neglected and vulnerable children. Voluntary Health Association of India. UNCRPD. (2006). Retrieved July 4, 2015, from http://www.un.org/disabilities UNESCO. (2000). Educational for all 2000 assessment, statistical document. World Education Forum. UNESCO. UNICEF. (2001). Pocket guide for a rights based approach to programming for children, application in South Asia. UNICEF Regional Office for South Asia.

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UNICEF. (2007). Promoting the rights of children with disabilities, Innocenti digest no. 13. UNICEF Innocenti Research Centre. Retrieved June 17, 2014, from www.unicef-irc.org/publications/pdf/ digest UNICEF Innocenti Research Centre. (2007). http://www.unicef-irc.org/publications/pdf/rc7_eng. pdf UNICEF East Asia and Pacific Region. (2011). Fight against marginalization of disabled children. Retrieved June 23, 2013, from http://www.unicef.org/eapro/media_16363.html UNICEF. (2020). United Nations children’s fund, children with disabilities: Ensuring their inclusion in COVID-19 response strategies and evidence generation. New York. UNICRC. (1989). Convention on the rights of the child. Retrieved June 23, 2013, from http://www. ohchr.org/en/professionalinterest/pages/crc.aspx World Bank. (2007). People with disabilities in India: From commitments to outcomes. Retrieved June 23, 2013, from http://worldbank.org.in World Bank Report. (2008). Website on data and statistics on disability at. Retrieved July 1, 2015. http://www.worldbank.org.disability

Chapter 25

Prevention of Abandonment of Children with Special Needs Through Community-Based Programmes and Intervention Chitra Shah

Introduction The Constitution of India ensures equality, freedom, justice, and dignity of all individuals and implicitly mandates an inclusive society for all, including persons with disabilities (PwD). This calls for a multi-sectoral collaborative approach, involving all the appropriate government institutions, i.e. Ministries of the Central Government, the State Governments/UTs, Central/State undertakings, local authorities, and other appropriate authorities. At the Central level, The Ministry of Social Justice and Empowerment is entrusted with the welfare, social justice, and empowerment of the disadvantaged and marginalized sections of the society, viz. Scheduled Castes, Backward Classes, Persons with Disabilities, Senior Citizens, and Victims of Drug Abuse, etc. As per the 2011 Census of India, the differently-abled population in India is 26.8 million. In percentage terms, this stands at 2.21%. There has been a marginal increase in the differently-abled population in India, with the figure rising from 21.9 million in 2001 to 26.8 million over the period of 10 years. As per the 2011 Census of India, there are 14.9 million men with disabilities as compared to 11.9 million women with disabilities. The total number of differentlyabled people is over 18.0 million in rural areas and just 8.1 million enumerated in urban settings. The percentage of men with disabilities is 2.41% as against 2.01% in women. Social group-wise analysis shows 2.45% of the total disabled population belong to the Scheduled Castes (SC), 2.05% to the Scheduled Tribes (ST) and 2.18% to other than SC/ST. Among the disabled population, 56% were males and 44% were females. Statement 3.1: Total Population and the population of disabled persons in India— Census, 2011. C. Shah (B) Satya Special School—An NGO Engaged in Services for Disabled Children, Puducherry, India e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_25

429

430

C. Shah

Population, India 2011

Disabled persons, India 2011

Persons

Males

Females

Persons

Males

Females

1210.8 million

623.2 million

587.6 million

26.8 million

14.9 million

11.9 million

Abuse Experienced by Children with Disability Children with disabilities are three to four times more likely to be victims of violence. Children and adults with disabilities often face a wide range of physical, social, and environmental barriers to full participation in society, including reduced access to health care, education, and other support services. Understanding the extent of violence against children with disabilities is an essential first step in developing effective programmes to prevent them from becoming victims of violence and to improve their health and the quality of their lives. To this end, research teams at Liverpool John Moores University and the World Health Organization conducted the first systematic review, including meta-analysis, of existing studies on violence against children with disabilities (aged 18 years and under). Seventeen studies, all from high-income countries, met the criteria for inclusion in the review. Prevalence estimates of violence against children with disabilities ranged from 26.7% for combined measures of violence to 20.4% for physical violence and 13.7% for sexual violence.1 Estimates of risk indicated that children with disabilities were at a significantly greater risk of experiencing violence than peers without disabilities: 3.7 times more likely for combined measures of violence, 3.6 times more likely for physical violence and 2.9 times more likely for sexual violence. The type of disability appeared to affect the prevalence and risk of violence, although the evidence on this point was not conclusive. For instance, children with mental or intellectual disabilities were 4.6 times more likely to be victims of sexual violence than their non-disabled peers. This review demonstrated that violence is a major problem for children with disabilities. It also highlighted the absence of high-quality studies on the topic from low- and middle-income countries, which generally have higher population rates of disability, higher levels of violence, and fewer support services for those living with a disability. This gap in the research urgently needs to be filled. A number of explanations have been put forward to account for the greater risk of violence for children with disabilities. Having to care for a child with a disability can put extra strain on parents or households and increase the risk of abuse. Significant numbers of children with disabilities continue to be placed into residential care, which is a major risk factor for sexual and physical abuse. Children with disabilities that affect communication may be particularly vulnerable to abuse, since communication barriers can hamper their ability to disclose abusive experiences. 1

https://www.pubmed.ncbi.nlm.nih.gov/22795511/.

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The Convention on the Rights of Persons with Disabilities aims to protect the rights of individuals with disabilities and guarantee their full and equal participation in society. In the case of children with disabilities, this includes ensuring a safe and stable progression through childhood and into adulthood. As with all children, a safe and secure childhood provides the best chance of achieving a healthy, welladjusted adulthood. Adverse childhood experiences, including violence, are known to be related to a wide range of negative health and social outcomes in later life. The extra demands placed on children with disabilities—who must cope with their disabilities and overcome societal barriers that increase their risk of poorer outcomes in later life—mean that a safe and secure childhood is particularly important. Children placed away from home need increased care and protection, and institutional cultures, regimes, and structures that exacerbate the risk of violence and abuse should be addressed as a matter of urgency. Whether they live in institutions or with their families or other caregivers, all children with disabilities should be viewed as a high-risk group in which it is critical to identify violence. They may benefit from interventions such as home visits and parenting programmes, which have been demonstrated to be effective for preventing violence and mitigating its consequences in children without disabilities. The effectiveness of such interventions for children with disabilities should be evaluated as a matter of priority.

Institutionalization of Children with Special Needs Throughout the world, millions of children with disabilities are separated from their families and placed in orphanages, boarding schools, psychiatric facilities, and social care homes. Children who survive institutions face the prospect of lifetime segregation from society in facilities for adults. According to the Convention on the Rights of Persons with Disabilities (CRPD), segregating children on the basis of their disability violates the rights of every such child. Article 19 of the Convention requires governments to establish the laws, social policies, and community support services needed to prevent isolation or segregation from communities. Raising children in congregate settings is inherently dangerous. Even in clean, well-managed, and well-staffed institutions, children encounter greater risks to their life and health compared to those who grow up in families. Children who grow up in institutions are likely to acquire developmental disabilities, and the youngest among them also face potentially irreversible psychological damage. For a child who has already been institutionalized, falling ill can be a death sentence. Official statistics are unreliable and often understate reliance upon segregated service systems. The numbers are often limited to orphanages and do not include children detained in other types of institutions, such as boarding schools, healthcare or psychiatric facilities, criminal justice systems, or homeless shelters. Private or religious institutions, which may be much larger than government orphanages, are often not counted.

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C. Shah

No child should ever be taken away from her or his family on the basis of their disability. Disability Rights International (DRI) is calling on every government and international donor agency to commit to preventing any new placements in orphanages. It is much harder to protect children and provide them with an opportunity for a life in society when their ties to family have already been broken. The detention of children in institutions is a fundamental human rights violation. We can bring it to an end, on a worldwide scale, through a moratorium on new placements and alternative models of protecting them through community-based rehabilitation approaches.

Status of CWSN in Puducherry, India The services offered to CWSN in Puducherry are not adequate for the population’s needs. Actors within the field of disabilities (special schools, NGOs, parents’ and teachers’ associations, governmental initiatives, etc.) do not interact and do not coordinate their actions. This leads to an ineffective system which places Puducherry back by 10 years compared with other Indian states. Intellectual disability is defined as significantly sub-average general intellectual functioning, existing concurrently with defects in adaptive behaviour manifested during the development period, which is taken up to 18 years, and based on the Intellectual Quotient. It can be classified as mild, moderate, severe and profound. Mental challenge is also a source of stress to the family of an individual with this disorder. From identification through treatment or education, families struggle with questions about causes and prognosis, as well as guilt, a sense of loss, and disillusionment about the future. In most parts of India, irrespective of state, region, or religion, the disgrace of giving birth to a mentally disabled child is unanimous. Families, communities, and the medical profession often do not help to alleviate this guilt by their attitude to the baby and to the parents, calling the child a “vegetable”, “useless”, or “a burden.” Inevitably, this stigma and guilt result in isolation or segregation of the mentally disabled child.

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NSS Report No. 583: Persons with Disabilities in India NSS 76th Round (July–December 2018) The National Statistical Office (NSO), Ministry of Statistics and Programme Implementation has conducted a Survey of Persons with Disabilities during July 2018 to December 2018 as a part of 76th round of National Sample Survey (NSS).2 Prior to this, survey on the same subject was carried out by NSO during the 58th round (July–December 2002). The main objective of the Survey of Persons with Disabilities conducted by NSO in its 76th round was to estimate indicators of incidence and prevalence of disability, cause of disability, age at onset of disability, facilities available to the persons with disability, difficulties faced by persons with disability in accessing/using public building/public transport, arrangement of regular care givers, out-of-pocket expenses relating to disability, etc. In the NSS 76th round survey, for classification of disabilities, all the specified disabilities as stated in The Rights of Persons with Disabilities Act, 2016 have been considered. The status of persons with disability in Puducherry as per the NSS Report No. 583 is as follows:

2

Persons with Disabilities (Divyangjan) in India—A statistical profile: 2021.

36.2

Person having disability since birth

65.3 24.1

Literacy rate of persons of age 7 years and above with disability

Persons of age 15 years and above with disability having highest level of completed education secondary and above

Source NSS Report No. 583: persons with disabilities in India

62.9

Persons with disability having certificate of disability

5.3

0.3 0.0

Person with other type of disability

0.2

Person with mental retardation/intellectual disability

Person with mental illness

0.8 0.4

0.4

Person with visual disability

Person with speech and language disability

1.9

Person with locomotor disability

Person with hearing disability

3.7

Person with any type of disability

Person with disability who are living alone

Female

Person

17.0

49.1

54.7

2.5

30.3

0.0

0.2

0.1

0.1

0.6

0.6

1.2

2.7

20.8

57.8

59.1

4.0

33.5

0.0

0.3

0.1

0.2

0.7

0.5

1.5

3.2

42.2

73.3

54.2

0.8

28.3

0.0

0.1

0.3

0.1

0.4

0.2

1.4

2.3

26.7

56.5

50.5

6.2

27.1

0.0

0.2

0.2

0.1

0.4

0.2

1.4

2.3

34.9

65.6

52.5

3.3

27.8

0.0

0.1

0.2

0.1

0.4

0.2

1.4

2.3

34.2

69.7

58.1

2.8

31.8

0.0

0.2

0.3

0.2

0.5

0.2

1.5

2.8

22.3

53.2

52.4

4.5

28.6

0.0

0.2

0.1

0.1

0.5

0.3

1.3

2.5

Female

Rural + urban Male

Male

Person

Male

Female

Rural urban

Statement 3.36.1: Statistical profile of persons with disability: Puducherry (all figures are given in %)

28.6

62.1

55.4

3.6

30.3

0.0

0.2

0.2

0.2

0.5

0.3

1.4

2.6

Person

434 C. Shah

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Consequently, children with disabilities are among the most marginalized sections of society in India. According to the report “People with disabilities in India: from commitments to outcomes” published by the World Bank (2007), there is growing evidence that people with disabilities comprise between 4% and 8% of the Indian population (around 40–90 million individuals). This includes persons with visual, hearing, speech, locomotor, and mental disabilities. In this general framework, The National Plan of Action for Children (2005) recognizes the actual limitations existing in the system and the need to urgently reach the next goals: • To ensure inclusion and effective access to education, health, and vocational training along with specialized rehabilitation services to disabled children; • To ensure the right to development as well as recognition of special needs and of care and protection to children with disabilities who are vulnerable, such as, children with severe multiple disabilities, children with mental illnesses, severe mental impairment, children with disabilities from poor families, girl children, etc. The World Bank’s report “Dying for Change” explored the views of around 60,000 people who were defined as poor. The report highlighted the problems these poor people had in accessing appropriate and affordable health care. The problems they spoke of are common all over India: • Cost of treatment and care (including costs of transport and loss of wages during treatment) • Low quality of health services available • Staff shortages and absenteeism • Lack of drugs and equipment • Difficulties in accessing and understanding information • Another problem that poor people commonly talk about is the rudeness and lack of respect shown to them by health workers. Most of the mentally challenged children suffer from physical deformities in addition to their mental disability; they are in need of regular therapy to help overcome their gross motor difficulties. At present, the Puducherry Government healthcare system does not have the necessary facilities, and private facilities are beyond the reach of these children from economically poor families.

Context Analysis and Justification The main problems of Children with Special Needs which need to be addressed are: (i)

Social Stigma and Lack of Awareness About Mental Disability

436

C. Shah

As already explained, being born or having a child affected by disability is often perceived as “God’s punishment” for some kind of past sins, or a shame to bear. The ratio of CWSNs to the total number of abandoned children has constantly increased in the last 10 years, and for the majority of them, it is not possible to find an adoptive family and they are doomed to a (very short) life in institution. (ii)

No Access to Health, Rehabilitation, and Educational Services

For instance, children with impairments may be hidden away at home, and are more likely than their peers to not go to school, and receive less food, and generally be neglected, which makes it even harder for them to develop their potential and find employment when they grow up. According to a CIAI’s (Centro Italiano Aiuti all’infanzia) and Satya Special School’s study report (2009–2010), in Puducherry U.T., a population of 8000 disabled children has been estimated. Of them, around 1700 are mentally challenged and at the time, only 47 of them were receiving adequate health, rehabilitation, and education services. The number of rehabilitation facilities available in Puducherry is inadequate, and the qualification is insufficient. In the rural areas, they are almost inexistent. For a population of more than 250,000 persons, there were only two clinical psychologists, one small prosthetics workshop, one neurosurgeon, five special educators of whom only one is trained in handling mentally challenged children, and no occupational therapist. The existing private facilities are beyond the reach of the poor or the rural areas inhabitants. Education for “children with mild disabilities” remains very low, due to the lack of capacities of the government to give specific training to teachers, and the need of special “bridge courses”, extracurricular activities, transport, and structural facilities, etc., to facilitate the integration of these children in normal schools. The education of children with severe disabilities is even worse. There are about 24 special schools in Puducherry U.T., most of them running without special teachers. (iii)

Lack of Vocational Training and Employability Opportunities for People with Disabilities

In Puducherry, there is only one government-run Vocational Training Centre for Challenged Children, but only mild and moderate mentally challenged children (1% of the seats in the centre) can attend the training because of the limited capacity of the centre. The Government of India has reserved 4% of vacancies for people with disabilities in government establishments. However, departments are free to apply for exemption from this reservation and many have chosen to do so as well. With a significant lack of education and training opportunities for youth with intellectual and developmental disabilities and delays, the problem is compounded. This leaves a sizeable population in the employable age of 18–25 years marginalized and away from mainstream society.

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Lack of Trained Human Resource Professionals to Work with Children with Special Needs in Puducherry

The law-established ratio of one teacher for every seven mentally challenged children is definitely not attained in Puducherry, with only 15 qualified special educators for 24 special schools. The main reason for the lack of qualified human resources is that a certified training course for special teachers does not exist in Puducherry. The nearest available programme is in Chennai, where the higher costs of training, boarding and lodging make it unattractive for Puducherry aspirants. Satya Special School has started a 2-year Diploma in Special Education with specialization in Mental Retardation but the result of this effort will be noticed only in a year when the first batch of students finish the programme. (v)

Lack of Coordination Among Actors in the Field of Disabilities

A preliminary research conducted in governmental centres, special schools, and institutes in Puducherry, showed that: • Among parents of CWSNs, there is no networking that will help in sharing information and practices to enable them to better help their children; • Special schools, fearing competitors or for lack of professionalism, do not share information among themselves; • Special schools are concentrated in urban areas, where duplication of services is abundant and rural areas are uncovered; and • There are no associations entirely led by PwDs that can fight and advocate for their rights. Also, since most of the schools are charity driven rather than dignity driven, they work more towards creating sympathy about the child’s condition rather than actual rehabilitation. In Puducherry, the added vacuum created due to lack of the community-based rehabilitation initiatives is also a major cause of concern as facilities are beyond the reach of children in the semi urban and rural areas. Generally speaking, the disability sector actors’ lack of coordination, a lot of small schools competing for the same territory with the same services and there being neither common vision nor common action to find optimized common solutions to common problems. Ideally, facilities like maternity clinics responsible for child birth, the child specialist or paediatrician who does the first assessment of the new born child, early intervention clinics or special schools, and therapists must have a network where any child identified with special needs is immediately referred for therapy or early intervention, as the case may be. Unfortunately, in India, parents neglect the crucial developmental years (0–3 years), due to fear of social acceptance: parents rely more on “God men” and “quacks” for quick and easy ways of changing their “karma” or past sins. In some cases, even medical practitioners, understanding the desperation shown by parents in “curing” their child’s condition rather than rehabilitating them to live with their condition, promise miracles through unnecessary medical interventions like scanning, various tests, expensive medicines, etc. Traditional alternative

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medical treatments like Ayurveda, Unani, or herbal medicines also promise a cure for mental disability. The situation gets further complicated as therapy facilities are too expensive even for the middle-income group. Also, since most of the schools are charity driven rather than dignity driven, they work more towards creating sympathy about the child’s condition rather than actual rehabilitation. Concentration of special schools in urban areas and duplication of services is also a major cause of concern. In Puducherry, the added vacuum created due to lack of the community-based rehabilitation initiatives is also a major cause of concern as facilities are beyond the reach of children in the semi urban and rural areas. Initially as parents are keen on curing the child’s condition, their efforts are directed towards running from a specialist who promises a cure, to a quack who promises a miracle on a full moon day, to a therapist who can provide quick results. Eventually, having exhausted all their financial capabilities, as a last option with almost no hope, parents approach special schools. In some cases, due to a lack of awareness and since the child has lost his/her important years of development, parents reconcile to the fact that there is no future for their children and do not even make the effort of getting the child to attend any special school. Also, since most of the schools are charity driven rather than dignity driven, they work more towards creating sympathy about the child’s condition rather than actual rehabilitation. Concentration of special schools in urban areas and duplication of services is also a major cause of concern. In Puducherry, the added vacuum created due to lack of the communitybased rehabilitation initiatives is also a major cause of concern as facilities are beyond the reach of children in the semi urban and rural areas. In some cases, medical intervention is also stopped. For example, when Satya organized a dental check-up for the children—even children as old as 15 years had never been assessed or treated by a dentist! This clearly brought to light the fact that Children with Special Needs are deprived on a social, medical, and emotional level—they lead lives as second class citizens. It is only ironic that some Indian cities boast of the state-of-the-art clinics, but less than human facilities for CWSNs. Though awareness creation is the answer, a major hurdle is the lack of coordinated rehabilitation efforts by the government, NGOs, and professionals involved in working with CWSNs. Lack of coordination has left facilities in Puducherry lagging behind by nearly two decades, with established NGOs in the major metros doing some unique and wonderful work. Negative contributing factors include over crowded government medical facilities in Puducherry and a lack of specialized therapy services and qualified staff to attend to the mentally and multiply challenged children. In addition, existing private facilities are beyond the reach of the poor.

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Satya Special School in Puducherry Satya Special School exists to provide an integrated system to help people with disabilities, especially children with intellectual and developmental disabilities, reach their potential. While the name might indicate an educational institution, the organization is much more than that and encompasses initiatives to ensure the holistic integration of people with disabilities into the social fabric. Vision and Mission of Satya Special School: An inclusive society where integrated and holistic rehabilitation system prevails to improve their lives, dignity, socio-cultural and economic status of children/person with disability. In the Territorial Union of Puducherry, Satya estimated that the population of disabled children is almost 8000 and only 1% of them receive adequate heath, rehabilitation and education services. Puducherry is the fourth state in India in the ranking of “proportion of disabled not seeking any treatment” (in 2002 almost 90% of CWSN had not been attended), and the main health constraints remain the demand and the supply of services: • At an individual level, Satya observed the lack of awareness, and/or physical and financial ability to demand or access existing governmental schemes, and the general problems in health delivery for all. • At the Puducherry UT and the national level, Satya observed the low priority to disability in an already overburdened health system. The number of rehabilitation staff available in Puducherry is inadequate, and the qualification is insufficient overall in the case of therapies for multiple disabilities, including children with intellectual disabilities. As an illustration, in Puducherry, in 2010, for a population of more than 250,000 persons there are only two clinical psychologists, one prosthetics small workshop (one trained personnel is required to meet the needs of 1000 people, as per WHO’s guidelines), zero occupational therapists, one neurosurgeon, and five special educators of which only one is trained in handling children with intellectual disabilities. In Puducherry, and in the villages around, not only the health and school facilities are insufficient, but there is also lack of studies and knowledge about the reality of CWSN in rural areas.

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Beneficiaries of Satya

Target groups

Number

Status

Selection criteria

VRC Children 120 (65 + 55) Positively affected on (Villianur + Seliamedu) education, rehabilitation and participation activities

Village children from marginalized and poor groups, at risk of abandonment, with limited opportunity for education and rehabilitation

Main City Centre

85

Positively affected on education, participation activities, rehabilitation and participation

Semi-urban children from marginalized and poor groups

MDC and VTC

105

Positively affected on education, participation activities, rehabilitation and participation

Semi-urban children from marginalized and poor groups

Home-based activities

85

Positively affected on therapeutic and ADL activities

Village children from marginalized and poor groups

Parents and care takers

375

Positively affected by the project on education and disability rights awareness

Parents and relatives of target group children

Project staffs =

33

Positively affected by project trainings and improve their professional skills

The main human resources required for the project. They are from in and around the project working areas. Main supporting staffs in implementing the project

PwDs in target villages

2679

Positively affected by the project through community-based rehabilitation (CBR)

Village children from marginalized and poor groups, at risk of abandonment, with limited opportunity for education and rehabilitation

Positively affected by the project on rights awareness and sensitization activities base

People from local communities with limited opportunity for accessing quality information and awareness, with lack of capacity in defending the children right to education and protection

Village Stakeholders 725 (including local parents, SHGs, youth groups, Anganwadi workers)

(continued)

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(continued) Target groups

Number

Status

Selection criteria

Project area population (Villianur commune)

109,752

People affected by poverty positively affected by the project on disability rights awareness. They will receive awareness interventions on disability

People from local communities with limited opportunity for accessing quality information and awareness on disability rights

PwD living in Puducherry

25,857

They will benefit from the increased rehabilitation and education services available in Puducherry District, through Satya Special School Centres

People from local communities with limited opportunity for accessing quality information and awareness on disability rights

The total population of Puducherry District

950,289

They will benefit from the more inclusive environment they are living in and from the increased networking and advocacy skills of members of civil society

People from local communities with limited opportunity for accessing quality information and awareness on disability rights

Stakeholders of Satya’s Interventions Satya is intervening with children, parents and care takers, bureaucrats, health workers, and community members towards promoting inclusive families and society, and also to stop institutionalization of CWSN. • • • • • •

Children with Special Needs (CWSN) Parents and caretakers of CWSN Families of CWSN Educators (teachers and school management) People with Disabilities Rural community stakeholders (community, panchayat members, Anganwadi workers) • Department of Health • Department of Education • Department of Social Welfare.

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Milestones Some of the key milestones are:

2003: Founding of Satya Special School 2005: Free Therapy Division 2007: First Vocational Centre 2009: First Village Centre/First Mobile Therapy Unit 2011: Early Intervention Centre 2012: Own State-of-the-art infrastructure 2013: Centre for Multiple Disabilities/Special Disability Park 2014: New Born High-Risk Clinic at JIPMER 2015: Prosthetic and Orthotics Unit 2016: Skill Training and Autism Centre 2017: AICE/Braille Library 2019: Inclusive Pre-School 2020: Satellite Centres in Marakkanam and Pollachi.

Theory of Change Satya Special School has framed its own Theory of Change (ToC) which explains the intended path to impact CWSN and PwD by outlining causal linkages. Theory of change is a structured and systematic process for thinking of achieving the impact through a set of values, strategies, and activities. The following table and diagram explain the “Theory of Change” of Satya Special School. All the projects being implemented by Satya Special School fall under the logic model of theory of change.

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Logic Model of Theory of Change

Activities

Values and strategies

Outcome

Impact

1.1. Personalized socio educational programmes for CWSN/PwDs through rehabilitation centres and home-based intervention 1.2. Accessible transport facility to PwDs 1.3. Capacity building of parents/families to advocate for the rights of their children 1.4. Capacity building of staff to help improve the interventions with children 1.5. Early intervention services to new-born babies 1.6.School readiness programme 2.1. Skill development training to 15 PwDs each year 2.2. Sustainable livelihood through supported employment opportunities to PWDs 2.3. Establish 2 mobile crew services 2.4. Capacity building of PwDs towards formation of self-advocacy group 2.5. Conference of PwDs for promoting employment action plan

Tailor-made plan for each child based on their disability Zero rejection policy in enrolment of children in Satya Collaborate with universities and hospitals for better outreach Community-Based Rehabilitation (CBR) approach Comprehensive approach to CWSN—covering all aspects of their life at different ages Vocational skill development for sustainable living of CWSN and PwDs Obtain full co-operation and involvement of parents and care takers Self-sustainability of CWSN/PwDs

(a) Increased Knowledge • Literacy and numeracy sports and culture events • Vocational skills • Facts about disability • parenting skills (b) Better attitude • Motivation of CWSN • Aspirations • Challenge their disability • Independence • Feeling of inclusion • Non-discrimination • Feeling proud of CWSN achievements (c) Better Behaviour • School integration • Participation in sports, cultural events • Income generation activities • Health seeking behaviour • Acceptance of CWSN/PwD within family

1. Access to early diagnosis, therapeutic interventions, special education and employment of children/person with development disabilities improved 2. CWSN/PwDs enjoy their rights with inclusive family and social environment, and participate in social, economic, and political spheres as equal citizens

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Nature of Services

Rehabilitave educaonal and Therapeuc Intervenon

Comprehensive approach to CWSN – covering all aspects of their lives at different age.

School readiness programme

Community Based Rehabilitaon (CBR) approach.

Transport facilies

Zero rejecon policy in enrolment of children in Satya.

Capacity building of parents and stakeholders

Vocaonal skill training

Literacy and numeracy open up opportunies

Sports and culture events improve identy and space

• • • • • • •

Obtain full co-operaon and involvement of parents and care takers.

Movaon of CWSN Aspiraons Challenge their disability Independence Feeling of inclusion Non discriminaon Feeling proud of CWSN achievements

Vocaonal skills enable self-sustainability

• • • • •

School integration / inclusion Parcipaon in sports, cultural events, Income generaon acvies. Health seeking behaviour Conducive family environment for CWSN / PWD.

Access to early diagnosis, therapeuc intervenons, special educaon and employment of children / person with development disabilies improved.

CWSN / PWDS enjoy their rights with inclusive family and social environment and render their parcipate in socio, economic and polical spheres as equal cizens.

Acvies

Values / Strategies

Outcome

Impact

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The partnership between CIAI and Satya Special School was initiated during the year 2010 and continues for over a decade now. The collaboration has mainly focussed on improving lives of CWSN from Puducherry through community-based intervention. This project’s aim is to promote the inclusion of CWSNs in their own communities, offering them specific programmes of rehabilitation and education and supporting the families in taking better care of them, through 3 levels of intervention: • Rehabilitation: providing the children with free medical assistance, education and therapies through the actions of Satya main city Centre of Puducherry, two Community Rehabilitation Centres in Villianoor and Seliamedu, vocational training centre and home-based intervention. • Family Development: Improving CWSNs families’ and environment, parenting skills of the parents. • Inclusion: Inclusion of CWSN in the family, educational institutions and in the society. The Logical Framework Analysis of the project for the past one decade has been iterated several times, keeping in mind the expected result and indicators of progress. The major activities towards rehabilitation, family development, and inclusion remain the key principles of all the interventions towards promoting knowledge, attitude, and behaviour of the stakeholders, as explained in the theory of change logic model and diagram.

Uniqueness of Satya Special School While many projects and organizations are doing excellent work with CWSNs, there are a few factors that make Satya Special School’s work unique: 1.

2.

Emphasis on mothers of CWSN: The nurture of a CWSN is often extremely taxing on the mother, who faces social ostracization or abandonment, and is unable to create a stable livelihood that can care for her and her child independently. She is also the most invested in the child’s wellbeing and inclusion. Our programme takes the “mothers as co-therapists” approach, and this empowerment of the mother has worked wonders for the child. We also give loans to mothers of CWSNs for setting up small businesses, and this has been very impactful in freeing the mother emotionally and financially, for overall wellbeing. Networks and relationships: Having worked on empowerment of PwDs with a community-based approach, Satya Special School has built deep roots within the villages of Puducherry and its neighbouring districts of Tamil Nadu. The organization’s capacity for networking—be it with the government, knowledge partners, institutions or hospitals—has enabled the optimal use of resources for maximum impact.

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For Satya, every child is unique. Our Individual Education Plans (IEP) for each child in collaboration with parents ensures tracking of progress of the children throughout the year. Empowerment not charity. Satya Special School is actively moving away from a charity model of empowerment of PWDs to an inclusion model, where providing the tools, techniques, and environment to succeed independently are emphasized. Satya Special School also strongly encourages self-advocacy and is taking significant steps in that area.

Programmes of Satya to Promote Rights of CWSN and Stop Institutionalization All of Satya Special School’s programmes have empowerment of the disabled at their core. The organization provides education at four levels, based on the child’s needs: 1. 2.

3.

4.

Children with severe disability are provided with basic literacy and numeracy skills. The focus here is on developing skills required for independent living. Early intervention for children includes a school readiness component. This strategy works on developing the skills—the three Rs, language, communication—for integration into mainstream schools. Children with mild and moderate levels of intellectual and developmental disability (IDD) are given tailored programmes for them to complete school under the National Open Schooling system. At Satya, we provide the academic input to help them clear exams for Class 8 and Class 10, offering practical courses like gardening, business maths, etc. Our inclusive school, Alternative Inclusive Centre for Education (AICE), is a school for CWSN and Children in Need of Care and Support (CNCP), prisoners’ children, and children with scholastic difficulties, through innovative technology-based and ability-based teaching methods.

The education intervention is carried out among CWSN in Puducherry, Thindivanam, Chengam, Marakkanam, and Kallakuruchi. The parents/care takers are also direct beneficiaries of the intervention along with CWSN. The major focus of the intervention, expected result, key indicators of progress and actual achievements of Satya are explained below. The specific objective of the education intervention is to promote development of CWSN through Community-Based Rehabilitation, age- and ability-appropriate academic skills, vocational skills, and employability, and to promote development outcomes, parent–child interaction, and a supportive family environment.

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Expected Result of the Intervention Result 1: An individualized education, health and home-based therapeutic and educational services are provided to CWSN in Satya through centre-based rehabilitation services, early intervention, and school readiness and early simulation programmes. Result 2: New Born High-Risk assessment and Follow-up clinic at JIPMER are established. Result 3: 4 Satellite centres for Early Intervention Programme in Thindivanam, Chengam, Marakkanam, and Kallakuruchi are established.

Indicators to Measures the Progress of Intervention • 25% of the children in village resource centres and city centres improved their skills in recreation, sports and participate in all events at the end of the project. • Family environment for parent and child improve in 80% of the families. • 70% of the CWSN in all intervention would achieve two development goals as per IEP. • 20% parents of CWSN from home-based therapy acquire skills on parenting skills. • Follow-up rate at JIPMER New Born High-Risk Clinic high, at 84%. • 98% of the children from Class 3–5 at the Alternative Inclusive Centre for Education noted that they experienced and completed first 3 milestones (as defined by the project), and 27% completed all the milestones of change. • 33% of the children from AICE between Classes 6–9 noted that they completed all the milestones (as defined by the project). • 70% of the children learning under NIOS shared that they have undergone the 10 milestones of change. Among children already graduated from NIOS, 65% of the children have completed all the 10 milestones.

Achievements Till Date Achievement of rehabilitation centres: 1.

2.

The multiple disability programme provided intervention to over 75 children. It focuses on improving academic ability of the CWSNs through the open schooling curriculum (NIOS). As many as 10 children cleared their 10th standard last year and 2 passed Standard 12th. This year a fresh batch of 13 children are being trained to appear for their 10th standard board exams. As the government is focusing on skill training of the disabled, Satya Special School works in partnership with the Government Women’s Polytechnic (nodal

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agency) to implement the scheme for integrating PwDs in mainstream technical and vocational education. Around 10 adults from Satya are undergoing a 3-month skill training programme on “Computer hardware, repair and maintenance”. The adults selected for training are already part of the data processing unit and have some knowledge in computers. This training will enhance their open employment opportunities. Around 10 adult PwDs were provided training in housekeeping, and one adult has joined a catering college to pursue a diploma in food service management. Five adults have secured full time employment in various centres of Satya as part of the housekeeping team. Three adults have secured open employment. Four adults with multiple disabilities who are part of the online data processing programme have now cleared their final quality test and will be employed for online data entry from March 2019.

Achievement of Early Intervention Centre EIC—Ongoing Project Since 2013 to Date: Since inception, around 800 children have benefitted. The focus of the EIC programme was to ensure inclusion of the CWSNs be it at integrated preschools or primary schools and ensure that their process of integrating into mainstream schools is streamlined. Accordingly, in the previous year, 1.

2.

3.

4. 5.

16 children who have completed the Early Intervention (EI) programme successfully have been in admitted into mainstream schools (seven into Satya’s Alternative Inclusive Centre and nine into various government schools). Due to the strength of the programme, Satya Special School has been able to impress upon the government to integrate CWSNs into SSA-supported schools. This year, nine CWSNs have been integrated into various SSA schools and Satya’s special educators are periodically assisting government teachers on handling CWSNs. Thanks to the pilot school readiness programme, Satya Special School has now been able to bridge the gap between CWSNs and mainstream schools. This year, six children have benefitted by the programme. Due to the success of the programme and the lessons learnt, Satya is looking to integrate as many as fifty children in the next three years through this programme. Satya Special School has partnered with three NGOs in setting up Inclusive EI classrooms catering to eight CWSNs in total. Henceforth, if CWSNs are identified in the area where these preschools are located, they will directly be referred to the preschools; however, Satya will monitor the progress and provide additional therapy or guidance as and when needed. Ten Children from the Early Intervention Programme of the Village Rehabilitation Centres have been integrated into their respective anganwadis. Three children have been integrated into rural government schools.

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Out of the Mobile Therapy Unit, Satya has integrated six children into their respective Anganwadis and three into Satya’s Village Centres. The follow-up rate at JIPMER’s New Born High-Risk clinic is 84%. This indicates a high rate of follow-up and early intervention. Due to the awareness creation programmes conducted for Anganwadi staff, Satya Special School is now able to identify CWSNs and integrate them after the EI programme.

Achievement of Autism Centre Satya Centre for Autism, started in 2016, has served thirty-five children till date. None of the mothers or children have been abandoned since they started coming to Satya Special School. Around 80% of the parents are completely involved in the development wellbeing of their child, and 40% are co-therapists in the whole programme. Children are provided remedial services to help enhance their educational levels: 1. 2.

Alternative centre providing full-day remedial schooling After school remedial training. • CWSNs who cannot go to mainstream school receive teaching in an open school. • 50 children of prisoners & children in conflict with law participate in a mentoring programme. • One resource centre is opened in the main centre by the end of the project, where children, parents and teachers can get information and counselling. • A 12-hour helpline, where children, parents and teachers can get information and counselling serves parents and caretakers who need help. • Parents and community members visit the mobile resource exhibition for vital information on children’s special education and remedial teaching.

Conclusion Working for over ten years in the urban and rural areas of Puducherry (India), it is evident that any successful sustainable rehabilitation model must not only cater to the needs of the child but also ensure participation of the immediate family. Sensitization of various stakeholders, government officials, law makers, etc. also play a major role in removing stereotypical attitudes about CWSNs. Prevention of abandonment of CWSNs can only be achieved through interventions at various levels: from the individual family to the neighbourhood and the society.

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Challenges There are a number of challenges in delivering effective services at the community level. Social stigma is one of the barriers which prevent people to come forward for need-based support services. Lack of trained professionals compared to the need of services required for the beneficiaries, need-based materials, lack of financial support for expenses related to logistics and lack of coordination between the Government and NGOs are other challenges which hinder the quality of services at the community level. Admitting children with multiple or severe disabilities in mainstream educational institutions and ensuring barrier-free infrastructure is also another challenge, especially in rural set-ups. It is important to bring children with disabilities into mainstream society after providing them with need-based support services.

