The Voices of Maltreated Children at Child Helplines
A cross-regional comparison of calls to child helplines
Masterscriptie Forensische Orthopedagogiek Graduate School of Child Development and Education Universiteit van Amsterdam Eefje Vonk, 11011661 Begeleider: dhr. prof. dr. R. G. Fukkink Tweede beoordelaar: dhr. dr. M. J. Noom Amsterdam, oktober 2018
Contents Abstract ………. 3 Introduction ………... 4 Method ……….………. 8 Sample ………...…… 8 Measures ……… 8 Data analyses ………...………. 10 Results ………. 11 Regional analyses ………... 11 Longitudinal analyses ……….…. 13 Discussion ……….……….…. 16
Strengths and limitations ………. 19
Recommendations ……….... 20
Conclusion …...……….…. 20
Abstract
Children all over the world reach out to child helplines to talk about child maltreatment. The aim in conducting this study was to investigate if there are global variations in calls related to child maltreatment in all its forms (physical abuse, sexual abuse, emotional abuse and neglect) to child helplines and whether trends can be observed during the period 2002-2011. Using a mixed model, we found significant differences in the reason for calling between children from Asia, Africa, Europe, North America, the Pacific, South America, and the region Middle East and North Africa (MENA). Children from Africa and the Pacific called the most frequently about physical abuse and sexual abuse, whereas children from Europe and North America called the most frequently about emotional abuse and neglect. Children from Asia and MENA called the least frequently about child maltreatment in all its forms. The longitudinal analyses showed a relatively stable pattern during the studied period [2002-2011] for physical abuse, emotional abuse and neglect. However, an increasing trend was observed for sexual abuse at the child helplines in Africa, Europe and the Pacific.
Introduction
Child maltreatment is one of the most common reasons youth contact a child helpline (Child Helpline International, 2012; 2017; Fukkink, Bruns, & Ligtvoet, 2016), causing thousands of children and young people to approach the global network of Child Helpline International (CHI) for counsel. One in six contacts made to the helplines is related to child maltreatment (Child Helpline International, 2013). This trend is observed in all regions of the world, irrespective of the economic and social development levels present in the region (Child Helpline International, 2012). Child maltreatment is a widespread and pervasive problem, which transcends economic, cultural and social borders, and affects children of all ages and in all regions of the world.
The child helplines affiliated with the CHI offer help to youth in an easily accessible and confidential conversation (Child Helpline International, 2017). Often, child helplines are a young person’s first contact with a child protection service, as they are a trusted and easily accessible gateway for young people to find help. The child helplines offer counselling services to the youth and can guide them through the child protection system. These counselling services are proven to be helpful to the child (Fukkink & Hermanns, 2009; Haner & Pepler, 2017). After the conversation, youth report a higher sense of well-being, a reduced sense of severity of their problems and a lower level of distress.
Child maltreatment covers all acts of commission and omission by parents or caregivers that result in harm, or potential harm, to a child under the age of 18 (Myers et al., 2002). In accordance with this definition and the administration of CHI, the following types of child maltreatment are distinguished; (1) physical abuse, (2) sexual abuse, (3) emotional abuse and (4) neglect. This study investigates if there are global differences between the calls related to child maltreatment of children made from different parts of the world and whether trends can be observed in the period 2002-2011.
Child maltreatment results when various risk and protective factors interact (Belsky, 1993; Bronfenbrenner, 1979). These factors appear at multiple interacting levels: child level, familial level and societal level. The influence of these factors varies with each situation and is to be considered together in context with other risk and protective factors. High influence risk factors for child maltreatment are parents with psychopathology, stress, depression or a history of child maltreatment as children themselves (Assink, van der Put, Kuiper, Mulder, & Stams, 2016; Mulder, 2018). Living in a society that tolerates violence, has high levels of poverty, gender inequality, unemployment, and lacks prohibition of physical abuse by law, also increases the possibility of child maltreatment (Berger, ten Berge, & Geurts, 2004; Jonson-Reid, Drake, & Kohl, 2009; WHO, 2006).
