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A Psychosocial Understanding of Child Sexual Abuse Disclosure Among Female Children in South Africa (2016)
A Psychosocial Understanding of Child Sexual Abuse Disclosure Among Female Children in South Africa (2016)
To cite this article: Shanaaz Mathews, Natasha Hendricks & Naeemah Abrahams (2016) A
Psychosocial Understanding of Child Sexual Abuse Disclosure Among Female Children in South
Africa, Journal of Child Sexual Abuse, 25:6, 636-654, DOI: 10.1080/10538712.2016.1199078
Introduction
Child sexual abuse (CSA) is considered to be endemic in South Africa. The
2014–2015 South African crime statistics report 22,781 sexual offenses
against children under the age of 18 years, which are estimated to be 44%
of reported sexual offenses (South African Police Service, 2014). But estab-
lishing the true magnitude of CSA is difficult due to underreporting and
underrecording, which are influenced by the developmental stage and psy-
chological responses of the child and by access to support and effective
services (Battiss, 2005; Jewkes & Abrahams, 2002; Jewkes, Penn-Kekana, &
Rose-Junius, 2005; Maniglio, 2009). A community-based prevalence study
among participants aged 18–26 years in the Eastern Cape Province of South
Africa found 38% of women and 17% of men reported experiences of sexual
abuse before the age of 18 (Jewkes, Dunkle, Nduna, Jama, & Puren, 2010).
Methods
The data for this study was taken from a broader study that explored the
psychosocial adjustment of the child and their caregiver post-CSA (Mathews,
Abrahams, Jewkes, Martin & Lombard, 2013). Data was collected during
three separate in-depth interviews with each child and their caregiver. The
focus of the main study was to develop an understanding of mental health
adjustment of children post–sexual assault through the use of psychological
screening tools and semistructured interviews with caregivers and children.
The broader study also explored the use of support services and to what
extent they were meeting the needs of CSA survivors. For this article, only
data on disclosure of CSA from the three sets of in-depth interviews with the
children and their caregivers were analyzed.
abuse, while “telling” is more often used when adults share their abuse
experiences (Alaggia, 2004). Within the current study, disclosure will be
defined as the act of a child telling someone about the sexual abuse regardless
of whether that person is an authoritative figure.
Study design
The choice of qualitative research methodology is crucial in allowing the
researcher to focus on participants’ experiences and the meaning(s) they
ascribe to them while also allowing for a variety of data collection methods.
Studies with children who have been exposed to trauma in South Africa have
shown that qualitative methods, such as semistructured interviews, are a
viable approach for engaging children, thereby determining their levels of
psychological distress (Cluver, Gardner, & Operario, 2007; Seedat, Nyamai,
Njenga, Vythilingum, & Stein, 2004).
Study sample
A purposive sample of female children who experienced penetrative sexual
abuse and presented to either of two sexual assault centers located in the
Cape Town metropole, with their caregivers, were recruited into the study.
Thirty-one participants aged between 8 and 17 years and their caregivers
were recruited. Interviews with both the children and caregivers were used in
the analysis for this paper.
Data collection
Interviews were conducted by trained research assistants in three languages,
namely: English, isiXhosa, and Afrikaans. All interviews were recorded,
transcribed, and translated into English by the research assistants. The dura-
tion of interviews was between 30 and 45 minutes. All participants were
compensated by a voucher to cover transport and time costs. Interviews were
only conducted with adult participants who signed consent forms and, in the
case of minors, only with children whose main caregivers signed consent,
while children over 10 years also provided assent. Structured interviews were
conducted with the children using activity-based worksheets to allow for
discussion on issues such as the sexual assault experience, how the abuse
was disclosed, how they are coping since the event as described in an earlier
study (Mathews, Abrahams, Jewkes, Martin, & Lombard, 2013). Data were
collected through a range of participatory methods, such as drawing, story-
telling, and play. Worksheets were adapted from standardized screening tools
to measure depression, anxiety, and post-traumatic stress disorder, described
in an earlier study (Mathews et al., 2013).