Recommendations • There is an urgent need for advocacy with the Department of Social Welfare, to mainstream and strengthen systems and support services to PwDs and CWSNs. • NGOs, in collaboration with the Department of Social Welfare, should take up periodic skill development training programs for capacity building of the healthcare providers and programme managers. • There is an urgent need to increase public awareness through electronic media for understanding disability from the right perspective. • NGOs and government institutes should emphasize documentation system and systematic research which will, in turn, help in designing effective intervention programmes and in providing need-based quality support services (Kumar et al., 2012).

References Balogh, R., Bretherton, K., Whibley, S., Berney, T., Graham, S., Richold, P., et al. (2001). Sexual abuse in children and adolescents with intellectual disability. Journal of Intellectual Disability Research, 45(3), 194–201. Census of India. (2001). Data on disability. Office of the Registrar General and Census Commissioner. CIAI Centro Italiano per l’AdozioneInternazionale (Italian Center for Inter-Country Adoptions) and Satya Special School Study Report on Disability in Puducherry. (2009–2010). Ganesh, K. S., Das, A., & Shashi, J. S. (2008). Epidemiology of disability in a rural community of Karnataka. Indian Journal of Public Health, 52, 125–129. Hershkowitz, I., Lamb, M. E., & Horowitz, D. (2007). Victimization of children with disabilities. American Journal of Orthopsychiatry, 77(4), 629–635. https://doi.org/10.1037/0002-9432.77. 4.629

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Hibbard, R. A., & Desch, L. W. (2007). Maltreatment of children with disabilities. Pediatrics, 119(5), 1018–1025. https://doi.org/10.1542/peds.2007-0565 Jones, L., Bellis, M. A., Wood, S., Hughes, K., McCoy, E., & Eckley, L., et al. (2012). Prevalence and risk of violence against children with disabilities: A systematic review and meta-analysis of observational studies. Lancet, 380(9845), 899–907. https://doi.org/10.1016/S0140-6736(12)606 92-8. Epub 2012 Jul 12. PMID: 22795511. Kumar, G. S., Roy, G., & Kar, S. S. (2012). Disability and rehabilitation services in India: Issues and challenges. Disability and Rehabilitation Services, 1(1), 69–73. https://doi.org/10.4103/22494863.94458 Kyam, M. H. (2005). Experiences of childhood sexual abuse among visually impaired adults in Norway: Prevalence and characteristics. Journal of Visual Impairment and Blindness, 99(1), 5–14. Lightfoot, E. B., & LaLiberte, T. L. (2006). Approaches to child protection case management for cases involving people with disabilities. Child Abuse and Neglect, 30(4), 381–391. https://doi. org/10.1016/j.chiabu.2005.10.013 National Sample Survey Organization (58th Round, July–December 2002). (2003). A report on disabled persons. Department of Statistics, Government of India. Persons with Disabilities (Divyangjan) in India—A statistical profile: 2021. The state of the world children 2013, children with disabilities. UNICEF. The World Bank Report, Human Development Unit, South Asian Region. (2007, May). People with disabilities in India: From commitments to outcomes. The World Health Organization. (1989). Training in the community for people with disabilities. WHO. The World Health Organization. (2011). World report on disability. WHO.

Chapter 26

Psychosocial Support for Protection of Children in Disasters Subhasis Bhadra

Introduction With the development and growth at high speed in the twenty-first century, the danger and humanitarian challenges are also increasing considerably in every space of life. The vulnerability to disasters is increasing day by day, and the intensity of the problem is becoming deeper and more exhaustive. With the threat of climate change the numbers of natural disasters have increased in the last few decades and in India too. The political unrest all over the world also has created considerable humanmade disaster through multiple incidents of conflict, war, and refugee situations. The issues of vulnerability also differ according to the nature of the disaster. The factors of vulnerability are typically connected with the social system and capacity of the system to deal with the threats. Disaster as a threatening situation destroys the social support systems that usually exist to maintain the tranquility of a social structure. Thus, the vulnerability increases for the groups and the destroyed social support system fails to ensure adequate protective mechanisms for these vulnerable groups. While there is debate that every society may not have adequate concern for protection even in a normal situation, the vulnerable groups are exploited in a systematic default, but the situation becomes worrisome and out of control after a disaster. This disorder and disorganization due to disaster are well defined by WHO (1991) that states “it is a severe disruption of ecological and psycho social which greatly exceeds the coping capacity of the affected community.” For the purpose of social intervention practice, Bhadra (2006) defined disaster as “physically, psychosocially, ecologically devastating event of such a nature which exceeds the coping capacity…. It demands external help to rejuvenate life by facilitating the psychosocial resources of the survivors to reduce the stress of various life events immediately as well as in the long term at individual, family, and community levels.” Reduction of stress S. Bhadra (B) Department of Social Work, School of Social Sciences, Central University of Rajasthan, Bandarsindri, Kishangarh, Ajmer, Rajasthan, India © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_26

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is connected with the reduction of vulnerabilities among the survivors of disaster. The disaster increases the vulnerability of the marginalized sections of the society and reduction of vulnerability could only be activated through enhancing protective mechanisms and supporting the atmosphere to normalize life and build normalcy at a faster rate. The typical nature of different types of disaster requires an exploration to understand the impact of the children and adolescent. There are an increasing number of complex emergencies that are causing severe crises and threats to well-being. The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) mentioned that a complex emergency is a “humanitarian crisis where there is a breakdown of authority resulting from internal or external conflict and which requires an international response” (Keen, 2008, p. 237). Extensive violence and loss of life; severe survival crisis; massive displacements of people; widespread damage to socioeconomic equilibrium, are common that destroy the nurturing and caring atmosphere. The incidences like civil war, “ethnic cleansing,” and genocide are common in such situation. The civil unrest coupled with natural disasters causes the situation even more challenging for the humanitarian response. Often, political and military constraints hinder humanitarian assistance and pose significant security risks for humanitarian aid workers. The threat of CBRN (Chemical, Biological, Radiological and Nuclear) disasters was of less concern though there were a number of incidences from Chernobyl nuclear disaster, to Bhopal Gas Leak disaster, and damage of Fukushima Nuclear power plant caused serious threat to the survival and wellbeing of the disaster-affected communities. Use of chemical and nuclear weapons has been strictly condemned and banned by UN resolutions (UN Office of Disarmament affairs, 2019) yet in wars in Syria, Iraq the use of biological weapons is reported. Child survivors always face a very high impact of the CBRN disasters and often the impacts are lifelong causing severe disabilities. War and unrest in society are the major reasons for forced internal displacement and refugee situations that severely threaten the safety and well-being of the children and adolescents. Being displaced, often children are separated from their parents, exposed to a number of abuses and forced to live in relief, refugee or detention camps where safety and well-being are highly compromised. Almost after a century, the resurgence of the pandemic due to the SERS (Severe Acute Respiratory Syndrome) virus called as COVID-19 caused a serious crisis across the globe. In such a situation maintaining well-being for the children and adolescents became a difficult task as protective nurturing, caring social institutions became jeopardized to deliver an adequate protective environment. The schools are closed and families are in crisis with financial, social, and disease burden. The threat of the third wave of the virus is becoming more serious for the children, as the mutant variant has high potential to cause infection among the children and adolescents. In the absence of vaccines for the younger age group the medical worries loom higher with a higher intensity of threat for the children who lost schools, security of midday meals and even may not be able to return in future. Many children also became orphans and many others became single parents with added features or vulnerabilities and insecurities.

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There are a number of survivors in any disaster situation and the vulnerability of the survivors differs based on some important determining factors dealing with gender, age profile, disabilities, cultural practices, local belief system, government policies, program, and ultimately capacity of the vulnerable groups to deal with the limitations and challenges. Children are often described as the most vulnerable groups of the society and specifically in the disaster situation (Bhadra & Jadav, 2003; Dyer & Bhadra, 2013, p. 195; Sekar & Bhadra, 2003; Sekar et al., 2005b). The reasons of multiple complicated vulnerabilities of the children and adolescent in the disaster need to be understood in the background of the impact of the disaster to examine the importance and implementation of the various psychosocial support interventions and protection for the children in the critical difficult circumstance like disaster, conflict, complex emergencies and pandemic.

Tender Age and Developmental Risk Among the Children in Disaster The Tender age needs special care and protection for flourishing in a healthy manner in future. Childhood at a tender age is a period of growth and development to lay the foundation for a healthy life. The atmosphere and upbringing at childhood and adolescent stage are crucial for development into a well-adjusted adult. At each stage of development there are certain tasks which the child must get opportunities to master for healthy, emotional, and personality development. Relevant and continuous interactions with caregivers, as well as their environment, enable children to master these tasks and move on to the next phase of development. The development theories by Erick Erikson (Morgan et al., 1997, pp. 472–474) highlighted the important role environmental factors play within the normal development of the child, adolescent and how lack of opportunities to adequately master the developmental tasks can lead to dysfunctional behavior. Disaster leads to multiple developmental risks for the children and adolescents as the destroyed environment and facilities fail to give the required caring atmosphere. Care and support in childhood is the most essential task of the primary socializing agents for the development of the child to be well-adjusted in the society. These primary socializing agents facilitate a developmental atmosphere by cultivating cultural values, norms, practices, daily routine, and ensure social control, the disaster alters the tranquility and systematic arrangements of this developmental order.

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Destruction of the Nurturing Atmosphere Children in difficult circumstances suffer from the harshness of the environment and surroundings that puts them at multiple developmental risks. Disaster is characterized by destruction of the nurturing atmosphere and puts the children in a harsh reality. In such a situation the children and adolescents find themselves in a most unprecedented condition and feel alien to the situation. A disaster disrupts the process of interaction the child has with his/her environment. It leads to a displaced lifestyle wherein the familiar environment (home, school, peers, etc.) is lost. Loss of familiarity from the known caring atmosphere causes a severe distress among the children and adolescent that they are most incapable to handle and thus shows multiple stress reactions (Sekar et al., 2005a). The nurturing atmosphere is an essential requirement for learning and developing a socially desired behavior and for the protection of the children from the abuses and difficulties like struggle for food, stay, physical abuse, exploitation, etc. (Dyer & Bhadra, 2013, p. 183). Thus, disaster is a situation that cripples the capacity of the institutions and social systems that are supposed to ensure care and protection.

Inability of the Family and Caregivers to Provide Adequate Support The family is the primary caregiver for the children. During disaster and in postdisaster situations the destroyed social structure causes a serious disabling impact on the families to perform the regular activities. The family routine gets altered and family resources usually shrink or destroy. Families may lose their livelihood assets, regular income and become dependent on external support for daily requirements. External help is also needed to rebuild their life and to start normal life as a family unit. If the assistance is inadequate or the response and support are delayed in the situation, this may also be worsening. In such a situation the parents and other adult family members find it difficult to provide adequate supportive and caring atmosphere to the children. Immediately after the disaster, it is difficult to ensure adequate food, health care, accommodation in a safe and secured environment and in the long term it may continue as multifold problems. These inadequacies of support care and protected environment lead to living in cramped unhygienic camps or temporary shelters. Such a camp or settler obviously lacks the basic amenities and the children are devoid of their basic rights for days, months, and years together based on the response strategy in the country in a particular disaster.

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Traumatic Experiences Due to Disaster Disaster is connected with various traumatic experiences that are related to personal loss, injury, multiple deaths, and loss of normal living atmosphere. The children also witness and experience exploitation, violence, torture, and struggle for basic facilities. These experiences are not an issue of daily life that the child ever experienced in such magnitude prior to the specific disaster experience and thus termed as traumatic experiences of disaster. The loss leads to stress, psychosocial disability, and traumatic experience for the child survivors of the disaster. As an impact of these traumatic experiences the children exhibit multiple stress reactions that include body discomfort, psychological reaction (i.e., nightmare, crying spell, anxiety, depression, etc.) behavior reactions, relational problems, scholastic decline, etc. Thus the disaster experiences become severely disabling at the tender age and these unhealed traumas may cause severe detrimental impact on the development of the children.

Destruction of Educational Setup Education is the basic rights of children. Lack of educational facilities leads to high disengagement among the children and causes child abuse. In a situation of disaster the children out of school and educational environment become victims of the chaotic situation and subjected to experience and witness problems around them characterized by anger, frustration, fighting, and untoward behavior of adults. Many a time it is also seen that the children are used for different assisting jobs not appropriate for the age. The areas affected by war, border conflict, continuous military activity, mortar cell led to huge disturbances, and complete, partial or frequent closure of the schools. Children miss the school and even long closure of the school significantly increases the chance of school dropout, inability to progress with academic career and to have a healthy living as an adult. “Education is not only a right, but in situations of emergencies, chronic crises and early reconstruction, it provides physical, psychosocial, and cognitive protection which can be both life-saving and life-sustaining. Education sustains life by offering safe spaces for learning, as well as the ability to identify and provide support for affected individuals—particularly children and adolescents.” (The Inter-Agency Network for Education in Emergencies (INEE) 2004, p. 5) Educational set-up is not just for the purpose of teaching lessons for the children; rather it is part of their identity and a formal mechanism of facilitating the growth and personality. The children learn group norms, desired expected behavior, get affectionate peer relations, and also gets guided, protected, safe atmosphere from the teacher. Educational setup is meant to provide a protective and safe environment, and destruction of this formal set-up accounts for a large vacuum in the life of the children.

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Physical Injuries and Disabilities Among the Surviving Children Physical injuries are common in disasters, due to falling of heavy objects, burning, firing or bomb blast. Fighting with oppositional force, security force also causes severe injuries and risk to life for the children. The severe injuries causing amputation, paraplegia, long-term disabilities are quite devastating. Losing limbs, eyesight, hearing capacity, abilities to move freely become the obvious restriction for the rest of their life. Many a time the social condition and the post-disaster situation are not equipped enough to deal with the needs of these children for treatment, and rehabilitation. The impact of such injuries is long-term, and mostly affects their social status, income profile, access to resources, ability to live with dignity and tranquility.

Become Orphan or Semi-Orphan, Without a Stable Care Giver Losing parent/s or caregiver is a severe traumatic event for the children, and they become highly vulnerable in the disturbed social circumstance. Living as orphan and semi-orphan always exposes the child to number of adverse situations, and survival becomes challenging with a severe threat to their well-being, in the absence of any alternative social security measures. Potentials for development are carved as many of them from the lower socioeconomic background are compelled to work as child labor or even become victim of trafficking and exploitation.

Experiences of Abuse and Exploitation Experiences of abuse during disasters and conflict are quite common in the absence of strong protective mechanisms and social support networks. During humanitarian emergencies both formal and informal support systems usually become ineffective. The informal support system includes the family, community network, extended relatives and others who are usually concerned and become a crucial help in the difficult time. The formal support systems include the government supported child care agencies, or the civil society organizations and functional legal systems and structures. During disasters, all these support systems are disrupted and children become vulnerable to exploitation and abuse. The incidences like child trafficking and sexual exploitation also become rampant, while the post-disaster disturbances continue for a longer period, or the rehabilitation measures fail to ensure adequate protections. The girls are always disproportionately affected in such situations, and being trafficked for sexual purposes or abused in exchange for food or other support. Issues of child soldiers is another area of concern where children are abducted and

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used by rebel groups and they face severe abuse and exploration. The countries with poor socioeconomic conditions are always highly threatening for the children to maintain well-being and ensure safety.

Subsidiary Impacts of Disaster on Child and Adolescent Survivors The impacts of the disaster described previously highlight other arising problems connected to the situation of a disaster and can be called as fallout of the disaster due to inadequate policies, programs and insufficient rehabilitation measures to ensure protections are taken care of. These issues are often referred to as the second wave of disasters. IASC-MHPSS (2007) specially mentioned humanitarian aid related problems. In the post-disaster period lack of appropriate measures and policies cause severe humanitarian crises which are a threat to the well-being of the survivors. Sense of Insecurity In the post-disaster period, due to lack of basic amenities and fear of recurrence of the disaster and presence of threat in the surrounding areas cause a wider sense of insecurity among the children and adolescents. Children fail to get any reassurance about the situation that prevails and the fear of the disaster is being exhibited in various psychosomatic, behavioral stress reactions. The feeling of security is derived by the children from the atmosphere that they live in. Conducive atmosphere, regular routine, living with the caregiver, having interaction with peer groups, being well accustomed with the surroundings (e.g., playground, prayer hall, school, roads, places to hang around on regular basis) generate the sense of security and adjustment. Familiar environment is a key factor for having a sense of security which is lost after the disaster for as long as the factors of providing a secured environment are being evolved through rehabilitation, normalization, and establishing a predictable pattern of positive interactive atmosphere. Lack of security makes the children vulnerable to abuse and exploitation in a disaster and post-disaster situation.

Threat to the Sense of Well-Being A psychological sense of well-being is a prerequisite for health development for the children and adolescents. The environment has essential considerations and contributions in giving a sense of well-being. As it is seen in different disasters that attachments are affected within caregivers relationships. The affected surrounding area of disaster can cause distress and disaffection multiplied with the continued unorganized pattern of daily living. Being dependent on the common kitchen, living in camps the family ceased to function as a cohesive family unit that provided the sense of well-being for a child or adolescent. If these situations in post-disaster period

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continue for long, the developmental problems and stress among the children go higher that may even jeopardize their future. Struggle for Survival Disaster relief, rehabilitation is an important humanitarian concern that is not just essential to support rather it is an important human rights consideration for the survivors to get the support in the time of distress. Effective relief distribution, quick rehabilitation programs reduce the struggle for survival as a normal, regular pattern of interaction can be established and strengthened. An unattended disaster or a disaster that receives less attention causes more problems for the survivors. Though at times a disaster gets quick response for relief, getting much less attention during rehabilitation increases the difficulties in the long term. The struggle is much higher for the marginalized survivors of disaster who may belong to a far-off place, women, disabled, the survivors belonging to lower caste and category. Thus, the social status of the survivors and their capacity to control the aid mechanism, the government system, and the response of civil society are combined to contribute toward the struggle for survival. In such a situation, the children and adolescents become the obvious party to the situation.

Issues of Child Protection as the Worse Victim of Disaster: Indian Context India has witnessed multiple disasters within this century with some large natural and human-made disasters of the history. Namely, the natural disaster like Orissa Super Cyclone (1999), Gujarat Earthquake (2001), Indian Ocean Tsunami (2004), Kashmir Earthquake (2005), repeated severe floods in north and northeast India, and the recent disaster in called as Himalayan Tsunami (2013) in Uttarakhand, Chennai Flood (2015), Kerala Flood (2018), number of other cyclones and floods across the country showed the nature’s fury and increased vulnerability of the people across the different zones of India. Similarly, there were a number of human-made disasters that showed the fragile nature of social structure in different parts of India that always imposed a higher order challenge for disaster interventions and humanitarian response. The human-made disasters namely, the Gujarat riots (2002), Mumbai serial train Blast (2006), Mumbai terrorist attack, continuous Kashmir unrest, riots in Orissa (2008), incidences of riots and ethnic violence in Assam, Delhi Riots 2020 and many other such incidents of increased vulnerability of human-made disaster poses a real threat to the tranquility of the disaster-affected zones in particular and the nation in general. The pandemic COVID-19 as biological disaster crippled the normal life of the people in India but the poor, marginalized families and going to face the socioeconomic consequences for much longer and the children will have to face the brunt of it, with increasing crisis of health care, nutrition, education and other safety measures. The poor, marginalized, weaker sections are always the worst victims of disaster and every disaster pushes more people into poverty (Hallegatte et al., 2020). It any disaster children are the most vulnerable groups and they require long-term intensive care

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and rehabilitation measures for sustainable recovery and strengthening resiliency (Mudavanhu, 2016). A detailed analysis of the impact of these different disasters in India showed some specific points of vulnerability of the children and adolescents that are closely connected to the child protection concerns and requirements. Considering the various impacts of disasters on the children, it can be said that any disaster is connected with the issues of protection. Disasters impose security threats, challenges in daily living, witnessing or experiencing violence, shutdown of educational facilities, losing family members, and ultimately it shrinks the opportunities of living a free life for the children and adolescents. In all these disasters, the specific child protection issues that aroused were complex and critical and some of these issues are described here. The protection issues of the children are connected with four basic dimensions of human rights. (a)

Rights related to physical security and integrity: 1. 2. 3. 4.

(b)

Rights related to basic necessities of life: 1. 2. 3.

(c)

Inadequate food, clean water, sanitation and health care. Inadequate shelter, lack of privacy (specifically for adolescent girls), breakup of family. Problem of reproductive health care (specifically for adolescent girls).

Rights related to other economic, social, and cultural protection needs 1. 2. 3. 4.

(d)

Sexual assault of the children and adolescents. Physical assault and violence. Deliberate harm to the children, forced labor, trafficking, and displacement. Harm to psychological integrity and dignity.

Denial of the right to education or delay in right to education. Relocation to areas where there is no opportunity for schooling and other facilities. Discriminatory practice against children, adolescents, and children with disability (Differently abled). Children and adolescents lose the rights of property of their parents/ancestors.

Rights related to other civil and political protection needs: 1. 2. 3. 4.

Separation from family members. Denial of freedom of expression, speech, association, and religion. Loss of certificates, personal documents. Arbitrary restrictions on freedom of movement, including punitive curfews or roadblocks that prevent access to school, playground.

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Guidelines in Disaster for Child Protection The international guidelines for disaster intervention in schools and communities have included both psychological and physical health aspects or recovery and holistic well-being for development. The International declaration of child rights is a premier document to establish the importance of child rights. In General Assembly Resolution 1386 (XIV) of November 20, 1959, the general assembly expressed profound concern about the “that the situation of children in many parts of the world remains critical as a result of inadequate social conditions, natural disasters, armed conflicts, exploitation, illiteracy, hunger and disability, and convinced that urgent and effective national and international action is called for” (Steven, 2003). The sphere project (The Sphere Project, 2011, p. 25) is one of the most important documents to uphold and advocate the minimum stands in disaster response mentioned the protection to ensure human dignity and commitment to humanitarian charter. “The Humanitarian Charter provides the ethical and legal backdrop to the Protection Principles and the Core Standards and minimum standards that follow in the Handbook (i.e., Sphere Handbook)” (The Sphere Project, 2011, p. 20). The concerns for protection give rise to four basic Protection Principles that inform all humanitarian action according to the Sphere Handbook: 1. 2.

3.

Avoid exposing people to further harm as a result of your actions. Ensure people’s access to impartial assistance—in proportion to need and without discrimination. 3. Protect people from physical and psychological harm arising from violence and coercion. Assist people to claim their rights, access available remedies, and recover from the effects of abuse. The Child Protection Working Group (2012) meticulously designed The Minimum Standards for Child Protection in Humanitarian Action (Child Protection Working Group (CPWG) 2012) that broadly categorized the standard responses in humanitarian action under four headings. These are as follows: (a)

(b)

Standards to ensure a quality child protection response, that deals with coordination with major actors in the field; appropriate trained human resources for working with children, facilitating adequate communication, advocacy and dealing with media; developing adequate program cycles for management; standard information management, and ensuring child protection monitoring. These standards are to ensure a child protection oriented view for each of the work that humanitarian agencies and government do in a situation of emergency. Standards to address the child protection need focus on various risks that the children and adolescents face after a disaster. These standards included protection from danger and injuries, physical violence and other harmful practice, sexual violence, psychosocial distress and mental disorders, protection of the children associated with armed force or armed groups, child labor, and the unaccompanied, separated children. The last

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(c)

(d)

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standard of this section has specified the need of ensuring justice for the children as a vital component of humanitarian action. Standards to develop adequate child protection strategies recommended developing case management, community-based programming, developing child-friendly spaces, and protecting excluded children. Standards to mainstream child protection in humanitarian sections are a wider description that targets the different sectors of intervention which has clear implications to strengthen and maintain child protection standards. These sectors are focusing on economic recovery of the disaster survivors, re-establishing the educational system, health system, facilitating adequate nutrition, water, sanitation, and hygiene practice. Children protection is also connected with adequate shelter, camp management, and distribution of the relief items.

INEE (The Inter-Agency Network for Education in Emergencies (INEE) 2004) and IASC guidelines on Mental Health and Psychosocial Support in emergency settings (2007) also highlight the protection principles for humanitarian action. These include guidelines and documents detailing protection mechanisms, psychological, physical health interventions, protection of the children in disaster, facilitating hygienic practices, promoting life skills education, working with community, participatory approach in educational intervention, development of policies and guidelines for the country, etc. The unique features which are noted in these documents, as follows: • Formal and informal education: Both formal and informal education has been promoted for the children and adolescents. Hence, educational involvement is considered as a need of the community to enhance protection and psychosocial support. After a disaster, informal educational setup is the most suitable option to facilitate normalcy. Though restarting the formal education may be time consuming, the informal education should be initiated as early as possible. In this process involving a larger number of local community leaders, volunteers, and teachers are encouraged. For the disaster-affected communities, different patterns of progressive educational strategies are to be adapted. This may range from various recreational activities, sports, games, cultural activities, simple creative expressive activities (drawing, drama, storytelling, etc.), and catch-up courses to deal with studies, alternative classes, and vocational skill classes for youths. These patterns of engagements would help to bring the child and adolescent to develop a routine in the most unorganized state of affairs and also protect the children from being misused or abused. • Community-based program: School is the integral part of disaster interventions and always it should be done in adequate coordination with the local community. Hence the program becomes part of the community recovery and connectivity of intervention between the schools, communities, and familiars are consolidated. This specifically focused on participation of the parents and other community

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leaders in school intervention with the students, teachers, and others involved in the regular school activities. It is essential to develop the school committee and also community-based child protection committee to monitor and protect the vulnerable children. Equally, the parents need support to ensure adequate care for the children. Community engagement, mobilization, and developing social support mechanisms that ensure community control over the recovery process are essential strategies for strengthening the community-based protection for the children in disaster. • Accessibility of learning: This focused on accessibility of education for all that deals with ensuring no discrimination and creating opportunities for all. The marginalized groups are to be included and ensured that the traditional discrimination of the society is not promoted. Accessibility of physical space and availability of services within the vicinity of shelter or housing, creating a safe, and stimulating atmosphere is being highlighted. To facilitate accessibility in MHPSS guidelines (Inter-Agency Standing Committee (IASC) (2007) it is being recommended to rapidly organize safe spaces where children can play and participate in structured, supportive activities and where children and adults can receive or mobilize psychosocial support. Within the facility including life skills training and provision of information about the emergency and other education support that build confidence and strengthen resiliency to be adapted and practiced. • The skill building of educators: Educators are the key personnel for intervention in schools. Developmental program in the schools or a disaster response is dependent on the knowledge, skills, and capacities of the educators. Giving recognition to the educators and ensuring required skills through capacity building sessions, followup, and culturally appropriate materials are very crucial. Therefore, involving the teachers in various training modules on psychosocial support, hygiene promotion, nutritional supplement, and safe school protocol should be considered. Teachers or educational staffs are the key in facilitating a protective environment and sense of well-being among the children. Thus preparing and encouraging educators to support learners’ psychosocial well-being, helping them, e.g., to deal constructively with learners’ issues such as anger, fear and grief, to cope with their own situation is a crucial need and service requirement after the disaster. The teachers should also be trained to make referrals for severely affected learners. This supportive atmosphere keeps the children within a secured environment. • Creating safe and secure learning environment: Creating safe and supportive education through formal or non-formal systems of education has been prioritized in any disaster intervention. Safety of the children is an important concern which deals with structural and non-structural safety from internal and external factors related to disasters (threat, possibility or reoccurrence, etc.), health and nutritional safety as well as creating a culture of safety and prevention of disaster/crisis among the school community. Thus, the guidelines focused on developing both a physically and emotionally safe environment. Physical environment is the most important determinant for the children to have a healthy pattern of living with availability of safe drinking water,

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mead-day meal, free of possibilities of diseases, like waterborne, vector-borne, and airborne diseases. Equally, the structural safety, and safety from any violent attacks are vital. These safety aspects are also connected with the safety at home and the safety in the area the students travel to come to the school. Developing skills of the teachers, strengthening and reviving the facilities in schools, awareness generation, and community action are combined efforts toward the commitment of ensuring a safe and secure learning environment. • Health promotion and disease prevention: In the school promoting health and facilitating a hygienic environment is crucial for recovery of the survivors. Postdisaster situations as well as prevailing conditions are very important to be considered for reducing the health risk and problems of the target population and children. The Sphere project (2011) has minute details of each of the factors under this category to be considered for the water, sanitation, nutrition, and health promotion of the pupil. WHO (2003) defines a health-promoting school as “one that constantly strengthens its capacity as a healthy setting for living, learning, and working” (WHO, 2003, p. 4). WHO (2005a, 2005b) also published a manual titled “The Physical School Environment, As an Essential Component of Health—Promoting School.” The American Academy of Pediatrics defines a “healthful school environment” as “one that protects students and staff against immediate injury or disease and promotes prevention activities and attitudes against known risk factors that might lead to future disease or disability” (American Academy of Pediatrics, 1993). These documents mentioned about provision of safe and sufficient water, sanitation, and shelter from the elements of basic necessities for a healthy physical learning environment. Equally protections from biological, physical, and chemical risks are important to maintain safety and security of the children and adolescents. • Educational Policies: In any country an effective educational policy should be promoted and organized that the children could be educated by maintaining quality and effective development in a consistent manner throughout the developmental age. The educational policy should have clear mention of providing education to children and adolescents of different age groups, capacity building of the educators, maintaining and developing the educational facilities, facilitating easy accessibility of education for all, etc. Many a time lack of education policy in the country causes lack of resources in the educational system and also this sector becomes a low priority area. Inadequate priority on education makes the children out of safety and protection networks especially during post-disaster situations. • Psychosocial Interventions: These guidelines dealing with disaster situations have very high emphasis on the mental health care and resiliency building among the students. Facilitating normalization, establishing routine life, strengthening disaster preparedness, reducing traumatic experiences, are the goals of psychosocial support interventions in disaster (Herrman, 2012). The Sphere Handbook (2011) has considered psychosocial support activities and school intervention under each of its sectoral domains that deals with health, water sanitation, food security, shelter, etc.

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Psychosocial considerations in Child protection: Rapidly organize safe spaces where children can play and participate in structured, supportive activities and where children and adults can receive or mobilize psychosocial support; provide sports that promote nonviolent conflict resolution; organize youth clubs that promote joint problem-solving and life skills; organize social support for parents, especially mothers of very young children; ensure that community-based child protection committees monitor and respond to risks and support highly vulnerable children; support parents and community members to better support and care for their children. Remember to give children control and power over the decisions that affect them. Also keep them regularly informed of events, or even nonevents such as “we have not found your parents yet, we looked here and here.” This is often forgotten and is an enormous source of distress (Inter-Agency Standing Committee (IASC) Global Cluster Working Group and IASC Reference Group for Mental Health and Psychosocial Support in Emergency Settings 2010, p. 10). The Incheon Declaration (UNESCO, 2015) is an important document toward fulfilling the commitments of inclusive and equitable education and lifelong learning for all by 2030 and recognized that education is the main driving force for development. A large number of children out of the school are living in the conflict affected areas. The violent attacks on educational institutions, natural disasters, and pandemics are continuously threatening the safe learning environment. Developing an inclusive, responsive, resilient education system from emergency response through to recovery and rebuilding with adequate coordinated efforts from local to global level is essential to ensure education is maintained during situations of emergency, post-disasters, and recovery. For ensuring protection for the children and adolescents during disasters, continuing education is an essential tool. Education is the vehicle for socioeconomic mobility and escaping poverty. SDG (Sustainable Development Goals)-4 stated “Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all” (UN, 2015) and considered education as a measure for protection, well-being, development and for enriching sustainable solutions for many problems. The other important SDGs that target child care and protection are as below: • SDG 3.4: Promote mental health and well-being. • SDG 5.2: Eliminate all forms of violence against all women and girls. • SDG 5.3 Eliminate all harmful practices, such as child, early and forced marriage, and female genital mutilation. • SDG 8.7 End child labor, including the recruitment and use of child. • SDG 16.2 End abuse, exploitation, trafficking, and all forms of violence against and torture of children SDG 16.3 Promote the rule of law at the national and international levels and ensure equal access to justice for all. • SDG 16.9 By 2030, provide legal identity for all, including birth registration. Natural disasters, pandemics, conflict can leave entire generation traumatized, uneducated, and incompetent to contribute actively for their own development or for the nation. Therefore, action toward safety, disaster risk reduction, emergency

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preparedness, promoting resiliency, peace education, and climate change adoption are crucial for protection of the children and adolescent. Attaining the SDGs critically depends on successful attainment of disaster risk reduction and mitigation efforts. These guidelines depicted a wider frame to work in the education system immediately after a disaster or as part of long-term rehabilitation. In practice adapting and following each of these guidelines require a strong commitment of the local government, humanitarian actors, and flow of resources. Though the government of India does have any special guidelines for protection of children in India, the existing policy and law regarding the protection of children are having equal importance and implementation requirements during the disaster too. The National Commission for Protection of Child Rights (NCPCR) was set up in March 2007 under the Commission for Protection of Child Rights Act, 2005, which is an essential act and policy implementation authority for child protection in disasters in India. The Psychosocial Support and Mental Health Services (PSS-MHS) guidelines (Government of India, 2009) have mentioned protection is important in the event of disaster and especially for the children. The guideline mentioned “provision of special care will be made for children, especially those who have lost their parents and siblings” (Government of India, 2009, p. 42) and “the rights of the children among survivors as well as the international convention stipulations for this vulnerable group shall be taken into consideration. Child Trafficking and violence against children need to be tackled.” (p. 52). Psychosocial first aid is recommended as one of the most essential service provisions for normalization and protection of further emotional harm of the children in the post-disaster periods through non-formal schooling, group engagement activities and play therapy. The National Disaster Management Guidelines on school safety policy (NDMA, 2016a, 2016b) widely focused on mitigating the risk of natural disasters and ensuring safety for the children and other stakeholders from the safety issues arising both from inside and outside of the school premises. The policy document focused on implementing “child centered community-based disaster risk reduction at the local context,” by capacity building, ensuring structural safety, and mainstreaming safety education in school curriculum. The Disability Inclusive Disaster Risk Reduction Guidelines (NDMA, 2019) mentioned about inclusion and participation of the persons with disabilities in the safe school program and specific capacity building for the special school to limit the trauma and damage due to disaster. Though both the policy guidelines are silent about the issues of violent attacks, incidents or cross border firing and other human-made disasters and pandemic situations that severely threaten the safety and security of the children in school premises. The guideline on Management of Biological Disaster (NDMA, 2008) mentioned about various measures to prevent the spread of pandemic including closure of the school, improving the nutritional standards of the children to boost immunity, awareness generation and risk community with the school going children and incorporation of the knowledge about pandemic in school syllabi. Yet, the preparedness for biological disaster was never taken up as the threat was largely ignored prior to the breakout of COVID-19.

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Psychosocial Support for Children in Disaster Considering the international/national guidelines the psychosocial interventions in a school should be designed and implemented. In order to promote psychosocial support and protection for the school children, a school intervention program was developed and implemented by the Red Cross in Kanyakumari District of Tamil Nadu, after the Indian Ocean Tsunami. The school intervention program was designed strategically and sustainability components were built-in within the program. For this intervention the objectives were three fold, first, developing resiliency among the children affected by Tsunami through various psychosocial support activities; second, facilitating physical health and well-being of the children; and third, creating a culture of safety through safe school practices. Based on these objectives the program activities were developed. (a) (b) (c) (d)

Building resiliency among the children and adolescents through creative expressive activities. Developing a participatory model for working in the school for designing, planning, implementing, and evaluating the program. Capacity building of the teachers and other members of the school community to ensure rebuilding and rehabilitation focusing on child protection and welfare. Organizing activities toward creating “sense of place” among the children in the school, developing “child-friendly” atmosphere and culture of safety.

