James A. Mercy PhD Division of Violence Prevention National Center for Injury Prevention and Control Centers for Disease Control and Prevention

1. James A. Mercy, PhD
Division of Violence Prevention
National Center for Injury Prevention and Control
Centers for Disease Control and Prevention
MOBILIZING GLOBAL ACTION TO END VIOLENCE AGAINST
CHILDREN:
LESSONS FROM AROUND THE WORLD

2. IMAGINE IF…

3. Violence Across the Lifespan
EARLY
CHILDHOOD ADOLESCENCE ADULTHOOD
Bullying Youth Violence
Child Maltreatment:
physical, sexual, emotional, neglect
Dating Violence
Sexual Violence
Intimate Partner Violence
Elder
Maltreatment

4. Violence Against Children is Common in the U. S.,
NatSCEV, 2008
Finkelhor, D., Turner, H., Ormrod, R., Hamby, S., and Kracke, K. 2009. Children’s
Exposure to Violence: A Comprehensive National Survey. Washington, DC: U.S.
DOJ, OJP, OJJDP, CDC.

5. HIV/AIDS
Chronic Lung
Disease
Fractures
Pregnancy
Complications
Cancer
Burns
Unintended
and Adolescent
Pregnancy
Fetal
Death
Internal
Injury
Diabetes
Heart
Disease
HIV
STDs
Violence
Against
Children
Alcohol
And Drugs
Unsafe
Sexual
Practices
Violence Against Children Is Costly and
Destructive
Maternal and
Child Health
Injury Non-Communicable
Disease
Communicable Disease
and Risk Behaviors
Stroke
Alcohol
Smoking
Obesity
Physical
Inactivity
Multiple
Partners
Head
Injury
Mental Health
Problems
Suicide
Depression
and Anxiety
PTSD
Assault

6. Paths From Violence to HIV and Back
Again
Direct transmission
Compromised negotiation
Reduced self efficacy
Forcing children out of homes
HIV Risk Behaviors
Risk for violence post-
diagnosis
Social isolation & vulnerability
Stigma
Stress
Violence
Against
Children
HIV
Infection

7. Violence Damages Body Via
Impact on the Brain
Violence
Against
Children/
Youth
Mental and
Physical Health
and Cognitive
Development
Infancy Adulthood
Risk
Behaviors
And
Conditions
Premature Aging
Toxic
Stress

8. Violence Against
Children Surveys
(VACS)
Photo by Nadia Todres

9. Together for Girls: A Global Partnership
Generate data to guide action
Support governments in evidence-based prevention and response
Mobilize action through communication strategies
 Centers for Disease Control and Prevention
 United Nations Children’s Fund
 President’s Emergency Plan for AIDS Relief
 The Joint United Nations Programme on HIV/AIDS
 World Health Organization
 United Nations Development Fund for Women
 United Nations Population Fund
 Becton, Dickinson and Company
 CDC Foundation
 Nduna Foundation
 Grupo ABC

10. VACS Addresses Key Issues
 MEASURES violence and its’
IMPACT on children’s lives
with a strong gender lens
 Uses data to foster
POLITICAL ENGAGEMENT
AND PROGRAMMING to
prevent and respond to
violence against children
Photo by Nadia Todres

11. Completed, Planned, and Potential
Violence Against Children Surveys (VACS)
Swaziland
Cote D’Ivoire
MozambiqueMalawi
Indonesia
Cambodia
Kenya
Tanzania
Zimbabwe
Haiti Nigeria
Zambia
Uganda
Rwanda
Botswana
Laos PDR
? Thailand
? Malaysia
? Vietnam
? Guatemala
? Colombia
? Mexico
? Papua
New Guinea
? Nepal
? India
? Philippines
? China

12. VACS Methods
 National household survey
 Three-stage cluster sample
survey design
 Randomly select one eligible
female or male aged 13-24
years in each household
 Swaziland – girls only; All subsequent surveys both girls
and boys
 Surveys carried out by in-country institutions
 Extensive efforts to protect child respondents

13. Violence
is
Common
in the Lives
of Children
Photo by Nadia Todres
LESSON #1

14. + Please do not share these data because data for some of these countries have not been officially released.
* Only girls interviewed in Swaziland
Prevalence of Sexual Violence Prior to Age 18 Reported by
Females and Males 18-24 Years of Age
in Seven VACS Country Sites+
38
33 32
27 26
22
4
9
18
12
21
15
6
0
5
10
15
20
25
30
35
40
45
50
Swaziland* Zimbabwe Kenya Tanzania Haiti Malawi Cambodia
Females
Males
Seven Country Comparison

15. Prevalence of Physical Violence Prior to Age 18 Reported by
Females and Males 18-24 Years of Age by Parents, Adult
Caregivers, and Authority Figures in Six VACS Country Sites+
66 64
61
55 53
42
73
76
57
53 54 54
0
10
20
30
40
50
60
70
80
90
100
Kenya Zimbabwe Haiti Tanzania Cambodia Malawi
Females
Males
Six Country Comparison
+ Please do not share these data because data for some of these countries have not been officially released.

