Sexual violence against children happens everywhere: in wealthy enclaves, in slums, in suburbs, in rural villages.
Invariably, it happens in secret: in the privacy of family homes, in dark corners of schools and churches, and in murky shadows at neighborhood, community, sporting and scouting events.
It happens often, and periodically groups put out reports to call attention to the issue. "That's usually where the story stops," says Daniela Ligiero, CEO and executive director of Together for Girls, an organization that works to prevent violence against children. "But there's a lot to be done to prevent it. We want to showcase solutions."
Together for Girls, in partnership with the Oak Foundation and the Equality Institute, organizations with similar goals of preventing violence against children, examined scientific studies and sought expert opinion to compile a review of evidence. Their report, "What Works to Prevent Sexual Violence Against Children," was released Nov. 19.
It presents a much-needed guide for policymakers around the world, says Regan Hofmann, acting director of the U.S. Liaison Office, UNAIDS. "The global community has been hungry for a resource clearly outlining cost-effective, evidence-based solutions to prevent sexual violence against children and adolescents," she says.
We spoke with Ligiero about the report. Research details included from the report are bracketed.
I understand that it was a personal epiphany that led you to your life's work to prevent childhood sexual abuse. Tell me about that.
I started being sexually abused at the age of 6 by a close family friend. For many years I lived in silence. I was terrified. I was living in Paraguay at the time. Without getting into detail, it was genital touching, rape — everything. It didn't start off being violent and gruesome, but slowly it escalated. In my own way, I was trying to let my parents know that I didn't want to be alone with this man. I wasn't heard. The abuse ended after three or four years when we moved to the United States.
By 16, I was suicidal, depressed, starting to experiment with drugs and alcohol. I lived in silence. Then I saw a made-for-TV movie. I don't even remember the name of it. I'm 44 now, but that movie opened up this whole journey. It was about a girl, an adolescent, who was sexually abused by her dad. Eventually, people discovered the abuse, and she was able to access support. For the first time I felt like I wasn't alone. It helped me have the courage to speak about it. And finally, I got help and support.
What you experienced was clearly sexual abuse. Within this report, how do you define sexual abuse of children?
We were trying to have a big umbrella. Sexual violence consists of a range of sexual acts against a child, including but not limited to incest, rape, sexual violence in the context of dating and intimate relationships, sexual exploitation and online sexual abuse.
For some kinds of abuse — incest and rape, for example — the definition is pretty clear. But there can be differences of opinion among people who live in cultures where very young girls become brides about whether child marriage is sexual abuse. In most of those cultures, it's very young girls marrying older men. [Around 15 million girls are married before the age of 18. Some countries are moving to strengthen laws to protect young girls from forced marriage. Malawi, for example, in 2015 increased the minimum age of marriage to 18.]
How common is it for children around the world to experience sexual abuse?
Some form of sexual abuse — including inappropriate touching, incest, child pornography and rape — happens each year to 120 million girls age 18 and younger around the world, or 1 in 10. [That's according to a 2014 UNICEF report, "Hidden in Plain Sight."] Global estimates for sexually abused boys are not available because few countries collect that data. But a 2013 analysis in the International Journal of Public Health looked at the problem in 24 high- and middle-income countries and found that from 8 percent to 31 percent of girls under 18 in those 24 countries were victims of sexual abuse, as were from 3 percent to 17 percent of boys.]
Are there areas of the world where sexual abuse of children is especially prevalent?
It's bad everywhere, and there are millions of children affected. In areas of conflict, war and poverty, the prevalence is higher. Childhood sexual violence is the single largest silent pandemic of our time. It needs to be addressed everywhere. Several of our partners contributed to the Economist Intelligence Unit's report "Out of the Shadows: Shining Light on the Response to Child Sexual Abuse and Exploitation." [The Economist Intelligence Unit is an arm of the Economist media group that includes The Economist magazine; it provides research and analysis that it believes to be of interest to businesses, the financial sector and governments. Its report highlights steps that 60 countries are taking to stop child sexual abuse.]
Can you give me some specific examples of interventions that work?
A couple of interventions used in schools are effective. These are age-appropriate approaches where you work with students, focusing on facts about sexual abuse and telling them what to do if they feel uncomfortable. Some interventions focus on kids as bystanders and suggest what they can do if they see something inappropriate. Programs teach younger kids basics like, for example, the difference between safe touching and unsafe touching. [The report notes that programs might teach that an acceptable touch is a hug or kiss from moms, dads, grandmas and grandpas, if the child wants them. But that an unacceptable touch is a touch underneath clothing or a touch anywhere that makes the child feel uncomfortable or scared.]
For older kids, a program called "Safe Date" is designed to prevent dating violence. It teaches kids about healthy relationships and gets kids talking to each other, practicing conversations about sex and helping girls feel empowered.
Parenting programs can be effective. They teach mothers and fathers how to have conversations with their kids. They encourage parents to believe their children when they express concerns about, for example, being alone with someone.
In the community, abuse would go down if all youth-serving groups, such as schools, YMCAs, sports and scouting organizations, had mandatory background checks for staffers. Those groups also should have mechanisms in place for staffers or kids to report abuse. Most organizations that work with children don't have these safeguards in place. Just think about [the Olympic women's gymnastics team doctor] Larry Nassar. He was able to abuse athletes for more than 30 years. [Nassar was convicted of sexually abusing more than 250 girls, most of them on the U.S. women's gymnastic team.]
Are there interventions intended to reduce child sexual abuse that backfire and do more harm than good?
We know that laws that require sex offenders to register do not work for juveniles. Those laws, when directed at boys under the age of 18, don't deter future abuse. Instead, they increase the incidence of suicide among the juveniles who must register. For those young perpetrators, individual and group treatment can be effective deterrents, studies have shown
Back to your personal story. Would any of the interventions you've studied have helped you when you were being abused as a little girl?
If someone in my school had talked about this, I would have felt less alone. If my parents had been taught to listen to their children's fears, it would have helped. I was on sports teams and in Girl Scouts, and people talked about avoiding strangers. But no one talked about what to do if someone close to you was doing this. That would have helped.
We need to get uncomfortable and have some of these conversations with children.
Susan Brink is a freelance writer who covers health and medicine. She is the author of The Fourth Trimester and co-author of A Change of Heart.
A previous version of this story incorrectly identified Larry Nassar as an orthopedic surgeon. Nassar is an osteopathic physician.