Important Concepts for School Interventions Before going into the details of the school intervention some important concepts are discussed here that are relevant for further explanation about the intervention strategies in the schools. Psychosocial Support: IASC-MHPSS (Inter-Agency Standing Committee (IASC) 2007, p. 1) guidelines defined psychosocial support as “any type of local or outside support that aims to protect or promote psychosocial well-being and/or prevent or treat mental disorder.” The most accepted definition for the development practices can be “psychosocial care as a broad range of community-based interventions that promote the restoration of social cohesion and infrastructure, as well as the independence and dignity of individuals and groups. Psychosocial care fosters resilience in survivors and the community, and serves to prevent pathological developments and further social dislocation” (Aarts, 2001). Psychosocial refers to the dynamic relationship between the psychological and social dimension of a person, where one influences the other. The psychological dimension includes the internal, emotional and thought processes, feelings, and reactions. The social dimension includes relationships, family and community networks, social values, and cultural practices. Psychosocial support refers to the actions that address both the psychological and social needs of individuals (Hansen, 2008). Considering this

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definition the broad range of activities which need to be carried out include working with the individual, groups, families, social institutions, and in community at large. Numbers of psychosocial activities were conducted through the school interventions. Psychosocial interventions are most crucial to prevent further damage and to ensure well-being of the disaster-affected children for strengthening the protective atmosphere (Des Marais et al., 2012, pp. 347–49). Resiliency: “Resiliency is the capacity to transform oneself in a positive way after a difficult event” (Annan et al., 2003). In other words resiliency is an increased or enhanced ability to cope with difficult situations. Children and adolescents learn and adopt coping mechanisms from the environment they live in. It is very important that they receive an environment which is supportive for appropriate growth and development. Through psychosocial interventions resiliency building is fostered by engaging the children in activities that encourage to expressive their views, overcome stress reactions, develop abilities to deal with challenges, encourage group participation, and strengthen social networks and relationships. From the very first day the resiliency building activities were started in the relief camps and in the schools subsequently. Creative Expressive Activities: Children cannot express themselves with words so well. Adolescents are hesitant to talk about their thoughts as many social norms and restrictions are imposed on them. There are some methods and activities by which the children can express their feelings, emotions, views, and opinions. These methods of expression are called creative expressive methods and activities are conducted by using drawing, storytelling, creative writing, clay modeling, school drama, skit, etc. (Bhadra, 2012, p. 221). Play or games as a form of physical activity also help a lot to express their ideas, learn social norms, and develop new thoughts. Child-Friendly Space: Various international documents (The Sphere Project, 2011; UNICEF, 2012) explained child-friendly space as one of the physical space within the living area of the survivors or in the school to mitigate emotional and psychological impact of disaster on the children by practicing the activities that provide a caring, protective, safe, and normalizing environment. Child-friendly approach allows the children to express their views and also allows the children to participate in making a better environment for themselves (Dyer & Bhadra, 2013, p. 189). Child-friendly approach is characterized by five main points which were ensured through the project’s implementation in the Tsunami-affected schools in Kanyakumari District (IFRC, 2009). (a) The school environment should be actively designed to ensure that the children feel free from any threat and hazards from the immediate environment. (b) Recovery program should be participatory; specifically involvement of parents, local leaders, and eminent personalities would ensure an effective planning, implementation of the school activities and projects. (c) The children in the school have a chance to develop skills through various experiential learning facilitated by the teachers. (d) The educational system ensures equal opportunities for the marginalized group and the children who have faced the direct impact of disaster. The children having problems in the home due to poverty or any other reasons are also taken care adequately to support their educational needs. Similarly, the weak students should get the option of additional learning space. (e) Physical

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health is an integral part of the growth and development of the children. Child-friendly schools ensure adequate sanitation facilities, hygiene promotional activities, consider the nutritional requirements of the children and adequate preventive and promotional health interventions. Sense of Place: With various loss and damage the specific problem which the disaster survivors face is the loss of “sense of place.” The sense of place (Fullilove, 1996) deals with identity, familiarity and attachments with the place, environment, and neighbors. A change due to disaster disrupts this equilibrium of the society, predictable daily routine activities, and feelings of safety. In the rehabilitation process, developing a sense of place among children is vital for their growth. McMillan and Chavis (1986) propose that “sense of community” is composed of four elements, (1) membership, (2) influence, (3) integration and fulfillment of needs, and (4) shared emotional connections. This concept is being used for the development of the school atmosphere after a disaster. Membership means a sense of identity, belonging and working together for a common purpose and goal by the school community and specifically for the children. Influence reflects that the members have equal opportunities of participation in the activities in schools and could influence the planning, decision making or implementation process for their own well-being. The group norms are followed and shared responsibilities facilitate a cohesive atmosphere. Integration and fulfillment of needs refer to an integrated approach with multiple activities with common goal orientation. Shared emotional connections consider the common identity, familiarity among the community people who are living in the same place, and have common cultural orientation, language, pattern of living, and many other factors like shared history, common experiences, and even the presence of a spiritual bond (Holms et al., 2003). The school interventions were designed in the Tsunami-affected schools to ensure development of “sense of place” among the children. Prevention of School-Related Gender-Based Violence (SRGBV): SRGVB negatively affects many children and adolescents and becomes a major hindrance for development of self-esteem, continuing education and severely threatens the integrity and rights of the pupil. “School-related gender-based violence is defined as acts or threats of sexual, physical or psychological violence occurring in and around schools, perpetrated as a result of gender norms and stereotypes, and enforced by unequal power dynamics” (UNESCO, 2016). Active measures for preventing physical, psychological and sexual abuse are very much essential. Often corporal punishment, bullying by senior students, cyber bullying, extortion, physical, psychological sexual abuse are reported that are having quite harmful long-term impact. The different risk factors like having disabilities, HIV-positive status, sexual orientation (LGBTQI) increase the individual risk factor. Similarly, gender discrimination in family, family conflict, addictive behavior of parents or caregivers increase the risk of GBV within family. Therefore, prevention of SRGVB is an important component of psychosocial support for enhancing well-being. The preventive program must include, awareness and capacity building, for teachers, students, parents and other

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stakeholders, inclusion of marginalized groups (e.g., LGBTQ, disabled, etc.), vigilant system, monitoring of the gender responsive program and effective policies are crucial. Peace Education: Extensive damage is caused by conflicts in young minds. It is not just the war, rather the incidences of violence between the caste, class, ethnic, religious, linguistic, regional groups cause severe unrest and trauma in the mind of the children. Peace education is an essential process for promoting knowledge, skills, attitude and values that are crucial for behavior changes to enable the children and youths to avoid conflict and violence thereby resolving conflicts peacefully and creating an environment of harmony and tranquility to develop healthy relationships. Schools help in shaping the social norms, culture value and attitude. Thus, peace education can bring a long-term change in the society to end any form violence and help in developing the value of pluralism, encouraging tolerance and acceptance. To prevent chaotic situations during or after disasters, as well as to strengthen disaster response, promoting healthy relationships, supportive nature and peaceful coexistence are crucial. Similarly, addressing the issues of cultural and structural violence in school is crucial. Peace education needs to be framed according to the local, cultural, social, historical and political context, and ensure an effective outcome not only among the children, but to the large society, as children are the massager of good information in the community. In this context peacekeeping, peacemaking and peace-building are crucial (International Alert, 2020). Peacekeeping is about maintaining peace, thus there is no eruption of violence. Peacemaking is about proactive measures for quick solution of conflicts, restoration of discipline and nonthreatening atmosphere for all. Peace-building focuses on reduction of barriers, bridging the possibilities of conflicts and achieving sustainable peace. Peace education in school is connected with achieving peace in society, and political stability of the region or nation. Life Skills Education (LSE): “Life skills are abilities for adaptive and positive behavior that enable individuals to deal effectively with the demands and challenges of everyday life” (Bharath & Kumar, 2010; WHO, 1997, 2005a, 2005b). Life skills development is one of the most effective interventions for building resiliency among the children and adolescents. Life skills have become an important component in psychosocial support programs in disasters, as the pedagogical approach of life skills has enormous potential for developing positive coping abilities developing toward healthy living and maintaining well-being even during the challenging time. The specific learning outcome and skill development for the participants are always the key focus for designing the LSE sessions. The participants are actively engaged through an activity during the session that may be role play, drawing, group game, group discussion, etc. The activities encourage the participants to resolve the given problem as a group by discussion, reflection, debate, sharing, exchanging views, and being psychically, psychologically active. Thereby, participatory learning takes place in a cooperative, supportive atmosphere (Bhadra, 2018). Environmental Education (EE): Deterioration of the natural environment is the major reason for the increasing number of natural disasters all over the world. Severe food, cyclones, heat and cold weaves become almost regular events in some of other

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parts of the globe. Thus, environmental education further becomes crucial for dealing with disaster risk reduction and for maintaining well-being. From 2003 India has started formalizing EE as part of school curriculum (Sonowal, 2009). EE is a process that allows pupils to explore environmental issues, engage in problem-solving and take action for improving the situation. So, they become environmentally sensitive, responsible, develop attitude and skills for protecting and promoting the natural environment. The actions include, planting trees, protecting junglE, water bodies, birds, and animals in its natural habitat, use of renewable energy, following three Rs (reduce, reuse, recycle), and such other activities that have immediate and long-term impact to improve the environment and reduce pollution, greenhouse emissions, etc. EE is essential to mitigate the impact of disaster and also to enhance their emotional wellbeing as the students become responsible toward healthy environmental practices (Ilyasa et al., 2020). Safe School: The concept of safe school has been used in different aspects of safety like safety from crisis, events of disaster, gender-based violence, psychological, physical abuse, free from threats or dangers, etc. Within the United Nations Decade of Education for Sustainable Development (2005–2014) UNESCO (2005), it is emphasized that education for disaster reduction should be part of the curriculum and disaster reduction begins at school. Safe school programs ensure the culture of protection and safety among the students and teachers by understanding the hazards and risks within the school and immediate environment and utilizing the resources to mitigate the same. Hence, the safe school program is an important component for developing the safety aspect of schools. As part of the program the students and teachers join together, assess the school’s risk and resources, develop safe school protocol and practice the same on a regular basis thus ensuring that the school is capable of dealing with the hazards. The regular practice and update ensure the practice of safety rules based on the hazards that the school children may face (UN/ISDR 2007; Satapathy & Yoshida, 2007). Digital Empowerment: In the twenty-first century digital capability has become an important determinant of psychosocial well-being and adjustment as digital dependency of the children and adolescents has increased over the last few years. Further, the pandemic situation has made the digital capability relevant and visible to society (Iivari, 2020). Digital empowerment is about providing knowledge, skills and abilities to use the digital device and access relevant, appropriate, useful information, and thereby, become a responsible citizen. Digital empowerment also encompasses the capacity of a user to be engaged in the virtual world without compromising the real life situations and maintaining a harmonious balance. Imparting knowledge about digital dependency and addiction is also essential to ensure psychosocial well-being of the children and adolescents. During the pandemic, schooling through online classes made the students highly dependent on the digital devices and increased the risk of inappropriate use like gaming, sexting, chatting, or extensive use of social media. At this juncture, due to stark digital divide many students are away from school and many are addicted to surf inappropriate content. Therefore, digital empowerment is most crucial for developing responsible online behavior and engagement, and also

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facilitating basic digital devices to the students who are unable to be part of the digital world.

Intervention in Kanyakumari Tsunami-Affected School Immediately after the Tsunami in the relief camp the volunteers started working with the children to facilitate care and support. Within a few days, the local NGOs of the area were contacted and also the government systems or support mechanisms (i.e., government school, integrated child development scheme centers “Anganwadi,” village health care system) were identified. Subsequently capacity building for psychosocial support was conducted for the NGO and government staff who were directly working with the survivors in the relief camps and temporary shelters. The NGO staff were mainly the field workers, coordinator for the program, the community level volunteers, self-help group members, or other community leaders. From the government sector mainly the school teachers, health workers and “Anganwadi” (preschool teachers) were trained. This group of trained workers continued psychosocial support activity with the affected children through regular meetings, sessions with parents and through close interaction with the children by using multiple creative expressive activities. This engagement helped the children to deal with their traumatic experiences and develop confidence. These activities also protected the affected children from any kind of further psychological harm and abuse while the nurturing and protective environment was completely destroyed in the Tsunami-affected areas (NIMHANS, 2007; NIMHANS & WHO, 2006; WHO, 2006). As the formal school started, the recovery program focused on these schools in a designed manner to implement various concepts of international guidelines (like safe school and child-friendly space) in a structured fashion. An outline of the school recovery program is presented here that was developed by the American Red CrossIndia Delegation team with the Indian Red Cross local branch in Tsunami-affected areas of Kanyakumari District (Bhadra & Pratheepa, 2009; IFRC, 2008). The main features of this program were: 1. 2. 3. 4.

5.

Primary assessment of the school by involving the teachers, students, and parents. Development of proposals for facilitating the school recovery. Administrative clearance from the Education Department of Government to work in the schools. Training of the teachers by focusing on the three main issues that include facilitating the concept and approach of child-friendly space, developing sense of place in the schools, and safe school protocol. Developing the school committee by involving the teachers, parents, and student representatives to facilitate a community school interaction and to ensure holistic recovery of the children.

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Conducting joint assessment by the students, teachers, and parents and developing the three-dimensional school map to understand the situation and the possibilities of making changes. Designing various protection activities toward health, psychosocial, safe school interventions, and events that will encourage the children to participate and gain resiliency to deal with future challenges.

The school recovery program was a series of continuous activities that ensured creating child-friendly space, developing a sense of place and a safe school program. In this process capacity building of the teachers, to provide adequate knowledge and skills to work with the children was a vital step. The training was conducted in two phases. In the first phase, the module of training focused on psychosocial interventions and health promotion. The psychosocial components included working with children by using different mediums, developing positive habits, positive coping skills among the students, facilitating study habits, etc. Heath interventions included promoting health and hygiene practice, providing first aid, awareness about prevention of various communicable diseases, nutritional support, etc. In the second phase the teachers were specifically trained on “safe school” intervention that focused on identifying the risk, hazards and developing response strategies as part of disaster preparedness. Following the training program the teachers with the project staff through community interaction developed the school committee that could design the interventions according to the needs of the children and community perspective. The parents, village leaders, and traditional leaders became the most crucial members in the school committee and facilitated this process of school intervention. They were also provided with various reading materials and had meetings to explain the school recovery program. The committees took an active role in mobilizing local resources to strengthen the activities in the schools. In the classroom teachers started conducting various psychosocial support activities with specific goals to reduce fear, to talk about the issues, changes after Tsunami over time, developing positive attitude toward studies, etc. To facilitate these activities the teachers were supported with materials (like notebooks, color box, pencils, color papers, etc.) and activity manuals. These manuals were produced for the primary, middle, and high school students with different activities and corresponding goals. Some of the activities were spread over 3–4 classes and also can be repeated from time to time to generate, discuss, and review the progress over time. In the activity manuals, for psychosocial support the activities were “build the strength of group,” “support your family,” “help your friend,” “develop and achieve your dream,” “study well,” “develop concentration and motivation,” etc. All these sessions were designed to conduct in group with the students based on experiential learning and participatory methodology. The sessions were written as a guiding tool for teachers, as they could follow step by step. Each session was having clear aim, objectives, and process to be followed, with a broad outcome and session follow-up steps for the same. Similarly, there were sessions on the health and hygiene promotion that deal with topics like “fool hygiene techniques,” “hand washing practice,” “drinking water solution,” “water-/air-/vector-borne disease and prevention,” “first

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aid,” etc. (Singh & Mini, 2009). These sessions were also focused on specific learning points and skill orientation for the student to strengthen the behavioral pattern for adapting healthy practices. All the schools implemented the safe school program. In the second phase of the training the teachers were trained on disaster preparedness and the safe school module. Further in the schools the teachers developed the safe school practice. As part of this module each school developed the school map to identify the specific risks and resources in the schools. This assessment is called a “hazard, vulnerability, and capacity assessment” and further the students were trained on the preparedness aspects of identifying risks of Tsunami, cyclone, high tide, incidence of fire and road accidents. On each of these risks the students and teachers were engaged to identify the strategies for safety and thus mock drills were conducted regularly. Each school developed their disaster safety plans and displayed the same for everyone’s understanding and knowledge. The schools were provided with the basic disaster safety tools like, megaphone, rope, blanket, sand buckets for fire safety, water pipes, etc., according to the safe school protocol developed by them.

Interventions in Schools in Other Disasters in India Psychosocial interventions in schools for the children and adolescents are now an integral part for any disaster response and intervention program. Considering the cycle of disaster, intervention as part of disaster preparedness is extremely crucial to enhance the capacity to deal with disaster and reduce the impact of any disaster. Thus, through safe school training program capacity building of the teachers and implementation of the safe school planning is now being implemented by NIDM and NDMA with the disaster management institutes across the nation. National School Safety Project (NSSP) is implemented in 22 states and union territories that focus on capacity building of the school community, planning, practice of mock drill, structural safety, developing IEC materials of local languages and disseminating the same (NDMA, 2016a, 2016b). These training modules have an important focus on psychosocial care, inclusion of the marginalized and facilitating well-being to enhance psychosocial competencies (Raj, 2018). School interventions in conflict affected zones have always been a major challenge, as the security threat, prevailing turmoil, mobility restrictions are important barriers to facilitate psychosocial support interventions. In the communal violence affected areas of Gujarat during 2002, the interventions with the school going children started in the relief camps and continued in the schools, as it resumed over next few months. Initial interventions were by the trained community volunteers and subsequently the school teachers working in the riots affected areas were trained. The major focus of the psychosocial interventions was dealing with the trauma due to communal violence, facilitating well-being and restoring communal harmony. Various sessions with the children focused on enhancing motivation, promoting plural values, learning about others’ faith, and dealing with academic requirements. Life skills education

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approach was used to promote harmonious living, communal harmony, and peacebuilding. In this intervention, the Muslim religious schools Madrasa were included to reach out to the students who were also having very psychosocial issues and trauma due to riots. The intervention showed a positive outcome and change in terms of higher engagements of teachers, improved attention, interest, attendance, discipline among the students and continuous support from the school management (Bhadra, 2018). The children living in the border areas affected by cross-firing between India and Pakistan are a very vulnerable group, who are often being displaced, and education is closed because of incidents of firing. The indiscriminate firing also caused a lot of injuries, death and loss to the families too. There are incidences that the children have been trapped inside school and mortar cell heat the school building and premises. The children and communities living across the border are the worst sufferers as there is no long-term solution yet, and the situation is continuously disturbed over decades, with some intermittent agreement of ceasefire. Sometimes schools are occupied by the armed forces, and losing the school days, inability to complete the syllabi, living in the bankers or relief camps, inability to get back to school are quite common (Kousar & Bhadra, 2021). A time-limited intervention was conducted with few children in 5 schools to provide psychosocial support and facilitate resiliency building. The children expressed that they are not allowed to speak about their feelings and find it very difficult to overcome the feeling of discomfort as firing may start any time. Through intervention the children were allowed to express their feelings through storytelling, drawing, role play, and children relaxed and also discussed how they should play safe and further sessions deal with resiliency building. COVID-19 pandemic, with serious impact on the life and daily routine of the children across the Globe became a serious mental health pandemic for the people, and children are badly trapped in the situation. Attending the school through online engagement became impossible for many students as their family could not afford a device or internet connection. The children who went out of the ambit of online school line education and psychosocial support for them is still a difficult reality as their basic right to education is hampered. Few of such students are sporadically given support through a number of civil society organizations and volunteers, that included providing counseling, facilitating online engagements with groups, and helped in continuing education. These efforts were quite minimal considering the vast need across the nation. Many national and local NGOS and CBOs across India facilitated a number of help, like providing food supplies, hygiene kits, educational equipment and other medical support according to the situation. Number of capacity building programs for the care workers, teachers, parents and direct sessions on psychosocial support were also conducted to facilitate well-being. Some of the important organizations are CRY1 (Child Rights and You), Save the Children 2 Child Fund India,3

1

https://www.cry.org/blog/help-indias-children-survive-the-second-wave-of-covid-19/. https://www.savethechildren.in/covid-19-second-wave. 3 https://childfundindia.org/response-to-covid19-crisis/. 2

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Pratham,4 Room to Read5 , etc. played an important role. UNICEF6 across the globe through its multiple national offices have been in the forefront to facilitate well-being, care protection for the children in different critical circumstances as well as in the community. The government of India launched a psychosocial support program for the children to ensure psychosocial care through different kinds of activities, like training teachers on mental health care, providing educational materials to the teachers, students, and parents on mental health issues for maintaining healthy living. The online portal “Manodarpan”7 was started by the Ministry of Human Resource Development, Government of India, on July 22, 2020, to give valuable advisory and resources on psychosocial support. Number of discussions, webinars, and active online engagement sessions are conducted to facilitate psychosocial support to the children and adolescents across the nation. But, often the Schools in India are not well equipped with the computer facilities and stable electricity and internet connection caused major bottlenecks to reach out extensively and equally. Often the digital divide of the Indian population surfaced and it showed the non-availability of digital devices in the hands of rural people. But the recent data showed that the use of smartphones and other digital devices has increased from 36.5% from 2018 to 61.8% in 2020 in rural areas (PTI, 2021). Still a large section of the poor marginalized families could not afford a digital device for their children to continue school education through online mode. Thus, large sections of the poor children are at high-risk of drooping out and many of them are out of the ambit of psychosocial support during the pandemic and subsequently. With the problem of poverty and hunger the children might be forced to leave school and supplement family income (ReliefWeb, 2021). Thus, the psychosocial support for the children in India during COVID-19 is yet to reach out effectively till the bottom of the society.

Protective Environmental Framework Protecting the civilians and especially the child and other vulnerable groups during war and national disaster is a prime concern of the United National and various international bodies. Boothby and Ager (2010) explained “Protective Environment Framework” that was developed as a basis to identify the key areas, where actions can be taken to increase the protection available to children (Landgren, 2005). This framework is designed to promote children’s well-being with recommended eight action points, which together can reduce harm toward the children or develop a “shield” around children, but necessarily not eliminate all the risks and vulnerabilities. The belief is that the implementation of this framework will reduce the impact 4

https://www.pratham.org/covid-19-response/wave2-india/. https://www.roomtoread.org/covid-19-response/. 6 https://www.unicef.org/appeals/covid-19. 7 http://manodarpan.mhrd.gov.in/index.html. 5

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of the disaster and develop better active protective mechanisms and strategies for the children. These action points include, (a) government commitment and capacity; (b) legislation and enforcement; (c) culture and customs; (d) open discussion; (e) children’s life skills, knowledge, and participation; (f) capacity of families and communities; (g) essential services; and (h) monitoring, reporting, and oversight. Bizzarri (2012) criticized that despite significant development of knowledge and theoretical understanding the protection of the vulnerable groups in disaster is far from being practiced in disaster management. There is considerable inconsistency in the application of the different international law for the protection of the marginalized sections and lack of disaggregated data about different vulnerable groups is a major challenge to ensure enough protective mechanism for the vulnerable groups. The SDG 16.2 “ending all forms of violence against children” is a major commitment that was taken up by the UN Secretary General and “The Global Partnership and Fund to End Violence Against Children” was launched in July 2016 (End-violence, 2016). This is a coalition of UN agencies, NGOs, government, academic institutes, private sector groups and networks to bring evidence-based advocacy and action. Further INSPIRE a seven evidence-based strategy is designed to prevent and respond to violence against children between 0 and 17 years. INSPIRE (WHO, 2016) stands for, • • • •

Implementation and enforcement of laws: to ensure safety and stop violence, etc. Norms and values: gender norms-roles, establishing equality, etc. Safe environments: enabling safe environments – like safe housing, school, etc. Parent and caregiver support: empowering through training, giving knowledge, skills support in parenting, etc. • Income and economic strengthening: microfinance, livelihood support, etc. • Response and support services: rescue, treatment, training, rehabilitation, etc. • Education and life skills: ensure quality education and life skills to cope with challenges. Considering the threat to the well-being of the children, UNICEF is in the process of developing the Child Protection Strategy 2021–2030 that focused on three important objectives, (a) promote social and gender based to support child rights and prevent any harm, (b) development of inclusive effective child protection system, (c) addressing child protection issues in any humanitarian emergency settings. This strategy document would advocate toward developing legal mechanisms, access to justice, prevention of family separation, any harmful practice, violation against children, facilitating health and psychosocial well-being, and strengthening action against GBV (UNICEF, 2020).

Conclusion Child protection in disasters is a matter of long-term commitment and practice for the humanitarian sector and also for the government mechanisms of a nation to

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ensure well-being. Psychosocial support programs are crucial for strengthening and implementing child protection work in an effective and efficient manner through participatory practice in the community and schools. Child protection is an essential mandate of the United Nations for all time but during disasters this becomes a crucial issue with increased factors of vulnerability and erosion of social support and traditional protective mechanisms of society (i.e., family, neighborhood, school, etc.). COVID-19 pandemic exposed the human rights vulnerabilities of the children that are closely associated with poverty, economic crisis, political stability, climatic condition, and functional service delivery systems like healthcare facilities, educational opportunities, food supplies, hygienic condition, water availability, sanitation facilities, etc. Each disaster increases the vulnerability of the children and exposes the children to a situation of higher risk that they are unable to comprehend and control. Disaster interventions at every stage (i.e., rescue, relief, rehabilitation, recovery, preparedness) need considerable focus on building mechanisms for child protection.

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Steven, T. W. (2003). Declaration of the rights of the child. Retrieved August 26, 2013, from www.uni cef.org: http://www.unicef.org/lac/spbarbados/Legal/global/General/declaration_child1959.pdf The Inter-Agency Network for Education in Emergencies (INEE). (2004). Minimum standards for education in emergencies, chronic crises and early. INEE Network. The Sphere project. (2011). Humanitarian charter and minimum standards in humanitarian response. The Sphere Project. UN Office of Disarmament affairs. (2019, July 12). Treaty on the prohibition of nuclear weapons. Retrieved June 23, 2021, from United Nations Office of Disarmament affairs. https://www.un. org/disarmament/wmd/nuclear/tpnw/ UN, ISDR. (2007). Towards a culture of prevention: Disaster risk reduction begins at school good practices and lessons learned. International Strategy for Disaster Reduction. UN. (2015). Transforming our world: The 2030 agenda for sustainable development. United Nations. Retrieved from https://sustainabledevelopment.un.org/content/documents/21252030% 20Agenda%20for%20Sustainable%20Development%20web.pdf UNESCO. (2005). UN decade of education for sustainable development, 2005–2014. Paris. UNESCO. (2015). Education 2030-incheon declaration and framework for action. United Nations Educational, Scientific and Cultural Organization. UNESCO. (2016). Global guidance on addressing school related gender based violence. United Nations Educational, Scientific and Cultural Organization and UN women. Retrieved from https:// unesdoc.unesco.org/ark:/48223/pf0000246651 UNICEF. (2012, May 25). Child friendly schools. Retrieved August 27, 2013, from www.unicef.org: http://www.unicef.org/lifeskills/index_7260.html UNICEF. (2020, November 2). Child protection strategy (2021–2030)—consultation draft. Retrieved July 16, 2021, from UNICEF: https://www.unicef.org/moldova/media/4421/file/UNI CEF%20Child%20Protection%20Strategy%20.pdf WHO. (1991). Psychosocial consequences of disasters: Prevention and management. World Health Organization. WHO. (1997). Life skills education for children and adolescents in schools; program on mental health. World Health Organization, Mental Health Division. WHO. (2003). Information series on school health document: The physical school environment: An essential component of a health-promoting school. World Health Organization. WHO. (2005a). Child and adolescent mental health policies and plans. Mental health policy and service guidance package. WHO. WHO. (2005b). The physical school environment, as an essential component of health—promoting school. World Health Organization. WHO. (2006). Psychosocial support for tsunami affected populations in India. Non Communicable Diseases and Mental Health Cluster, WHO Country Office, India. WHO. (2016). INSPIRE-seven strategies for ending violence against children. World Health Organization. Retrieved from INSPIRE: http://inspire-strategies.org/sites/default/files/2020-06/978924 1565356-eng%20%283%29.pdf

Part V

Protective Measures

Chapter 27

Developing Countries and the Potential of Mandatory Reporting Laws to Identify Severe Child Abuse and Neglects Ben Mathews

Introduction Child abuse and neglect affects many children worldwide. Differences in measurement mean findings must be interpreted with care (Mathews et al. 2020a, 2020b), although systematic research provides a reasonably sound indication of the extent of the problem. A meta-analysis of studies of self-reported emotional abuse found approximately 36.3% of all children were victimised, with both boys (36.3%), and girls (38.4%) experiencing similar levels of victimisation (Stoltenborgh et al., 2012), and higher rates in Africa, Asia and North America. For physical abuse, a metaanalysis found approximately 22.6% of all children were victimised, with no substantial difference according to gender or location (Stoltenborgh et al., 2013). Similarly, a meta-analysis of sexual abuse found approximately 12.7% of all children were victimised, with both girls in general (18.0%), girls in Australia (21.5%), and boys in Africa (19.3%) experiencing this type of abuse most frequently (Stoltenborgh et al., 2011). A recent global estimate concluded that 1 billion children experienced some form of physical, sexual or emotional violence in the prior year (Hillis et al., 2016), with Asian, African and Northern American regions having the highest minimum prevalence. This study concluded there is “an urgent need to escalate global commitments to protecting children” and that improved surveillance of violence against children, and improved access to core prevention interventions “is essential to target prevention, monitor progress, and drive the urgent action endorsed in the 2030 Sustainable Development Agenda” (Hillis et al., 2016, p. 10). Despite methodological variations, there is ongoing progress in measuring the extent and nature of maltreatment, shown by the proliferation of national studies such as the Violence Against Children Studies (Nguyen et al., 2019), the Multiple Indicator Cluster Studies (Cuartas et al., 2019), multi-country regional studies (Nikolaidis B. Mathews (B) School of Law, Queensland University of Technology, Brisbane, Australia e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_27

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et al., 2018) and many others (Mathews et al., 2020a, 2020b). It is also clear that child maltreatment in its five major forms continues to present massive and multiple challenges to all societies around the world. Recent work has identified global challenges presented by psychological abuse (Brassard et al., 2020), neglect (Kobulsky et al., 2020), sexual abuse (Mathews & Collin-Vézina, 2019), physical abuse (Vlahovicova et al., 2017), and exposure to domestic violence (Kimber et al., 2018). The vast body of literature on the consequences of child abuse and neglect continues to grow, and it is clear the various forms of abuse and neglect both individually and when experienced in combination often cause severe and lifelong consequences for mental and physical health (e.g. Hughes et al., 2017; Teicher & Samson, 2016; Teicher et al., 2016), and for the attainment of core capabilities due to compromised educational outcomes (Fry et al., 2018). All societies therefore face ethical, economic and practical challenges in determining how to respond to child maltreatment, how to prevent it, and which types of child maltreatment to prioritise. As will be shown below, international human rights instruments and policy documents emphasise the obligation of all nations, including those in lower- and middle-income countries (LMICs), to take multiple legal, administrative, and practical actions to protect children from these types of maltreatment. Recent years have witnessed increased international policy recognition of the importance of maltreatment prevention. The Convention on the Rights of the Child, especially through article 19, recognises children’s right to be free from abuse and neglect. The UN Sustainable Development Goals urge all nations to eradicate child maltreatment, and require governments to report on their efforts (United Nations General Assembly, 2015). In particular, SDG Target 16.2 aims to end abuse, exploitation, trafficking, and all forms of violence against and torture of children; Target 5.2 aims to eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation; and Target 5.3 aims to eliminate all harmful practices, including child, early, and forced marriage and female genital mutilation. The various forms of child maltreatment—physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic or family violence—are often grouped together as if they are homogenous. Yet, different forms of maltreatment have different characteristics. There are also particular types of maltreatment that may present as significant problems in some societies but not others, such as child trafficking, child sexual exploitation, unlawful child labour, and female genital cutting. It is essential to recognise this heterogeneity of maltreatment, and the jurisdictionspecific contexts and priorities that may exist, when considering what legal and policy frameworks may be most useful and feasible to detect and respond to cases of child maltreatment, both in Western nations and in developing economies. Severe physical battering of an infant, and sexual abuse, e.g., are very different to mild povertyrelated neglect of a child who lives in an otherwise loving family. This heterogeneity across and even within types of maltreatment, together with the cultural, social and economic conditions present in a particular society, suggests that some legal and policy responses will suit one form of maltreatment better than others.

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In addition, now, more than ever, societal conditions are under immense strain and new challenges dominate. The catastrophic effects of the COVID-19 pandemic, displaced persons and migration of refugees, and climate change, all mean we are not dealing with a single set of social and clinical circumstances, but rather a complex, dynamic and in some cases chaotic and devastating daily existence, with societies struggling to cope with the fundamentals of life. The pressures associated with life under pandemic conditions are likely to increase various types of maltreatment, and has been shown already to elevate the level of violent discipline in the home (Fabbri et al., 2021). As acknowledged by the previous version of this chapter (Mathews, 2015a), upon which this chapter expands, an understanding of the types of maltreatment, the nature of these laws, and of social context is essential to inform deliberations about optimal measures in law and policy to interrupt severe cases of child maltreatment. This chapter will first consider some of the key characteristics of different types of child abuse and neglect (Part 1) and will then outline the international context of children’s rights and expanding cross-cultural social norms in which international instruments and human rights agency recommendations endorse strong approaches to prevention and early intervention (Part 2). The chapter will then outline the nature and justifiability of mandatory reporting laws, which are one of the key legal responses made to child abuse and neglect in many nations (Part 3). Mandatory reporting laws have been created in many nations in different forms, as one component of a child protection system, aiming to assist in identification and interruption of severe abuse and neglect that would otherwise likely remain hidden. The purpose of these laws is to require designated professionals who deal with children in the course of their work to be educated about these duties, and enabled and compelled to report severe cases of maltreatment to social welfare agencies, so that the child’s victimisation can cease, health rehabilitation and other support can be delivered, and, where necessary, perpetrators can be held accountable (Drake & Jonson-Reid, 2007; Mathews, 2012; Mathews & Bross, 2008; Mathews & Kenny, 2008). The issue of whether such a strategy may be useful for child protection in developing countries with emerging economies is an important one. “Developing country” is an arbitrary term used by various institutions for convenience to describe a nation which has a lower living standard, industrial base, and human development index (HDI) compared to other countries (World Bank, 2012; United Nations Development Program, 2013). In the context of developing countries, Part 4 of this chapter will then address two questions: first, might some forms of maltreatment be more suited to this legal response to child maltreatment than others? Second, what options may be considered by developing countries, taking into account children’s needs, cultural conditions and practices, economic imperatives, and the different levels of preparedness to implement child protection strategies?

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Different Types of Child Abuse and Neglect: Definitions and Cultural Circumstances To properly inform this discussion, it is essential to define the different types of child abuse and neglect. It is also important to recognise that for some types of maltreatment—with neglect being the most relevant—a nation’s social, economic, and cultural contexts will have significant implications for deliberation about appropriate legal and policy responses. Since this chapter deals with child maltreatment across cultures, different cultural practices in child-rearing must be considered (Finkelhor & Korbin, 1988; Korbin, 1977, 1979). Some practices that are customary practice in a particular culture may be perceived by others as constituting maltreatment; similarly, what some cultures see as maltreatment might be seen by some specific cultures as permissible. There is no comprehensive all-encompassing model of what practices that are universally defined as abusive or neglectful. A clear example of this is xxx. Later in this chapter, further remarks will be made about cultural differences. Nevertheless, some acts towards children are so severe and so broadly recognised as harmful and non-normative that the scholarly and international community has arrived at some generally accepted understandings of the domains of child maltreatment. These understandings represent areas of common ground which can be adopted for the purposes of this discussion. Here, I will use the following general definitions of each maltreatment type, which draw on those proposed by leading scholars and international policy bodies, and which are generally consistent with rights and obligations in criminal law and civil law: • Physical abuse includes intentional acts of physical force by a parent/caregiver (for current purposes, not including reasonable and minor acts of corporal punishment permitted by a society’s laws and norms) (WHO, 2006); • Sexual abuse includes contact and non-contact sexual acts by any adult or child in a position of power over the victim, to obtain sexual gratification for the person or another person whether immediately or deferred in time and space, when the child either does not have capacity to provide consent, or has capacity but does not provide consent (Mathews & Collin-Vézina, 2019); • Psychological or emotional abuse occurs through parental behaviour, typically repeated, that conveys to the child they are worthless, unloved, unwanted or only of value in meeting another’s needs, exemplified by acts of hostility, terrorising, rejection, isolation, corruption and denying emotional responsiveness (Glaser, 2002, 2011; Kairys et al., 2002); • Neglect is constituted by omissions by parents or caregivers to provide the basic necessities of life such as food, shelter, clothing, supervision and medical care, as suited to the child’s developmental stage and as recognised by the child’s cultural context, which result in serious harm or present an imminent risk of doing so (Dubowitz et al., 2005); • Exposure to domestic violence (also referred to as family violence) occurs when the child witnesses (through seeing or hearing) a parent/family member subjected

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to assaults, threats or property damage by another adult/teenager who normally lives in the household; (this can also include other forms of interparental coercion) (Hamby et al., 2010). It is important to note that the degree and scale of abuse differ in each child’s lived experience, and this has implications for the likelihood of harm the child will experience. For example, a child may experience one or multiple repeated acts of physical abuse; a minor act or severe and life-threatening acts; acts from an otherwise loving and stable parent or acts from a hateful, violent and dangerous parent. Some types of maltreatment can be life-threatening, especially for young children; others will not. This heterogeneity exists across and within types of maltreatment, and in their consequences for individuals. As another example, the various domains of neglect—medical, nutritional, emotional, educational and supervisory—can all have different extents and significance. An infant who is not provided with necessary vaccinations or nutrition when these are available will be exposed to a different level of risk than a 7-year-old who is left alone at home for a day because his parents (or parents) have to go to work. Acknowledgment of this spectrum of experiences is especially important when considering appropriate legal and policy responses to intervene and respond to specific types of maltreatment and individual circumstances.