Child maltreatment can have devastating short- and long-term consequences for the well-being of a child (Jud, Fegert, & Finkelhor, 2016; Tran, Alink, van Berkel, & van IJzendoorn, 2017). Child maltreatment is associated with adverse psychological, somatic and social consequences, such as: depression, PTSS, ADHD, substance abuse and suicidal behaviour (Gilbert et al., 2009; Norman et al., 2012; Scott, Smith, & Ellis, 2010). These consequences can persist into adulthood and result in delinquent behaviour and intergenerational transmission of maltreatment (Berlin, Appleyard, & Dodge, 2011; Mersky & Reynolds, 2007). Furthermore, maltreated adults have, on average, lower educational levels, lower employment rates and lower incomes in consequence of the child maltreatment in the past (Currie & Wisdom, 2010; De Jong, Alink, Bijleveld, Finkenauer, & Hendriks, 2015).
Little is known regarding the prevalence of child maltreatment and the global variations in the specific types, especially in low-resource countries (Stoltenborgh, Bakermans-Kranenburg, Alink, & van IJzendoorn, 2015). In a series of meta-analyses, Stoltenborgh et al. (2011; 2012; 2013a; 2013b) attempted to provide estimates of the global prevalence of the multiple types of child maltreatment and the global variations. Studies were included if they measured child maltreatment either with a retrospective self-report design or by the reports of
informants, such as professionals in health care. Stoltenborgh et al. (2015) found a significant gap between the prevalence rates from informant studies and self-report studies. This is in line with previous studies, showing that professionals recognize and officially record only a small fraction of the self-reports (e.g. Gilbert et al., 2009). The global prevalence rates from informant studies were 0.3% for physical abuse, 0.4% for sexual abuse and 0.3% for emotional abuse. The prevalence of neglect could not be calculated due to the lack of informant studies. The global prevalence from self-report studies was strikingly higher, with 22.6% for physical abuse, 36.3% for emotional abuse and 16.3% for neglect. There was a significant difference by sex for sexual abuse, with an estimated 18% for girls and 7.6% for boys.
Cultural-geographical factors do not seem to affect the prevalence of physical abuse, emotional abuse and neglect (Stoltenborgh et al., 2015). However, for sexual abuse there were some significant differences between the continents (Stoltenborgh, van IJzendoorn, Euser, & Bakermans-Kranenburg, 2011). The highest combined prevalence was found in the Pacific for girls and in Africa for boys, whereas the lowest combined prevalence was found in Asia for both genders. With respect to the level of economic development of the sample’s country of origin, significant differences were found for boys. The prevalence of sexual abuse was higher in low-resource countries than in high-resource countries.
There is a lack of knowledge about whether and how the prevalence of child maltreatment changes over time. Until now, research has been focused on individual and predominantly developed countries (Finkelhor, Saito, & Jones, 2018; Finkelhor, Shattuck, Turner, & Hamby, 2014; Radford et al., 2012). Both in the United States and the United Kingdom a declining trend can be observed (Finkelhor et al., 2018; Radford et al., 2012). More specifically, in the United States from 1992 to 2016 sexual abuse declined by 65%, physical abuse by 53% and neglect by 12% (Finkelhor et al., 2018). Furthermore, emotional abuse declined by 26% from 2003 to 2011 (Finkelhor et al., 2014). Similar data from the United
Kingdom showed a major decline for both physical abuse and sexual abuse between 1998 and 2009 (Radford et al., 2012).
Present Study
To date, there is limited knowledge regarding the prevalence of child maltreatment and the global variations of the specific types. Research is mainly from developed regions, often for a limited period (e.g. Finkelhor, Saito, & Jones, 2018). Studies that compare the prevalence rates between countries are often meta-analyses with limited validity due to methodological limitations such as different measurements, study procedures, or different definitions for child maltreatment (Tran et al., 2017). To address these issues, we analyse an international database from CHI, with more than 4 million registered calls related to child maltreatment in all its forms. With the CHI data we can compare the different regions of the world (Asia, Africa, Europe, Middle East and Northern Africa, South America and the Pacific). Due to factors such as defective telecom infrastructure, poverty and little awareness of the existence of child helplines, the data is limited and not equal to the actual prevalence of child maltreatment (Child Helpline International, 2012; Lave & Katz, 2016). Even though the CHI data has its restrictions, it still provides valuable insight into the hidden concerns and problems of children worldwide and thereby contributes to present knowledge about child maltreatment.
The following questions are central in this study:
1. Are there international differences in calls to the child helplines about child maltreatment?
2. Is there, internationally or for specific regions, a longitudinal trend effect in calls to Child Helplines about child maltreatment?