JOURNAL OF CHILD SEXUAL ABUSE 641
Data analysis
Thematic analyses of interviews were conducted. Transcripts were analyzed
inductively, which is a standard analytic technique characterized by a process
of iteratively coding and subcoding and interpreting the findings (Silverman,
2001). Initial codes broadly correspond to questions as grouped in the scope
of inquiry. Broad coding had been established, thematic categories were
refined, with subcategories being formed and relationships between these
elucidated.
Ethical considerations
Ethics approval for this study was granted by the University of Cape Town’s
Faculty of Health Sciences Research Ethics Committee. For the main study,
ethical approval was also granted by the South African Medical Research
Council’s Ethics Committee. Children were recruited into the study if they
were accompanied by a caregiver at the sexual assault center. Fieldworkers and
interviewers were well trained in working with children in a sensitive manner
to avoid retraumatizing the child and caregiver. A list of trauma counseling
services was given to all participants. Where children showed signs of distress
and trauma, they were immediately referred for crisis intervention at specia-
lized centers working with abused children and their families. Participation
was voluntary, and participants had the right to withdraw from the study at
any time. In cases in which the child’s safety was compromised, ethical
obligations led the researchers to refer the child to a social worker for
immediate intervention to ensure protection. Confidentiality was strictly main-
tained and all participants were referred for counseling to a service provider
for children and their families.
Results
Participant sociodemographics
The mean age of children was 13.5 years, with 80% of the sample 12 years
and older. Nine primary caregivers were mothers (29%), one was a father
(3.2%), 15 children lived with both parents (48.3%), and six were in the care
of other relatives (19.3%). Perpetrators mainly consisted of known persons
(75%) including acquaintances, family members, and friends. Half (n = 16) of
the children disclosed the abuse to relatives, friends, neighbors, teachers, and
the police rather than a caregiver. Disclosure by the children to caregivers
was seldom voluntary or purposeful; they were forced to disclose through
threats of punishment when parents noticed physical symptoms or changes
in behavior as well as when children were abducted and disappeared, which
alerted parents that something had happened. Children who disclosed within
642 S. MATHEWS ET AL.
24 hours were often sexually abused by a stranger, while those who disclosed
after a few weeks or months were more often abused by a known person, in
particular a family member. Three out of the 5 children who disclosed after a
few months were sexually abused by a family member. Four main themes
emerged and are discussed in the following discussion.
This child returned home the following day, although she did not disclose
immediately, the mother knew something was wrong and placed pressure on
her with threats of a beating to elicit disclosure.
Sexual abuse has devastating psychological, emotional, and physical effects
on the child (Maniglio, 2009; Mathews et al., 2013). The process of disclosure
is complex and ambiguous as caregivers note changes in behavior or other
physical signs that are causing concern. For some caregivers this led them to
create a safe and enabling environment for the child to disclose what was
troubling them. A father explained that although he was quick to reprimand
and shout at his daughter for staying out late, he knew something was wrong:
My reaction was shouting at her because she had left and had me worried and now
she was crying because she thought I was mad at her and that would get her off. I
said to her, “Get out of my room; I do not want to hear anything.” But as I was
sitting there in my room I felt disturbed and I thought that I should go and talk to
her. I saw that she was bruised and I asked her what had happened and she told me
that she was raped.
Some caregivers had a feeling that their child was “not right,” “sick,” or
that “something was wrong.” Children would display different symptoms,
JOURNAL OF CHILD SEXUAL ABUSE 643
in that light. I, I should have, I told myself I should have never gone away
because, I, I, don’t usually leave them alone.”
All caregivers were concerned about the safety of their children and
their families following the rape as most perpetrators were not arrested,
lived in close proximity, and in some cases, threatened to harm the
child. Post-CSA disclosure, most caregivers became extremely overpro-
tective of the movements of their children. Many children were not used
to having boundaries set by their caregivers, and older children were
particularly overwhelmed by the rules implemented by their caregivers
after the sexual abuse. Children did not understand or welcome the
sudden change in parenting style and that often led to tension within
the parent–child relationship because they felt confused and punished.
When they disobeyed these rules, they would be viewed as disrespectful,
defiant, and completely uncontrollable by their caregivers. These despe-
rate attempts to protect the child also led to insinuations of blame. A
mother of a 13-year-old girl reported:
I don’t want her to be outside at night; I want her to be near me all the time
which is what she doesn’t want to do . . . she will come back saying she had just
accompanied so and so. And I said to her, “When this happened to you, you
were accompanying someone but still” . . . and her father said she must no
longer accompany people; she must stay in the house but still she is not doing
that.