The Consequences of Serious Child Abuse and Neglect Different kinds of maltreatment may be more likely to present different kinds of consequences for the child; moreover, even within maltreatment types and even where the acts are the same kind, duration and chronicity, not all individuals will experience the same type or extent of consequences for mental and physical health, and social, and behavioural consequences (Widom, 2014). However, there is broad acceptance of the variety of severe consequences and the size of the costs of child maltreatment. In general, younger children are most often victimised, apart from sexual abuse (United States Department of Health and Human Services, 2009). The adverse physical and mental health, behavioural, educational, social, and economic consequences of all forms of serious abuse and neglect are often extremely substantial (Gilbert et al., 2009). Studies have identified these consequences for discrete maltreatment types: for physical abuse (see, e.g., Lansford et al., 2021); sexual abuse (e.g. Chen et al., 2010); for emotional abuse (e.g. Egeland, 2009; Stoltenborgh et al., 2012); and neglect (e.g. Perry, 2002). The economic costs to survivors, families, and communities are vast (Fang et al., 2015). Overall, in addition to fatalities, prominent common effects, which in many cases compromise development and which persist through the lifespan, include: failure to thrive; impaired brain development; impaired social, emotional, and behavioural development; reduced reading ability and perceptual reasoning; depression; anxiety; post-traumatic stress disorder; low self-image; physical injuries; alcohol and drug

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use; aggression; delinquency; long-term deficits in educational achievement; and adverse effects on employment and economic status (Fry et al., 2018; Hughes et al., 2017; Teicher & Samson, 2016; Teicher et al., 2016). All these consequences also affect the child’s dignity and capacity to develop fully and functionally as a human being; their core capabilities are compromised (Nussbaum, 2011).

Specific Risk Factors in LMICs As shown by meta-analyses of physical abuse (Stoltenborgh et al., 2013), sexual abuse (Stoltenborgh et al., 2011) and emotional abuse (Stoltenborgh et al., 2012), the prevalence of these types of abuse is substantial in many LMICs. Because of their different nature, however, it is difficult to pinpoint specific risk factors for these types of maltreatment. A multi-country analysis in six nations in different regions—Cambodia, Haiti, Kenya, Malawi, Nigeria and Tanzania—found a need for more rigorous country-specific research to identify risk factors to inform prevention strategies, but also found high levels of poly-victimisation (Palermo et al., 2019). Some literature has posited specific risk factors, however. A systematic review and analysis of studies of violence against children in LMICs found that, while no specific factors were significant for physical violence, being a girl was associated with sexual violence, and lower household socioeconomic status, being a girl, and primary education of mothers and adults in the household were associated with emotional violence (Cerna-Turoff et al., 2021). For sexual abuse, some studies in LMICs have concluded that the lack of a father in the home, due to death or absence, places girls at heightened risk (Kidman & Palermo, 2016). In LMICs, Veenema et al. (2015) posited that contributing factors include poverty, and that family strain contributes to all forms of child sexual abuse, including early marriage, child trafficking, rape and coercion. Studies in other countries, such as the meta-analysis by Finkelhor et al. (2013) of sexual abuse in China, have concluded that one reason for lower rates of sexual abuse is a high level of parental supervision, in turn related to greater marital stability and fewer children. Overall, research has posited that in general, physical abuse may be even more common at younger ages, while emotional abuse may remain relatively constant (see, e.g., Devries et al., 2018). Other research has concluded that some types of maltreatment such as emotional neglect are more frequent at early ages, while other types of maltreatment occur at consistent levels throughout childhood (Teicher & Parigger, 2015).

Secrecy and Non-disclosure For all forms of severe child abuse, it is well-established that those inflicting the maltreatment rarely disclose their own actions to social agencies (US DHSS, 2009).

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A key feature of the general field of child maltreatment is that for a range of reasons, children themselves cannot or do not tell anyone about their experience. As a result of this, they are themselves unable to prevent their ongoing maltreatment and have no other person able to assist them from a socially protective agency. Neonates and infants cannot speak; young children cannot understand what is happening and cannot represent themselves; and even older children and young adolescents may be unable to disclose their experience and seek assistance or protection. Research has been conducted into non-disclosure and delayed disclosure of child sexual abuse into in particular. This research has found that across cultures, non-disclosure and delayed disclosure is typical, and influenced by multiple factors (e.g. Alaggia et al., 2017). Moreover, most disclosures are to trusted individuals rather than social agencies. Disclosure of sexual abuse has also been shown to be infrequent in LMICs such as Nigeria and Malawi (Nguyen et al., 2021). The acts of child maltreatment generally occur in private and are often unknown by adults outside the family. The vulnerability of children, combined with secrecy and non-disclosure, means they are typically unable to access help from law enforcement or other protective agencies such as health, educational or social welfare. These children are vulnerable to abuse continuing, and frequently need health rehabilitation as well as protection.

The International Context of Children’s Rights and Expanding Cross-Cultural Social Norms: International Instruments and Policy Recommendations For almost a century, international human rights instruments have recognised childhood as a time of special vulnerability. In 1924, the Geneva Declaration of the Rights of the Child declared that all nations owe to children the best they have to give, and included express recognition that children “must be protected against every form of exploitation” (League of Nations, 1924). The Charter of the United Nations (1945) and the Universal Declaration of Human Rights 1948 recognised that motherhood and childhood are special states of being entitled to special care and assistance. The Declaration of the Rights of the Child 1959 explicitly justified the need for children’s rights (Principle 2): “the child, by reason of his [or her] physical and mental immaturity, needs special safeguards and care, including appropriate legal protection”.

United Nations Convention on the Rights of the Child In 1990, the United Nations Convention on the Rights of the Child (UNCRC) gave further impetus to children’s rights generally in all nations and to protection from

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child maltreatment as a public health concern. The primary strength of the UNCRC lies in its aspirational vision, establishment and reinforcement of fundamental norms, and advocacy for a universal commitment to better promote and protect children’s safety and development, as well as its monitoring function. Several parts of the CRC, exemplified by articles 19, 34, 39, and 44, express a clear commitment to primary, secondary, and tertiary prevention of child maltreatment, and to the use of strategies including monitoring and programme evaluation. Article 19 has a special focus on the requirement to take all appropriate measures to protect children from abuse and neglect. Most relevantly for this chapter, article 19(2) states that these protective measures should include procedures for the “identification, reporting, referral, investigation, treatment and follow-up of instances of child maltreatment”. Also significant is that article 34 has further specific emphasis on protection of children from sexual abuse, and article 39 contains a separate focus on the provision of rehabilitation and support to children who have experienced maltreatment. These key provisions are set out in Box 27.1. Box 27.1: Key articles from the United Nations Convention on the Rights of the Child Article 19 1.

2.

States Parties shall take all appropriate legislative, administrative, social and educational measures to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse, while in the care of parent(s), legal guardian(s) or any other person who has the care of the child. Such protective measures should, as appropriate, include effective procedures for the establishment of social programmes to provide necessary support for the child and for those who have the care of the child, as well as for other forms of prevention and for identification, reporting, referral, investigation, treatment and follow-up of instances of child maltreatment described heretofore, and, as appropriate, for judicial involvement.

Article 34 States Parties undertake to protect the child from all forms of sexual exploitation and sexual abuse. For these purposes, States Parties shall in particular take all appropriate national measures to prevent (a) the inducement or coercion of a child to engage in any unlawful sexual activity; (b) the exploitative use of children in prostitution or other unlawful sexual practices; (c) the exploitative use of children in pornographic performances and materials. Article 39

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States Parties shall take all appropriate measures to promote physical and psychological recovery and social reintegration of a child victim of: any form of neglect, exploitation, or abuse; torture or any other form of cruel, inhuman or degrading treatment or punishment; or armed conflicts. Such recovery and reintegration shall take place in an environment which fosters the health, self-respect and dignity of the child.

Committee on the Rights of the Child: Guidance on Article 19 Accompanying guidance on the nature and application of article 19 of the UNCRC appears in the Committee on the Rights of the Child’s General Comment on the right of the child to freedom from all forms of violence (United Nations Committee on the Rights of the Child, 2011). On the reporting of child abuse, the Committee stated (pp. 19–20) (author’s italics): The Committee strongly recommends that all States parties develop safe, well-publicized, confidential and accessible support mechanisms for children, their representatives and others to report violence against children, including through the use of 24-h toll-free hotlines and other ICTs. The establishment of reporting mechanisms includes: (a) providing appropriate information to facilitate the making of complaints; (b) participation in investigations and court proceedings; (c) developing protocols which are appropriate for different circumstances and made widely known to children and the general public; (d) establishing related support services for children and families; and (e) training and providing ongoing support for personnel to receive and advance the information received through reporting systems. Reporting mechanisms must be coupled with, and should present themselves as help-oriented services offering public health and social support, rather than as triggering responses which are primarily punitive ... In every country, the reporting of instances, suspicion or risk of violence should, at a minimum, be required by professionals working directly with children. When reports are made in good faith, processes must be in place to ensure the protection of the professional making the report.

Other international instruments also endorse the use of such reporting mechanisms, especially in some categories of maltreatment. For example, the Optional Protocol on the Sale of Children, Child Prostitution and Child Pornography article 9 requires states parties to “adopt or strengthen, implement and disseminate laws, administrative measures, social policies and programmes to prevent the offences referred to in the present Protocol.” The UN Committee on the Rights of the Child Guidelines on the implementation of the Optional Protocol (2019) encourage the promotion of reporting mechanisms (article 28) have extensive provisions on training requirements (Part G, articles 29-30) and contain a general provision supporting the implementation of measures to prevent and identify cases. Article 31 imposes on States parties “an obligation to adopt or strengthen, implement and disseminate

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laws, administrative measures and social policies and programmes to prevent the offences covered by the Optional Protocol”, and article 33 recommends that States parties “take all measures necessary to identify, support and monitor children at risk of falling victim to the offences covered by the Optional Protocol, especially children in vulnerable situations, and to strengthen prevention programmes and the protection of potential victims.” Similarly, the Council of Europe Policy Guidelines on Integrated National Strategies for the Protection of Children from Violence (CM/Rec (2009) 10) provide an unequivocal recommendation for mandatory reporting legislation. These Policy Guidelines were adopted by the Committee of Ministers in 2009 and recommend that member states “integrate, as appropriate, in their legislation, policy and practice the principles, and implement, as appropriate, the actions set out in the Council of Europe Policy guidelines on integrated national strategies for the protection of children from violence, as they appear in the Appendix”. Most relevantly, the Appendix has provisions on reporting of violence (6.4 Part 2), and professional training (4.2): 6.4. Reporting of violence. 1. Education on the rights of the child and the knowledge and understanding of authorities to whom violence can be reported are two essential conditions enabling wider reporting of violence by both children and adults. To be truly effective, the reporting mechanism should be child-friendly and part of a broader system comprising reporting, referral and support services. Such a system should respect the rights of the child and offer children (and, where appropriate, their families) the necessary protection, including the protection of their privacy, without undue delay. 2. Reporting of violence should be mandatory for all professionals working for and with children, including those in organisations and private entities performing tasks on behalf of the state. Where mandatory reporting already exists, the extent to which various agencies fulfil their reporting obligations should be examined and kept under regular review.

Other major policy documents and recommendations also endorse and support the use of reporting systems to assist in child protection. In her 2019 report Keeping the Promise: Ending Violence against Children by 2030, the UN Special Representative of the Secretary-General on Violence against Children (SRSG) outlined measures to be taken in order to help states reach target 16.2 of the UN SDGs. Amongst other things, the SRSG recommends that legislative frameworks tackling violence against children should establish mandatory reporting for institutions and professionals working regularly with and for children (p. 30). The Office of the Special Representative of the Secretary-General on Violence against Children has also advocated for and outlined the requirements of mandatory reporting mechanisms. In Toward a world free from violence: Global survey on violence against children (2013, p. 77), the SRSG concluded that “Mandatory reporting by professionals who work with child victims of sexual abuse and other acts of violence causing physical injury and psychological violence should be given due consideration by all countries.” In 2016, in Safe and child-sensitive counselling, complaint and reporting mechanisms to address violence against children, a joint report with the UN Human Rights Office of the High Commissioner, it was concluded that (Office of the Special Representative of the Secretary-General on Violence against Children, 2016):

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The authors of the present report consider that some form of mandatory reporting, including the reporting by professionals who work with children, of sexual abuse and acts of violence causing physical injury and psychological violence is appropriate for all societies (p. 11) … Those working with children should have clear guidance on reporting requirements and consequences. Mandatory reporting responsibilities should be defined with respect for children’s rights, including confidentiality and privacy; standards establishing an obligation to report violence should be incorporated into regulations or rules of conduct of all institutions and agencies that deal with children at risk of violence. Mandatory reporting by professionals who work with children of sexual abuse and other acts of violence causing physical injury and psychological violence should be given due consideration by all countries. Rules that protect the identity of professionals and private individuals who bring cases of violence against children to the attention of the competent authorities should also be enacted into law (p. 20).

In 2006, in the Report of the Independent Expert for the United Nations Study on Violence Against Children, Paulo Sérgio Pinheiro recommended (Pinheiro, 2006, p. 27): “States should establish safe, well-publicized, confidential and accessible mechanisms for children, their representatives and others to report violence against children.” At p. 26, Pinheiro recommended: The capacity of all those who work with and for children to contribute to eliminate all violence against them must be developed. Initial and in-service training which imparts knowledge and respect for children’s rights should be provided. States should invest in systematic education and training programmes both for professionals and non-professionals who work with or for children and families to prevent, detect and respond to violence against children. Codes of conduct and clear standards for practice, incorporating the prohibition and rejection of all forms of violence, should be formulated and implemented.

Accordingly, there is sustained and broad-based support at the highest level of international policy for the adoption of mandatory reporting mechanisms, at least for some types of child maltreatment, where these experiences reach a certain level of severity. This emerging consensus is informed by an understanding of the nature and consequences of severe maltreatment, its secrecy, and the child’s need for protective assistance from people outside the family who can act as sentinels to help bring the child’s situation to the attention of helping agencies. Moreover, these statements expressly acknowledge the kinds of supportive measures that must assist any reporting law: professional education and systemic support. They also acknowledge that these measures are simply one part of an entire child protection system, which should be accompanied by primary and secondary prevention measures.

Cultural Difference and Fundamental Norms It is important to acknowledge that cultural child-rearing practices differ widely across human societies. Some non-Western societies would interpret some Western practices as maltreatment; and similarly, some practices in specific non-Western nations may be interpreted by most Western nations as maltreatment (Korbin, 1977,

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1979, 1980). Accordingly, it is difficult and perhaps impossible to arrive at a comprehensive model of child maltreatment that applies universally. However, it is nevertheless still possible to identify some classes of maltreatment that at a universal level are and should be seen as unacceptable. The variation in humanity’s cultural norms and practices does not restrict discussion or policy to a completely relativistic acceptance of any and all behaviour (Finkelhor & Korbin, 1988; Korbin, 1979), which would preclude social, legal, and policy approaches to responding to child maltreatment. It is not acceptable to adopt a posture of normative moral relativism which would hold that different cultural standards both exist and preclude any and all claims that some customs are unacceptable. In contrast, a posture of moral universalism acknowledges and accepts that different standards exist, but maintains that we can still assert that some standards are more justifiable than others, and proceed on this basis at the policy level. Such an endeavour is essentially the same kind of task undertaken at a general level by international human rights instruments and policy bodies. As shown above, some types of conduct are viewed as universally unfavourable and unjustified, and as requiring policy intervention to secure and support the fundamental rights and interests of the child wherever she or he may live. These are expressed as rights in the UNCRC to protection from all forms of abuse and exploitation while in the care of parents and caregivers (art 19), freedom from economic exploitation and hazardous labour (art 32), freedom from sexual abuse and exploitation (art 34), and freedom from sale and traffic (Article 35). Despite cultural variance, there are some classes of conduct that are sufficiently broadly disapproved that they form absolute standards of unacceptable behaviour. These fundamental norms include: child sexual abuse and exploitation; child trafficking; severe physical abuse; and severe neglect. Scholars have also noted types and manifestations of child abuse and neglect that occur internationally and within which there are subspecies which can form the basis for international action. As long ago as 1988, Finkelhor and Korbin recommended that three forms of child abuse should be the immediate focus of international action: parental child battering, sexual abuse and selective neglect (i.e. neglect based on discrimination related to gender, disability, or birth order) (p. 16). More recently, international movements have continued to proliferate to criminalise other acts traditionally inflicted on children. For example, criminal laws continue to be enacted in countries around the world to prohibit female genital mutilation both within the country of residence, and removal of a child from the country for the purpose of conducting it (Mathews & Dallaston, 2020). Another example is that in an increasing number of nations, laws prohibit corporal punishment (Durrant et al., 2020). By September 2021, 63 nations had prohibited corporal punishment (Global Initiative to End All Corporal Punishment of Children, 2021). A cogent case can therefore be made for a systematic response in all societies to some specific forms of child maltreatment. However, important questions arise about the feasible and optimal form of such responses. We will now consider the nature and justifiability of mandatory reporting laws as one potential response for some types of maltreatment.

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The Nature and Justifiability of Mandatory Reporting Laws Mandatory reporting laws were first created in the USA in the 1960s to respond to the problem presented by the fact that severe child maltreatment is a largely hidden phenomenon. It occurs within the family sphere and is often inflicted on infants, who are pre-verbal, and young children, who cannot resist, represent themselves, resolve the situation, or disclose the experience (Mathews, 2012). Neonates, infants, and very young children are most vulnerable to fatality and serious harm from severe abuse and neglect. In the definitive article which exposed physical abuse and doctors’ failure to respond appropriately to it, Kempe et al. (1962) stated that severe physical abuse was mostly inflicted on children aged under 3 years of age. Overall, children rarely disclose their own suffering, and because the acts are severe and often constitute criminal conduct, those who inflict the abuse or neglect are also unlikely to reveal it to authorities or agencies which can help the child (Mathews, 2012). Disclosure by children of their maltreatment will be even less frequent in societies which have not yet developed a culture of child protection and in which other societal features silence children in general, and girls in particular (e.g. Shalhoub-Kevorkian, 1999). A mandatory reporting law is a specific kind of law which imposes a duty on specified categories of persons outside the family, such as teachers, to report suspected cases of designated types of child maltreatment to child welfare agencies. These designated persons are usually members of occupational groups who frequently encounter children in the course of their work: typical examples are doctors, nurses, teachers, and police. The underlying concept is to impose a requirement on designated people who are well-placed to detect cases of severe child abuse and neglect to report known and suspected cases to the attention of government welfare agencies, so that measures can be taken to ensure the child is safe, that the maltreatment stops, that rehabilitation can be provided, and that the needs of the child and the family can be identified and supported. By employing the expertise and concern of persons outside the family who encounter the child, the hidden nature of child maltreatment can be overcome. It is important to note that these laws are generally not designed to require reports of any and all manifestations of harm or “maltreatment”; rather, for the most part they are directed at serious forms of harm and maltreatment of children, and not at trivial incidents or simply “less than ideal parenting” (Mathews, 2012; Mathews & Kenny, 2008). The law in Ireland, first enacted in 2017, provides a good example of the limitation of the duty only to report cases of significant harm. As with virtually all such laws, it requires reports of all sexual abuse on the basis that any sexual abuse is sufficiently serious to warrant a report. However, it restricts the scope of the reporting duty by defining the concept of “harm” to mean: “(a) assault, ill-treatment or neglect of the child in a manner that seriously affects or is likely to seriously affect the child’s health, development or welfare, or (b) sexual abuse of the child”. Because of its hidden nature, the first primary objective of these laws is to identify cases of serious child abuse and neglect. For example, if in the course of their work a doctor or a police officer or a teacher encounters a 3-year-old child who has suffered

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severe intentional physical injury, or injuries suggesting sexual abuse, or severe neglect, the legal obligation requires the professional to report their knowledge or reasonable suspicion that the child has been abused and has suffered harm to a government child welfare agency so that the agency can assess the child’s situation to determine what protective and supportive actions need to be taken. The legislation provides the reporter with protections: their identity as the reporter is confidential, and they cannot be liable in any civil, criminal, or administrative proceeding for any consequences of the report (Mathews & Kenny, 2008). It should be noted that reporters are not expected to always be correct. It is often not easy to detect child abuse because the indicators of abuse can mimic other health conditions or accidental injury.

A Spectrum of Approaches from Broad to Narrow The laws can be designed to be broad or narrow. There are two major dimensions in which the laws differ across jurisdictions (both between countries, and within countries): first, which types of abuse and neglect must be reported; second, which persons have to report. Hence, there is a spectrum of mandatory reporting laws. At one extreme, a law might require reports only of sexual abuse, as in the Australian state of Western Australia (Mathews et al., 2009a, 2009b), and limit the reporter groups to teachers, doctors, nurses, midwives, and police. Or, like the first reporting laws, it might only require doctors to report serious physical abuse (Mathews, 2015b). A nation may require reports only of sexual abuse and physical abuse, as in the Australian states of Queensland and Victoria (Mathews et al., 2020a, 2020b). At the other extreme, a jurisdiction might design its law more broadly, requiring reports of all five forms of child maltreatment, as in the Australian states of New South Wales, Tasmania, and the Northern Territory (Mathews et al., 2020a, 2020b); and there may be a broader range of reporter groups. While laws across nations may have some differences in scope, the laws generally have common dimensions (Box 27.2).

Box 27.2: Dimensions of mandatory reporting laws 1. 2. 3. 4.

5. 6.

Definition of which groups of persons must make reports. Expressing the state of mind a reporter must have before the reporting duty is activated (e.g. either suspects on reasonable grounds, or knows). Definition of the types of abuse that must be reported. Stating whether the duty applies only to past or present abuse, or also to abuse which has not occurred yet but which is thought to be likely to occur. State penalties or criminal sanctions exist for failure to report (if any). Provide a reporter with confidentiality regarding their identity.

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Provide a reporter with immunity from liability arising from a report made in good faith. State when the report must be made (e.g. immediately). State to whom the report must be made (e.g. direct to the Department). State what details a report should contain. Enable any other person to make a report in good faith, even if not required to do so, and grant confidentiality and legal immunity to these persons.

Mandatory reporting laws can therefore be seen as one part of an overall public health response to child protection which should include primary prevention at the population level, secondary prevention of high-risk subsets of the population, and tertiary responses to identify and assist those who have already endured severe maltreatment. Being primarily concerned with identifying cases of maltreatment that have already occurred, the laws are an aspect of tertiary response (Gostin, 2008; Turnock, 2009). However, in their capacity to also identify cases of maltreatment before they have occurred, they are also a measure of secondary response.

Broad Use of Mandatory Reporting Laws Across the World Many Western jurisdictions and non-Western nations now have enacted these laws, requiring a range of occupational groups to report a number of types of child maltreatment. In Western nations, for example, the laws exist in scores of nations, including all 72 jurisdictions in the USA, Canada and Australia. Nations continue to enact the laws, including Ireland’s recent Children First Act, effective from December 2017. The laws are also widespread in LMICs. A 2006 survey of 33 developed nations and 29 developing nations found that 80.3% of the nations participating had some form of mandatory reporting, including 81.8% of developed nations and 78.6% of the developing nations (Daro, 2006; Mathews, 2019). By region, some form of mandatory reporting was present in: 90% of the nations in the Americas; 86.4% of the nations in Europe; 77.8% of the nations in Africa; and 72.2% of the nations in Asia. Examples of mandatory reporting laws in a range of nations are provided in Appendix 1. The provisions differ in several respects—for example, in relation to the types of abuse that must be reported, and the designated categories of mandated reporters—but have a similar structure.

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The Laws Are Part of a System A number of circumstances must be created to enable this legal response to be implemented successfully (Mathews & Bross, 2015). While mandatory reporting legislation of its nature tends to use some concepts which are not concrete, such as “suspects on reasonable grounds”, the legislation must be drafted well to avoid ambiguity and vagueness. Reporter training programmes must be high quality, delivered to all reporters, and delivered repeatedly. Positive working relationships between child welfare agencies and reporters must be maintained. Intake and response agencies must be adequately resourced by sufficient numbers of well-trained staff. Data systems must be well-maintained to enable monitoring of effectiveness and identification of problems so that solutions can be designed and implemented. All these aspects of the strategy clearly require substantial economic investment and personnel and expertise. To avoid overreach, the scope of any mandatory reporting law (e.g. its application to which types of maltreatment, and applying to which groups of reporters) should be congruent with the realistic capacity and ambition of the jurisdiction’s child welfare system (Mathews, 2012). A jurisdiction which is considering this strategy may have to make hard choices, at least in the short-term, about its scope.

Professional Education and Training Importantly, the laws must be accompanied by education and training for reporters, because reporters need to know the scope of their duty, the indicators of child abuse and neglect, what they should and should not report, how to make a useful report, and to whom they must report. This education is essential because it is known that systemic problems can arise where laws are poorly drafted, and reporters are not appropriately prepared to comply with the duty (Mathews, 2012). Even in countries where the laws have existed for decades, it is unfortunate that the frequency and quality of training is still lacking (Baker et al., 2021). Education of mandated reporters is essential to ensure the system functions effectively. Instrumentally, this education is aimed at creating the optimal conditions for mandated reporters to achieve two public policy objectives: (1) increase the likelihood of reporting known or suspected circumstances of sexual abuse (avoiding “failure to report”); and (2) decrease the likelihood of reporting situations that should not be reported (avoiding “clearly unnecessary reporting”). Studies of professions including teachers, nurses, doctors, and counsellors have found that more effective reporting is associated with (Fraser et al., 2010; Goebbels et al., 2008; Mathews et al., 2008): accurate knowledge of the reporting duty; accurate knowledge of the indicators of child abuse and neglect; positive attitudes towards the reporting duty; and experiencing specific child protection training.

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This education should be multi-dimensional and focused on (Mathews et al., 2017a, 2017b): 1.

2.

3.

Multidisciplinary understanding of the context of child abuse. This should include coverage of the indicators of different types of abuse, its prevalence, the settings in which it occurs, and risk and protective factors. It should include coverage of the health, behavioural and social consequences of child abuse, and the role of different social agencies such as police and the child protection system in responding to maltreatment. Development of knowledge, including accurate and in-depth coverage of the exact nature of the legislative duty to report, how to make an effective report, to whom to report, what to expect after making a report, how to deal with the child and the child’s family, and how to deal with colleagues and the organisation. Development of affective dispositions, to inculcate positive attitudes towards the reporting duty, and towards the professional’s role in the child’s life.

Optimal Reporter Support: User-Friendly Resources A recent study identified key approaches to better support mandated reporters across a range of health, educational, law enforcement, and other professions (Mathews, 2018). Education and training should be supplemented by a suite of user-friendly resources. For example, there should be a manual that contains more detailed information about the various types of child abuse (including its definition, nature, prevalence, indicators, and health outcomes); the nature of the legislative duty; and how the reporting duty is intended to work as part of the child protection system. There should also be fact sheets can give clear, focused, easily digestible information on key topics. Quick reference guides can give clear and accurate advice on key information (e.g. information on contact numbers and reporting forms); specific “What to do” information for common circumstances of key abuse types; and advice on any circumstances in the local context identified as being “hotspots of concern” (e.g. organised criminal networks, sex trafficking). These user-friendly products should employ concrete terms and give clear directions about what to do in different sets of circumstances. They should include documents that simply and clearly detail recommended actions for discrete categories of cases, with clear examples. For example, guidance can be clearly given about: (1) the types of situation that must always, immediately, be reported; (2) the types of situation that may justify consultation with an experienced colleague or an initial conversation with the child welfare agency (e.g. a difficult case where the indicators are unclear); and (3) the types of situation that should never be reported (e.g. clearly consensual peer sexual activity between 15 year olds).

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Child Welfare Agencies and Systemic Responses Child welfare agencies need to be equipped with staff to receive reports and assess them, and where necessary to investigate them and determine the appropriate course of action as set out in child protection legislation. Generally, the least intrusive course of action is preferred, but where necessary, cases of severe maltreatment where a child cannot be protected within the home may result in more formal action including removal of the child from the family home for the child’s protection. Such removal to foster care or kinship care is often only temporary before being returned to the family home, but in some cases it may be necessary to be of a more extended duration, and sometimes may result in permanent placement with other careers. The department for child protection which receives the report determines if it contains sufficient information justifying an investigation, or whether it can be screened out or added to an existing file. An investigation can involve as little as telephone or brief in-person enquiries, or can extend to consultation with the child— ensuring all interactions with the child to explore the situation are developmentally appropriate, trauma-informed, and sensitive to the child’s unique position—and interviews with the child’s parents, and other professionals like the child’s school teacher. The agency often has specialised multidisciplinary teams for this role. Child protection investigation teams must avoid unnecessary intrusion during investigations. However, there is no compelling evidence showing investigations cause unavoidable trauma for children, parents and others, especially for sexual abuse, where fewer cases will involve suspected parental involvement (Drake & Jonson-Reid, 2007). It is also arguable that the need to protect children from such fundamental violations outweighs mere distress and intrusion (Finkelhor, 1990, 2005). Some small studies with mothers have identified both positive and negative experiences with investigations and other systemic interactions, which indicate ongoing efforts are required to develop the required professional attributes and monitor investigators’ practice (Plummer & Eastin, 2007; Softestad & Toverud, 2012). Moreover, it is essential for systems as a whole to ensure the multiple component parts are functioning adequately. A review by McTavish et al. (2017) found reporters often are not satisfied with systemic outcomes of reports, which offers further confirmation that it is important for any society employing mandatory reporting laws to ensure it is part of a well-functioning and coherent system. This review found anecdotal reports of unsatisfactory outcomes in specific environments connected to the operation of the system, including accounts of children being revictimised by the reporting process, children whose abuse intensified after a report was filed, and foster care environments that were perceived to be worse than family-of-origin environments. The authors concluded that further research was required and that (p. 11) “Whether or not these negative experiences are reflective of national or international experiences must be assessed.” These conclusions point to areas requiring continuous monitoring and a commitment to ongoing systemic improvement.

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However—and recalling that the fundamental principle of these laws is to enable intervention in serious cases of abuse—many criticisms of the laws are connected with the failure of post-report responses, rather than the principle and purpose of the laws themselves. In addition, some elements of dissatisfaction with the outcomes of reporting are a result of misunderstanding of the nature and scope of the duty to report; namely, reporters sometimes complain that adverse or unintended consequences ensue from a report, but these are inevitable outcomes of reports that should not have been made in the first place because they were outside the scope of the reporting duty.

Empirical Data on Reporting Practice and Outcomes There remains a need for far more research on mandated and non-mandated reporting trends, agency practice and outcomes, and post-decision service delivery and outcomes, as applied to child maltreatment generally, and disaggregated by specific maltreatment type. This research needs to be accurately situated within the relevant nation’s legislative framework and reporter education framework so that legal and policy effects can be considered, and it needs to also be embedded within a close understanding of agency practice to allow accurate understanding of the quality and outcomes of reports. Ideally, child welfare agencies should publish far more detailed analyses of these data and considerations to allow more comprehensive understanding of the functioning of the system at all points in the sequence of reporting to post-report outcome. Data on reporting trends and outcomes must also be extremely carefully interpreted, with attention paid to different trends in relation to different maltreatment types. However, there is a range of evidence indicating that implementation of these laws with their associated mechanisms will identify substantially more cases of child maltreatment, although there will also be an element of systems burden which depends on the nature and scope of the laws and the efficacy of their implementation (Drake & Jonson-Reid, 2007; Mathews, 2012, 2014, 2018; Mathews & Bross, 2008; Mathews et al. 2020a, 2020b). It needs to be remembered that the purpose of the laws, and compliance with them, is to bring cases of significant maltreatment to the attention of the relevant social agencies, and then to allow them to do their job in determining what (if anything) is required to protect the child and support the child’s parents. These improvements in case identification include those involving serious physical abuse, which were the initial target of the first reporting laws in the USA in the 1960s. American researcher Doug Besharov concluded that the US mandatory reporting laws had resulted in a massive and sustained decline in child fatalities from physical abuse. Besharov (2005, p. 287) estimated that due to increased reporting and investigation and treatment services, annual child deaths in the USA had fallen from 3000–5000 to about 1100. Some 20 years earlier, he declared “there is no dispute that the great bulk of reports now received...would not have been made but for the

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passage of mandatory reporting laws and the media campaigns that accompanied them” (Besharov, 1985, p. 545). In addition to this, a comprehensive programme of research in the Australian setting has considered the effect of mandatory laws on reports of child sexual abuse, and the outcomes of these reports in relation to case identification. A summary of this research on mandatory reporting of child sexual abuse is presented here: • A study in a single Australian state (Western Australia) explored the impact of introducing a new mandatory reporting law for child sexual abuse. The study analysed seven years of government data, comparing trends in numbers and outcomes (including distinct children in identified cases) of reports of child sexual abuse for a three year period before the introduction of the law compared with a four year period after its introduction. Data were further stratified by individual and combined mandated and non-mandated reporter groups, allowing for assessment by specific professions. Amongst other findings, this study found that as a result of the introduction of the reporting law, twice the number of sexually abused children were identified each year (Mathews et al., 2016). • A study in a single Australian state (Victoria) to analyse trends in numbers and outcomes (including distinct children in identified cases) of reports of child sexual abuse for a 20 year period, with a focus on trends in reporting of girls and boys. The study analysed data over a period that witnessed the initial introduction of a mandatory reporting law, but no legal change thereafter, enabling consideration of long-term effects of the law, and of other social factors. Data were stratified by mandated and non-mandated reporter groups. Amongst other findings, this study found that the rate/100,000 reports for boys increased 2.6-fold, and the rate/100,000 of reports for girls increased 1.5-fold; moreover, positive report outcomes (i.e. substantiations, findings of harm, and referral to services) increased 12-fold for boys, and nearly five-fold for girls, and were based on actual clinical need (Mathews et al., 2017a, 2017b). • A national study using government data over 10 years found that mandated reports of child sexual abuse accounted for approximately 5–6% of all reports of all types of child abuse and neglect combined, and annual trends in sexual abuse reports were stable over time (Mathews et al., 2015). • A study of two similar jurisdictions (Victoria and Ireland), only one of which has a mandatory reporting law, to compare numbers and outcomes (including distinct children in identified cases) of child sexual abuse reports. This allowed analysis of different reporting practices of similar professional and non-professional reporter groups under different circumstances of legal requirement. The study found the jurisdiction with mandatory reporting identified 4.73 times the number of sexually abused children; moreover, confirmed cases of sexual abuse identified as a result of reports by mandated reporters in the jurisdiction with mandated reporting were 2.5 times the entire amount of cases identified by all reporters in the other jurisdiction (Mathews, 2014). • A study in a single Australian State (Queensland) of 930 nurses across 22 health districts), to identify their knowledge of and attitudes towards legal reporting

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duties for all forms of child maltreatment. This allowed identification of accurate and inaccurate understandings of specific elements of the law, and of aspects of attitudes that were supportive or otherwise in relation to a legal reporting duty. The study also analysed actual reporting practices and differences in trends according to the presence or absence of a legislative reporting duty (Mathews et al., 2008), and other factors influencing reporting practices (Fraser et al., 2010). Amongst other findings, the study found very good levels of knowledge of the reporting duty, positive attitudes towards the responsibility to report, and anticipated reporting behaviour congruent with the duty. • A study in three Australian States (New South Wales, Queensland, and Western Australia) of 470 elementary school teachers, to identify their knowledge of and attitudes towards legal reporting duties in relation to child sexual abuse, and their actual reporting practice. This allowed identification of accurate and inaccurate understandings of specific elements of the law, and of aspects of attitudes that were supportive or otherwise in relation to a legal reporting duty. The three States had different legal reporting duties, enabling consideration of the effects of different laws on reporting practices. The study also analysed levels of professional training, self-reported adequacy of professional training, and factors influencing knowledge and reporting (Mathews, 2011; Mathews et al., 2009a, 2009b). Amongst other findings, the study found the presence of a legislative mandatory reporting duty made a substantial difference to positive reporting behaviour. • A study in one Australian State (New South Wales) of trends over one year in numbers and outcomes of reports of all five types of maltreatment, stratified by different professional and non-professional reporter groups (mandated vs non-mandated). This analysis enabled identification of the different origin of reports of each of the five types of child maltreatment, and of their outcomes at agency level (screened out vs investigated vs substantiated). This enabled a more complete understanding of multiple phenomena: legal clarity and confusion; trends in reporting by maltreatment type; trends in reporting by reporter group; relative burden on the child protection system of reports of different types of maltreatment; combined burden of maltreatment reports, stratified by reporter types and groups; and overall systemic functioning (Mathews, 2018). Amongst other findings, this study again indicated the low proportion of all reports related to sexual abuse (13.6%), and the very high proportion (61.7%) related to “indirect” maltreatment (e.g., neglect, exposure to domestic violence) or circumstances of need related to the child, or the child’s parents or caregivers (Mathews, 2018). • A study in two Australian States (Victoria and Western Australia) of trends over seven years in numbers of reports of two types of maltreatment (sexual abuse and physical abuse), stratified by reporter type (professional group vs non-professional group, correlating with mandated status). The two States had different legal frameworks, with one (Victoria) requiring reports of both sexual and physical abuse, and the other (Western Australia) requiring reports only of sexual abuse. This analysis allowed identification of the relative burden on child protection systems for reports of sexual abuse compared with physical abuse. It also enabled comparison of trends in reporting of child sexual abuse where the legislative duty in both

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jurisdictions was the same, and comparison of trends in reporting of physical abuse where the legislative duty was different (Mathews et al., 2020a, 2020b). Amongst other findings, the study found Victoria experienced nearly three times as many reports of physical abuse as Western Australia. The relative burden on the child protection system was most clearly different in Victoria, where reports of physical abuse were relatively stable and two and a half times higher than for sexual abuse. Significantly, rates of children in reports, even at their single year peak, indicate sustainable levels of reporting for child welfare agencies. In Victoria, the single year peak for child sexual abuse reports in 2012 equated to 1 in 172 children being the subject of a report: a similar contextual proportion for a school of 400 children involving two to three per year. In Victoria, the single year peak for child physical abuse reports in 2010 equated to 1 in 84 children being the subject of a report: a similar contextual proportion for a school of 400 students involving five per year.