Hypotheses
Even though the prevalence studies indicate that cultural-geographical factors do not seem to affect the prevalence of physical abuse, emotional abuse and neglect, we assume there are differences internationally in the number of calls related to the specific types of child
maltreatment (H1). Due to difficult living conditions in the developing countries, and the resulting presence of risk factors, we hypothesize that there is a negative correlation between HDI and CHI calls related to child maltreatment (H2). Furthermore, we expect to observe a negative relationship between prohibition of physical abuse by law and CHI calls related to physical abuse (H3).
Method
Sample
The data from the present study was collected by the CHI in collaboration with their affiliated helplines. In total 111 child helplines were included in the dataset. These helplines were located all over the world: Africa (n = 18 helplines; total number of calls: 593,225), Asia (n = 20 helplines; total number of calls: 593,335), Europe (n = 40 helplines; total number of calls: 1,825,630), North America (n = 2 helplines; total number of calls: 112,796), South America (n = 19 helplines; total number of calls: 685,133), the Pacific (n = 3 helplines; total number of calls: 125,329) and the Middle East and Northern Africa (MENA; n = 9 helplines; total number of calls: 242,303). The dataset contained all registered calls between 2002-2011. The dataset did not contain every year of every child helpline.
Measures
Child maltreatment covers all acts of commission and omission by parents or caregivers that result in harm or potential harm, to a child under the age of 18 (Myers et al., 2002). In accordance with this definition and the administration of CHI, the following types of child maltreatment were distinguished; (1) physical abuse, (2) sexual abuse, (3) emotional abuse and (4) neglect.
Physical abuse. Physical abuse is defined as those acts of commission by a parent or
caregiver that result in actual or potential physical harm to a child (Compier-de Block et al., 2016; WHO, 2006). It includes hitting, beating, kicking, shaking, biting, strangling, scalding, burning, poisoning and suffocating.
Sexual abuse. Sexual abuse is the involvement of children in any sexual activity that
they do not fully understand, are unable to give informed consent to, for which they are not developmentally prepared or that violates the laws or the standard of the society (Stoltenborgh, Bakermans-Kranenburg, Alink, & van IJzendoorn, 2015; WHO, 2006).
Emotional abuse. Emotional abuse is defined as a chronic pattern of behaviours such
as threatening, restricting movement, belittling, blaming, frightening, discriminating against, denigrating, humiliating and ridiculing a child (Compier-de Block et al., 2016; WHO, 2006). Also, the failure of a parent or caregiver to provide a developmentally appropriate, supportive environment that allows a child to create a stable and full range of emotional and social competencies, according to the child’s personal potential and in the context of the society in which the child grows up.
Neglect. Neglect includes physical and emotional neglect (Compier-de Block et al.,
2016; WHO, 2006). Physical neglect refers to the chronic failure of a parent to provide a child with the necessities such as nutrition, clothing, shelter, personal hygiene, medical care, educational opportunity, protection and supervision. Emotional neglect is characterised by the consistent failure to provide a child with appropriate support, attention and affection. Allowing children to be witnesses of domestic violence is also a form of emotional neglect (Stoltenborgh, Bakermans-Kranenburg, & van IJzendoorn, 2013).
Human Development Index (HDI). The HDI is a composed index of average
achievement in human development and is based on three dimensions: (1) public health, (2) the access to knowledge and (3) a decent standard of living (http://www.hdr.undp.org/). The index is available for most of the countries of the dataset, except Antigua, Aruba, Curacao, Macedonia, Netherlands Antilles, Sint Maarten and Taiwan. These countries were therefore excluded from the analyses and questions regarding the differences between developing and developed countries.
Prohibition of physical abuse. Currently, 53 countries have specific laws prohibiting
physical abuse in all settings, including the home (see States which have prohibited all physical abuse: http://www.endcorporalpunishment.org/). We used this data for an additional analysis, distinguishing between countries with and without the prohibition of physical abuse by law.
Data analyses
The dataset obtained from CHI was entered in SPSS 24. The data from countries with several helplines was subsequently merged at country level. Standardised proportions were created for each type by dividing the number of calls by the number of children living in the country. These proportions were labelled as ‘Prevalence proportions’, since they gave an indication of the scope of the problem among the population. Furthermore, we created standardised proportions by dividing the number of calls by the total number of calls made to the individual child helplines. These proportions were labelled as ‘Popularity proportions’, since they gave an indication of the popularity of the topic within the child helpline. Box plots were used for data screening and identifying outliers. Outliers were removed from the data.
