|Year : 2021 | Volume
| Issue : 2 | Page : 74-80
A preliminary study of self-reported childhood sexual abuse among college students from southern India
Rajesh Duraisamy Rathinam1, Abhishek Singh2, Vikas Gupta3, Rajarajan Ramalingam4, LD Darshini4
1 Department of Forensic Medicine, Indira Gandhi Medical College and Research Institute, Puducherry, India
2 Department of Community Medicine, SHKM Government Medical College, Nalhar, Haryana, India
3 Department of Community Medicine, Government Medical College, Shahdol, Madhya Pradesh, India
4 Indira Gandhi Medical College and Research Institute, Puducherry, India
|Date of Submission||09-Jan-2021|
|Date of Decision||02-Mar-2021|
|Date of Acceptance||07-Mar-2021|
|Date of Web Publication||28-May-2021|
Department of Community Medicine, Government Medical College, Shahdol, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: Childhood sexual abuse (CSA) is truly a multidimensional issue having long-lasting effect on subject's physical and psychological health. The study was conducted with an aim to study various aspects of self-reported childhood sexual abuse in a sample of students from South India. Methods: This cross-sectional study was carried out during July to September 2018 among 399 students of two colleges located at Puducherry using a self-administered questionnaire. The desired sample size was calculated considering the proportion of college students suffered from childhood sexual abuse as 53.2%. In each college, the line listing of students from 1st year to final year was done and simple random sampling technique was used for selecting the study subjects. The study was initiated after obtaining institutional ethical approval, and every student was ensured of complete confidentiality and privacy. Results: Of total 399 students, 130 (32.7%) students reported experiencing one or other form of CSA. Majority (40.0%) did not inform or share the instance of CSA to anyone. Fear of negative consequences (48.1%) and feelings of guilt (32.7%) were two top most factors that made them not to inform such abuse to their family members. Conclusion: Approximately one-third of students reported an incident of sexual abuse at least once in his/her life in Puducherry; thus, roots of CSA are deep in the society in which we live.
Keywords: Children, psychological problems, sexual abuse
|How to cite this article:|
Rathinam RD, Singh A, Gupta V, Ramalingam R, Darshini L D. A preliminary study of self-reported childhood sexual abuse among college students from southern India. Asian J Soc Health Behav 2021;4:74-80
|How to cite this URL:|
Rathinam RD, Singh A, Gupta V, Ramalingam R, Darshini L D. A preliminary study of self-reported childhood sexual abuse among college students from southern India. Asian J Soc Health Behav [serial online] 2021 [cited 2021 Jul 27];4:74-80. Available from: http://www.healthandbehavior.com/text.asp?2021/4/2/74/317110
| Introduction|| |
Sexual abuse is an extremely important issue but unfortunately does not remain away from limelight. Child sexual abuse (CSA) has received growing attention over recent decades. It is an extremely important issue with legal, social, and psychological dimensions having long-lasting effect on subject's physical and psychological health. CSA is the indulging of a child in sexual act that he or she may not comprehend, unable to provide consent for the act, or not prepared from the development point of view or the act not following the laws or social taboos laid down by the society. CSA includes an array of sexual activities such as fondling, inviting a child to touch or be touched sexually, intercourse, exhibitionism, involving a child in prostitution or pornography, or online child luring by cyber-predators.
CSA is a serious problem of considerable magnitude throughout the world. Worldwide, an alarming rate of CSA is observed, with averages of 18% ± 20% for females and of 8% ± 10% for males, with the lowest rates for both girls (11.3%) and boys (4.1%) found in Asia and highest rates found for girls in Australia (21.5%) and for boys in Africa (19.3%).
CSA is grossly underreported offence in our country, reaching to epidemic proportion. India is home to approximately 19% of the world's children. As per estimates, a child under 16 years of age is raped in every 155th min. In every 13th h, child under 10 years of age and every 10th child is sexually abused in our country. Nation was shocked by the findings of a study conducted by the central government among more than 17,000 children and adolescents. The study revealed that every second child in the country was sufferer of CSA, i.e., more than half (53%) reported experience of sexual abuse, defined as sexual assault, making the child fondle private parts, making the child exhibit private body parts and being photographed in the nude, and over 20% reported severe sexual abuse.
A combination of individual, relational, community, and societal factors contributes to the risk of child abuse and neglect. Although children are not responsible for the harm inflicted upon them, certain factors have been found to increase their risk of being abused and/or neglected.
CSA has profound consequences for the child. It is known to interfere with growth and development. CSA has also been linked to numerous maladaptive health behaviors, and poor social, mental, and physical health outcomes throughout the lifespan. In accordance with that, there is evidence that CSA can affect neurobiological systems, for example, the cortical representation of the genital somatosensory field. Other common sequelae for adult survivors of CSA may include relational challenges (e.g., increased risk for domestic violence), violent behaviors, and increased risk of perpetration of CSA as adults.
Literature on the burden and pattern of sexual abuse among children in India is patchy and scanty. In the light of above facts and since the key to combating the rising trend of CSA is understand the burden and dynamics of factors behind the problem, so the present study was conducted to estimate the prevalence of childhood sexual abuse and associated factors among college students from South India. An additional objective of the study was to explore the psychological problems associated with childhood sexual abuse.
| Methods|| |
Study area and study period
The present study was conducted in Puducherry district of union Territory of Pondicherry during July to September 2018.
Study design and the participants
This cross-sectional study included college students (18 years or above) as participants.