In the Context of Developing Countries, Might Some Forms of Maltreatment Be More Suited to This Legal Response Than Others? Nations continue to explore the use of mandatory reporting laws and to implement them in various forms. Saudi Arabia relatively recently introduced the laws (Al Eissa & Almuneef, 2010) and Ireland’s Children First Act commenced in December 2017. Yet, even in the context of those countries’ child protection systems which use mandatory reporting laws as one element of their approach, not all forms of maltreatment are always included within the ambit of mandatory reporting laws. Some jurisdictions do not require reports of neglect, for example, and very few require reports of exposure to domestic or family violence. Others enable reports of neglect to be made to welfare agencies rather than child protection authorities. Others require reports of neglect, but not of neglect caused only by poverty. Some jurisdictions do not require reports of emotional abuse; some have suggested that more formal immediate child protection responses may not be appropriate for emotional abuse, due to its particular characteristics which distinguish it from other maltreatment types (Glaser & Prior, 1997) and others have also questioned the use of formal child protection processes for this form of maltreatment (Melton & Davidson, 1987). These parameters do not necessarily mean these jurisdictions do not take these forms of maltreatment; it may simply mean that other strategies are preferred to deal with these kinds of adversity, or that other forms of maltreatment are deemed to have priority. Some nations may face specific challenges in implementing a legislative mandatory reporting duty, given their local conditions. These could include: different levels of systemic preparedness; different levels of familiarity with various types of child abuse; cultural norms and attitudes towards family privacy, religious influence; migrant populations and challenges; and competing economic imperatives.

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Developing Countries It is likely that in developing countries, a variety of conditions mean that some forms of maltreatment may be more suitable targets of a mandatory reporting law than others, and some will likely be contraindicated. In general, the term “developing country” is a shorthand term which is inevitably arbitrary and used for convenience to describe a nation which has a lower living standard, industrial base, and human development index (HDI) compared to other countries. The term is generally derived from an assessment of a country’s GDP per capita and is implicitly related to an economic standard of living. Different institutions have slightly different calculation methods. For example, the World Bank (2012) classifies countries into four income groups: low income, lower middle income, upper middle income, and high income. The World Bank classifies all low-income and middle-income countries as developing countries. Moving beyond a pure economic measure, the United Nations Development Programme and its Human Development Report (2013) gauges human development progress using life expectancy, schooling, and per capita income (gross domestic product); or, as concisely described, it is a “composite index measuring average achievement in three basic dimensions of human development—a long and healthy life, knowledge and a decent standard of living” (p. 151). On these dimensions, an overall HDI score is calculated, and four categories of nations’ overall development are devised: very high; high; medium; and low. The UN also reports on gender inequality, on measures of inequality in achievements between women and men in three dimensions: reproductive health, empowerment, and the labour market. By its nature, a developing country will normally possess less favourable economic conditions for broad-scale social policy in various realms. It is likely to have competing priorities, such as for clean water, food, and basic housing and educational provision, which may be thought to be even more urgent than the broader field of child welfare. Cultural practices and economic imperatives may also preclude policy responses to particular forms of maltreatment, especially neglect. It should be noted again that a society can choose various methods to respond to various individual forms of child maltreatment, and maltreatment as a whole. Mandatory reporting laws are only one option, which are principally a tertiary response, and which in many jurisdictions are restricted to the most severe types of abuse, such as sexual and physical abuse. Especially in the COVID-19 era, a country may be experiencing extremely dire social and economic conditions which affect its capacity to implement functioning child protection systems, or which indicate that only an extremely limited form of mandatory reporting law may be currently viable. In this sense, the aspirations of international instruments and policy declarations confront a harsh reality of daily life. Yet, given the gravity of these types of child abuse, and the immediate and enduring pain and suffering caused, their principles and aspirations remain relevant; and some may argue they may become even more pronounced given children’s increased vulnerability to some types of predation such as sexual abuse and exploitation. These are exceptionally difficult problems.

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Context-Specific Priorities: An Example of India Internationally, some societies will have particular areas of concern. The Indian context is a useful illustrative example. In the 2020 human development index, India was ranked 131 (United Nations Development Programme, 2020). Low birth weight remains a major challenge. In 2008, 1.8 million children under 5 died, including 1 million in the first month of life; undernutrition caused between one third and one half of all these deaths (Black et al., 2010). The most recent National Family Health Survey (NFHS-4) indicated that 18% of registered births in the prior 5 years had a low birth weight (under 2.5 kg), down from 22 percent in 2005–06 (International Institute for Population Sciences, 2017). This is likely conservative, since 22% of all births are unregistered, and their weights were not counted. In the 2020 human development index, the proportion of moderately or severely underweight children under 5 was 34.7% (United Nations Development Programme, 2020). The state of children’s nutrition in India—which is not strictly a matter of parental neglect, but which is more related to poverty—is a national emergency, and given its consequences could legitimately be argued to take at least equal priority in relation to any other imperative. Other significant issues include education accessibility and completion, and child marriage. School attendance is compulsory, but the rate of attendance is low (Deb & Mathews, 2012). The 2020 HDI Report found that girls have a mean of only 5.4 years of schooling, and boys have 8.7 years (United Nations, 2020). Data from the 2015– 16 National Family Health Survey (NFHS-4) indicate that only 43% of children complete upper secondary school (International Institute for Population Sciences, 2017). Child marriage is illegal, but is extremely common, and severely restricts girls’ and women’s life chances (Deb & Mathews, 2012; Raj et al., 2009). In 2020, 27% of women aged 20–24 had been married or in union before age 18 (United Nations, 2020). Child abuse and neglect are serious problems in India, influenced by factors including poverty, over-population, lack of education, cultural beliefs and practices, gender bias, and patriarchy. The most comprehensive Indian national study of selfreported prevalence revealed widespread maltreatment (Ministry of Women & Child Development, 2007), with 69% of children reporting physical abuse (p. 44); 53% sexual abuse; and 48% emotional abuse (p. 106). Runyan et al. (2010) found substantial levels of harsh physical discipline (almost 20%) including striking the child with an object (over 40%). Child trafficking and commercial exploitation is also a significant problem in India. Child trafficking involves the recruitment, transport, and transfer of children, through abduction, deception or force, for exploitative purposes. Trafficking of children for commercial and sexual purposes is highly lucrative and is known to be a serious problem in South Asian and East Asian countries. Modern slavery—an umbrella concept including human trafficking, forced labour, debt bondage, forced marriage, other slavery and slavery-like practices—was conservatively estimated to affect over 40 million people worldwide in the year 2016, with approximately one in four victims being children (International Labour Office, 2017). Trafficking in

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India is usually conducted through outright abduction and sale, or by false offers of marriages and jobs, which entice desperate individuals seeking marriage, enhanced employment prospects, and a higher standard of living (Kempadoo et al., 2005). Parents sell their children, mostly daughters, who are trafficked to cities or across borders. Once relocated, the children work as labourers, domestic servants, or in commercial industry, and many become involved in prostitution. Some of these phenomena are not hidden and are not the traditional forms of child abuse and neglect. Yet, some of these phenomena are exactly those which inspired the first reporting laws; and others such as trafficking and child marriage are also serious issues which demand attention. When considering methods of responding to such issues, especially those which are clandestine, India and other nations may consider whether a form of mandatory reporting may assist to identify hidden cases and also help to influence culture change about what standards of conduct are acceptable.

What Options May Be Considered by Developing Countries, Taking into Account Children’s Needs, Cultural Conditions and Practices, Economic Imperatives, and the Different Levels of Preparedness to Implement Child Protection Strategies? Each nation will have its own jurisdiction-specific conditions, concerns, and hierarchy of priorities. Acknowledging this, while they recommended priority action internationally in three specific fields—parental child battering, sexual abuse, and selective neglect—Finkelhor and Korbin (1988) also suggested that individual nations should develop their own focuses and plans of action. This strategy can accommodate the unique set of cultural and societal conditions, economic resources, and human infrastructure characterising each society. It would be driven from the ground up and would have a higher chance of being sustainable, as well as avoiding or diminishing the problems inherent to a set of priorities imposed in a “top-down” manner by an external authority. Similarly, Mikton et al. (2013) noted that countries have different levels of preparedness to implement child maltreatment prevention programmes, due to the extent to which they possess features including: (1) professionals with the required skills, knowledge and expertise to implement programmes; (2) institutions to train these professionals; and (3) funding, infrastructure, and equipment. In addition, the attitudes held by adults about what is acceptable conduct towards children are a crucial feature of society which influences behaviour and the success of child protection initiatives. Efforts to identify and improve attitudes may be just as necessary as other legal and systemic reforms. For example, Dunne et al. (2008) noted the mismatch between the maltreatment of children in Chinese societies and adults’ perceptions regarding the acceptability of violence inflicted towards children. Deb and Mathews (2012) found a widespread belief amongst Indian parents and

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teachers that children should not possess rights (although some particular rights were unanimously approved), and a very low level of awareness of the existence of children’s rights as enshrined in legislation. Much work remains to promote healthy and child-rights based approaches to parental discipline (Knerr et al., 2013), which can have substantial positive effects on the reduction of harmful physical practices and other maltreatment. Accordingly, a particular nation may choose to focus first on a smaller selection of priorities, or in some cases it may be even one particular issue that receives priority attention in the first instance. A focused “small-target” approach could be adopted especially if economic resources are extremely limited; for example, in nations where the population endures dire conditions such as food shortages, low life expectancy, civil conflict, or multiple effects related to the COVID-19 pandemic. Hence, in such conditions, a chosen priority could be sexual abuse generally, trafficking for commercial or sexual exploitation, child marriage, child soldiers, gender-based infanticide, neonatal health, or primary schooling. Depending on the priority and the nature of the problem addressed, especially whether it is a clandestine problem or not, mandatory reporting (with associated educational campaigns, reporter training, systemic capacity-building and the like) may assist to uncover cases and change cultural attitudes towards the practice. In addition, creative solutions can be customised to the setting; for example, a nation could begin by applying mandatory reporting only to sexual abuse of any child, and to severe physical abuse of children under a specified age to enable intervention in the most serious cases. Such a pragmatic approach would not mean that other grave problems and injustices were accepted or endorsed; nor would it mean that government was resigned to those other problems always existing. Rather, it may mean accepting that in the short-term, a concerted and thorough approach to one severe problem or a small number of them is what can feasibly be accommodated such that it has a realistic chance of success; whereas if an inadequately resourced effort to confront a wider set of problems was attempted, all these may be hopelessly compromised and doomed to failure. Such challenges face public administrations daily. However, less leeway in this respect can reasonably be granted to wealthier countries. On Nussbaum’s view (2011), it is the State’s responsibility to ensure the individual’s core capabilities are protected and nurtured, and it is their task to ensure that sufficient resources from the public purse are devoted to such tasks. What can motivate societies to make greater efforts to identify and respond to severe child maltreatment? To prosper, nations require inclusive political and economic institutions and conditions ensuring security and opportunity for its citizens (Acemoglu & Robinson, 2012). There are growing calls at the highest policy levels for global agendas for child health and wellbeing in multiple domains of clinical care, systems development, and policy (e.g. Goldhagen et al., 2020). It may be that some forms of responses to children’s maltreatment or deprivation may be seen by developing countries as being important and indeed essential for its economic development and social fabric, as well as being a principled approach to children’s and human rights. India’s newly elected Prime Minister Narendra Modi called for a development of the nation’s intellectual capital if the nation is

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to be competitive (Bagchi, 2014). Nobel Prize winning researchers in development economics have advocated for investment in human capital from the perspective that an educated workforce is more productive and efficient (Schultz, 1971). A substantial body of work by Nobel Prize winner James Heckman has shown the massive long-term health and economic benefits of early intervention in childhood to boost psychosocial capacities, both generally (e.g. Francesconi & Heckman, 2016), and in LMIC environments as shown in a study in Jamaica (Gertler et al., 2014). A nation cannot flourish if its children are not properly educated generally, and if the education of girls in particular is marginalised. Equally, national development and prosperity is compromised if children’s health and security and life chances are jeopardised through maltreatment. Efforts to identify severe child maltreatment and to rehabilitate children and provide them with adequate life chances represent a part of a much broader concern to ensure a society is inclusive at political, humanitarian, and economic levels, and can prosper and grow.

Conclusion All nations including developing economies face multiple challenges in designing law, policy, and systems to best protect children and support their development through childhood and adolescence. Social and economic challenges are a constant in human history, and these are heightened at particular times due to significant events. The COVID-19 pandemic is one such stark event; the challenges of climate change are another. Challenges of this depth and scale present are undeniable difficulties for all societies. Nevertheless, there also exist ongoing deep structural challenges, and the protection of children from severe abuse constitutes one of these. This challenge is of such significance that the major international policy documents in this arena have not only recognised it, but made remarkably strong declarations about what all societies should do to better respond to it. At the broadest level, the SDGs aim to eradicate child abuse, and the Convention on the Rights of the Child article 19 urges all nations to take all appropriate steps necessary to protect the child from significant abuse. In giving guidance on the implementation of this article, the United Nations Committee on the Rights of the Child made a clear and strong declaration that “In every country, the reporting of instances, suspicion or risk of violence should, at a minimum, be required by professionals working directly with children” (United Nations Committee on the Rights of the Child, 2011, pp. 19–20). This same Committee has also emphasised that financial commitments to child welfare are imperative (United Nations Committee on the Rights of the Child, 2016). In its General Comment on public funding, the Committee declared that: prioritizing children’s rights in budgets, at both national and subnational levels, as required by the Convention, contributes not only to realizing those rights, but also to long-lasting positive impacts on future economic growth, sustainable and inclusive development, and social cohesion. …

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States parties should take all children’s rights into consideration throughout all stages of their budget processes and administrative systems at the national and subnational levels. While recognizing that budget processes differ to some extent between States, and that certain States have developed their own child rights budgeting methods, the present general comment provides guidance regarding four major budgetary stages that concern all States, namely planning, enactment, execution and follow-up.

These imperatives are re-emphasised by global partnerships, even in the era of COVID-19 and climate change, which while presenting additional obligations on governments, also emphasise the importance of child maltreatment prevention efforts since they likely only further heighten the risk to children. As but one example, the Global Partnership and Fund to End Violence Against Children, an international collective of government and non-government organisations focused on SDG 16.2 (ending all forms of violence against children by 2030) published its Leaders’ Statement in July 2021, declaring (Together to #ENDviolence, 2021): We must create a world: where every child can grow up and thrive with dignity; where violence and abuse of children is legally outlawed and socially unacceptable; where the relationship between parents and children prevents the intergenerational transmission of violence; where children in every community can safely take advantage of the digital world for learning, playing and socialising; where girls and boys experience stronger developmental and educational outcomes because schools and other learning environments are safe, gendersensitive, inclusive and supportive; where sport is safe for children; where every effort is made to protect the most vulnerable children from all forms of violence, exploitation and abuse, including those living in situations of conflict and fragility (including climate-related fragility); and where all children can access safe and child-friendly help when they need it.

Nations are justified in continuing to pursue the most suitable methods of prevention and response to child maltreatment in their local settings, and these should include various methods of primary and secondary prevention. Examples include policies to shape broader social and ecological factors such as social welfare and employment, poverty reduction programmes, compulsory schooling, adequate nutrition, community violence reduction, housing, gender equality, and prenatal and postnatal care. In addition to this, the evidence also shows that specific types of mandatory reporting laws, with mandatory reporting laws for sexual abuse being perhaps the best example, can also contribute to tertiary prevention and form a vital part of a holistic public health law framework to best respond to severe child abuse and support children’s rights to safety and development.

Obligation to report s 368D. (b) If a physician, nurse, educator, social worker, social welfare employee, policeman, psychologist, criminologist or a person engaged in a paramedical profession, as well as a director or staff member of a home or institution in which minors or persons under care live, has—in consequence of his professional activity or responsibility—reasonable grounds to believe that an offense was committed against a minor or against a helpless person by the person responsible for him, then he is under obligation to report that as soon as possible to a welfare officer or to the police; if a person violates this obligation, then he is liable to six months imprisonment (c) If the person responsible for a minor or for a helpless person has reasonable grounds to believe that another person responsible for him committed an offense against the minor or the helpless person, he is under obligation to report that as soon as possible to a welfare officer or to the police; if a person violates this obligation, then he is liable to six months imprisonment (c1) If a person has reasonable grounds for believing that an offense under Sections 345 to 347, 348 and 351 was recently committed against a minor or against a helpless person by a relative who has not yet reached age 18, then he must report that as soon as possible to a welfare officer or to the police; if a person violates this obligation, then he is liable to three months imprisonment; in this section, "relative" – within its meaning in paragraph (2) of the definition of "guardian of minor or helpless person" in Sect. 368A

Section 27. (1) If a medical officer or a registered medical practitioner believes on reasonable grounds that a child he is examining or treating is physically or emotionally injured as a result of being ill-treated, neglected, abandoned or exposed, or is sexually abused, he shall immediately inform a Social Welfare Officer 28.(1) If any member of the family of a child believes on reasonable grounds that the child is physically or emotionally injured as a result of being ill-treated, neglected, abandoned or exposed, or is sexually abused, he shall immediately inform a Social Welfare Officer 29.(1) If a child care provider believes on reasonable grounds that a child is physically or emotionally injured as a result of being ill-treated, neglected, abandoned or exposed, or is sexually abused, he shall immediately inform a Social Welfare Officer

Section 42(1) Notwithstanding the provisions of any other law every dentist, medical practitioner, nurse, social worker or teacher, or any person employed by or managing a children’s home, place of care or shelter, who examines, attends or deals with any child in circumstances giving rise to the suspicion that that child has been ill-treated, or suffers from any injury, single or multiple, the cause of which probably might have been deliberate, or suffers from a nutritional deficiency disease, shall immediately notify the Director-General or any officer designated by him or her for the purposes of this section, of those circumstances

Brazil Statute of the Child and Adolescent

Israel Penal Law 5737–1977

Malaysia Child Act 2001 (Act 611) (As at 1 February 2018)

South Africa Child Care Act (No. 74/1983)

(continued)

List of reporters and essence of duty

Article. 13. Without prejudice to other legal measures, cases involving suspicion or confirmation of maltreatment of children or adolescents will obligatorily be notified to the Council of Guardianship Article. 245. Should the medical doctor, professor or element responsible for an institution of health assistance and basic education, preschool or day-care center, fail to notify the proper authority of cases of which he has become knowledgeable, involving suspicion or confirmation of maltreatment against a child or adolescent

Jurisdiction

Appendix 1 Legislative Mandatory Reporting Duties: Selected Jurisdictions

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Section 124B. Duty of certain people to report sexual abuse of children (1) A person who—(a) is a doctor, nurse, midwife, police officer, teacher or boarding supervisor; and (b) believes on reasonable grounds that a child—(i) has been the subject of sexual abuse…; or (ii) is the subject of ongoing sexual abuse; and (c) forms the belief—(i) in the course of the person’s work (whether paid or unpaid) as a doctor, nurse, midwife, police officer, teacher or boarding supervisor; and (ii) on or after commencement day, must report the belief as soon as practicable after forming the belief Section 124C Reports under s. 124B, form and content of: (1) A report may be written or oral but if oral the reporter must make a written report as soon as practicable after the oral report is made. (2) A written report may, but does not need to be, in a form approved by the CEO (3) A report is to contain—(a) the name and contact details of the reporter; and (b) the name of the child or, if the child’s name cannot be obtained after reasonable inquiries, a description of the child; and (c) if, or to the extent, known to the reporter—(i) the child’s date of birth; and (ii) information about where the child lives; and (iii) the names of the child’s parents or other appropriate persons as defined in Section 41(1); and (d) the grounds for the reporter’s belief that the child has been the subject of sexual abuse or is the subject of ongoing sexual abuse; and (ea) if, or to the extent, known to the reporter — (i) the name of any person alleged to be responsible for the sexual abuse; and (ii) the person’s contact details; and (iii) the person’s relationship to the child; and (e) any other information that is prescribed

Victoria (Australian State) Children, Youth and Families Act 2005

Western Australia (Australian State) Children and Community Services Act 2004

(continued)

List of reporters and essence of duty

Section 184 Mandatory reporting. (1) A mandatory reporter who, in the course of practising his or her profession or carrying out the duties of his or her office, position or employment as set out in Section 182, forms the belief on reasonable grounds that a child is in need of protection on a ground referred to in Section 162(1)(c) or 162(1)(d) must report to the Secretary that belief and the reasonable grounds for it as soon as practicable—(a) after forming the belief; and (b) after each occasion on which he or she becomes aware of any further reasonable grounds for the belief. (2) It is a defence to a charge under subsection (1) for the person charged to prove that he or she honestly and reasonably believed that all of the reasonable grounds for his or her belief had been the subject of a report to the Secretary made by another person. … (4) [A] belief is a belief on reasonable grounds if a reasonable person practising the profession or carrying out the duties of the office, position or employment.. would have formed the belief on those grounds Section 162(1)(c)-(d) [A] child is in need of protection if…(d) the child has suffered, or is likely to suffer, significant harm as a result of physical abuse or sexual abuse and the child’s parents have not protected, or are unlikely to protect, the child from harm of that type

Jurisdiction

(continued)

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List of reporters and essence of duty

Duty to report child in need of protection Section 125(1) Despite the provisions of any other Act, if a person, including a person who performs professional or official duties with respect to children, has reasonable grounds to suspect one of the following, the person shall immediately report the suspicion and the information on which it is based to a society: 1. The child has suffered physical harm inflicted by the person having charge of the child or caused by or resulting from that person’s, i. failure to adequately care for, provide for, supervise or protect the child, or ii. pattern of neglect in caring for, providing for, supervising or protecting the child 2. There is a risk that the child is likely to suffer physical harm inflicted by the person having charge of the child or caused by or resulting from that person’s, i. failure to adequately care for, provide for, supervise or protect the child, or ii. pattern of neglect in caring for, providing for, supervising or protecting the child 3. The child has been sexually abused or sexually exploited by the person having charge of the child or by another person where the person having charge of the child knows or should know of the possibility of sexual abuse or sexual exploitation and fails to protect the child 4. There is a risk that the child is likely to be sexually abused or sexually exploited as described in paragraph 3 5. The child requires treatment to cure, prevent or alleviate physical harm or suffering and the child’s parent or the person having charge of the child does not provide the treatment or access to the treatment, or, where the child is incapable of consenting to the treatment under the Health Care Consent Act, 1996, refuses or is unavailable or unable to consent to, the treatment on the child’s behalf 6. The child has suffered emotional harm, demonstrated by serious, i. anxiety, ii. depression, iii. withdrawal, iv. self-destructive or aggressive behaviour, or v. delayed development, and there are reasonable grounds to believe that the emotional harm suffered by the child results from the actions, failure to act or pattern of neglect on the part of the child’s parent or the person having charge of the child 7. The child has suffered emotional harm of the kind described in subparagraph 6 i, ii, iii, iv or v and the child’s parent or the person having charge of the child does not provide services or treatment or access to services or treatment, or, where the child is incapable of consenting to treatment under the Health Care Consent Act, 1996, refuses or is unavailable or unable to consent to, treatment to remedy or alleviate the harm 8. There is a risk that the child is likely to suffer emotional harm of the kind described in subparagraph 6 i, ii, iii, iv or v resulting from the actions, failure to act or pattern of neglect on the part of the child’s parent or the person having charge of the child 9. There is a risk that the child is likely to suffer emotional harm of the kind described in subparagraph 6 i, ii, iii, iv or v and the child’s parent or the person having charge of the child does not provide services or treatment or access to services or treatment, or, where the child is incapable of consenting to treatment under the Health Care Consent Act, 1996, refuses or is unavailable or unable to consent to, treatment to prevent the harm 10. The child suffers from a mental, emotional or developmental condition that, if not remedied, could seriously impair the child’s development and the child’s parent or the person having charge of the child does not provide the treatment or access to the treatment, or where the child is incapable of consenting to the treatment under the Health Care Consent Act, 1996, refuses or is unavailable or unable to consent to, treatment to remedy or alleviate the condition 11. The child’s parent has died or is unavailable to exercise the rights of custody over the child and has not made adequate provision for the child’s care and custody, or the child is in a residential placement and the parent refuses or is unable or unwilling to resume the child’s care and custody 12. The child is younger than 12 and has killed or seriously injured another person or caused serious damage to another person’s property, services or treatment are necessary to prevent a recurrence and the child’s parent or the person having charge of the child does not provide services or treatment or access to services or treatment, or, where the child is incapable of consenting to treatment under the Health Care Consent Act, 1996, refuses or is unavailable or unable to consent to treatment 13. The child is younger than 12 and has on more than one occasion injured another person or caused loss or damage to another person’s property, with the encouragement of the person having charge of the child or because of that person’s failure or inability to supervise the child adequately

Jurisdiction

Ontario (Canadian province) Child, Youth and Family Services Act, 2017

(continued)

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Chapter 28

Child Sexual Abuse in Brazil: Awareness, Legal Aspects, and Examples of Prevention Strategies Lucia C. A. Williams and Sabrina M. D’Affonseca

Introduction Child sexual abuse is a traumatic event with well-documented immediate and longterm effects, such as problems in individual physical health, mental health, and school functioning, as well as problems in social interactions and community life. Unfortunately, child sexual abuse is a widespread phenomenon, with comparable prevalence rates among internationally studied countries ranging from 7 to 36% for females, and 3–29% for males (Finkelhor, 1994). A meta-analysis of the prevalence of CSA involving 65 studies covering 22 countries (Brazil not included) showed that 7.9% of men, and 19.7% of women had suffered some form of sexual abuse prior to the age of 18 (Pereda et al., 2009). These authors call attention to the fact that even the lowest prevalence rates include a large number of victims that need to be taken into account, confirming the seriousness of the problem. Stoltenborgh et al. (2011) also conducted a meta-analysis encompassing 217 studies, published between 1980 and 2008, on the prevalence and incidence of child sexual abuse across all continents, indicating a global rate of 11.8% (18% of girls, 7.6% of boys). The lack of epidemiological comparison studies involving Brazil in the above studies is not coincidental, as the country has yet to conduct population studies covering prevalence rates of child sexual abuse. The objectives of the present chapter are: (a) to present a brief overview of legal aspects pertaining to CSA in Brazil; (b) to describe cases widely reported in the L. C. A. Williams Full Professor at the Department of Psychology, Founder of Laprev - Laboratory for the Analysis and Prevention of Violence, Universidade Federal de São Carlos (Federal University of São Carlos), UFSCar, São Carlos, Brazil S. M. D’Affonseca (B) Adjunct Professor at the Department of Psychology, Laprev—Laboratory for the Analysis and Prevention of Violence, Universidade Federal de São Carlos, São Carlos, Brazil e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_28

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national media which helped increase awareness of stakeholders; and c) to give examples of preventive intervention strategies to curb this serious problem in the country.

Brazil’s Legislation on CSA To understand and address the problem of CSA in Brazil, one must first mention Brazilian laws against sexual offenses. Brazil is a federal republic, composed of 26 states, and the federal state of Brasilia, the capital. Brazilian laws are regulated federally, and not by state; therefore, the country has a uniform legislation covering its wide territory. The Brazilian Criminal Code was altered in 2009 (Law no. 12.015), the first change since 1940. Sexual abuse is covered under Title VI—Crimes against Sexual Dignity in two chapters: I—Crimes against Sexual Freedom, and II—Crimes against Vulnerable Persons. Several articles typify sexual abuse, but the most important is Article 213, dealing with rape, which is defined by the law as “to embarrass someone through violence or serious threat to body penetration or to practice or allow other sexual acts”, with the detention penalty of 6–10 years, which is increased to 8–12 years if the rape results in serious physical harm or if the victim is under 18 or older than 14, and to 12–30 years if the rape results in death (Brasil, 2009). Article 218 deals with the Corruption of Minors, defined by law as “to induce someone younger than 14 to satisfy another person’s lust”, with a detention penalty of 2–5 years. Article 218-A concerns sexual acts in front of children; and article 218-B deals with “favouring prostitution or other types of sexual exploitation of vulnerable persons”. In addition to the Criminal Code, the Child and Adolescent Act (Estatuto da Criança e do Adolescente—ECA) was revised to incorporate several types of child sexual abuse, including child pornography (Brasil, 2017). Although Brazil has not conducted prevalence CSA studies to inform practice and public policies, the country has been concerned and actively involved in establishing a network of protection services to address child maltreatment, and child sexual abuse in particular. The most striking example is the nation’s efforts to pass pertinent laws in terms of child protection. Brazil’s Constitutional Article 227 (Brazil, 1988) was approved with the support of 1.5 million signatures from a popular initiative led by activists, intellectuals, and religious leaders, giving rise to a movement called Children, A National Priority. The article reads, in part: It is the family’s duty, society’s, and the State’s to ensure that children and adolescents have as an absolute priority the right to life, to health, food, education, leisure, professional training, culture, dignity, respect, freedom, family and community life, in addition to rendering them safe from all types of negligence, discrimination, exploitation, violence, cruelty and oppression. (Brazil, 1988)

Subsequently, Brazil’s Child and Adolescent Act, implemented in 1990 (Law 8.069) (Brasil, 1990), and inspired by the Convention of the Rights of the Child (CRC), is considered a progressive regulation in child protection, requiring mandatory reporting of child abuse by professionals who serve or have direct contact with

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children. A Child Protection Service (CPS) was created and regulated in the Child and Adolescent Act, designated as the agency responsible for monitoring and assuring the rights of children. Every municipality with 100 000 inhabitants must have its CPS office, whose members are elected by the community for a three-year term. In 2017, the law 13.431 established the rights guarantee system of the child and adolescent victim or witness of violence and changed the Law 8069 (Brazil’s Child and Adolescent Act). In its Articles 7 and 8, two distinct procedures were established to be used with children or adolescents victims or witnesses of violence: the Specialized Listening and the Special Testimony. The first is defined as an interview about a violence situation with a child or adolescent before an agency child network protection. The report is strictly limited to what is necessary for the fulfillment of its purpose. The Special Testimony, on the other hand, is described as the hearing of a child or adolescent victim or witness of violence before the police or judicial authorities. It should be noted that Article 11 establishes that the Special Testimony must be guided by protocols and, whenever possible, it will be carried out only once, based on the anticipated production of judicial evidence, guaranteeing the full defense of the investigated person (Brasil, 2017).

Media Attention to CSA Although there is no scientific knowledge of the scope of CSA in Brazil, professionals working with children agree that it is a serious and widespread health problem requiring immediate attention by the government, policy makers, and society as a whole. A review of notorious sexual abuse cases reported by Brazilian media illustrates clearly the need for CSA prevention in the country. The readiness to consider this problem is illustrated by the fact that Brazil has a national day, May 18, to fight child sexual abuse and sexual exploitation proposed by Federal Representative Rita Camata, and instituted by federal law (no. 9.970) in the year 2000. The initiative sprang from a group of over 80 agencies in 1998 at the first Brazilian meeting in Salvador, State of Bahia of ECPACT (End Child Prostitution, Child Pornography, and Trafficking of Children for Sexual Purposes). The date, May 18, was chosen to mark the day Aracelli Crespo, an eight-year-old girl from the State of Espírito Santo, was brutally raped and murdered after being abducted in 1973. The murder suspects were two youths with a history of drug abuse, but who came from influential families, and whose conviction on plentiful evidence in 1980 was nullified. The two were acquitted at a second trial in 1991. José Louzeiro’s 1976 book on the Aracelli case (Louzeiro, 2013), described how 14 possible witnesses suffered suspicious deaths, and the author himself was threatened while doing his research for the book. Although, fortunately, murder following sexual violence is rare in Brazil, the case is considered emblematic of the difficulties encountered when prosecuting CSA. Another significant and notorious case of sexual abuse was featured in the media in 1994, when a private school in Sao Paulo, Escola Base, was closed after allegations

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were made against six different adults, including a teacher and the school’s owner, of child sexual abuse of 4 and 5 year olds. The allegations had some similarities with those presented at the McMartin trial in California (Pezdek et al., 2004) and were later to be judged unfounded. The accused were able to successfully manage to charge important stakeholders of the Brazilian press for biased coverage. While the Escola Base case is often mentioned in Brazilian discourse to stress ethical coverage by the press, it has unfortunately given the general public, lawyers, and politicians the incorrect notion that most sexual abuse allegations are false. Brazilian public opinion was horrified in 2007, with a case involving a 15-year-old girl who was placed in a jail cell among men in the city of Abaetetuba, State of Para, in the Amazon region. She was sexually abused by different inmates in all but two of the 27 days that she was incarcerated. The notoriety of this case was exacerbated when the media revealed that judge Clarice Maria de Andrade had authorized the police chief to place the girl in an adult male cell, as the girl had a history of thefts handled by the same judge. This incident not only calls attention to the serious violation of human rights, and of the Child and Adolescent Act by officers of the law, but also to the disparities of protection services in remote parts of the country. In 2008, Joana Maranhão, a 20-year-old international award-winning swimmer disclosed publicly that she had been sexually abused as a child by her swimming coach. This provoked, as a consequence, the altering of Brazilian law, in 2012, to accept delayed allegations of previous CSA cases which in the past would have been prescribed. The so-called Joana Maranhão Law (no.12.650) is an advance for Brazilian children in terms of CSA prevention, as well as bringing awareness of the problem of CSA concerning coaches in sports. In 2012, there was public outcry, including reprimanding remarks from the United Nations, when the media reported that Brazilian Supreme Court Judge Maria Theresa de Assist Maura considered non-guilty a male adult who had sex with three 12-yearold girls prior to Brazil’s current legislation on sexual crimes, with the argument that the girls were “prostitutes”. The case was subsequently reviewed and the man found guilty. In May, 2012 Brazilian TV star Xuxa cried and disclosed on public television that she had been sexually victimized as a child by three different adults (her father’s friend, her grandmother’s fiancé, and a teacher) and that she had kept the abuse secret to family members. The Human Rights Secretary communicated that, as a consequence of the actress’s disclosure, they had to train more staff to work for the Children’s Helpline (Disque 100), as the average number of calls jumped 30%—from the daily average of 80 thousand calls to 285,051 in the following two days. In August 2020, there was a huge repercussion in the media about a pregnant 10year-old girl. Sexually abused by her uncle since she was 6 years old in São Mateus, Espírito Santo, the Court of Justice of Espírito Santo granted her the right under Brazilian law to terminate the pregnancy. Although abortion in rape case of a vulnerable person has been provided by Brazilian Penal Codes since 1940, the medical staff from the hospital in Espírito Santo refused to carry out the legal abortion, claiming that it did not have the capacity to perform the procedure. After a judge intervention, the girl finally had an abortion 1400 km away from her home. Although the case

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was supposed to take place under judicial secrecy, a radical extremist published the girl’s name and the name of the hospital where she would undergo the procedure, in violation of Brazilian law. Anti-abortion protesters blocked access to the hospital and harassed and insulted its staff. When the girl arrived, she had to sneak inside the trunk of a vehicle. The examples above help to assess the impact CSA has in the country, showing that Brazil is still learning how to implement effective prevention strategies, such as the training of its key professionals as recommended by ISPCAN (International Society for the Prevention of Child Abuse & Neglect). However, there is a growing awareness about the harmful consequences of CSA in the country, and the Brazilian media have been instrumental in this regard.