In order to address the assumption of normally distributed data, a logit transformation was applied to the standardised proportions for each type of child maltreatment by dividing the standardised proportions by (1 – standardised proportions). The correlation between the standardised proportions and the original data was calculated to verify if the proportions were a good representation of the original population. The correlations between the prevalence proportions and the original data were moderate. However, the correlation between the original data and the popularity proportions was very low. Indicating that these proportions were not an adequate reflection of the original population. Therefore, the prevalence proportions were used for inferential statistics. For descriptive statistics, the raw frequencies were used for ease of interpretation. Annual rates of physical abuse, sexual abuse, emotional abuse and neglect have been multiplied by 1000 respectively in Figures 1, 2, 3 and 4.
A mixed model was used to analyse the longitudinal data over time and between regions. We used the restricted maximum likelihood model with random and fixed intercepts and slopes, under the assumption of an unstructured covariance structure. Models were fitted for each type of child maltreatment. We calculated Spearman’s rank-order correlation between the CHI measures and the HDI measures to explore how the types of child maltreatment related to developing or developed countries. Finally, a mixed model was used to examine if the presence of prohibition of physical abuse by law affected the number of calls related to physical abuse.
Results
During the period from 2002-2011, physical abuse was the most common topic discussed by children and youth who contacted a child helpline about child maltreatment. On an average day, about 294 children worldwide called the child helplines to talk about physical abuse. The child helplines also received a large number of calls from children who wanted to talk about neglect. Every day approximately 235 children called about this topic. Sexual abuse was discussed 172 times on an average day. Emotional abuse seemed to be the least popular topic of child maltreatment at the child helplines, but still about 171 children called to talk about this topic during an average day.
Regional analyses
To examine hypothesis 1, the variations between the regions were analysed (see Table 1). There were clear differences between the regions in the way children reached out to the child helplines to talk about child maltreatment. More specifically, children living in the Pacific and Africa discussed physical abuse more often than children living in the other regions, including Asia (p < .05). Children living in Asia contacted their child helplines the least frequently about physical abuse, compared to their peers from all other regions, including Africa, Europe and the Pacific (p < .05).
Children in the Pacific reached out the most frequently to their child helplines to discuss the topic of sexual abuse when compared with the other regions. The difference was only
significant for Asia and MENA (p = .015 and p = .029). European and African children discussed sexual abuse more often than their peers from Asia, Mena, North America and South America, including Asia and MENA, (p < .05).
Emotional abuse seemed to be a more recurring topic among children in the developed regions of the world. More specially, emotional abuse was discussed the most frequently by children from North America, including Asia (p = .048). Furthermore, children from Europe and the Pacific discussed this topic more frequently in comparison with children from Africa, Asia, MENA and South America. For Europe, the differences with Asia and MENA were significant (p = .001 and p = .015).
Neglect was discussed the most frequently with child helplines by children from developed regions of the world. The topic was most prominent for the Pacific child helplines, however these differences were insignificant. Furthermore, European and North American youth reached out more frequently to talk about neglect in comparison with their peers from Asia, Africa and MENA. These differences were also insignificant.
Table 1
Reason for calling: Test of differences between global regions
df F p Region
differences
Physical abuse 6, 88 6.52 .000** PA/AF > AS
Sexual abuse 6, 87 5.97 .000** PA > AS/MENA
Emotional abuse 6, 87 5.26 .000** NA > AS
EU > AF/AS
Neglect 6, 78 3.01 .011* EU > AS
Prohibition of physical abuse 1, 393 1.24 .267
Note. Degrees of freedom are rounded for denominator df. EU, Europe; NA, North America; SA, South America; PA,
Pacific; MENA, Middle East & Northern Arica; AF, Africa, AS, Asia. * p < .05. ** p < .01.