Discussion
Findings from this study provide valuable and important insight into the
complexities of CSA disclosure. Our study found that nearly half of the
children failed to disclose their abuse to their caregivers immediately because
they feared their reactions. Nevertheless, they purposefully disclosed to a
trusted adult whom they considered a confidant and able to act as mediator
to inform their caregiver and provide them with the required support. We
found a larger number of children made a purposeful disclosure compared to
another South African study that reported 30% of respondents purposefully
648 S. MATHEWS ET AL.
presented to a sexual assault center and reported their abuse to the police,
therefore care should be taken as these data are not generalizable to broader
populations who did not necessarily follow this path. However, a strength of
this article is the direct engagement with child participants to obtain their
point of view and take into account their experiences to develop a better
understanding of disclosure. In addition, the study participants were only
female children, and we are therefore unable to generalize the findings to all
children in South Africa. Nevertheless, this article provides important
insights with respect to the process of disclosure among girls and is reflective
of the paucity of data on male children who experience CSA in non-Western
settings.
CSA disclosure is a complex process influenced by many factors such as
where and how the incident occurred, the child’s response to the abuse, caregiver
anticipated reactions and actual reactions, threats by perpetrators, dysfunctional
family environments, and social ideologies, all which have detrimental impacts
on the child and caregiver (Reitsema & Grietens, 2015). This study found most
children purposively disclosed the sexual assault to a trusted individual whom
they relied on to assist with disclosure to caregivers. This process of disclosure is
embedded in the parent–child relationship as most children in the study feared
“telling” parents, and parents’ responses often supported their fears. The process
of disclosure highlighted by our study suggests an urgent need to educate
parents, caregivers, and communities on how to respond appropriately to
disclosure and the role of support services post disclosure. It is important that
community members, including teachers, are equipped and educated to support
children when disclosure occurs. Building the capacity of children to understand
what constitutes sexual abuse and the importance of “telling” should be high-
lighted in the life orientation curriculum at all public schools. Community-wide
campaigns to increase both awareness and knowledge can assist communities to
deal more effectively with disclosure. Of importance is the need to strengthen
the caregiver–child relationship. Harsh parenting practices act as a deterrent to
disclosure to caregivers, and enhancing parenting skills by upscaling parenting
programs not just limited to the early years are critical if we aim to shift parent–
child relationships in South Africa. Finally, preventing stigmatization by shifting
social norms and developing an understanding of the dynamics of CSA should
be prioritized to facilitate disclosure and the development of an appropriate
therapeutic response to facilitate healing and recovery for all children.
Funding
This study was funded by the UK Department for International Development (DFID) as part
of a research project to support the development of the national curriculum on sexual assault
for health care providers in South Africa.
JOURNAL OF CHILD SEXUAL ABUSE 651
Notes on contributors
Shanaaz Mathews, MHP, PhD, is an associate professor in the Faculty of Health Sciences
and the director of the Children’s Institute at the University of Cape Town. Her main
research interests include gender-based violence against women and children, intimate
femicide, fatal child abuse, the shaping of violent masculinities and multidisciplinary
approaches to strengthen child protection. She received her MPH at the University of Cape
Town and her PhD at the University of the Witwatersrand.
Natasha Hendricks, MA, MPH, is a researcher with Gender and Health Research Unit at the
South African Medical Research Council. Her research interest is youth violence and child
maltreatment using qualitative approaches.
Naeemah Abrahams, MPH, PhD, is a professor in the Faculty of Nursing at the University of
Cape Town and senior specialist scientist in the Gender and Health Research Unit at the South
African Medical Research Council. Her main areas of research include research in gender-based
violence including risk factor studies of men who use violence against women, femicide, health
sector responses to gender-based violence, stigma in sexual assault reporting, adherence to
postexposure prophylaxis after sexual assault, and violence within school settings.
ORCID
Shanaaz Mathews http://orcid.org/0000-0002-4743-3829
Natasha Hendricks http://orcid.org/0000-0001-6174-8985
Naeemah Abrahams http://orcid.org/0000-0002-6138-6256
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