Preventive Intervention Strategies and Challenges The Child and Adolescent Act has allowed for a diverse creation of services to attend victims. Health professionals are required to send documentation of child abuse cases to the Ministry of Health. Unfortunately, specialized treatment to offenders is still rare in Brazil (Williams, 2012). The Ministry of Social Services (Ministério do Desenvolvimento Social) created Project Sentinel in 2002 to help victimized children (Castanha, 2006), and this project was instituted in each municipality. Project Sentinel has since been expanded to incorporate all forms of child maltreatment in the local municipal centers called CREAS (Centro de Referência Especializado de Assistência Social (Specialized Referral Center of Social Assistance)). Brazil’s Ministry of Education developed an ambitious and countrywide project called Escola que Protege (School which Protects), in 2004, (Henriques et al., 2007), which was initially aimed at training teachers on child sexual abuse, and was later expanded to incorporate other forms of child maltreatment and school violence, as well as to train professionals other than educators. This project particularly targets municipalities located along child sexual exploitation routes which are routinely mapped by the government (Secretary of Human Rights), with the help of the police, the International Labor Organization, and Childhood Brazil. The latter is the Brazilian branch of World Childhood Foundation (WCF), founded by Queen Silvia of Sweden who gives Brazil special attention due to the fact that she has a Brazilian mother. Along with Save the Children, WCF illustrates the important role NGOs have in child abuse prevention in Brazil, with valuable initiatives (see Marques, 2009), such as the prevention of child sexual exploitation associated with tourism, by partnering with tourist businesses, as hotels, and teaching truck drivers as prevention agents. Brazil’s Secretary of Human Rights has had, since 2003, a free of charge helpline (Disque 100) to report child sexual abuse, which also may be accessed by the Internet (www.disque100.gov.br). The country has had, since 2000, a National Plan to Face Child Sexual Abuse, and has given an example of international leadership when hosting the Third World Congress Against Sexual Exploitation of Children and

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Adolescents, organized by ECPACT International, in 2008, when the Rio de Janeiro Declaration and Call for Action to Prevent and Stop Sexual Exploitation of Children and Adolescents was written. In spite of all these efforts, Child Protection Services in Brazil are short-funded, professionals still need specialized training, services for victims and offenders are scarce, CSA cases are under-reported, and reporting is done manually without a computerized general registrar or database. In addition, child abuse offenses have a disturbingly low conviction rate (Williams, 2009): The child has to take part in repetitive interviews with different professionals, which is inadequate as it re-traumatizes the victim, as well as contaminates evidence, and the child is seldom requested to testify in court, or, when this occurs, the testimony is often conducted in an inadequate or unsafe way. Brazilian psychologists have also developed evidence-based therapeutic interventions for sexually abused children using a cognitive-behavioral model (see, e.g., Habigzang et al., 2013). The Laboratory of Violence Analysis and Prevention (Laprev) (www.ufscar.br/laprev) has also several examples of successful CSA prevention efforts (Williams et al., 2009). These efforts range from doing research to better understand the phenomenon in the Brazilian population (as in Padovani and Williams 2010) to assessing intervention efforts to teach child abuse prevention to health professionals (Bannwart & Williams, 2012) and teachers (Brino & Williams, 2006). Brazil’s National School of Magistrates Training and Development (ENFAM) offered its first course on CSA to judges. This online multidisciplinary course was very well received and over 200 judges from all areas of the country took part in this first initiative. Among jurists involved in teaching such courses, there were one social worker, one physician and one psychologist. Also, the National Council of Justice, in partnership with the United Nations Children’s Fund in Brazil (UNICEF) and Childhood Brasil, launched in July, 2020, the Brazilian Protocol for Forensic Interviews with Children and Adolescents (PBEF), a document that details in a didactic but in-depth manner the stages to be preserved for an effective and protective interview. The protocol will be disseminated in child protection networks in order to guarantee the support and safeguard the rights of abused children or who have witnessed acts of violence. The PBEF is an adapted version of The National Advocacy Center (NCAC) Forensic Interview Protocol, Alabama, USA, internationally known for being one of the pioneer organizations in offering a model integrated care for cases of violence against children and adolescents. In Brazil, the adaptation of the PBEF was carried out within the training process of which the NCAC participated directly and within a research project supported by the National Research Council (CNPq) and accompanied by professors from three Brazilian universities: Catholic University of Brasília (UCB), University of Brasília (UnB), and Federal University of Rio Grande do Sul (UFRGS). In addition, practical use of this protocol has begun in 2012 in several Brazilian courts, mainly those in the Federal District and Territories, Rio Grande do Sul and Pernambuco (Childhood Brasil, Conselho Nacional de Justiça—CNJ e Fundo das Nações Unidas para a Infância—UNICEF, 2020).

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Although there is still no published data regarding the use of the PBEF in Brazil, there is some data available with the validation of the NICHD (National Institute of Child Health and Human Development) protocol (Lamb et al., 2008), the well-researched structured protocol to interview children suspected of child sexual abuse victimization (http://nichdprotocol.com/nichdbrazil.pdf). For example, results of training in the use of the NICHD Protocol with 15 Brazilian forensic professionals (psychologists and social workers) involved in CSA cases from different municipalities showed significant changes in the interviewing of children: Professionals increased the number of open-ended questions and gathered more relevant information about details involved in the CSA cases (Hackbarth et al., 2015) when using the NICHD Protocol compared to when not using this method.

Conclusions Although Brazil has not yet had solid epidemiological research to estimate the prevalence of CSA to inform practice, professional experience has been confirming the high prevalence shown in most countries. The media has been instrumental in raising awareness about CSA’s impact, giving visibility to a once unspoken phenomenon. Preventive interventions in education, health, and forensic areas are present in the country. Many challenges still remain and will take a well-coordinated effort from many segments of society. Finkelhor (2011), Finkelhor and Jones (2006) has been analyzing the declining trends of CSA in the USA, Canada, and some European countries (among other types of child maltreatment), a phenomenon which is associated with different variables involving prevention measures. The impression one has from Brazil is that we have to have solid data on CSA rates to observe a subsequent raise (motivated by awareness and improvement of the protection system), followed by a much needed future decline.

References Bannwart, T. H. & Williams, L. C. A. (2012). Increasing awareness of Brazilian family health team professionals on reporting child abuse: A case study. In: A. Muela (Org.), Child abuse and neglect—a multidimensional approach (pp. 117–136). InTech. Brasil. (1988). Constituição da República Federativa do Brasil [Constitution of the Federative Republic of Brazil]. Senado Federal. Brasil. (1990). Lei Federal nº 8.069, de 13 de julho de 1990 [Federal Law No. 8069 of 13 July 1990]. Brasília, DF. Brasil. (2009). Lei nº 12.015, de 7 de agosto de 2009 [By-Law No. 12 015, August 7 2009]. Brasília, DF. Brasil. (2017). Lei nº 13431, de 4 de abril de 2017 [By-Law No. 13431, April 4 2017]. Brasília, DF.

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Brino, R. F. E., & Williams, L. C. A. (2006). Brazilian teachers as agents to prevent child sexual abuse: An intervention assessment. In D. Daro (2006). World perspectives on child abuse (pp. 75– 78, 7a ed.). ISPCAN—International Society for Prevention of Child Abuse and Neglect. Castanha, N. (2006). Plano Nacional de Enfrentamento da Violência Sexual Infanto- Juvenil: Uma política em movimento. [National Plan to Curb Child Sexual Violence: A changing policy]. 2003–2005 Report. http://www.sedh.gov.br/clientes/sedh/sedh/spdca/publicacoes/.arq uivos/.spdca/plano_naparte1.pdf (March 29, 2013). Childhood Brasil (Instituto WCF/Brasil), Conselho Nacional de Justiça—CNJ e Fundo das Nações Unidas para a Infância—UNICEF. (2020). Protocolo brasileiro de entrevista forense com crianças e adolescentes vítimas ou testemunhas de violência [Brazilian Protocol for Forensic Interviews with Children and Adolescents]. In B. R. Dos Santos, I. B. Gonçalves, & R. T. Alves Júnior (Orgs.), Childhood—Instituto WCF-UNICEF. Finkelhor, D. (1994). The international epidemiology of child sexual abuse. Child Abuse & Neglect, 18(5), 409–417. https://doi.org/10.1016/j.chiabu.2008.07.007 Finkelhor, D. (2011). Prevalence of child victimization, abuse, crime, and violence exposure. In J. W. White, M. P. Koss, & A. E. Kazdin (Eds.), Violence against women and children: Mapping the terrain (pp. 9–29). American Psychological Association. Finlkelhor, D., & Jones, L. (2006). Why have child maltreatment and child victimization declined?. Journal of Social Issues, 62(4), 685–716. Habigzang, L. F., Damásio, B. F., & Koller, S. H. (2013). Impact evaluation of a cognitive behavioral group model in Brazilian sexualized abused girls. Journal of Child Sexual Abuse, 22(2), 173–190. https://doi.org/10.1080/10538712.2013.737445 Hackbarth, C., Williams, L., & Lopes, N. (2015). Avaliação de capacitação para utilização do Protocolo NICHD em duas cidades brasileiras [Evaluation of the NICHD protocol training in two Brazilian municipalities]. Revista de Psicología, 24(1). https://doi.org/10.5354/0719-0581. 2015.36916 Henriques, R., Fialho, L. & Chamusca, A. (Orgs.). (2007). Proteger para Educar: A escola articulada com as redes de proteção de crianças e adolescentes. [Protect to educate: The school articulated with child protection networks]. Caderno SECAD, 5. Brasília: Ministério daEducação. http://por taldoprofessor.mec.gov.br/storage/materiais/0000015504.pdf, March 29, 2013. Lamb, M. E., Hershkowitz, I. Y., Orbach, W. & Esplin. (2008). Tell me what happened: structured investigative interviews of child victims and witnesses. Wiley Series in Psychology of Crime, Policing and Law. Wiley Blackwell. Louzeiro, J. (2013). Aracelli, meu Amor. [Aracelli, my Love]. Editora Prumo. Marques, M. (2009). O papel do Instituto WCF-Brazil (World Childhoold Foundation) no combate e prevenção da violência sexual: Relato de experiências bem sucedidas no Brasil. [WCF’s role in curbing and preventing sexual violence: Reporting successful experiences in Brazil]. Em L. C. A. Williams & E. A. C. Araújo (Orgs.), (pp. 193–202). Prevenção de Abuso Sexual Infantil: Um enfoque interdisciplinar. [Child sexual abuse prevention: An Interdisciplinary approach). Editora Juruá. Padovani, R. C., & Williams, L. C. A. (2010). Family violence history and poverty among psychiatric patients in Brazil. In: G. M. Lovisi, J. J. Mari, & E. S. Valencia (Orgs.), The psychological impact of living under violence and poverty In Brazil (pp. 9–103). Nova Science Publishers. Pereda, N., Guilera, G., Forns, M., & Gómez-Benito, J. (2009). The prevalence of child sexual abuse in community and students samples: A meta-analysis. Clinical Psychology Review, 29, 328–338. https://doi.org/10.1016/j.cpr.2009.02.007 Pezdek, K., Morrow, A., Goodman, G., Quas, J. A., Saywitz, K. J., Bidrose, S., Pipe, M-E., Rogers, M., & Brodie, M. (2004). Detection deception in children: Event familiarity affects criterionbased content analysis ratings. Journal of Applied Psychology, 89 (1), 119–126. https://doi.org/ 10.1037/0021-9010.89.1.119 Stoltenborgh, M., Ijzendoorn, M., Euser, E., & Bakermans-Kranenburg, M. (2011). A Global perspective on child sexual abuse: Meta-Analysis of prevalence around the world. Child Maltreatment, 16(2), 79–101. https://doi.org/10.1177/1077559511403920

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Williams, L. C. A. (2012). Pedofilia: Identificar e prevenir. [Pedophilia: How to identify and preventing]. Editora Brasiliense. Williams, L. C. A. (2009). Introdução ao estudo do abuso sexual infantil e análise do fenômeno no Município de São Carlos. [Introduction to Child Sexual Abuse and analysis of the phenomenon in the city of São Carlos].Em L.C.A. Williams & E.A.C. Araújo (Orgs.), (pp. 21–40). Prevenção de Abuso Sexual Infantil: Um enfoque interdisciplinar. [Child sexual abuse prevention: An interdisciplinary approach). Editora Juruá. Williams, L. C. A., Padovani, R. C., & Brino, R. F. (2009). Empowering families to face domestic violence. EDUFSCar/PAHO.

Chapter 29

A Multidisciplinary Approach to Child Protection for Sexual Abuse in India: The Law Lina Acca Mathew

Introduction: The Ideology Governing Child Rights against Sexual Abuse in India The Government of India ratified the Convention on the Rights of the Child on 12 November 1992. Thereby India committed to follow a principle of child sensitivity within the legal and policy-level framework. The need to address offences against children came to the forefront during discussions relating to the commission of the Study on Child Abuse: India 2007, which identified widespread abuse of children in the country. The consultations, which were initiated in 2005, led to the conclusion that there was a need for legislation on child abuse. Consultations in 2009 with Non-Government Organisations (NGOs), legal experts, child rights activists, and concerned government officers revealed that, instead of a general legislation covering all offences against children, focus should be on a Bill for Sexual Offences against children. It was felt that the relevant sections of the Indian Penal Code 1860 (IPC), the Criminal Procedure Code 1974 (CrPC), the Indian Evidence Act 1872, and other laws could be amended concurrently to ensure that children were not victimised further and justice was rendered in a time-bound manner. It was further felt that the Draft Bill on Sexual Offences against children should be expanded to cover pornography and to provide for more child-friendly procedures. Later in the second stage, the Juvenile Justice (Care and Protection of Children) Act, 2000, would be expanded to include other offences against children, which were not addressed in any other law. Various changes have been incorporated by the Juvenile Justice (Care and Protection of Children) Act of 2015 and its Model Rules of 2016. The system of child protection as laid down in legislations requires continued collaborative and coordinated efforts of various stakeholders for effective implementation of the child protection framework in India. L. A. Mathew (B) Government Law College, Ernakulam, Kerala, India © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_29

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International Obligations India is signatory to a host of International Covenants and Instruments focussing on child protection. The following are the international documents which guarantee certain rights to children in India: UN Standard Minimum Rules for the Administration of Juvenile Justice (The Beijing Rules), 1985, which endeavours to provide a stabilising environment to a juvenile and a juvenile in conflict with the law so as to reduce and reform delinquent behaviour. United Nations Convention on the Rights of the Child, 1989 (UNCRC)—a Convention which states that in all actions concerning children, whether undertaken by public or private social welfare institutions, courts of law, administrative authorities or legislative bodies, the best interests of the child shall be a primary consideration. In addition, appropriate legislative, administrative, social, and educational measures are taken to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse, while in the care of parent(s), legal guardian(s), or any other person who has the care of the child. India acceded to the UNCRC on 11 January 1993.1 UN Guidelines for the Administration of Juvenile Delinquency 1990 (the Riyadh Guidelines), UN Rules for the Protection of Juveniles Deprived of their Liberty 1990 (JDLs or Havana Rules) and UN Standard Minimum Rules for Non-custodial Measures 1990 (The Tokyo Rules) are other guidelines to reform juveniles from delinquent behaviour. These guidelines concern counteracting the detrimental effects of all types of detention, fostering integration in society, and promoting the use of non-custodial measures in punishment, as well as minimum safeguards for persons subject to alternative punishment to imprisonment. Stockholm Declaration and Agenda for Action, 1996: The agenda for action agreed upon by 119 countries including India were the setting targets for reducing children vulnerable to exploitation at the local/national level, developing implementation and monitoring mechanisms in cooperation with civil society to reduce the vulnerability. This was achieved by creating a database of at risk children at the local/national level and close cooperation and coordination with the government and non-government sectors to monitor and evaluate the measures against sexual exploitation of children. Optional Protocol To The Convention On The Rights Of The Child On The Sale Of Children, Child Prostitution And Child Pornography 2000 mandates international obligations to pass specific laws against child pornography ‘punishable by appropriate penalties that take into account their grave nature’ as well as enable extradition, mutual assistance in investigation, and seizure of property. The protocol expresses grave concern over the problems of child sexual exploitation—international traffic in children, sale of children, sex tourism, and online child pornography.

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Furthermore, it is stated that member states of the United Nations were ‘concerned about the growing availability of child pornography on the Internet and other evolving technologies…’. India ratified this instrument on 16 September 20052 . Optional Protocol on the Involvement of Children in Armed Conflict 2000 requires governments to ensure that children under the age of eighteen are not recruited compulsorily into their armed forces and requires governments to do everything feasible to ensure that members of their armed forces who are under 18 years of age do not take part in hostilities. India ratified this instrument on 30 December 20053 . The Yokohama Global Commitment 2001: The commitment was to develop national agendas and strategies or plans of action for implementation of measures to address the root causes which lead to sexual exploitation, for closer networking with stakeholders and enforcement agencies to combat sexual exploitation, furthermore, to ensure adequate resource allocation, to take adequate measures to address negative aspects of new technologies, to stress the importance of family and strengthen social protection of children, and to commit to cooperation and protection at levels to eliminate all forms of sexual exploitation. SAARC Convention on Prevention and Combating Trafficking in Women and Children for Prostitution 2002 emphasises that trafficking women and children for the purpose of prostitution is a violation of basic human rights. SAARC Convention on Regional Arrangements on the Promotion of Child Welfare in South Asia 2002 recognises survival, protection, development and participatory rights of the child and promotes solidarity, cooperation and collective action between SAARC countries in the area of child rights. UN Convention on the Rights of Persons with Disabilities 2006 intends to protect the rights and dignity of persons with disabilities. Parties to the convention are required to promote, protect, and ensure the full enjoyment of human rights by persons with disabilities including such children and ensure that they enjoy full equality under the law. India ratified the convention on 1 October 2007.4 The Rio de Janeiro Declaration and Call for Action to Prevent and Stop Sexual Exploitation of Children and Adolescents 2008 provides a blueprint for governments, intergovernmental and non-governmental organisations, human rights institutions, ombudspersons, the private sector, law enforcement and legal community, religious leaders, parliamentarians, researchers and academics, civil society and children and adolescents. This declaration seeks to call such bodies and persons to prevent, prohibit and stop sexual exploitation of children and adolescents and to provide the necessary support to children who have fallen victim to abusers. Non-commercial sexual exploitation in the family, child marriage, sexual exploitation of child domestic labourers, the commercial sex industry, child pornography and sexual exploitation of children in cyberspace were examined.

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Indian Constitutional Provisions The Indian Constitution guarantees certain values to all its citizens, which aim to protect the dignity of the individual and create conditions in which every human can develop to the fullest potential. The Indian Constitution imposes negative obligations on the state not to encroach on individual liberty in its various dimensions. The following rights are relevant to child protection: Article 14: The state shall not deny to any person equality before the law or the equal protection of the laws within the territory of India. Article 15: The state shall not discriminate against any citizen on grounds only of religion, race, caste, sex, place of birth or any of them. Article 15 (3): Nothing in this article shall prevent the state from making any special provision for women and children. Article 19(1) (a): All citizens shall have the right (a) to freedom of speech and expression. Article 21: Protection of life and personal liberty-no person shall be deprived of his life or personal liberty except according to procedure established by law. Article 21A: Free and compulsory education for all children of the age of 6–14 years. Article 23: Prohibition of traffic in human beings and forced labour—(1) traffic in human beings and beggars and other similar forms of forced labour are prohibited, and any contravention of this provision shall be an offence punishable in accordance with law. Article 24: Prohibition of employment of children in factories, etc.—no child below the age of 14 years shall be employed to work in any factory or mine or engaged in any other hazardous employment. Article 39: The state shall, in particular, direct its policy towards securing: (e) that the health and strength of workers, men and women, and the tender age of children are not abused and that citizens are not forced by economic necessity to enter vocations unsuited to their age or strength; (f) that children are given opportunities and facilities to develop in a healthy manner and in conditions of freedom and dignity and that childhood and youth are protected against exploitation and against moral and material abandonment.

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National Legislations on Child Rights There are various national legislations for protection of children in India like The Indian Penal Code, 1860, Guardian and Wards Act, 1890, Hindu Adoption and Maintenance Act, 1956, Probation of Offenders Act, 1958, Orphanages and Other Charitable Homes (Supervision and Control) Act, 1960, Bonded Labour System (Abolition) Act, 1976, Immoral Traffic Prevention Act, 1986, Prevention of Illicit Traffic in Narcotic Drugs and Psychotropic Substances Act, 1987, Pre-natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994, Persons with Disabilities (Equal Protection of Rights and Full Participation) Act, 2000, The Information Technology Act, 2000, Juvenile Justice (Care and Protection of Children) Act, 2000, Commission for Protection of the Rights of the Child Act, 2005, Prohibition of Child Marriage Act 2006, The Juvenile Justice (Care and Protection of Children) Rules, 2007, The Protection of Children from Sexual Offences Act, 2012 and The Protection of Children from Sexual Offences Rules, 2012. In addition to these national instruments, there exists the Goa Children’s Act 2003, a law applicable only to the state of Goa, which guarantees children’s rights in Goa. The first legislation recognising the need to cater to children was the Apprentice Act 1850, providing children in the age group of 10–18 convicted by courts, to be provided with vocational training for their rehabilitation. This was followed by Reformatory Schools Act 1897 to amend the law relating to reformatory schools and to make provisions regarding youthful offenders comprising of boys below the age of fifteen. The Indian Jail Committee (1919–1920) emphasised the vital need for a fair trial and treatment of children in conflict with law. Recommendations from this act prompted the enactment of the Children Act in Madras in 1920. This was followed by Bengal and Bombay Acts in 1922 and 1924, respectively. The central enactment, the Children Act 1960, was passed post-Independence with a view to make uniform the laws and institutions governing and protecting children in all the Union Territories of India. This act established separate Child Welfare Boards to handle cases relating to neglected children. It also created the position of a probation officer who could advise and assist neglected or delinquent children (Section 53(2)). In addition, it established separate Children’s Courts for cases related to delinquent juveniles, thereby separating the judicial process for delinquent and neglected children. Certain amendments were made to the Children’s Act 1960 in the year 1978. However, this enactment was confined to the Union Territories of India alone. While uniform legislation regarding Juvenile Justice for the whole country was needed, it was not legally possible to pursue the matter at the union level as the subject matter of such legislation fell in the State List of the Constitution. However, such changes were later possible with India becoming signatory to the UN Standard Minimum Rules for the Administration of Juvenile Justice in 1985. In order to bring the operations of the Juvenile Justice system in the country, in conformity with its international obligations, the Parliament exercised its power under Article 2535

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and passed the Juvenile Justice Act 1986, authorising the establishment of separate Juvenile Welfare Boards for neglected children nationally. After the Convention on the Rights of Child of 1989 was ratified by India, the Central Government repealed the 1986 Juvenile Justice Act and passed a new act known as the Juvenile Justice (Care and Protection) Act (2000) with a view to incorporate the principles of the UNCRC and further streamline the judicial system for children.

The Juvenile Justice (Care and Protection of Children) Act (JJ Act) 2015 and the Juvenile Justice (Care and Protection of Children) Model Rules 2016 The Juvenile Justice (Care and Protection) Act enacted in the year 2000 defined the law relating to children in conflict with law and that concerning children in need of care and protection. It stressed upon a child-friendly approach with a focus on the best interests of children. In 2007, the Juvenile Justice (Care and Protection) Rules brought clarity to different aspects of the act of 2000. In 2013, the Nirbhaya incident in led to amendments in criminal laws. As part of these reforms, the government also succumbed to pressure to amend the Juvenile Justice Act of 2000. The Juvenile Justice (Care and Protection) Act of 2015 (referred to as JJ Act) and the Model Rules 2016 made comprehensive changes to the law. Children in conflict with law are to be tried by the Juvenile Justice Board (referred to as JJB), which consists of Metropolitan Magistrate or Judicial Magistrate of the First Class and two social workers of whom at least one shall be a woman. A procedure was laid down for protecting a child victim of sexual abuse through the mechanism of a Child Welfare Committee (referred to as CWC). The CWC consists of Chairperson and four other members, of which one shall be a woman and the other an expert on matters concerning children. However, this committee does not have any member of the judiciary. The constitution of a Child Protection Unit (called as CPU) for the state and for every district, in order to ensure the implementation of this act is for various purposes and in order to ensure the implementation of the infrastructure of JJBs, CWCs, Special Juvenile Police Units (SJPUs) and homes in each district, identifications of families at risk and children in need of care and protection, creating district-specific databases to monitor trends and patterns, setting up of District, Block, and Village level Child Protection Committees for effective implementation of programmes and carrying out coordination with governmental and other agencies for effective child protection. The creation of the SJPU for police officers to coordinate and to upgrade the police treatment of the juveniles and the children is another special feature of this legislation. There can be SJPUs at city and district levels. The SJPU shall consist of a child welfare officer of the minimum rank of the assistant sub-inspector and two social workers having experience of working

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in the field of child welfare, of which one shall be a woman. The unit shall be headed by a police officer of the rank of Deputy Superintendent of Police and above. This act provides for punishment for adult offenders who have treated a child with cruelty, or given the child intoxicating liquor, narcotic drug or psychotropic substance or exploited a child employee or kidnapped and abducted a child. Use of children by self-styled, non-state militant groups and for other illegal activities is also punishable. Punishment can be awarded for disclosure of identity of a child in need of care and protection and a child in conflict with law by the media. Corporal punishment in a child care institution has been made punishable. Twice the penalty provided for these offences would accrue if the child victim is disabled. The principles of best interests of the child, non-stigmatising semantics and principles embodied in the UN Convention on the Rights of the Child have been incorporated into these enactments. The Juvenile Justice (Care and Protection of Children) Act of 2015 introduced a new category of offences wherein children who fall within the age groups of 16– 18 years of age and who have committed ‘heinous crimes’ which consist of crimes for which the minimum punishment prescribed is above 7 years imprisonment would be removed from the Juvenile Justice system altogether and would be tried under the adult system of criminal justice prosecutions. In this regard, a preliminary assessment would be conducted by the JJB to find out the child’s mental and physical capacity to commit such heinous offence, the ability of the child to understand the consequences of the offence and the circumstances in which the child allegedly committed the offence. The machinery for trial of adult offenders of children was not covered by the JJ Act. Offences committed by adults against children follow ordinary courts of the land, governed by the Criminal Procedure Code of 1973. Formerly, the general rules of evidence were applicable uniformly to all. However, with the advent of the historical case Sakshi v. Union of India6 , a separate child-friendly procedure for trial of sexual offences came into existence in the ordinary courts. Here, the Supreme Court lay down that the following specifications are to be kept into consideration by all courts in the Union of India during the trial of a case of sexual offences, namely (1) The provisions of subsection (2) of Section 327, CrPC, in addition to the offences mentioned in the subsection, shall also apply in inquiry or trial of offences under Sections 354 and 377, IPC. (2) In holding trial of child sex abuse or rape: (i) a screen or some such arrangements may be made where the victim or witness (who may be equally vulnerable like the victim) does not see the body or face of the accused; (ii) the questions put in cross-examination on behalf of the accused, insofar as they relate directly to the incident, should be given in writing to Presiding Officer of the court who may ask questions put to the victim or witness in a language which is clear and is not embarrassing; (iii) the victim of child abuse or rape, while giving testimony in court, should be allowed sufficient breaks as and when required. Thus, through this judgement, the Supreme Court attempted to incorporate the principles of non-stigmatising semantics, dignity and worth of the child, innocence of the child, safety and positive measures, equality and non-discrimination, privacy and confidentiality, best interest of the child, etc., as enshrined in the UNCRC into the Indian court procedure.

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Goa Children’s Act, 2003 (GCA) In the meantime, the State of Goa felt the need to draft a separate law for itself on the issue of child protection against adult abuse, incorporating child-friendly practices in tune with the UNCRC. For the first time in Indian statutory legislation, the term ‘child abuse’ was used and sexual offences defined time in this legislation.7 Sexual offences were legally defined for the first time in India through this legislation.8 Section 8 criminalises ‘child abuse’ punishment for sexual assault, grave sexual assault and incest.9 Soliciting children for purposes of commercial exploitation is prohibited, which includes hosting websites, taking suggestively or obscene photographs, etc.10 Any person who exploits a child for commercial sexual exploitation shall be liable to pay a penalty which may extend to Rs. 1,00,000/- and simple imprisonment of 1 year. This will be in addition to any penalty or punishment that may be enforced under any other act in force. Developers of photographs or films, as well as airport authorities, border police, railway police, traffic police have to report sexual/obscene depictions of children, suspected cases of trafficking of children, etc. GCA establishes a Children’s Court for the purpose of prosecution of adult offenders. This court has the powers of a District (civil) and Sessions (criminal) Court. GCA defines ‘child’ as any person who is under 18 years of age. Principles that are in the best interests of the child and non-stigmatising semantics have been adopted by GCA. GCA lays down fair procedure for children like presumption of age of innocence; privacy and confidentiality, shifting of burden of proof upon the accused; child-friendly cross-examination, in-camera trial, reduced delays in procedure, etc.

The Protection of Children from Sexual Offences Act, 2012 (POCSO Act) It defines various forms of sexual offences including Penetrative Sexual Assault,11 Sexual Assault,12 Sexual Harassment,13 and Use of child for pornographic purposes14 , etc. For the first time in a national legislation, reporting of the offences was made mandatory. Any person (including the child), who has apprehension that an offence under the POCSO Act is likely to be committed or has knowledge that such an offence has been committed, shall provide such information to (a) the SJPU or (b) the local police. The report shall be recorded in writing and ascribed an entry number, be read over to the informant and be entered in a book kept by Police Unit. The SJPU/local police is to make immediate arrangement to give him such care and protection (admitting child to shelter home or nearest police station) within 24 h, after recording reasons in writing. Within 24 h, the SJPU/local police report matter to CWC and Special Court or Sessions Court. The statement shall be recorded at residence of child or place of his choice and as far as possible by a woman police officer not below rank of sub-inspector. When the statement of child is recorded, it shall be in the presence of his parents or any person

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of child’s trust. This shall be done when the police officer is not in uniform. The police officer has to ensure that the child does not come into contact with accused while examination is taking place. No child is to be detained in police station at night. The police officer has to ensure that child is protected from public media. The Magistrate shall record the statement of the child in the presence of his parents or any person of child’s trust. The Advocate of the accused shall not be present while recording the statement of the child. A copy of the final report of the police is to be given to the child and his parents/representative. Whenever possible, the statement of child shall also be recorded by the Magistrate and the police officer by audio–video electronic means. Even though the First Information Report (FIR) or private complaint is not registered, medical examination is also to be conducted. For girl victim, medical examination can be conducted only by a woman doctor. The medical examination is to be conducted in the presence of a parent of the child/other person of the child’s trust. In case a parent or other person of trust is not present, the medical examination is to be conducted in the presence of a woman nominated by the head of the institution. The presumption of culpable mental state is upon the accused. Hence, the burden of proof is on the accused to prove that he had no intention to commit an offence under the act. In any prosecution for any offence under POCSO Act which requires a culpable mental state on the part of the accused, the Special Court shall presume the existence of such mental state, but it shall be a defence for the accused to prove the fact that he had no such mental state with respect to the act charged as an offence in that prosecution. This is against the section 101 of the Indian Evidence Act 1872. Every one charged with a penal offence has the right to be presumed innocent until proved guilty according to law in a public trial at which he has had all the guarantees necessary for his defence so stated in Article 11(1) of the UDHR. There is a wide concern that the presumption of guilt is against the cardinal rule of presumption of innocence and hence is to be removed from statute book. However, it is understood that children who are victims as well as the prime witnesses in the legal system constitute a very delicate category of victims and witnesses. As these kinds of offences are committed in secrecy, such children who become prime witnesses and victims may not be mature enough to understand the sexual intent of the accused. It is for such situations that it is necessary to resort to the principle of ‘reverse burden of proof.’ The Kerala High Court in Justin@ Renjith v. Union of India15 held that reverse burden in POCSO Act is constitutional. The provisions relating to presumption of culpable mental state and reverse burden of proof in the POCSO Act are based on intelligible differentia treating child victims as a class. POCSO Act is based on the mandate under Article 15(3) of the Constitution. The constitutional right against self-incrimination comes into operation only when the accused is subjected to duress. A Court of Sessions is to be the Special Court in order to conduct speedy trial. The evidence of the child is to be recorded within 30 days of the Special Court taking cognisance and the reasons for delay to be recorded. The trial is to be completed within 1 year.

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A post of Special Public Prosecutor has been created. The Special Public Prosecutor and Advocate for accused have to put questions for chief, cross and reexaminations to the Judge, who shall ask the child. A child-friendly atmosphere is to be created by allowing a family member, friend, relative or any person of the child’s trust to be present. The child shall not be repeatedly called to testify in the court, shall be given frequent breaks, there shall be no aggressive questioning or character assassination, non-disclosure of identity of child during investigation and trial including identity of family, school, relatives, neighbourhood, etc. Video conferencing can be used for recording the child’s statement or by utilising single visibility mirrors or curtains or any other devices. The trial must be in camera. The Legal Services Authority has to provide a lawyer for the indigent. Subject to rules, the State Government shall prepare guidelines for the use of non-governmental organisations, professionals and experts or persons having knowledge of psychology, social work, physical health, mental health and child development to be associated with the pre-trial and trial stage to assist the child. The National Commission for Protection of Child Rights (NCPCR) and the respective State Commissions (SCPCR) shall monitor the implementation of this act.

The Indian Penal Code 1860 The Criminal Law Amendment Act 2013 brought about extensive changes to the Indian Penal Code, 1860. The old laws relating to sexual offences against women have been considerably changed. It raises the age of consent for sexual activity for a woman from 16 to 18.

Rape of a Minor Wife Under the Indian Penal Code However, vestiges of the past still remained as the amended Indian Penal Code still upheld that sexual intercourse by a man with his wife above 15 years of age is an exception to rape. As a result, sexual intercourse with a wife above 15 years of age and below 18 years of age will not amount to rape under the IPC. But the POCSO Act, 2012 conflicts with this, as it penalises sexual activity among or with all children below the age of eighteen. In the first edition of this book, it was pointed out that this is a matter of debate, given the existing Prohibition of Child Marriage Act, 2006 which was enacted for the lofty purpose of rendering child marriages voidable at the option of the under-age party to such marriage. In this connection, it is welcome to note the change in the law in this regard which was brought about through the Supreme Court decision in Independent Thought v. Union of India and Another (2017).16 The honourable court held that sexual intercourse by a man with his wife who is above the age of 15 years cannot be exempted from the ambit of the offence of rape as it is violative of constitutional rights of equality, non-discrimination and

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life and personal liberty and conflicts with provisions of the POCSO Act which has defined the offences of penetrative sexual assault and aggravated penetrative sexual assault. The Supreme Court pointed out section 42A of the POCSO Act which clarifies the prevalence of POCSO over conflicting laws. The Supreme Court even referred to documentary evidence stating that immense negative effects may be caused impacting the physical and mental health of sexually abused girl children in addition to grave social consequences, which may cause adverse impact upon child wives throughout their lives and even carry on the ill effects to the next generations.

The Child Witness Courtroom An interesting development is India’s first child witness courtroom (CWCR), designed specifically to protect and insulate children appearing in courts against the usual rigours associated with a courtroom. This was set up at New Delhi’s Karkardooma Court Complex in September 2012, even before the POCSO Act came into force. The model courtroom resembles a ‘child-friendly play area’ with brightly coloured walls, toys, a small pantry and a one-way mirror where the child will not be able to see the accused. The child has a different entrance to the sixth floor court room. In order to make the child feel more at ease and not get intimidated under the normal court set-up, the dais of the judge is made much lower. The child (witness/victim) is allowed to interact with the court in two ways. One is through video conferencing which is connected to the courtroom and enables the judge and the accused to see and hear the child. In the second arrangement, the child-friendly courtroom is fitted with a one-way mirror. Here the accused sits in an adjacent room and is able to see the victim through the mirror, while the child witness/victim will be seated in front of the judge, on a couch, with his attendant. The accused can see the examination of the witness and be a part of the fair trial using the one-way glass. In September 2014, the second vulnerable witness deposition complex for kids was set up at Saket District Court in New Delhi. In the Saket Court complex, the vulnerable witness is escorted to the court by a facilitator in a vehicle. The vehicle is provided by the court administration to build rapport and make the witness comfortable. The witness enters the court complex through a separate entry away from the public glare. The facility has been developed in such a manner that while in the court complex including during recording of evidence, the accused and witness are never face to face. Child witness courtrooms (CWCR) have thereafter been revamped in these lines in different parts of the country. However, making witnessing an easy task still remains a challenge as waiting areas still continue to be common. Hence, even though the witnessing may be in a child-friendly manner, all that good work gets negated as the child and the persons who accompany the child still spend hours waiting alongside the accused and his cronies for court proceedings to commence.

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The Role of NGOs Laid Down in Legislations The JJ Act 2015 recognises the importance of collaboration with Non-Governmental Organisations. It lays down various roles that can be filled by such organisation. Compulsory registration of all child care institutions run by NGOs who are housing, either wholly or partially, children in need of care and protection or children in conflict with law is required as per section 41. NGOs are allowed to the following roles: 1.

2.

3. 4.

5.

6.

7. 8. 9. 10. 11. 12.

To assist the State Government to establish and maintain Children’s Homes as per section 2(19) read with section 50. These Children’s Homes are to be registered for the placement of children in need of care and protection for their care, treatment, education, training, development and rehabilitation as per section 50(1). To function as a ‘fit facility’ as per sections 2(28) read with section 51 to temporarily take the responsibility of a child for a specific purpose after due inquiry regarding the suitability of the facility and the organisation to take care of the child in such manner as may be prescribed. To function as a ‘fit person’ as per section 2 (29) along with section 52. To maintain observation homes as per section 2(40) read with section 47 for the temporary reception, care and rehabilitation of any child alleged to be in conflict with law, during the pendency of any inquiry under the JJ Act. To run an open shelter as per section 2 (40) read with section 43, which shall function as a community-based facility for children in need of residential support, on short-term basis, with the objective of protecting them from abuse or weaning them, or keeping them, away from a life on the streets. To run a special home as per section 2(56) read with section 48 in order to provide housing or rehabilitative facilities to children in conflict with law who have been found to have committed an offence. To establish a Specialised Adoption Agency as per section 2(56) read with section 65. To assist the JJB in providing follow-up measures for rehabilitation of children in conflict with law. To assist the CWC in preparing the Social Investigation report as per section 30. To produce any child in need of care and protection before the CWC as per the provisions of section 31. To submit a report for the release of any child from a Children’s Home or a special home to the CWC or JJB as per section 97(1). To coordinate with the child welfare police officer of the SJPU as per section 107(1).