Additional correlation analyses were conducted to examine hypothesis 2. The analyses showed a small positive correlation between HDI and physical abuse (rs = 0.16, p < .001),
sexual abuse (rs = 0.24, p < .001) and emotional abuse (rs = 0.16, p < .001), indicating that these
expectations and therefore hypothesis 2 has been rejected. There was no significant correlation between neglect and HDI, indicating there were no differences between developing and developed countries in the number of calls related to neglect. Finally, our results showed no differences between countries with or without prohibition of physical abuse by law and the number of calls related to this topic (p = .267), and thereby refuting hypothesis 3 (see Table 1).
Longitudinal analyses
The results of the longitudinal analyses are displayed in Table 2 and Figures 1, 2, 3 and 4. The data did not reveal general statistically significant linear trends for the four types of child maltreatment (see Table 2). Further, there were barely any significant interaction effects of time for the different regions. This indicates that there was a relatively stable pattern over the years in the way children reached out to child helplines with concerns related to child maltreatment. However, the results of the present study showed an increasing trend in calls related to sexual abuse from children in Africa, Europe and the Pacific (see Figure 2). This suggests that over the years, more children from these regions reached out to their child helplines to talk about sexual abuse.
Table 2
Estimates for the different reasons for calling at child helplines
Parameter Physical Abuse Estimate (SE) Sexual Abuse Estimate (SE) Emotional Abuse Estimate (SE) Neglect Estimate (SE) Fixed effects
Intercept -0.925** (0.028) -0.939** (0.014) -0.927** (0.015) -0.926** (0.015) Time (linear trend)
Year 1 (2003) -0.006 (0.028) -0.004 (0.003) -0.007* (0.003) -0.005 (0.004) Year 2 -0.011 (0.012) -0.008 (0.010) -0.023* (0.011) -0.021 (0.014) Year 3 -0.010 (0.012) -0.019 (0.010) -0.012 (0.007) -0.018 (0.014) Year 4 -0.012 (0.009) -0.011 (0.007) -0.009 (0.008) -0.011 (0.011) Year 5 0.009 (0.009) 0.003 (0.010) -0.007 (0.011) -0.003 (0.014) Year 6 -0.005 (0.006) 0.003 (0.005) -0.002 (0.006) 0.000 (0.007) Year 7 -0.003 (0.006) -0.003 (0.005) -0.002 (0.005) -0.001 (0.007) Year 8 -0.000 (0.005) -0.001 (0.004) -0.000 (0.005) -0.002 (0.006) Year 9 (2011 - baseline) - - - - EU 0.011 (0.007) 0.014* (0.007) 0.014 (0.007) 0.011 (0.008) NA 0.000 (0.015) 0.008 (0.014) 0.011 (0.014) 0.005 (0.015) SA -0.000 (0.009) 0.002 (0.008) 0.007 (0.009) -0.000 (0.009) PA 0.013 (0.012) 0.030** (0.012) 0.012 (0.012) 0.004 (0.015) AS -0.013 (0.008) -0.006 (0.007) -0.010 (0.008) -0.008 (0.008) AF 0.015 (0.010) 0.025** (0.009) 0.015 (0.010) 0.007 (0.009) MENA (baseline) - - - - Random effects Residual 0.000** (0.000) 0.000** (0.000) 0.000** (0.000) 0.000** (0.000) Intercept variance 0.000** (0.000) 0.000** (0.000) 0.000** (0.000) 0.000** (0.000)
Note. EU, Europe; NA, North America; SA, South America; PA, the Pacific; MENA, Middle East & Northern Arica; AF, Africa, AS, Asia.
Figure 1 Figure 2
Regional trend of calls related to physical abuse from 2002-2011 Regional trend of calls related to sexual abuse from 2002-2011
Note. Actual scores have been multiplied by 1000. Note. Actual scores have been multiplied by 1000.
* p < .05. ** p < .01.
Figure 3 Figure 4
Regional trend of calls related to emotional abuse from 2002-2011 Regional trend of calls related to neglect from 2002-2011
Note. Actual scores have been multiplied by 1000. Note. Actual scores have been multiplied by 1000
0 5 10 15 20 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 M ea n s Years
Europe North America South America Asia
the Pacific Africa MENA
0 2 4 6 8 10 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 M ea n s Years
Europe* North America South America Asia
the Pacific** Africa** MENA
0 10 20 30 40 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 M ea n s Years
Europe North America South America Asia
the Pacific Africa MENA
0 20 40 60 80 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 M ea n s Years
Europe North America South America Asia
Discussion
The aim of the current study was to discover if there were global differences between calls related to maltreatment of children from different parts of the world, and if shifts in the studied 10-year period could be observed. We found that physical abuse and sexual abuse were most frequently discussed by children from Africa and the Pacific. Emotional abuse and neglect were most often discussed by children from developed regions. A relatively stable pattern over time was found for physical abuse, emotional abuse and neglect. However, the outcomes of the current study suggested there was an increasing trend in calls from children living in Africa, Europe and the Pacific regarding sexual abuse.