16. Prevalence of 12-month Sexual
Violence for Females by Age Group,
Tanzania, 2009
0
5
10
15
20
25
13-14 15-16 17-18 19-20 21-22 23-24
Prevalence(%)
Age Group

17. Some Categories of
Children are
Especially Vulnerable
to Violence
LESSON #2
Photo by Nadia Todres

18. * Statistically significant, p<0.05
19%
13%
5% 6%
26% 26%
8%
6%
0%
10%
20%
30%
40%
Unwanted
Sexual Touching
Attempted Sex Pressured Sex Forced Sex
Prevalence(%)
Type of Sexual Violence
Female Non-Restavèk
Female Restavèk
*
*
Prevalence of Childhood Sexual Violence in
Female Restavèks Compared to Non-Restavèks
*

19. * Statistically significant, p<0.05
33%
* 55%
0%
10%
20%
30%
40%
50%
60%
70%
Household Authority Figure EV
Prevalence(%)
Type of Emotional Violence (EV))
Female Non-Restavèk
Female Restavèk *
Prevalence of Childhood Emotional Violence in
Female Restavèks Compared to Non-Restavèks,
Haiti, 2012+
+ Please do not share these data because data for this country has not
been officially released.

20. * Statistically significant, p<0.05
26%
*50%
0%
10%
20%
30%
40%
50%
60%
70%
Household Authority Figure EV
Prevalence(%)
Type of Emotional Violence (EV)
Male Non-Restavèk
Male Restavèk
*
Prevalence of Childhood Emotional Violence in
Male Restavèks Compared to Non-Restavèks,
Haiti, 2012+
+ Please do not share these data because data for this country has not
been officially released.

21. Prevalence of Sexual Violence Prior to Age 18
Reported by Females and Males 13-24
by Camp Status, Haiti, 2012+
34.7
24.3
21.6
19.6
0
5
10
15
20
25
30
35
40
45
50
Females Males
Camp
Non-Camp
Any Sexual Violence Post Quake in Haiti
+ Please do not share these data because data for this country has not
been officially released.

22. Children Know Their
Perpetrators
LESSON #3

23. Top Three Types of Perpetrators of Childhood Sexual
Violence Reported by Females 13 to 24 Years of Age,
Swaziland – 2007 and Tanzania, 2009
Swaziland
Primary perpetrators:
 Male neighbors- 32.3%
 Boyfriends - 26.2%
 Relatives - 14.0%
(excludes parents)
Age Difference:
 60% 5 or more years
older
Tanzania
Primary perpetrators:
 Male neighbors- 32.2%
 Strangers - 32.0%
 Boyfriends - 24.7%
Age Difference:
 40% 10 or more years
older

24. 23.9
28.9
33.4
47.3
77.7
0
10
20
30
40
50
60
70
80
90
Cambodia Haiti Malawi Kenya Zimbabwe
Sources: UNICEF. CDC, and KNBS. Violence Against Children in Kenya: Findings from a National Survey, 2010. Nairobi:
UNICEF- Kenya Country Office; 2012; ZIMSTAT, UNICEF, and CCORE. National Baseline Survey on Life Experiences of
Adolescents, 2011. Harare: ZIMSTAT. 2013.
+ Please do not share these data because data for some of these countries have not been officially released.
Percentage of Females in Five VACS Sites Reporting
First Sexual Violence Incident Prior to Age 18 was
Perpetrated by a Boyfriend/Partner+
Percentage(%)

25. Violence Impacts the
Health
of Our Children
Photo by Nadia Todres
LESSON #4

26. Association Between Childhood Sexual Violence
and Selected Health Conditions, Females 13 to 24
Years of Age, Swaziland, 2007
3.7
3.5
3.0 2.9
2.3 2.3
2.0 1.8 1.2
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Adjustedoddsratio*
*Adjusted for age, community setting, SES, and orphan status
Source: Reza A, et al. Sexual violence and its health consequences for female
children in Swaziland: a cluster survey study. Lancet 2009;373(9679):1966-72 .
SES, Socioeconomic status
STDs, Sexually transmitted diseases

27. None or Infrequent Condom Use in the Previous 12 Months by
Experiences of Childhood Sexual Violence - As Reported by
19-24 Year Olds Who Ever Had Sex, Tanzania 2009
46.1
56.9
24.4 30.2
0
10
20
30
40
50
60
70
80
90
100
Percentage(%)
Experienced Childhood Sexual Violence Did not Experience Childhood Sexual Violence
MaleFemale
Source: United Republic of Tanzania, UNICEF, CDC, Muhimbili University.
(2011). Violence Against Children In Tanzania: Findings from a National Survey
2009.

28. Percentage of Males 18-24 Years of Age Who Reported Sexually
Transmitted Disease or Transactional Sex by Experience of Sexual
Violence as a Child: Kenya, Haiti and Cambodia
13.5%
3.8%
6.7%
0.9%
0.0%
4.0%
8.0%
12.0%
16.0%
20.0%
Penile discharge or sore Transactional sex
Experienced Sexual Violence Never Experienced Sexual Violence
Adjusted OR = 1.9
P-value < 0.01
Adjusted OR = 3.8
P-value < 0.01

29. Percentage of Females 18-24 Who Reported a Pregnancy
Resulting from Forced and/or Coerced Sex Prior to Age 18
in Four VACS Country Sites+
24.5
30.3
16.0
34.3
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
Haiti
Tanzania
Kenya
Zimbabwe
+ Please do not share these data because data for some of these countries have not
been officially released.