The Juvenile Justice (Care and Protection) Model Rules 2016 also add to the roles of NGOs as follows: 1.

To provide a ‘Case Worker’ who is a representative from a registered voluntary or non-governmental organisation who shall accompany the child to the Board

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3. 4.

5.

6.

7.

8.

9. 10. 11.

12. 13.

14.

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or the Committee and may perform such tasks as may be assigned to him by the Board or the Committee as per rule 2(iii). To provide assistance to JJBs for para-legal and other tasks such as contacting the parents of child in conflict with law and collecting relevant social and rehabilitative information about the child as per rule 7(x). A list of designated NGOs with contact details is to be prominently displayed in each police station as per rule 8(6). A panel of NGO who can provide the services of probation, counselling, case work and associate with the Police or Special Juvenile Police Unit or the Child Welfare Police Officer and assist in physical production of the child before the Board within twenty-four hours and during the pendency of the proceedings shall be maintained by the State Government as per rule 8(8). Rule 19(3) prescribes that when a child is brought before the CWC, inquiry shall be conducted by assigning the case for social investigation under section 36(2) of the JJ Act to a case worker or to an NGO through an order in Form 21. Rule 19(8) provides that when such social investigation is conducted, it must be as per the requirements of Form 22 and make an assessment of the family situation of the child in detail, and explain in writing whether it will be in the best interest of the child to restore him to his family. Rule 19 (17) stipulates that at the time of final disposal of a case, an individual care plan in Form 7 of such child must be prepared by the Case Worker or NGO. Rule 21 (5) (viii) provides that at the time of registration of any child care institution, the State Government may consider details of any linkages and networking with any NGOs on providing need-based services to children. NGOs may assist the State Government to establish open shelters as per rule 22 (1). Rule 27 stipulates that an application may be made by an NGO to the JJB or CWC to be recognised as a fit facility. Rule 35 (5) provides for mental health facilities of the child to be taken care of. For this purpose, every child care institution shall have the services of trained counsellors or collaboration for specialised and regular individual therapy for the child with external agencies such as NGOs. Rule 38 (8) (8) allows for maintenance of regular recreational activities in child care institutions with support of NGOs. Rule 65 (3) (iii) provides that all child care institutions must have a Rehabilitative-cum-Placement Officer to network with NGOs and other funding agencies to mobilise resources for sponsoring training programme and support for self-employment. Rule 65 (3)(iv) provides that all such Rehabilitative-cum-Placement Officers must facilitate and coordinate with NGOs and other funding agencies to set up vocational training units or workshops in child care institutions as per age, aptitude, interest and ability.

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15.

Rule 69 deals with the institutional management of children. With regard to rule 69(M)(5), the person-in-charge of the child care institution may seek the assistance of any NGO associated with the institution in dealing with a situation of unacceptable behaviour. Rule 82 details various roles of NGOs in release of the child from the institution and restoration of the child with his/her family, including accompanying the child back to his/her family for restoration as per rule 82(5) and preparing a follow-up plan as part of the individual care plan as per rule 82(9). Rule 87(1)(iii) highlights the role of NGOs in selecting members of the JJB and CWC at the state level. The selection committee shall be constituted for a period of 3 years and shall include two representatives from two different reputed NGOs that have worked in the area of child development or child protection for a minimum period of 7 years but not in the business of actually running or managing any children’s institution.

16.

17.

The role of NGOs under the POCSO Act and its rules is as follows: Section 39 of the POCSO Act states that the State Government shall prepare guidelines for use of NGOs, professionals and experts or persons having knowledge of psychology, social work, physical health, mental health and child development to be associated with the pre-trial stage and trial stage to assist the child. Section 44 of POCSO Act states the role of the NCPCR and SCPCR. Rule 9 of the POCSO Rules states that the NCPCR and SCPCR shall be in charge of monitoring the formation of guidelines under Section 39 of the act and monitoring the application of these guidelines. This means that from the time a child comes into contact with the justice delivery system, a social worker can actively engage with police to bring the child to the Child Welfare Committee and ensuring support from the CWC to the child.

Recommendations for a Multidisciplinary Approach Dimension It can be understood that no longer can civil society organisations be excluded from governance. The challenge lies in coordinating the various functionaries under the JJ Act and POCSO Act. There is further need for clarity on how NGOs and civil society groups can help in pre-trial and trial stage assistance, as per Section 39 of the POCSO Act. One way could be the preparation of a panel of trained doctors, police personnel, psychologists, social workers and lawyers by the District Child Protection Unit for each gram sabha, corporation or municipality to assist the concerned Special Courts, JJB, CWC and SJPUs in each locality. The services of the State Legal Services Authorities and the National Legal Services Authority should be utilised under Section 40 of the POCSO Act. Every child who has reported abuse should be examined by concerned personnel from this panel. Interview before the concerned police officer should be videotaped

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as per Section 26 (4) of POCSO Act. Medical examination should be conducted as per provisions in Section 27 of POCSO Act. Translator or interpreter or special educator facilities for the concerned police officer should be made available as per Sections 26(2) and (3) of POCSO Act. Accredited non-governmental/civil society organisations can be put in charge of coordinating the panel of experts for contacting the child, so that the child’s victimisation by the legal system is minimised. An issue which has remained unaddressed regarding child protection is the unavailability of accurate and updated statistical data and unavailability of official statistical reports nationally and regionally. Rules for each state have to make provision whereby accredited civil society organisations can be used to compile data on child sexual abuse cases, to be coordinated at the state level by the SCPCR. Notes 1.

2. 3. 4.

5.

6. 7.

8.

Office Of The United Nations High Commissioner For Human Rights (2006). ‘Status Of Ratifications Of The Principal International Human Rights Treaties As of 16 June 2006’ at 6 http://www2.ohchr.org/english/bodies/docs/Ratificat ionStatus.pdf (accessed on 31/05/2013 at 11:54). Id. Id. National Human Rights Commission India (2012). A Handbook on International Human Rights Conventions at 168 http://nhrc.nic.in/Documents/Pub lications/A_Handbook_on_International_HR_Conventions.pdf (accessed on 31/5/2013 at 13:07). Article 253: Legislation for giving effect to international agreements. Notwithstanding anything in the foregoing provisions of this Chapter, Parliament has power to make any law for the whole or any part of the territory of India for implementing any treaty, agreement or convention with any other country or countries or any decision made at any international conference, association or other body. AIR 2004 SC 3566. Section 2 (m) of GCA: ‘Child abuse’ refers to the maltreatment, whether habitual or not, of the child which includes any of the following: (i) psychological and physical abuse, neglect, cruelty, sexual abuse and emotional maltreatment;(ii) any act by deeds or words which debases, degrades or demeans the intrinsic worth and dignity of a child as a human being;(iii) unreasonable deprivation of his basic needs for survival such as food and shelter; or failure to immediately give medical treatment to an injured child resulting in serious impairment of his growth and development or in his permanent incapacity or death. Section 2 (y) of GCA: Sexual offence for the purposes of awarding appropriate punitive action means and includes. (i) ‘Grave sexual assault’ which covers different types of intercourse: vaginal, oral, anal, use of objects, forcing minors to have sex with each other,

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10.

11.

12.

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deliberately causing injury to the sexual organs, making children pose for pornographic photos or films. (ii) Sexual assault which covers sexual touching with the use of any body part or object, voyeurism, exhibitionism, showing pornographic pictures or films to minors, making children watch others engaged in sexual activity, issuing of threats to sexually abuse a minor, verbally abusing a minor using vulgar and obscene language. (iii) Incest which is the commission of a sexual offence by an adult on a child who is a relative or is related by ties of adoption. Section 8 (2)of GCA: Whosoever commits any sexual assault as defined under this act shall be punished with imprisonment of either description for a term that may extend to three years and shall also be liable to fine of Rs. 1,00,000/-. Whoever commits any grave sexual assault shall be punished with imprisonment of either description for a term that shall not be less than seven years but which may extend to ten years and shall also be liable to a fine of Rs. 2,00,000. Whoever commits incest shall be punished with imprisonment of either description for a term of one year plus fine of Rs. 1,00,000/-. Section 8(12) of GCA: Any form of soliciting or publicising, or making children available to any adult or even other children for purposes of commercial exploitation is prohibited. This includes hosting websites, taking suggestive or obscene photographs, providing materials, soliciting customers, guiding tourists and other clients, appointing touts, using agents or any other form which may lead to abuse of a child. This has been defined as penetration by penis (to any extent) of any person or insertion (to any extent) of any object or part of the body of any person or manipulation of any part of the body of a child so as to cause penetration, into vagina, mouth, urethra or anus of the child or making the child to do so with such person or any other person or application of such person’s mouth to the penis, vagina, anus, urethra of the child or making the child to do so to such person or any other person. This offence is punishable by imprisonment of either description from seven years to life and fine (Sections 3–4). Whoever, with sexual intent, touches the vagina, penis, anus or breast of the child or makes the child touch the vagina, penis, anus or breast of such person or any other person, or does any other act with sexual intent which involves physical contact without penetration, is said to commit sexual assault. The punishment for sexual assault is imprisonment from three years to five years and fine (Sections 7–8). Whoever, with sexual intent utters any word or makes any sound or makes any gesture or exhibits any object or part of body with the intention that such word or sound shall be heard or such gesture or object or part of body shall be seen by the child, makes a child exhibit his body/any part, shows any object to a child in any form or media for pornographic purposes, repeatedly or constantly follows or watches or contacts a child either directly or through electronic, digital or any other means, threatens to use in any form of media, a real or fabricated depiction through electronic, film or digital or any other mode, of

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15. 16.

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any part of the body of the child or the involvement of the child in a sexual act, entices a child for pornographic purposes or gives gratification, therefore, shall have committed the offence of sexual harassment. The punishment shall be imprisonment up to three years and fine (Sections 11–12). Whoever, uses a child in any form of media (including programme or advertisement telecast by television channels or Internet or any other electronic form or printed form, whether or not such programme or advertisement is intended for personal use or for distribution), for the purposes of sexual gratification, which includes representation of the sexual organs of a child; usage of a child engaged in real or simulated sexual acts (with or without penetration); the indecent or obscene representation of a child shall be guilty of the offence of using a child for pornographic purposes. An explanation is appended to the relevant section regarding the expression ‘use a child’. This expression shall include involving a child through any medium like print, electronic, computer or any other technology for preparation, production, offering, transmitting, publishing, facilitation and distribution of the pornographic material. Punishments are many and varied. For mere usage of a child for pornographic purposes, the punishment is imprisonment of either description up to 5 years and fine. In the event of subsequent conviction, punishment shall be imprisonment of either description up to 7 years and fine. If a person uses the child for pornographic purposes, he shall be guilty of penetrative sexual assault. He shall be liable for not less than ten years imprisonment of either description to life imprisonment and fine. If a person uses the child for pornographic purposes and commits an offence of aggravated penetrative sexual assault, the punishment is imprisonment for life and fine. If any person using a child for pornographic purposes commits an offence of sexual assault, the punishment shall be imprisonment of either description for a term which is not less than 6 years imprisonment up to 8 years and fine. If any person using the child for pornographic purposes commits an offence of aggravated sexual assault, the punishment shall be not less than 8 years imprisonment up to 10 years and fine. If any person commits the offence abetment of any offence under the POCSO ACT, the punishment shall be as provided for the actual commission of the offence. If any person attempts to commit an offence under the POCSO Act, punishment is imprisonment for a term up to one half of the imprisonment for life or one half of the longest term of imprisonment provided for that offence or with fine or with both. (Sections 13–15). WP(C).No.15564 OF 2017(U). WP(Civil) No. 382 of 2013 decided on 11/10/2017.

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Bibliography CCL-NLSIU. (2013). Child marriage and the protection of children from sexual offences act, 2012. https://www.nls.ac.in/ccl/justicetochildren/poscoact.pdf Pinho, E. (2011). Juvenile justice act; A reformative step for children in conflict with law. http:// www.scanindia.in/blog/tag/juvenile-justice-act-2000/ Representing Children Worldwide. (2005). “India”. http://www.law.yale.edu/rcw/rcw/jurisdictions/ assc/india/frontpage.htm#_edn5 Sabha, R. (2011). Department-related parliamentary standing committee on human resource development. 240th report on protection of children against sexual offences bill, 2011. http:// www.prsindia.org/uploads/media/Protection%20of%20children/SCR%20Protection%20of% 20Children%20from%20Sexual%20Offences%20Bill%202011.pdf The Delhi Commission for Protection of Child Rights. (2013). Guidelines for the prevention of child abuse [draft]. http://delhi.gov.in/wps/wcm/connect/DOIT_DCPCR/dcpcr/what+s+new/ draft+guidelines+for+the+prevention+of+child+abuse

Chapter 30

Protecting Children: Building Effective Systems Jenny Gray

Introduction ‘No violence against children is justifiable; all violence against children is preventable, (Pinheiro, 2006, p. 5).

Child maltreatment is not a new phenomenon. In 1962, 60 years ago, Drs. Henry Kempe and Brandt Steele published their seminal paper, The Battered Child Syndrome, which ignited debate internationally about child protection and highlighted the importance of professionals working together when responding to maltreated children. Their efforts, along with those of their contemporaries, to prevent and treat victims of child abuse and neglect continue to this day. Despite child maltreatment being known about and responded to for decades, we still do not have reliable data on its prevalence. Data on physical violence compiled for the UN Secretary General’s Study on Violence against Children (2006) estimated that between 500 and 1.5 billion children experience violence annually. More recently, Hillis et al. (2016) estimated that worldwide up to 1 billion children aged 2–17 years experienced physical, sexual, or emotional violence or neglect in the past year, i.e., one out of two children in this age band. WHO (2020) in its Global status report on preventing violence against children 2020 reported: A third of students aged 11–15 years worldwide have been bullied by their peers in the past month, and 120 million girls are estimated to have suffered some form of forced sexual contact before the age of 20 years (United Nations Children’s Fund, 2014; United Nations Educational, Scientific and Cultural Organization 2019). Emotional violence affects one in three children, and worldwide one in four children lives with a mother who is the victim of intimate partner violence (Stoltenborgh et al., 2012; United Nations Children’s Fund, 2017).

This demonstrates that much progress is still required across the world to fully implement the Convention on the Rights of the Child (CRC) adopted in 1989. J. Gray (B) Great Ormond Street Institute of Child Health, University College London, London, UK © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_30

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Currently, this implementation is being driven through the 2030 Agenda for Sustainable Development (WHO, 2016) and, in particular, Target 16.2, to ‘end abuse, exploitation, trafficking and all forms of violence against and torture of children.’ The Sustainable Development Goals (SDG) each have agreed targets for ending violence against children and the seven INSPIRE evidence-based strategies provide a road map for achieving these targets (World Health Organization, 2016, 2018; United Nations Children’s Fund 2018). The last decade has seen an increasing international and national awareness of the scale and societal costs of child maltreatment and a growing consensus on the types of violence that constitute child maltreatment (Dubowitz, 2012; Fang et al., 2015; Peterson et al., 2018; World Health Organization, 2016). We have however yet to reach what Henry Kempe described as the sixth stage of community recognition of child maltreatment—where each child is wanted, loved and well for, sheltered, fed and receives first-class preventative and curative services and health care (Kempe, 1976). The challenge for all nations and societies is still to develop effective systems which both prevent maltreatment and protect those children who have been abused or neglected. This chapter focuses on the key elements of an effective system which will support implementation of the UNCRC and in particular Article 19, the Right of the child to freedom from all forms of violence.

The UN Convention on the Rights of the Child, Article 19 The UNCRC sets out internationally agreed obligations on state parties to assure the rights of children are respected. Article 19 refers specifically to all forms of violence, which are elaborated in the recent General comment no 13 (2011): The right of the child to freedom from all forms violence (United Nations Committee on the Rights of the Child, 2011). Paragraphs 17–31 of this General Comment describe an extensive number of specific forms of violence including corporal punishment and violence through information and communication technologies as well as the more well-understood forms such as physical and sexual abuse and neglect.

UN Convention on the Rights of the Child, Article 19 1.

2.

State parties shall take all appropriate legislative, administrative, social and educational measures to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse, while in the care of parent(s), legal guardian(s), or any other person who has the care of the child. Such protective measures should, as appropriate, include effective procedures for the establishment of social programs to provide necessary support for the child and for those who have care of the child, as well as for other forms of

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prevention and for identification, reporting, referral, investigation, treatment and follow-up of instances of child maltreatment described heretofore, and, as appropriate for judicial involvement. The General Comment No 13: The Right of the Child to Freedom from All Forms of Violence was adopted by the UN Committee on the Rights of the Child in February, 2011. It aims to assist implementation of Article 19 by providing ‘clear interpretations, greater detail and supportive guidance’ to all those working with and for children. The General Comment No 13 is particularly directed at governments which have ratified the CRC, other stakeholders such as professionals, international and national non-government agencies and advocates, including children and young people (Bennett et al., 2012). The document takes a child rights approach to caregiving and protection, broadening the traditional narrow emphasis on protecting the child from loss of life and immediate harm to also securing optimal outcomes for the child’s wellbeing and development through adulthood. It provides a conceptual framework which emphasizes that ‘child protection must begin with proactive primary prevention’ of all forms of violence as well as explicitly prohibiting them (Bennett et al., 2012). Taking a child rights approach is not new in the field of child protection. Dr. C. Henry Kempe, the founder of International Society for the Prevention of Child Abuse and Neglect (ISPCAN), took this approach. Indeed this was a key area for discussion at his first international meeting held in Bellagio, Italy in 1975, to exchange information on child abuse. This discourse predated the UNCRC, which Henry Kempe actively supported, by 14 years.

Legislative Framework Within each country it is critical that there are national laws to protect children from all forms of violence and associated protocols and guidelines in place. The latter can set out clearly not only what the law says in relation to child protection but also explain what the policy intentions were in passing the legislation. They can be updated from time to time to ensure their underlying evidence base is current. These tools can help support the implementation of legislation as we know that in some countries although the law is sound, it is not implemented or only partially followed, for example depending on the availability of resources. In England and Wales, the Children Act 1989 is the key legislation regarding the welfare of children. Section 17 of this Act places a duty on local authorities1 to safeguard and promote the welfare of children in need in their local area: In addition, section 27 places a duty on education and health bodies to cooperate with the local authority in carrying out its responsibilities. In complementary legislation, the Children Act 2004, section 11 places a duty on key organizations and senior managers 1

There are 152 local authorities in England.

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to ensure their functions are undertaken having regard to the need to safeguard and promote the welfare of children. The organizations named in the legislation are all those that have a statutory responsibility for providing direct services to children and families—the police, health, probation, prison service, institutions working with young offenders and local authority children’s social care services. Critically the primary legislation provides a duty ‘to safeguard and promote the welfare of children’. It thus encompasses statutory responsibilities on agencies to prevent children from being harmed, to protect them from recurring harm and to provide services that focus on securing the best possible outcomes for them. More detailed guidelines for professionals, such as in Working Together to Safeguard Children (HM Government, 2018), assist organizations and professionals to implement the law in consistent and evidence-based ways.

Working Together to Prevent and Treat Child Maltreatment As the founder of the ISPCAN in 1977, Henry Kempe firmly believed that different professions needed to work together if communities were going to be able to effectively prevent and respond to maltreated children. This way of working also applies to state parties. Experience has shown that the more that a government is committed to securing the optimal wellbeing of the nation’s children across all its relevant Ministries, the more likely it is to achieve good outcomes for them. In any civilized society everyone has a responsibility to: • • • •

Protect children from harm; Respond to all forms of violence; Promote children’s wellbeing; and Ensure the right of each child to be free from all forms of violence.

This means taking responsibility for children’s wellbeing and safety within every stratum of society—from the government having a Minister/Ministerial Department with specific responsibility for the protection of the nation’s children, to senior managers in public/state bodies and all those who are delivering services to children and families having public accountability for children’s wellbeing, through to individual members of each local community believing they too must take action to prevent violence to children.

Process for Developing Collaborative Arrangements Effective professional working will be supported by having common child protection policies in place across the different partner organizations. This results in professionals from different disciplines being expected to follow the same overarching processes when managing an individual case. Importantly from an individual child

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and family’s perspective, this means that they are experiencing a coherent service response from all professionals with whom they are in contact. This is particularly important in the field of child maltreatment because different approaches to responding to a child where there are concerns about maltreatment, or professionals acting in conflict with each other about how to respond, can result in a loss of professional focus on the child’s wellbeing and safety. Written agreements or protocols between all the different professional parties may also support effective working together. This could be in relation to a particular area of work, such as sharing information about a child and family, where different professionals may work to different codes of practice or to the overall process. Having one document where the principles have been agreed by key stakeholders and senior professionals will also reduce the need for time being wasted debating conflicting views about how to manage an individual abuse or neglect case. In establishing a starting point for inter-sectoral collaboration on responding to child maltreatment, it is important to start where the land is most fertile. This can be from the ground up or government down or ideally both. Leaders taking forward this type of development should identify influential stakeholders within the key organizations (state and NGO) and those who have expertise in child protection. These key people can form the basis of a ‘working group’ or a number of working groups with specific tasks. It is also important to identify which organization(s) are able to provide the administrative support for these working groups as good quality minutes and efficient organization of meetings are also crucial to the delivery of such a project. In considering who should be involved, consideration should be given to being inclusive of all stakeholders—those from small as well as large organizations and those with relatively small parts to play in the protection of children as well as those that have a key role such as in child protective or children’s health services. Successful implementation of new policies and ways of working will depend not only on the commitment of all those working with children and families but also on those working with adults who are caregivers for children. In some countries the legislation may be sound but consideration may need to be given to amending it to provide additional powers or underpin new ways of working. In other countries the legislation may be outdated or piecemeal having developed over time and require new legislation to be developed and enacted. The working group should be well placed to consider the legislation. Here, the involvement of government officials will be invaluable in providing guidance on what might be possible and the best way of framing requests to politicians for change. International documents such as the UNCRC and the General Comment 13 will provide the underpinning principles for incorporation into new or amended laws. The more recent INPIRE strategies and associated guidance (World Health Organization, 2016, 2018) provide evidence-based approaches to support governments update or develop new legislation. As in all our work, practice experience as well as research findings should also inform these developments. Having decided on a working group’s objectives, it can play a number of different roles such as:

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• Leading the development of guidance, protocols, policies (local and/or national levels); • Training staff across sectors—multi-disciplinary where possible; • Supporting new/different evidence-based ways of working; and • Monitoring and evaluating changes.

Developing Guidelines or Protocols There is general agreement (see paragraphs 48–53 of the General Comment 13) across all countries that any child protection guidelines or protocols should include the following common components: • A referral/reporting system to the services that have statutory responsibility for protecting children, for example child protective or social services; • Agreement on how to undertake rapid multi-disciplinary assessments of nature and level of any harm being or likely to be suffered by the child; • Legal provisions for emergency protection (i.e., rescue) of children; • Agreement on how to undertake multi-disciplinary assessments of a child & family’s long term needs; • Services provided by different organizations to meet the identified needs of children and their families; and • Multi-disciplinary follow-up and evaluation of the adequateness of the interventions in a child and family’s life. This framework should be consistent with the legislative framework within which work with children and families takes place and any other national or standard setting guidance as well as the UNCRC. The process of obtaining agreement on the above areas will require careful discussion and debate across all the key professional groups that will be involved in implementing the framework. These groups would include, for example, social workers, police, doctors, nurses, teachers, staff working with preschool children and ideally those working with parents who have problems relating to drug and alcohol misuse, mental ill health, learning disabilities and domestic violence. The involvement of professionals working with adults who have parenting responsibilities is very important as we know that these types of parental problems are commonly identified in child protection cases (Cleaver et al., 2011). It should also involve all sectors of the community, most importantly including the meaningful participation of children (Article 12 of the UNCRC 1989). This collaborative effort to develop child protection guidelines or protocols will not only draw on professionals’ knowledge and experience in the field of child maltreatment but also facilitate their buy-in to the final document. This means that they in turn will support its implementation within their own organization or setting. It also enables all professionals to understand the policy intentions of these documents which support their successful implementation. Where local organizations

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and professionals work well together, such a framework provides the glue that binds these different people and groups together. Some countries have had these inter-agency processes in place for many years. For example, in England the first known inter-departmental communication from the government exhorting agencies to work together was issued in 1950. For others these may be relatively new.

Effective Inter-sectoral Collaboration Effective collaboration between agencies and professionals is essential in order to effectively prevent maltreatment and protect children from harm (World Health Organization, 2020). The support of professional organizations can also play an important role in developing these relationships as evidenced by the Department of Applied Psychology, Pondicherry University in association with Sri Balaji Vidyapeeth University, Puducherry, hosting an International Conference on Protection of Child Rights: Issues and Challenges, in Puducherry in 2013 that led to the publication of the first edition of this book. This shared professional commitment to working together across different sectors may take some time to generate. Regular meetings between and within organizations or sectors regarding common issues or projects can be a very important way of people getting to know each other and feeling sufficiently trusting to be able to discuss new approaches to working together or to debate controversial or sensitive issues, for example corporal punishment or forced marriages. Raising such topical subjects in a neutral environment can be a more productive method of considering new ways of working and responding to children who are being subjected to harmful practices than when discussing a very difficult case. The COVID-19 pandemic has disrupted the traditional face-to-face meetings and congresses with agencies and professionals being forced to quickly adapt to the new virtual world of communicating. For example, the most recent ISPCAN International Congress in Milan, Italy was held exclusively online in June 2021—the first of ISPCAN’s congresses not to be face-to-face events. This pattern was replicated around the world for both local, national and international congresses. A major advantage is that many people who would not be able to travel to an event are able to participate and it is more economical for them. However, virtual communication relies on participants having access to a computer and a good quality internet connection. It may also mean combining childcare with event participation and attending events in the middle of the night. In a recent EU project (Coordinated Response to Child Abuse and Neglect via a Minimum Data Set: from planning to practice) with which I was involved participants commented ‘face-to-face training would be preferable but due to the pandemic this was not an option’ (Gray, 2021). The same sentiment applies to meetings and congresses. At the time of writing, the world is gradually moving back to face-to-face events, albeit with additional public health measures in place.

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Multi-disciplinary, Multi-agency Training While individual professionals have a responsibility to make sure they are trained to recognize and respond to maltreatment, their employing institutions also have a role, both in ensuring their staff are trained to know what to do if they suspect abuse or neglect (single agency training) and in enabling them to take part in multi-agency, multi-disciplinary training. Working together across professionals and organizations can be very challenging especially when there are differences in values and beliefs about how best to work with cases of child abuse and neglect. It is however extremely rewarding when it goes well and the joint efforts of professionals support good outcomes for children. This collaboration can be facilitated by many different factors. Multi-disciplinary training, especially those events which involve the professionals who work together on a daily basis, not only teaches people what they need to do when they are concerned about a child’s safety and wellbeing, but it also enables them to meet colleagues and understand better what they do and how they work. It is this face-to-face contact, knowing who you are talking to and understanding each other roles and responsibilities which builds up a sense of trust between professionals and enables them to share information and work together effectively in often very stressful circumstances. Although there is a strong belief in the value of interdisciplinary training in the child protection field, surprisingly there is little available research to demonstrate whether it is indeed effective. In England, Carpenter et al. (2010) looked at the outcomes from multi-disciplinary training which had been commissioned by Local Safeguarding Children Boards.2 The researchers found that inter-agency training is highly effective in helping professionals understand their respective roles and responsibilities, the procedures of each agency and in developing a shared understanding of assessment and decision-making practices. Furthermore, the opportunity to learn together is greatly valued: participants report increased confidence in working with colleagues from other agencies and greater mutual respect.

Developing Multi-disciplinary Training Resources The development of multi-disciplinary training resources can be a very cost-effective way of supporting this training by providing those who lead it with quality materials. In England, the implementation of government policy has been supported by national training materials. Two examples are: The Developing World of the Child (2008) intended to support the development of professional knowledge about normal child development and Childhood Neglect: Improving Outcomes for Children (2012) 2

These were bodies set up by local authorities under the Children Act 2004. The purpose was to coordinate and ensure the effectiveness of member agencies in safeguarding and promoting the welfare of children. Membership consisted of senior representatives from all organizations that work with children and families, including adults.

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which focuses on identifying, responding to and intervening in child neglect cases. These materials were commissioned by the government and developed by multidisciplinary teams of professionals drawing on the most up-to-date research and knowledge from the field. The materials were piloted and reviewed prior to their completion, thereby involving an even larger group of professionals in their development and again giving greater assurance about their evidence base and relevance to practice. Child and Family Training UK have developed a large number of evidence-based resources relating to assessment, planning and intervention to prevent and address child abuse and neglect (Bentovim and Gray (eds), 2016, 2017, 2018; Bentovim & Bingley Miller, 2012; Cox et al., 2009; Pizzey et al., 2016). These were intended to support practitioners from all professional disciplines and volunteers who work with children and families. They were initially piloted in the UK and have been subsequently translated into several languages and utilized successfully in countries with different religious, linguistic, cultural and legal contexts (see https://www. childandfamilytraining.org.uk/101/Introduction). They are underpinned by knowledge of child development and based on evidence-based research. The intervention resources take a common elements approach and are informed by knowledge and practice wisdom about what are the most effective methods and tools for working with children and families whose developmental progress is being impaired (Bentovim & Elliott, 2014; Bentovim et al., 2018; Chorpita & Weisz, 2009; Chorpita et al., 2016). This means that the intervention resources can be utilized by all professional disciplines, at different levels of professional development, including those with previous backgrounds unrelated to child protection, and with volunteers, working in or with statutory agencies or NGOs (Bentovim and Gray 2016, 2017, 2018).

Data Collection and Evaluation Systems As was noted at the beginning of this chapter, we have not yet implemented adequate systems which enable us to know how many children are being maltreated (World Health Organization, 2020). We do however know that these numbers are greater than those reflected in official statistics. For example, a UK study by Radford and her colleagues (2011) found that 11 times more young people reported being maltreated than were known to statutory children’s social care services. A number of countries are developing or refining their national child protection data systems (World Health Organization, 2020). ISPCAN continues to support these developments through its child protection data collection working group in recognition of the importance of having robust systems for collecting data and just as importantly of using these data for strategic planning. Its website (www.ispcan.org) has resources to assist professionals who are developing their own data collection system. The ISPCAN Child Abuse Screening Tool (ICAST) instruments (available in a number of languages) which were updated in 2015 can be administered to populations of older children, young adults, and parents/caregivers to examine

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the occurrence and types of violence against children (https://www.ispcan.org/learn/ icast-abuse-screening-tools/?v=402f03a963). In Europe a minimum data set has been developed for collecting and then analyzing information from the point of referral of a child protection case. The Child Abuse and Neglect Minimum Data Set (CANMDS) 11 National Surveillance System, piloted in 6 European countries, was developed to provide ‘continuously comprehensive, reliable & comparable case-based information for (alleged) child victims of CAN who have used social, health, educational, judicial & public order services at national and international levels (information for action linked to public health initiatives) AND to serve as a ready-to-use tool in investigation and follow-up of child victims of CAN or those at risk of being (re-) victimized, by respecting the national legislation and applying all the rules necessary for ensuring ethical data collection and administration (case-level information linked to follow-up of individual cases)’ (Gray, 2021, p. 6). The evaluation found that the CANMDS 11 Surveillance System is fully capable of fulfilling these purposes. The system is available for use in other countries, following minor adaptations were necessary for language, culture and national legislation (See: http://can-via-mds.eu). As well as having systems for knowing how many children are being maltreated and being able to analyze these data, it is also important to be continually evaluating if the current systems and ways of working are effective. Again we know more about what professionals do than how effective their work is. This is particularly so when it comes to preventive programs which by their very nature make it challenging to measure the impact they have on improving outcomes for children. In England, an overview of a major safeguarding children research initiative (Davies & Ward, 2011) summarizes the findings from 15 individual studies commissioned by the then government to support the development of a stronger evidence base in the following three areas: • Identification and initial response to neglect; • Effective interventions after abuse or its likelihood have been identified; • Effective inter-agency and interdisciplinary working to safeguard children. Each of these areas was selected as it was considered to be significant in the statutory inquiry into the violent death of Victoria Climbie at the hand of her caregivers (Cm 5730, 2003). The findings were used to inform improvements in policy and practice. Their use provides an example of action that can be taken using a program of research to improve outcomes for children.

From Protection to Prevention Although we know that ‘programs that prevent occurrence of abuse are likely to be more effective than those that address its consequences’ (Davies & Ward, 2011), prevention programs can be low on the national priority list. There may be because, for example, there is a more pressing need to do something about the children who

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are being abused or neglected today and/or due to resourcing constraints. Nearly ten years ago, an ISPCAN survey (Dubowitz, 2012) provided evidence of prevention becoming a higher priority in some countries. At that time the evidence was clear that the ‘most effective targeted programs to prevent maltreatment and neglect are home visiting schemes and multi-component schemes’ (Davies & Ward, 2011). Programs such as the Triple P-Positive Parenting Program (Prinz et al., 2009), Nurse Family Partnership programs (Barnes et al., 2009; Olds et al., 1994, 1998 and 2002) and the Webster-Stratton Incredible Years program (Hutchings et al., 2009; WebsterStratton & Reid, 2010) had had positive evaluations. Since then, the INPIRE program (WHO, 2016) being implemented worldwide has brought together the evidence on effective interventions with a strong emphasis on prevention. One of the seven INPIRE strategies is to provide support to parents and caregivers with the objective of reducing harsh parenting practices and creating positive parent–child relationships. The INSPIRE Handbook (WHO, 2018) sets out the evidence base for the most effective strategies with a continuing focus on home visiting programs, delivering parenting skills building programs through groups and including parenting skills as part of other social or educational programs, such as life skills or economic strengthening programs. In achieving the 2030 Sustainable Development Goal to end violence against children (United Nations, 2015), key challenges remain not only in resourcing preventative work but also in commissioning those services where there is strong evidence of their effectiveness at improving outcomes for children and in training staff to use these approaches competently within their own local setting. Finally there is a need to continue to evaluate preventive approaches and programs in a wide variety of contexts to ensure they can transfer successfully across different cultures, races, languages and legal jurisdictions.

Conclusion and Recommendations When we look back over the past six decades, it is easy to wonder if anything has improved to prevent children suffering harm but there is some cause to be optimistic. Our understanding of the impact of different forms of abuse and neglect has increased dramatically and will continue to do so with the combination of advances in neuroscience and knowledge from practice with children and families. We are using this knowledge to improve services and systems to both protect children and prevent them from violence. Despite the disruption of the COVID-19 pandemic, regular international and national conferences currently held virtually in addition to face-to-face provide professionals with up-to-date information on key research and international and national policy developments, as well as support the exchange of information and ideas about new practices. Leading change is always potentially challenging. This is no less so in the field of child maltreatment where it may be difficult to get communities and politicians to

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recognize that abuse and neglect are occurring and recurring. The value of collaborative working—at all levels—is not always recognized as being cost-effective and supporting good outcomes for children. Here research findings can assist as can the testimonies of children and families who have been helped by professionals working together. Supporting agencies and staff to work together is an ongoing process, not just a one-off, and it is crucial for those controlling budgets to recognize its value, even in a difficult fiscal climate. One aspect of being cost effective is ensuring that the services provided are the most effective for the nature of problems being addressed. This may require professionals to move to different ways of working and to stop doing some of their preferred but ineffectual practices. It also requires senior managers and others to move beyond the process indicators of success traditionally used by the sector to those defined by measuring improved outcomes for the child and the protection of their rights. As Professor Margaret Lynch, a past President of ISPCAN, is keen to point out: Effective multi-agency working is ‘all about building bridges,’ i.e., ones that join up in the middle and are safe to travel across. We owe it to the children and families we are working with to work effectively with our colleagues and offer the best possible services to prevent maltreatment and to protect children from suffering harm.