Millions of children around the world sought support from child helplines with concerns related to child maltreatment. However, there were important differences between the regions. Children from Africa and the Pacific contacted their child helplines more often with concerns related to physical abuse and sexual abuse. Emotional abuse and neglect were mostly discussed by children in developed regions. Children from Asia and MENA contacted their child helplines the least frequently. We speculate that several factors may have influenced the data from the present study. Before we discuss these factors, we must note that it was not easy to match the data from the present study with other international prevalence data. Hence, we could only speculate what might have affected the data.
Differences in cultural beliefs and values might have been the underlying mechanism affecting whether children reached out to child helplines. For example, in collectivistic cultures, like those in Asia, the needs of the group are more important than the needs of the individual (Hofstede, 2011). Therefore, problems within the family, like child maltreatment, may not come to public attention (Futa, Hsu, & Hasen, 2006). For children from collectivistic cultures, the disadvantages of disclosing the maltreatment outweigh the advantages. The disclosure may not only result in the loss of an important relationship, but also jeopardize interpersonal harmony, thereby causing loss of face and withdrawal of support (Allard, 2009; Aronson Fontes &
Plummer, 2010; Foynes, Platt, Hall, & Freyd, 2014). This may have imposed a significant barrier to children from Asia and MENA in approaching their helplines. Therefore, the lower rates of calls from these regions may be attributable to underreporting (Zhai & Gao, 2009).
An alternative explanation might be that in some regions more risk factors for child maltreatment were present due to socioeconomic and cultural differences (Mbagaya, 2011). In Africa, for example, poverty may diminish parents’ abilities to provide warm and responsive parenting and therefore, increase the use of physical abuse (Dodge, Pettit, & Bates, 1994). Additionally, poverty may force children to have sex for financial support (McCrann, Lalor, & Katabaro, 2006). Further, in some parts of Africa it is believed that having sex with a virgin can be the cure for diseases, such as HIV, and therefore older men force young girls into having sex (McCrann et al., 2006). Also, the practice of polygamy, common in Africa, often leads to parental conflict, where children become the unwarranted victims of their parents’ frustration (Elbedour, Abu-Bader, Onwuegbuzie, Abu-Rabia, & El-Aassam, 2006). These factors may have led to physical abuse and sexual abuse being more prevalent in Africa, causing more African children seek support from their child helplines than their peers from other regions.
Results of the current study indicated that as the HDI level increased, so did the number of children reaching out to child helplines to talk about physical abuse, sexual abuse and emotional abuse. Several factors may explain these findings. Firstly, the child helplines in the developed regions have existed longer than the child helplines in the developing regions. Therefore, data from developing regions may have been limited, resulting in a distorted picture. Secondly, it is also possible that children from developing regions could not contact their child helplines due to practical reasons, such as poverty and the lack of telecom infrastructure (Child Helpline International, 2017). Finally, it is also possible that children from developing regions did not call about child maltreatment, because they had even more serious problems to talk about, such as having HIV/AIDS, being abandoned, in need of food or being orphaned (Child
Helpline International, 2013; Fukkink, Bruns, & Ligtvoet, 2016). Hence, these factors may have distorted the results, that thereby mistakenly suggest that physical abuse, sexual abuse and emotional abuse was more common in developed regions.
Our results indicated there was no correlation between HDI and children reaching out to child helplines with concerns related to neglect. This finding was consistent with prevalence studies (Hussey, Chang, & Kotch, 2006; Mbagaya, Oburu, & Bakermans-Kranenburg, 2014), suggesting there are no differences between developing and developed regions in the prevalence of neglect. Glaser (2005) suggested neglect might be the most prevalent type of child maltreatment across cultures. However, the factors that led to neglect varied per region. For example, in the Netherlands, neglect was more often the result of psychological problems of the parents (Mbagaya et al., 2014), whereas in Africa it was the consequence of financial abilities of the parents. Hence, children from both developed and developing regions reached out to their child helplines with concerns related to neglect, however, the situations that led to neglect varied considerably.
