A descriptive study of sexually abused children in China

Background: Chinese children are vulnerable to sexual victimization but little is known about the prevalence or characteristics of Chinese children who have experienced sexual abuse. Objective: To assess prevalence and characteristics of child sexual abuse in China Method: We have collected and systematically analysed the records of children evaluated for sexual abuse from 2007 to 2010. Statistical analysis of our data was accomplished with SPSS 13.0 software. Results: From 2007-2010, 1998 cases of alleged sexual abuse were investigated in children between 0-18 years of age. Females accounted for 95.2% of victims. When cases reported in 2008 and 2009 were compared with previous years, there was a significant increase (p<0.05). Children aged between 12 to 15 years were more vulnerable to be hurt (p<0.05). During 2010, most of the children were abused by acquaintances and there is a significant difference from 2009 in that strangers were more risky to children (p<0.05). In the recent two years (2009 and 2010), the Internet also shows its power and there is no difference between Internet and newspaper. Conclusion: Child sexual abuse is a serious societal problem in China. (


Introduction
In July 2009, China had a population of 1.38 billion people with over 300 million children under the age ___________________________________________ 1 Children's Hospital, Shaanxi Provincial People's Hospital, 2 Department of Psychology, Shaanxi Provincial People's Hospital, 3 Medical School, Xi,an Jiaotong University, 4 Department of Medicine, Beijing University, Xi'an 710068 , China (Received on 16 April 2014: Accepted after revision on 30 May 2014) of 16 representing 1/5 of the world's children 1 .Kempe in his landmark paper defined sexual abuse as the involvement of dependent, developmentally immature children and adolescents in sexual activities that they do not fully comprehend, to which they are unable to give informed consent 2 .The spectrum of sexual activities includes oral-genital, genital-genital, genital-rectal, hand-genital, hand-rectal, hand-breast contact, exposure of sexual anatomy, forced viewing of sexual anatomy and showing pornography to a child or using a child in the production of pornography 3 .
Sexual abuse is not a phenomenon of the 21st century but something that has been present since time immemorial.The increase in child sexual abuse reports is due to increasing awareness and a willingness to report 4 .Numerous studies have demonstrated the long term medical and mental health costs and consequences of sexual abuse of children 5 .Our study comes from the Child Abuse Prevention and Treatment Centre in Xian, the only child abuse aid centre in China where all abused children can receive free treatment and help.

Objective
To assess the prevalence and characteristics of child sexual abuse in China

Method
Cases included in the study were collected from the internet and from newspapers.The information was collected by 4 persons who focused on obtaining this information daily.The four persons are workers of the Aid Centre of Child Abuse Prevention and Treatment Centre in Xian, China and have all undergone professional training on how to collect this information.Two of these workers surf the main internet daily and find out the cases of child abuse reported on the internet.The other 2 workers also use the internet but focus on reports of child abuse which appear in the newspapers all over China.We have no good way to ensure that there is no overlap.
In this study we only focused on the sexually abused children under 18 years old.When confronted with a case, we took down the exact information.The source of information, time, place, information regarding the victim (gender, age, degree) and information regarding the abuser (gender, age, job, the relationship with the victim) were determined.Data was analysed with SPSS 13.0 software, using p<0.05 as the criterion for statistical significance.

Results
From 2007-2010, 1998 cases of alleged sexual abuse were investigated in children between 0-18 years of age.Of this 1902 (95.2%) were female and 96 (4.8%) were male (p<0.05).The numbers of sexual abuse cases reported during the different years are shown in Figure 1.

Figure 1: The year and number of the sexual abuse cases
In each of the 4 years there is a significant difference between male and female sexual abuse cases (p <0.05).When 2009 and 2010 are compared with previous years, there is a significant rise in the number of reported victims (p<0.05).
The ages and numbers of sexual abuse cases in the 4 years are shown in Figure 2. Children aged between 12 to 15 years are more vulnerable to child sexual abuse (p<0.05).
The trend of the ages of the victims is shown in Figure 3.The identity of the perpetrator is shown in Table 1.The source of information is shown in Table 2. ), the Internet also shows its power and there is no difference between the two media.

Discussion
Children living in poverty have increased reports of sexual abuse because of: (1) Increased number of crises in their lives (e.g.unemployment, overcrowding) (2) Limited access to economic or social resources for support during times of stress (3) Increased violence in the communities where they live (4) An association of poverty with other risk factors, such as teenage and single parenthood and substance abuse (5) The possibility of more scrutiny by community agencies and neighbours 6 .
Studies show that cases of sexual abuse are more in girls than boys.This may be because parents hide the cases in boys or boys feel awkward to tell 7 .In our study 95.2% of sexual abused children were girls.
Although the majority of victims in our study are girls there is the possibility that male victimization is grossly under reported as males in general are more reluctant to report sexual abuse than females.In our study the majority of children were in the age group of 12-15 years.One reason for this may be that most of the victims between 12 to 18 years old are 'left behind children' and have poor protection.One reason why cases of sexual abuse in children aged between 15 to 18 years was lower than in children aged between 12 to 15 years may be because children older than 15 years can protect themselves better.On the other hand, these children may have had the same incidence as children aged from 12 to 15, but the older children did not speak out due to shame.
Some sexual abuse against children occurs in families where there is divorce and separation, where parents are adversarial, where alcohol, drugs and mental illness are contributory.In these circumstances the children have many complex problems that can affect their emotional development such as communication barriers, jealousy, self-abasement, pessimism, abuse problem and so on 8 .From 10-40% of abusive parents have experienced physical abuse as children 6,9 .The occasion precipitating the abuse may be associated with a family crisis, such as loss of a job or home, marital strife, death of a sibling, physical exhaustion or development of an acute or chronic physical or mental illness in the parent or child 6 .Approximately 3% children with sexual abuse present with a sexually transmitted disease due to human papilloma virus, herpes simplex virus, gonococcus, chlamydia trachomatis, Treponema pallidum and/or HIV.A small percentage of adolescent girls become pregnant 10 .
One study showed that childhood abuse may leave its mark on DNA in ways that have effects on stress responses several decades later 11 .Others report that experiencing stress early on in life can have long-lasting physiological and behavioural consequences 12 .Those consequences can include eating disorders, PTSD, depression, substance abuse and cutting behaviours 13 .Research shows that the consequences of sexual abuse can impact on social skills, educational achievement, running away from home, anxiety, depression and suicide in the short term 8,14 .In the long term, it may be seen as the conflicts of one's gender, heterosexuality and other problems 15,16 .
We need to launch a national campaign of widespread education in the whole society to raise public awareness of all aspects of child abuse and neglect.With increased public awareness we will have an opportunity to develop a better understanding of the scope of child abuse in all its forms in China and begin taking the steps for a systematic response.This research contributes to our understanding of the scope of child sexual abuse in China and now provides an opportunity to build a response that is multidisciplinary and includes professionals as well as governmental entities to address this societal scourge.Over time a body of social, legal, judicial as well as medical and mental health research to inform policies can be developed to reduce the scope of this problem, assure appropriate protection and treatment so child victims can mature into healthy and contributing members of society 17,18 .

Figure 2 :Figure 3 :
Figure 2: The ages and numbers of sexual abuse cases in the 4 years