References Barnes, J., Ball, M., Meadows, P., Belsky, J., & the FNP Implementation Research Team. (2009). Nurse-family partnership program, second year sites implementation in England. The infancy period. London: Department for Children Schools and Families and the Department of Health. Bennett, S., Hart, S., & Wernham, M. (2012). The UN convention on the rights of the child general comment 13: Towards enlightenment and progress for global child protecton. In H. Dubowitz (Ed.), World perspectives on child abuse. Tenth Edition (pp. 120–123). Denver: ISPCAN. Bentovim, A., Vizard, E., & Gray, J. (2018). Treatment of complex maltreatment—beyond the NICE guideline? Manuals, muddles, or modules. Journal of Child and Adolescent Mental Health, 23(3), 297–300. Bentovim, A., & Bingley Miller, L. (2012). The family assessment: Assessment of family competence, strengths and difficulties. York, UK: Child and Family Training. Bentovim, A., & Elliott, I. (2014). Targeting abusive parenting and the associated impairment of children. Journal of Clinical Child & Adolescent Psychology. http://www.tandfonline.com/loi/ hcap20 Bentovim, A. & Gray, J. (eds) (2016; 2017; 2108). Hope for children and families: building on strengths, overcoming difficulties. York: Child and Family Training. Carpenter, J., Patsios, D., Szilassy, E., & Hackett, S. (2010). Outcomes of inter-agency training to safeguard children. Research Report DCSF-RR209. London: Department for Children Schools and Families. https://dera.ioe.ac.uk/809/1/DCSF-RR209.pdf. Accessed October 8, 2021. Chorpita, B. F. L., Park, A. L., Ward, A. M., Levy, M. C., Cromley, T., Chiu, A. W., & Krull, J. L. (2016). Child STEPs in California: A cluster randomized effectiveness trial comparing modular treatment with community implemented treatment for youth with anxiety, depression, conduct problems, or traumatic stress. Consult Clin Psychol, 85(1), 13–25. https://doi.org/10.1037/ccp 0000133

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Chorpita, B. F., & Weisz, J. R. (2009). Modular approach to children with anxiety, depression, trauma and conduct match-ADTC. Satellite Beach FL: Practicewise LLC. Cleaver, H., Unell, I., & Aldgate, J. (2011). Children’s needs – parenting capacity. child abuse: Parental mental illness, learning disability, substance misuse, and domestic violence (2nd Ed.) London: The Stationery Office. https://www.education.gov.uk/publications/eOrderingDownload/ Childrens%20Needs%20Parenting%20Capacity.pdf. Accessed on October 8, 2021. Cm 5730. (2003). The victoria climbie inquiry: Report of an inquiry by Lord Laming. London: The Stationery Office. Cox, A., Pizzey, S., & Walker, S. (2009). The HOME inventory: A guide for practitioners—The UK Approach. York: Child and Family Training. Davies, C., & Ward, H. (2011). Safeguarding children across services: messages from research on identifying and responding to child maltreatment. London: Jessica Kingsley Publishers. https:// www.education.gov.uk/publications/eOrderingDownload/DFE-RR164.pdf. Accessed October 9, 2021. Department for Education. (2012). Childhood neglect: Improving outcomes for children. http:// www.education.gov.uk/childrenandyoungpeople/safeguardingchildren/childhoodneglect/b00 209825/training-resources-on-childhood-neglect. Accessed on October 9, 2021. Dubowitz, H. (Ed.). (2012). World Perspectives on Child Abuse (10th ed.). Denver. Fang, X., Fry, D., Brown, D., Mercy, J., Dunne, M., Butchart, A., et al. (2015). The burden of child maltreatment in the East Asia and Western Pacific Region. Child Abuse and Neglect, 42, 146–162. Gray, J. (2021). External evaluation report. Action “CAN-MDS 11. can-via-mds.eu. Accessed on October 10, 2021. Hillis, S., Mercy, J., Amobi, A., & Kress H. (2016). Global prevalence of past-year violence against children: a systematic review and minimum estimates. Pediatrics, 137(3): e20154079. HM Government. (2018). Working together to safeguard children. London: Department for Children Schools and Families. https://www.education.gov.uk/publications/eOrderingDownload/003052010DOM-EN.PDF. Accessed September 7, 2021. Hutchings, J., Bywater, T., Williams, M. E., Shakespeare, M. K., & Whitaker, C. (2009). Evidence for the extended school aged incredible year’s parent program with parents of high-risk 8 to 16 year olds. School of Psychology, Bangor University. Kempe, C. H. (1976). Approaches to preventing child abuse: The health visitors Concept. American Journal of Diseases of Children, 130(9), 941–947. https://doi.org/10.1001/archpedi.1976.021201 00031005 Kempe, H., & Steele, B. F. (1962). The battered child syndrome. Journal of the American Medical Association, 181, 17–24. Olds, D. L., Henderson, C. R., & Kitzman, H. (1994). Does prenatal and infancy nurse home visitation have enduring effects on qualities of parental caregiving and child health at 25 to 50 months of life? Pediatrics, 93, 89–98. Olds, D., Henderson, C. R., Cole, R. C., Eckenrode, J., Kitzman, H., Luckey, D., et al. (1998). Longterm effects of home visitation on children’s criminal and anti-social behaviour: 15-year follow up of a randomized trail. Journal of the American Medical Association, 280(14), 1238–1244. https://doi.org/10.1001/jama.280.14.1238 Olds, D. L., Robinson, J., O’Brien, R., Luckey, D. W., Pettitt, L. M., Henderson, C. R., et al. (2002). Home visiting by nurses and by paraprofessionals: A randomized controlled trial. Pediatrics, 11(3), 486–496. https://doi.org/10.1542/peds.110.3.486) Peterson, C., Florence, C., & Klevens, J. (2018). The economic burden of child maltreatment in the United States, 2015. Child Abuse and Neglect, 86, 178–183. Pinheiro, P. S. (2006). Report of the independent expert for the United Nations study on violence against children. New York, NY: United Nations (UN) General Assembly. Pizzey, S., Bentovim, A., Cox, A., Bingley Miller, L., & Tapp, S. (2016). Safeguarding children assessment and analysis framework (3rd ed.). Child and Family Training.

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Prinz, R. J., Sanders, M. R., Shapiro, C. J., Whitaker, D. J., & Lutzker, J. R. (2009). Population–based prevention of child maltreatment: The US triple P system population trial. Prevention Science, 10(1), 1–12. https://doi.org/10.1007/s11121-009-0123-3 Radford, L., Corral, S., Bradley, C., Fisher, H., Bassett, C., Howat, N., et al. (2011). Child abuse and neglect in the UK today. London: NSPCC. http://www.nspcc.org.uk/inform/research/findings/ child_abuse_neglect_research_PDF_wdf84181.pdf. Accessed November 22 2012. Stoltenborgh, M., Bakermans-Kranenburg, M. J., Alink, L. R. A., van IJzendoorn, M. H. (2012). The universality of childhood emotional abuse: A meta-analysis of worldwide prevalence. Journal of Aggression, Maltreatment and Trauma, 21(8), 870–890. United Nations. (2015). Transforming our world: The 2030 agenda for sustainable development. Author. United Nations Children’s Fund. (2014). Hidden in plain sight: A statistical analysis of violence against children. Author. United Nations Children’s Fund. (2017). A familiar face: Violence in the lives of children and adolescents. Author. United Nations Committee on the Rights of the Child. (2011). General Comment No 13: The right of the child to freedom from all forms of violence. http://www2.ohchr.org/english/bodies/crc/com ments.htm. Accessed October 10, 2021. Webster-Stratton, C., & Reid, J. (2010). Adapting the incredible years, and evidence-based parenting program, for families involved in the child welfare system. Journal of Children’s Services, 5(1), 25–42. https://doi.org/10.5042/jcs.2010.0115 WHO. (2018). INSPIRE handbook: Action for implementing the seven strategies for ending violence against children. Author. World Health Organization. (2016). INSPIRE: Seven strategies for ending violence against children. Author. World Health Organization. (2020). Global status report on preventing violence against children 2020. Author.

Chapter 31

‘I Need My Space’: Governance of Social Spaces from Child Lens Akila Radhakrishnan

Abstract NASA’s popular slogan ‘I need my space’ triggered global concerns for exploring and protecting our universe and space. In the private sphere, as in the family, it is also a phrase that is often heard among children during their transitional stage to adolescence to adulthood, as they acutely begin to recognise their individual personality and value their privacy and preferences. Taking it forward to social spaces for children, the discussion in this paper is about adequate and appropriately planned spaces for children and adolescents, particularly in areas of higher demand for land use such as in cities and towns with chaotic growth. It discusses the limitations from a child lens and gender lens, and asks for policy attention to progressive development of child-friendly spaces. It promotes the idea of listening to the views of children in matters that directly and indirectly affect them. Especially in the context of pandemic, the emotional well-being of adolescents has needed safe and open spaces for interaction and positive engagement. The paper proposes that southern states discussed in the chapter could be potential torch-bearers in exploring and modelling healthy and happy social spaces for children. Keywords Child rights · Governance · Social space Social space has several dimensions: it has a geographic nature, which can be quantified and defined; a mental connotation which reflects the cultural significance of that space; and a relational meaning derived from how individuals occupy those spaces, 1

Elaborated in children, childhood and space: Multidisciplinary approaches to identity—Romero et al., 2015. Views and opinions expressed in this paper are personal and do not necessarily reflect the views of the affiliated organisation. The paper emerged from the active encouragement of V. S. Sambandan for exploring this new theme, and it was refined by the insightful comments of Anuradha Rajivan. Grateful acknowledgement is made to them for their contributions, while limitations are due to me. A. Radhakrishnan (B) United Nations Children’s Fund, UNICEF Office for Tamil Nadu & Kerala, Chennai, Tamil Nadu 600041, India e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_31

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based on who has the power to decide its use, especially when it is a high-demand product1 . These three variables seem important to explain the way different people, inclusive of children (defined as anyone below the age of 18 years), perceive, participate and even shape their identity through the given conditioning of their relationship with that space. Extrapolated for larger groups, space therefore derives sociological significance. Age, gender, caste and class are some of the key determinants in Indian context. People view themselves as located or growing up in a stable, or hostile, or egalitarian, or disadvantaged space according to the societal perceptions of these three variables. Although one’s notion of social space may seem to be personal and influenced by one’s psychosocial factors, it can be directed by policy, planning and good governance. This is the primary proposition of this paper. The second argument is that children are a potential agency in transforming social spaces, albeit in subtle ways. They can contribute to the organisation of spaces, created primarily by adults as administrators, city planners, institutional heads or parents. When the adult decision-makers do not factor in the rights and requirements of the children who are impacted by the public policies, they undermine the optimal ways of using the shared physical, cultural and social space into positive and democratic use among all the users. Governments, civil society and citizen groups can play a positive role together in this area. Available literature on spatial planning in Western countries indicates their engagement in multi-perspective planning, development of parks, community centres and cultural platforms. In contrast, India suffers from already unplanned growth, stubborn economic situations and lack of integrated approaches in spatial planning. Worse still from child perspective, it remains as tokenism, despite the fact that 36% of urban India’s population is made up of children (2011 Census)2 . This paper will discuss a wide spectrum of opportunity, starting from the fundamental non-negotiable like hygiene and sanitation as foundation stones. It has 3 sections; the first two of them are presented in a life-cycle approach to elaborate on the three main variables of space (stated in the beginning). As the purpose is to throw thought on the need to consider all the three variables, the paper prefers to concentrate more on the physical dimension of space in the first session and expand the focus to cultural and relational space in the next session. All the three are nevertheless important considerations across all ages of the child. Finally, in arguing for better governance through participatory planning and with child lens, the third and last section discusses children’s participation in governance on matters that affect them. It is not only for realising child rights but also for improving the optimal use of space under public control. Relatively better planned cities like Delhi and Chandigarh provide visible evidence of multiple user perspectives behind the use of urban social spaces. It is possible that some states like Tamil Nadu and Kerala could be a potential torch-bearer in exploring and modelling healthy and happy social spaces for children. At present, while several states must prepare their child policy, it is 2

Further disaggregation shows that about 9% or 36 million children in urban India are under 5 years of age, 7% are in the age group of 6–9 years, and 20% are adolescents, namely 10–19 years.

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promising to include not only core interventions and results in nutrition, education, health and child protection, but also a cross-cutting new theme like social spaces for children. Even path-breaking guidance and ideas brought out on child-friendly cities or safe spaces for girls in cities by UNICEF, SAVE and other international organisations3 did not specifically talk about the adequacy and standards for social spaces for children. Some recent studies in India4 which looked into the status of children in terms of developmental indicators related to health, nutrition, education, etc., have done so in silos, leaving out the critically important and cross-cutting area, namely the spaces for children outside of the home, which influence their overall shaping as a person through her/his experiences in growing up. There are, however, some preliminary concerns raised by some of the authors who have shown interest to India’s smart cities projects from a child lens5 . However, there is a dearth of data and evidencebased analysis as none of the available secondary sources of data on children, such as the Census, NFHS, U-DISE and NAS that provide data on health, education, child protection, etc., have created indicators to inform about the spaces used by children or the quality of such spaces. Hence, this paper calls for critical data, wider engagement and age-specific policy actions suitable for children.

Section 1: Social Space for Promoting the Development of Infants and Children The process of planning for physical space is not an exclusive matter for town planners and technocrats. Several projects tend to succeed when planners have visualised the users well enough during the planning phase or have heard the views of stakeholders for those spaces. Problems persist when they do not. A thumb rule in designing public spaces is that different categories of people in the community must be able to find them useful to engage in purposeful and shared manner. They demand detailing of management, maintenance, security and overall care6 . Often, when the use of public space is contended by different parties, children are more likely than adults to give up their right to use it. This is understandable as land is a matter of political economy and its use is controlled by power relations.

3

Resources and materials, including a virtual database, are available on www.childfriendlycitie s.org. 4 UNICEF-NIUA, 2016; CRY 2018. 5 Dhar and Thakre—‘No child’s play: The enduring challenge of creating child friendly cities’; ORF Issue Paper, October 2020. 6 The social value of public spaces, Katharine Knox, 2007.

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Cleaning and Dumping in Common Lands Let us attempt to situate this with Tamil Nadu as a case example. Despite relatively acceptable standards of physical spaces for all sections of the population, thanks to its early education and reformistic planning approach, an area that needs urgent attention is the continuing prevalence of open urination and defecation. Several waste lands, beaches, city lanes and several other places can be made as great havens for children to play and enjoy good health. Within a generation of time, several open lands have become concrete jungles or dumping yards. Despite an abundance of growing evidence relating open defecation to stunting among children, diarrhoea, water pollution and breeding of diseases, the scarcely available common grounds continue to be abused, thus obstructing the space for children and casting longer-term scars in their development trajectory. Do public facilities for sanitation and hygiene exist, and how do they serve the deserving populations? Data shows7 that 11% of ruralites and 30% of urbanites in Tamil Nadu use public or community toilets8 . A large 72% of villages in Tamil Nadu as against only 13% of villages in India have a community toilet, but 14% of Tamil Nadu’s villages report non-usage. Shockingly, the reason is that these toilets are not cleaned by anybody in 21% of the villages in the state9 . Comparatively better in urban areas, where 66% of wards in Tamil Nadu as against only 42% across India have a community toilet, the local municipal body is said to engage agencies to clean the toilets in almost 88% of the cases. Still, 5% of community toilets in urban Tamil Nadu report cleaning by nobody. Fact remains that our stubborn mindsets do not care for clean public spaces. This applies to the public facilities such as women’s toilet complexes as well. Anecdotal evidence suggests that in several cases, they are unused because the unit’s location is away from the habitation, they are ill-lit at nights, and the concerned authorities do not address the critical concerns of women and girls. There are also community sanitary complexes in several public places like bus stands, railway stations and areas that have high footfalls of floating populations. There have been cases of fake community groups pocketing the revenue from pay and use facilities, without caring for the maintenance of these units. In any case, these facilities are not adequate, quantitatively or qualitatively10 . It is time to review the policy and implementation to gauge how the community values such spaces and what course corrections are needed. Closer attention to the supply and demand of 7

Swachhta status report, 72nd Round of NSSO, 2016. Suffice this to note that a number of individual household toilets are dysfunctional, forcing open defecation. Only 40% of rural households in Tamil Nadu have access to water for use in toilets, and there are other reasons such as need for suitable design options. 9 There have also been protests by caste groups labelled with the pollution from toilet cleaning jobs. 10 Several positive features, acclaimed by the Planning Commission of India, included the user trainings, user fees raised by women self-help groups, incinerators and formation of panchayat monitoring committees. Sadly, during a work trip to a Scheduled Caste colony, I noted that local norms did not allow women to use the community sanitary complex during their menstrual period, thus defeating the purpose of well-intentioned facility. 8

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public utilities and stricter vigilance to curb misuse may also help to ensure that areas around schools, playgrounds and all public spaces are kept clean and hygienic. On another count, namely the system of garbage disposal from households, comparison with neighbouring Kerala shows a startling situation. 12% of households in Tamil Nadu as against only 0.5% of them in Kerala dispose their garbage in a public space, and 16% of them in Tamil Nadu against a smaller 6% in Kerala dump garbage from households into agricultural lands. It seems that the age-old practice of burying biodegradable waste around the house and use as manure is a lost practice, indicating the plight of overcrowded residential areas and apathy for the environment. Overflowing and ill-placed garbage bins and messing up by dogs and cattle are a common sight in traffic-jammed lanes and in other dump yards over dried-up lakes and water bodies. The issue of sanitation facilities and the consequent abuse of open spaces discussed in this section is an example of a reality that affects the life opportunities for a child, directly and indirectly, across the country. There is an urgent need for reviewing our well-meaning policies to gauge the gaps and limitations, specifically from the lens of the child.

Spaces Primarily Designed for Children Anganwadi centres (AWCs), meant for the 2–5 year olds to play, learn, socialise and get school-ready, are the first public spaces in which children spend considerable time on their own away from family. The positive cultural and social meanings that the child may form about the AWC could link a million wires in her/his brain that could build cognitive, emotional and social intelligence with everlasting benefit. However, there is no guarantee that these centres allow children to positively relate to the space, the teacher, the helper or the medley of toys and books. While the government has paid attention to the nutritional aspects, they are often left with substandard facilities and inadequate personal care. There are 13.49 lakh operational anganwadi centres (AWC) in the country, and each year, about 10,000–14,000 toilets get constructed in them11 . Yet, whether functioning in own or rented buildings, AWC toilets have a lot to improve. In Tamil Nadu, the Rapid Survey on Children found that 40% of the AWCs in the state did not have toilets,12 leave alone child-friendly toilets. In schools as well, despite the progressive data regularly published on availability of toilets, it is a fact that toilets are inadequate in numbers for the students, are poorly maintained and are left unused because of lack of water or a variety of unmet repairs. It is common to find boys urinating outside the school compound walls, while girls suffer from holding until they can find a relatively more private spot. Thus, the critical window of opportunity

11 12

Press information bureau of the Ministry of Women and Child, 2016. RSOC, 2014.

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to influence children for proper toilet use in public places is lost by the poor provisioning and use of the public facility in the institutions for children. Automatically, it creates a pool of citizens who do not mind abusing the public spaces by urinating and defecating in the open. Another critical indicator for children, namely exclusive breastfeeding during the first 6 months, is at a low 57% in the state and contributes to the poor nutritional status for so many children. The literature shows that women working in the many unorganised sectors do not have a facilitating environment for breastfeeding their infants, once they have started to work soon after delivery. Earlier, the government had set up a few breastfeeding rooms in bus terminals across the state, which are rightful social spaces for infants. There is certainly longer way to expand and improve the social space provisioning for infants and children. Closely related to the discourse on social space is the right of children to social services, which demands greater attention than this paper can discuss13 . Public policy and funds to ensure the quality of service provided to children are critically needed to prioritise early childhood care and education through anganwadis and schools.

Section 2: Social Space for the Development of Children and Adolescents Availability of physical public space is one aspect, while promoting positive cultural and mental connotations about that space is more important for its better use by all people to whom it is meant. Both aspects need equally good attention to ensure that children, especially adolescents, are well connected and feel secure physically and mentally14 .

Spaces to Interact with Friends Young people need community spaces which are supposed to help explore the local and wider community, meet up with friends, get some exercise or relaxation and feel connected in the society they live in15 . This could be the metaphorical banyan trees in villages, the culverts serving as chatting corners in streets (a fast-disappeared feature), courtyards in places of worship or community centres. Are they child-friendly, and 13

Serious gaps were evidenced by RSOC, 2014. Commonly found second-generation problems among adolescents emerge from the shortfalls of the first generation, namely broken families or poor child care practices, and expose the kids to substance abuse, addictions, sexual abuse and mental diseases leading to suicidal tendencies and crimes of sorts. 15 https://eprints.qut.edu.au/76139/2/76139.pdf. It discusses children and young people’s need to experience excitement and fun in what has been termed ‘unprogrammed space’ or simply to ‘hang out’ in unstructured social space. 14

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that equally for both boys and girls? What is the nature of surveillance and control of public authorities in these spaces? What are the constricting conditions against their use by adolescents? Most of the public spaces are essentially adult places, where control and surveillance are key concerns for shared use by adolescents. Posting of police personnel, surveillance cameras and security checks which have become essential in the troubled cities and towns that we live in have usurped the freedoms of teenagers and adolescents in many ways. In the name of supervision and control, children and adolescents are watched over, regulated and restricted to use public space in parks, beaches, playgrounds, neighbourhoods, markets and streets. Sometimes, they are even viewed as a threat to social order, when there are conflicting ideas between adults and adolescents. Adults try to influence who the kids mingle with, where and how. Caste leaders and khap panchayats have slapped several harsh punishments on younger people when they saw adolescent behaviours as a threat to their age-old customs, caste, etc., and overtly or subtly controlled them through punitive, conservative and patriarchal norm sets. Recently, the use of coloured wrist bands and neck bands as caste markers among students clearly displayed the adult preferences for controlling caste-mingling. It showed how parents and the community controlled the children’s physical and mind space for defining a certain social order.

A Double Whammy for Girls Negative stereotyping makes certain spaces as sites of selective inclusion and exclusion, and especially curtails the movement of girls more than boys16 . Predictably, the social constructs around gender burden girls’ access to public spaces. They have limited choices of public spaces for both essential and leisure time activities. The ways in which girls are socialised by their parents and the conditioning norm sets which constrict their relationship with the limited public space affect their mobility in physical as well as psychosocial terms. Many girls develop fear of moving out of their homes, lose self-confidence and mentally shut themselves away from exploring new opportunities, be it in education or livelihood opportunities. These have become highly significant especially in the new normal created by the pandemic when schools have remained closed, and public spaces are controlled for mobility. Girls are also suppressed by cultural and home-based control from discussing matters of their private concern, be it mundane or serious, among their peers and friends even within the same sex. In a number of cases of sexual abuse of children, girls mention that they did not disclose it to anyone because they did not feel encouraged to talk or seek help in the school or neighbourhood. Girls are also married off too early, and more stringent norms of mobility are slapped on them. Many are shunned away from productive employment and increase the poor workforce 16

Citizenship, community, public space and the marginalisation of children and young people; Dee, 2013.

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participation rates, even among educated girls and women. Data suggests that India loses $56 billion a year in potential earnings because of adolescent pregnancy, high secondary school dropout rates and joblessness among young women17 . An ICRW document18 succinctly summarised that safe spaces are more than the creation of physical structures; they are strategies through which girls have access to collective learning and sharing platforms and avenues, and where they feel comfortable enough to articulate their voices. There is thus an urgent need to recognise and build effective strategies to create safe social spaces for girls, community platforms and flexible support programmes with incentives to participate.

Rights Violations Everywhere No public environment is free from violation of child rights. Children are frequently abused at homes, on their way to school, in public transportations, at religious institutions, orphanages and in care homes. They are named and shamed by their caste affiliations, girls are harassed in street corners, and, being children, they are dumbfounded by the use of unjust power and authority in different forms. They are also ill-protected from the adverse influence of market forces which lure them to tobacco, drugs and alcohol. There are little public controls over the selling of such products even in close proximity to schools. Uncontrolled exchange of pornography and other illegal material through mobile phones lead them to several forms of cyber-crimes. The need for extra-caring teachers and counsellors, and local support mechanisms from civil society are most timely at present. Children must relate themselves positively in the school environment so that they can learn without fear and develop their full potential in art, sport and multiple dimensions. Domestic violence and cyber abuse are also highly critical areas, but need greater discussion outside of the present paper. Rights-based solutions for better planning and promoting of social spaces conducive for children and adolescents include decentralisation of powers and functions for the local self-governments to act as duty-bearers for children. Panchayats must be trained and empowered to monitor and promote safe institutions and clean public spaces for children and adolescents. In this regard, the positive attempts at child-friendly local governance by the panchayats in Kerala could attract policy attention19 . Equally, the contribution of civil society must be encouraged, and public–private partnerships must be explored.

17

India’s next generation of growth, India Economic Summit, New Delhi, November 2009, World Economic Forum; http://www.weforum.org/pdf/India/India09_report.pdf. 18 Addressing comprehensive needs of adolescent girls in India: A potential for creating livelihoods, ICRW, 2013. 19 Child friendly local governance: Operational Manual and Guidance Note; Raj, Akila, Kalidasan and Antony (ed), KILA and UNICEF, 2016.

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Section 3: Children as Agencies for Transforming Their Social Spaces Everywhere, a basic challenge for children and adolescents is that they are counted as mere users of public space and not potential agency in transforming this space. Use of social space is a citizenship right for all. The way they are socialised could explain the link between the adult world and their world, and help to propose ways of promoting positive behaviours for change, where needed. Do children and adolescents have scope to share their views and preferences on what they would like to learn, how they would like to play and what policy and programme changes do they imagine to improve their daily lives? How participatory are our classrooms and school-based clubs? Are there community or neighbourhood networks for children? Taking stock of these things may help to promote the capacity and creativity of children to participate in the social spaces relevant for them. States like Karnataka and Kerala have introduced special grama sabhas for children, to listen to their views for better governance. Matters that often come to this forum are around improvements in the footpaths leading to school, removal of waste dumps on the streets, solid and liquid waste management, closing of gutters, maintenance of playgrounds and support for clubs and libraries, to name just a few. Overall, promoting child participation can throw several ideas for better investment of public funds for children. While it is necessary to listen to their voices and address their concerns, it would also be important to train children not just as questioners and petitioners, but as active contributors to creative solutions and as the change-makers themselves. At present, rarely are children and young people actively and respectfully brought into planning and governance processes. It is time to explore this so that children have a rightful ownership and connect with the public spaces that matter to them. It could in fact be a good citizenship training for them. Besides, the active inclusion of children and young people better informs the implementation of public policy about the design and governance of public space. This is a promising way forward towards healthier and more inclusive social space for all.

Conclusion In sum, the perusal of the available literature in this barely explored but highly promising theme has shown that while the Western literature discusses the promotion of social spaces in the form of parks and gardens for multiple users at different staggered periods of time, community centres and cultural platforms, we are still grappling with making our public spaces at least open defecation free, clean and hygienic. Given the limited space in fast changing cities, we could turn to global

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examples that can show several creative and intelligent use of land20 and help us correct the past and present abuses of common areas. The available guidelines for building smart and child-friendly cities and institutions can be revisited for promoting child participation in governance21 . The local community must be energised to serve as planners and monitors to ensure best use of social spaces for children. On that exciting journey, the following suggestions may come handy: • In managing the exponential urbanisation, including promoting ‘smart cities’, governments and corporations/municipalities can draw upon and customise available guidelines to ensure child-friendly urban areas, infrastructure and institutions. Standards and customised guidelines can be decided in consultation with civil society and citizen groups, including children—both boys and girls. • Departments of Social Welfare and School Education can set up well-thoughtout minimum standards for child-friendly anganwadis and schools for children and adolescents, and regularly monitor and report on them. Social audits can be conducted by people and children. • School Education and Social Welfare Departments can take the lead, drawing from suitable NGOs, in designing and motivating child participation in all matters that concern them. Examples are (i) citizenship education in schools and residential institutions to encourage children to participate in social action, to develop social responsibility and to promote social cohesion and (ii) developing and strengthening the capacity of professionals and administrators to listen to children’s voices. • These same departments, school managements and teachers can work with parents, using platforms like the parent–teacher associations, to strengthen the articulation and prioritisation of child perspectives in social spaces. • States can review their social protection schemes for students and young people to review the child sensitivity and uptake. An example of a scheme that has promoted the freedom and mobility of young girls in Tamil Nadu is the free distribution of bicycles to students. While the positive breakthrough in approach and implementation is commendable, a review may show the need to increase the actual use of cycles by all students and to make the paths between home and schools safer for girls. • Local bodies can plan and ensure clean and hygienic public spaces and also identify the existing and potential social spaces for children in the available public places (like parks, roads, sidewalks, walkways, cultural/activity centres, etc.) through integrating genuine child friendliness, wherever relevant. They can 20

While planning the metro rail in Reso, Canada, the plan included 30 kms of underground shopping for its 500,000 population that allowed warm walk through hundreds of tunnels and shopping galleries during winters; in Manhattan, the former overhead railroad was not pulled down when better alternative routes were made, but changed into a landscape walking park concept. Discussed in Governance of public spaces: Presentation of 8 case studies; https://www.thecityfactory.com/fab rique-de-la-cite/data.nsf/AE50D9A5860ED183C1257B82003970F5/file/fiches_etude_eng.pdf. 21 The child friendly city governance checklist: An instrument to trigger reflection and dialogue on governance of child rights – Inter-agency Toolkit developed by Innocenti Research Centre, UNICEF. This is further customized in the Kerala context as quoted in earlier Reference 16.

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promote inclusiveness in design and implementation in all matters of social space. Good practices must be documented and disseminated. • Governments can support creative planning and promote bottom-up or at least bottom-linked approaches, coordinating across key departments and parastatals to minimise policy gaps and inconsistencies. • The pending preparation and updating of state child policy in several states can incorporate the promotion of child-friendly social space as a cross-cutting theme in all sectors like health, nutrition, education and child protection, considering the overall well-being of children and adolescents.

Chapter 32

Psychogenic Non-epileptic Seizures in Children: Prevention and Intervention Strategies K. Jayasankara Reddy, Sneha Vinay Haritsa , and Aeiman Rafiq

Introduction Psychogenic non-epileptic seizures (PNES) are observable, abrupt paroxysmal disturbances in behavior or consciousness resembling epileptic seizures, in the absence of correlating electrophysiological brain disturbances or clinical confirmation for epilepsy (Szabó et al., 2012). Unlike the other paroxysmal non-epileptic disturbances, PNES are explained based on their underlying psychological origins (Patel et al., 2021). Other alternative terms that have been used in the existing literature include pseudoseizures, pseudoepileptic seizures, hysterical epilepsy, functional seizures, and non-physical seizures, however, the term “PNES” is favored because it points toward the psychological or psychogenic etiology (Operto et al., 2019). The common presentation of PNES is in the form of violent thrashing, episodes of unconsciousness, non-epileptic auras, myoclonic movements, and complex movements (Kozlowska et al., 2017). Owing to its underlying psychological origins, it becomes imperative to explore the underlying psychological factors for PNES. However, researchers have identified that PNES is a result of biological, psychological, psychiatric and social factors rather than psychological factors alone (Ruber, 2009). Moreover, PNES has been identified as a biopsychosocial disorder which re-emphasis on the role of biological and social factors along with psychological factors in developing PNES (Kanemoto et al., 2017). In the pediatric population, although the risk factors have been classified as predisposing, precipitating and perpetuating factors, there is limited literature available. K. Jayasankara Reddy (B) · S. Vinay Haritsa · A. Rafiq Department of Psychology, CHRIST (Deemed to be University), Bengaluru, India e-mail: [email protected] S. Vinay Haritsa e-mail: [email protected] A. Rafiq e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 S. Deb (ed.), Child Safety, Welfare and Well-being, https://doi.org/10.1007/978-981-16-9820-0_32

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The following chapter explores pediatric PNES using an integrated biopsychosocial model. Most of the existing literature on PNES revolves around the adult population, and therefore literature on the pediatric population with PNES is limited (Patel et al., 2021). Owing to the presence of few population-based data of PNES, it becomes difficult to state the prevalence rate accurately in the pediatric population (Operto et al., 2019). But one study pointed out that the overall prevalence rate of PNES is 2–33/100,000 based on the estimate that approximately 10–20% of patients visiting epilepsy centers may be suffering from PNES (Patel et al., 2011). Additionally, a recent population study suggests that the incidence rates of diagnosis of PNES in the pediatric population have increased in the last two decades (Hansen et al., 2020). While the prevalence of adult PNES is predominant in the female population, however in the pediatric PNES the female predominance has been inconclusive. In the pediatric population, the clinical presentation of PNES often includes violent thrashing of a part of the whole body, slurred or loss of speech, altered state of consciousness, gaps in memory or loss of memory, change in temperature, dizziness, tingling, and fatigue. These clinical manifestations of PNES tend to vary from one episode to another unlike seizures (Wong-Kisiel & Hilliker, 2013). Other documented important markers for PNES in the given population include negative emotional reactions such as screaming, weeping, and moaning (Operto et al., 2019). Often a diagnosis of the PNES in the pediatric population is made based on these infrequent and non-uniform clinical manifestations, client’s clinical history, and lack of organic basis evidenced by medical investigations. It may be challenging to make accurate diagnoses based only on the symptom manifestation and therefore detailed medical investigations are often required. A video electroencephalogram (VEEG) is considered a gold standard to distinguish PNES from epileptic seizures (WongKisiel & Hilliker, 2013). It is important to point out that a definitive clinical diagnosis of PNES can only be made when the patient meets the “rule of 2s” (Patel et al., 2021). But despite these diagnostic guidelines, the research suggests that there is often a delay in diagnosis of PNES which may range from several weeks and can go up to 3.5 years on average. The diagnostic delay can be attributed to several factors including misdiagnosis as epilepsy, non-acceptance of psychogenic etiological rather than an organic one by caretakers and patients, non-available of VEEG and lack of other resources to formulate a correct diagnosis (Doss & Plioplys, 2017). Additionally, there is a difference in the clinical presentation, etiologies, associated features as well as the treatment outcomes of PNES in the pediatric and adult population which can further lead to the diagnostic delay (Operto et al., 2019). The repercussions of the misdiagnosis of epilepsy are serious for the pediatric population (Reilly et al., 2013). Children who get misdiagnosed with epilepsy have to undergo unwanted clinical tests, invasive procedures and medical interventions such as intubation (Doss & Plioplys, 2017; Wichaidit et al., 2014) This leads to disturbances in academic and social domains due to missed school days, unchanged and frequent episodes of PNES and other side effects caused due to anti-epileptic drugs (AEDs) usually prescribed for epilepsy (Doss & Plioplys, 2017). Along with the patient, there is a significant financial and emotional burden on the caretakers as well

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as the healthcare system (Wichaidit et al., 2014). On the contrary, researchers have pointed out that early diagnosis followed by proper interventions and management is essential to prevent PNES based behavioral patterns to integrate into the child’s personality fully (Operto et al., 2019). PNES in the pediatric population is further complicated by the prevalence of psychiatric and medical comorbidities such as depression and anxiety (Plioplys et al., 2014). If the presence of PNES is suspected, then there is a need for a complete evaluation by a certified mental health professional for both the diagnosis and appropriate treatment and management. In the pediatric population, the occurrence of frequent PNES is often correlated by the presence of psychosocial stressors such as family conflicts, academic stress, bereavements, interpersonal conflicts and physical or sexual abuse or trauma (Rawat et al., 2015; Wichaidit et al., 2014). While, surprisingly in the pediatric population, the prognosis of PNES seems to be better than the adult population PNES, however, the treatment outcomes are not uniform due to differences in social, psychological, cultural factors as well as the diagnostic guidelines (Rawat et al., 2015). In the pediatric population with PNES, the existing interventional strategies are quite limited owing to the multifaceted nature of PNES, frequent misdiagnosis or late diagnosis (Durrant et al., 2011; Operto et al., 2019; Patel et al., 2021). CognitiveBehavioral Therapy (CBT) and Retraining and Control Therapy (ReACT) are two forms of psycho-therapeutic interventions that have proved to be effective in treating pediatric PNES (Fobian et al., 2020; McFarlane et al., 2019). However, these interventional strategies are backed by limited studies as there is dearth of literature focusing on interventions for children with PNES. Moreover, there are huge gaps in the existing literature regarding the prevention strategies that can be employed to prevent the development of pediatric PNES. The aim of the existing chapter is to provide a holistic view of PNES with special emphasis on intervention and prevention strategies and convey about the existing gaps in the literature.

Clinical Picture (Semiology) In the pediatric population, the clinical manifestation of PNES varies from that of the adult population (Operto et al., 2019). The identification of specific psychopathological patterns and cognitive, behavioral and emotional symptoms, therefore, becomes crucial for formulating a diagnosis and differentiating non-epileptic and epileptic seizures (LaFrance et al., 2012). Owing to these reasons, it is important to highlight the semiological signs and symptoms of PNES in the pediatric population to develop a holistic understanding of the phenomenon. Although there is significant literature on the semiological classification of clinical manifestation of pediatric PNES, however, recent studies have found these classifications to be either difficult to follow or deficient. A recent study has established the semiological classification of PNES in the pediatric population using five categories.

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These include abnormal behavior, motor and sensory symptoms, unresponsiveness and visceral symptoms (Zhang et al., 2021).

Motor Symptoms Motor symptoms are symptoms that are categorized by abnormal movements or dysfunction of the motor muscles primarily the trunk, limbs and face (Zhang et al., 2021). One of the widely identified motor symptoms of PNES in the pediatric population is tremors (Operto et al., 2019; Szabó et al., 2012; Zhang et al., 2021). The tremors are considered universal ictal motor symptoms in PNES. Other observed motor symptoms that distinguish PNES from epileptic seizures include motor symptoms or tremors that are more asymmetrical and asynchronous in nature. Often these motor symptoms are classified into minor and major vigor phases (Operto et al., 2019). Additionally, earlier studies considered that pelvic thrusting was more common in adult PNES (Szabó et al., 2012). However, more recent studies have found that pelvic thrusting is a common motor symptom in the pediatric population as well (Zhang et al., 2021). Few other reported motor signs of PNES in the children include arched back, shaking and rolling (Zhang et al., 2021). Moreover, researchers have also identified that motor activity is more subtle in children (