The absence of laws prohibiting physical abuse did not show to be a risk factor for children experiencing physical abuse (Berger, ten Berge, & Geurts, 2004). We found no differences between countries with or without the prohibition by law of physical abuse. This is in contrast with several international studies that claimed the ban of physical abuse has led to a dramatic decline in the prevalence of physical abuse (Durrant, 2005; Janson, 2005; Stattin, Janson, Klackenberg-Larsson, & Magnusson, 1998). However, within these studies there were strong differences between countries in the awareness of the legal situation among the population. In addition, Bussmann (2004) suggests that much time is needed for traditional beliefs to change about right and wrong. The countries with prohibition, in the present study, implemented it recently before or during the observed period (http://www.endcorporalpunishment.org/). Perhaps, due to this short period of time, changes in
traditional beliefs had not yet been made, and therefore, no differences were found in the present study between countries with or without the prohibition of physical abuse by law.
Results of the current study showed a relatively stable pattern of children reaching out to child helplines with issues related to physical abuse, emotional abuse and neglect. However, there was an increasing trend for sexual abuse in Africa, Europe and the Pacific. This is in line with previous studies (Casey & Nurius, 2006; Mathews, Bromfield, Walsh, Cheng, & Norman, 2017), which found increasing trends in the reports of sexual abuse. This might be the consequence of changes made in agency policy and practices, and wider social and political contact. Further, it is also possible that due to improvement in economic, social and information technology, the taboo on reporting sexual abuse may have reduced over time and therefore it is possible that over the years more children called the child helplines to talk about sexual abuse (Tran, van Berkel, Nguyen, van IJzendoorn, & Alink, 2018). However, other studies suggest a declining trend in both the United States and the United Kingdom for the different types of child maltreatment (Finkelhor, Saito, & Jones, 2018; Radford et al., 2012). Considering the inconsistency between studies of trends in the prevalence of child maltreatment, more longitudinal research is needed to investigate the exact mechanisms and possible trends in child maltreatment.
Strengths and limitations
Strengths of this study were the cross-regional comparison and the longitudinal design. In addition, we were able to investigate if there were differences between developed and developing regions and between countries with and without the prohibition of physical abuse. However, several limitations to this study should be mentioned. Firstly, the data did not contain data on all affiliated child helplines for every year. Therefore, the statistical power for indicating trend effects was low. Secondly, since the child helplines in the developing regions were established relatively recently and children from these regions could not contact their child helpline due to practical reasons, our results might have been an underestimation of the actual
prevalence of child maltreatment among the population. Thirdly, even though we extensively screened the data, there were still some peaks over the years which seem unrealistic and therefore, the results might not have reflected the real situation. Finally, since the data was aggregated, we could not investigate the influence of gender, age and other background characteristics of the children.
Recommendations
We recommend duplicating the present study with more recent data from CHI, because the current data did not contain every year of all affiliated child helplines. In addition, there has been a large increase in the number of child helplines affiliated with CHI. CHI has also extended their support with online chat. Previous study suggests that the anonymous nature of online chat might be less threatening for children, and thereby, increases the possibility that children will disclose child maltreatment (Fukkink & Hermanns, 2009a). Because of these changes, it is possible that more recent data will give a more realistic view of the actual prevalence of child maltreatment. Furthermore, we recommend CHI to continue their activities around raising awareness of their services at schools and sport centers (Dogaru, Bond, & Palmer, 2017). In addition, it is also valuable to use social media and public figures to increase public awareness (Dihn, Farrugia, O’Neill, Vandorinck, & Velicu, 2016; Doguru et al., 2017).
Conclusion
The present study adds information to current knowledge about the concerns of children and young people around the world related to child maltreatment. Despite the United Nations Convention on the Rights of the Child (1989) in which the States Parties explicitly state that they will take all appropriate measures to ensure that children are protected from any type of maltreatment, we found that millions of children reached out to their child helplines to talk about child maltreatment. This highlights the practical importance of the counselling services provided by child helplines. However, a challenge that remains is ensuring that child helplines
are accessible to those most in need. Even though millions of children and young people know about the existence of Child Helplines International, there are still too many voices that go unheard.
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