30. Our Children Aren’t
Getting the Help
They Need
LESSON #5
Photo by Nadia Todres

31. Received
services for
sexual violence
Sought services
for sexual
violence
Told someone about
sexual violence
Girls Boys
0.4% - 6.6%2.7% - 10.0%
4.3% - 38.9% 2.1% - 5.9%
38.3% - 61.2% 20.6% - 64.7%
Source: Violence Against Children Surveys in Tanzania
Disclosure and Service Usage by 18-24 year old Victims of
Sexual Violence Prior to Age 18, VACS

32. Please do not share these data because data for some of these countries have not been officially released.
Percentage of 13-17 Year Old Girls and Boys Tested for HIV
Among Those Who Experienced Sexual Violence
in the Past 12 Months+
37.5
44.6
23.8
9.2
39.2
5
0
5
10
15
20
25
30
35
40
45
50
Zimbabwe Kenya Haiti
Females
Males
Percentage

33. Impact of the
VACS Data
Photo by Nadia Todres

34. VACS Catalyzes Action
Advocacy
tool
Breaks the
silence
Creates a
new
conversation
Guides
action
Multi-
Sector
Task
Force
USG
In-Country
Multi-Lateral
And Bi-lateral
Agencies
Civil Society &
NGOs
Universities
UNICEF
In-Country
Other
Government
Ministries
Government
Ministry Lead

35. HEALTH
• Child abuse
screening
• Access to
services,
including
comprehensive
post-rape care
JUSTICE &
POLICE
• Child- and
women-
friendly
policies and
laws
• Police
stations and
courts
• Legal aid
SOCIAL
SERVICES
• Child
helplines
• Child
protection
centers
• Increase
social welfare
officers
COMMUNITY
• Parenting
support
• Safe
spaces
• Helping
children
manage
risks
•Social norm
change
EDUCATION
• Teacher
codes of
conduct
• Early
childhood
education
• End
corporal
punishment
•Keep girls
in school
Multi-sector Interventions

36. IndividualRelationshipCommunitySocietal
Examples
• National education campaign
• Weekly children’s radio program
Examples
• Every police station has trained officers
• First shelter established for survivors
• First counselling center established
• First child-friendly court established
Examples
• Sexual Offenses Bill
• Child Welfare Bill
• Gender, children’s and
education policies
strengthened
Scope of Policy and Programs Influenced by the
Violence Against Children Survey in Swaziland

37. 1) Mauritius
2) Namibia
3) Tunisia
4) Libya
5) Morocco
6) Kenya
7) South Africa
8) Malawi
9) Algeria
10) Cape Verde
11) Rwanda
12) Burkina Faso
13) Madagascar
14) Botswana
15) Senegal
16) Seychelles
17) Egypt
18) Mali
African Child-Friendliness Index
Rankings in 2013 and 2008
Source: The African Child Policy Forum (ACPF)
2008 Ranking
1) Mauritius
2) South Africa
3) Tunisia
4) Egypt
5) Cape Verde
6) Rwanda
7) Lesotho
8) Algeria
9) Swaziland
10) Morocco
11) Seychelles
12) Libya
13) Togo
14) Malawi
15) Senegal
16) Botswana
17) Nigeria
18) Ghana
19) Burkina Faso
20) Gambia
2013 Ranking
…
45) Swaziland

38. Tanzanian Multi-Sector Task Force:
A National Response to Violence Against Children
 Comprehensive child protection
response
 Education
 Social Welfare
 Legal and Justice
 Public Health
 Community
 State and Civil Society Partnerships
 Local Government Service Delivery
 Public Awareness Campaign

39. Zimbabwe Protocol on Management
of Sexual Abuse and Violence

40. • T raining in parenting for caretakers
• H ousehold economic strengthening
• R educe violence by legislative protection
• I mprove services for victims of violence
• V alue norms that protect children
• E ducate and build life skills
• S urveys to monitor trends and progress
Key Actions Needed to Prevent and Respond
to Violence Against Children - THRIVES

41. The Strategic Importance of Preventing
Violence Against Children
 Big Human Rights, Public Health,
and Social Problem
 Influences many different health and
social outcomes
 Economic costs are substantial
 Viable Prevention Programs and
Policies Exist
 Scientifically Grounded
 Politically Feasible

42. “One of the most powerful ways
to change the world
is to make it better for kids.”
Jack P. Shonkoff
National Scientific Council for the Developing Child

43. For more information
Visit CDC’s National Center for
Injury Prevention and Control web site:
www.cdc.gov/ncipc

44. The findings and conclusions of this presentation
have not been formally disseminated by the
Centers for Disease Control and Prevention
and should not be construed to represent
any agency determination or policy.
Disclaimer