Study population and sample size
The sample size was calculated (n = 399) considering the proportion of college students suffered from childhood sexual abuse as 53.2% with confidence level of 95% and 5% absolute allowable error by applying the following formula: n = (Z1 − a/2) 2 × p (1 − p)/d2; where Z = Standard normal variate for level of significance (at 5% type I error [P < 0.05], Z = 1.96 for two-sided test), a = Level of significance (0.05), P = Prevalence (proportion - 50%), d = absolute allowable error (5%), n = sample size.
A complete list of colleges including government and private was obtained from directorate of higher and technical education. Considering the estimated sample size, from the obtained list of colleges, two colleges were selected by simple random sampling using lottery method. The selected colleges dean or director were approached by investigator for rapport building and to obtain permission for conducting the study and following which interview dates of study were fixed. In case any college authority not willing to permit, another college was selected from Puducherry.
Before conduct of the study in the two college, a health camp was organized by investigators with the support of college faculties to examine the students for serious illness such as severe anemia (extreme paleness of either palm or tongue or lower inner side of eye lids) or high-grade fever (temperature of 39.4°C or more on digital thermometer); or psychological distress (a score of three or more on general health questionnaire-12).
In each college, the line listing of students (as per their roll numbers in attendance registers) from 1st year to final year was done, and simple random sampling technique using computer-generated table of random numbers was used for selecting the study subjects. The subjects selected by SRS technique were contacted through phone calls and were asked for their availability on the defined days for the interview, and verbal informed consent was obtained. If any of randomly selected subject could not be contacted despite three attempts or explained their unavailability for defined days or denied consent or having serious illness then next subject was enrolled by simple random sampling technique.
Hence, the eligibility criteria include students currently studying in college (1st year to final year); having age 18 years or above; selected through SRS; presently not having any serious illness; being available on day of interview; and gave their consent for the study.
A pretested, structured, anonymous, self-administered questionnaire served as a study tool. The questionnaire included sociodemographic characteristics (age, gender, year of study, parents' education, type of family, religion, and socioeconomic status), type of CSA, characteristics of CSA (place of occurrence of sexual abuse, gender of sexual abuser, relationship with sexual abuser, and age of sexual abuser), inhibiting factors for not reporting CSA, and psychological problems among subjects. The questionnaire was prepared using core components of Child Sexual study by Halpérin et al. Term sexual abuse includes a variety of acts such as fondling genitals of a child, making the child fondle genitals of an adult, exhibitionism, pornography and sexual assault like intercourse, incest, rape, and sodomy. The questionnaire focusing psychological problems among subjects included six questions, i.e., ever had sense of insecurity at home, ever had suicidal thoughts, ever feel that parents dislike them, ever had sense of depression, ever had sense of anxiety, and ever diagnosed posttraumatic stress disorder.
The questionnaire was first prepared in English. Then, it was translated into Tamil by an expert in that language keeping semantic equivalence. To check the translation, it was back translated into English by two independent researchers who were unaware of the first English version. The collected questions 32 were subjected to content validation by a panel of 14 medical experts. The purpose was to identify the items with a high degree of agreement among experts. Aiken's V was used to quantify the concordance between experts for each item. Only 22 questions that had an Aiken's V > 0.7 and were selected for the study. All efforts were made to keep the questions simple and unambiguous according to the objectives of the study. It was pretested in a small group of students and modified accordingly.
The socioeconomic status was obtained using modified B. G. Prasad socioeconomic status classification (revised for year 2018, CPI 2001 as base). It is based on per capita monthly income and based on it has five categories such as Class I (6574 and above), Class II (3287–6573), Class III (1972–3286), Class IV (986–1971), and Class V (985 and Below).
The eligible students were briefed about the study objectives and ensured of complete confidentiality and privacy. Study subjects were informed that they have right to withdraw from this investigation at any point of time. Study subjects were explained and informed about not writing their names or put any mark that can help in their identification neither on the questionnaires nor on the envelopes except for consent form. Questionnaires along with consent forms placed in envelopes were handed out to the students just after completion of classes, and at the same time, issue of privacy was kept in mind. Students were instructed to fill the questionnaire and to sign the consent form and after completing it again putting both consent form and questionnaires back into envelopes and leave it in the prepared collecting box. This process helped us in maintaining the anonymity. After submission of envelopes in the collection box, study subjects were conveyed thanks for sparing time for the study and answering honestly, and questionnaire with the duly signed consent forms was separated from those who denied for the consent. After that, the immediately duly signed consent forms were detached from the questionnaire and were kept separately in record file. This helped us in maintaining the anonymity of the study subjects. The completed questionnaires were then checked for the completeness.
Permissions were obtained from the Institutional Ethical committee Letter number: IEC/IGMC/F-7/2017/9, dated November 21, 2017), respective colleges and Child Welfare Committee of Puducherry.
Collected data were entered in the MS Excel spreadsheet, coded appropriately, and later cleaned for any possible errors. Analysis was carried out using IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp. Armonk, NY, USA). During data cleaning, more variables were created so as to facilitate the association of variables. Clear values for various outcomes were determined before running frequency tests. Categorical data were presented as percentages (%). Chi-square test was used to test statistical significance wherever applicable. Multivariable logistic regression had been done to find out the strength of association between dependent variables and independent variables. First, a univariate regression was done to ascertain the relationship of the dependent variable with other independent variables. Only those found to be significant were entered into the multiple logistic regression model. All tests were performed at a 5% level of significance; thus, an association was significant if the P < 0.05.
| Results|| |
Study participants included 399 students currently studying in the colleges located at Puducherry. Out of total study participants, 43.1% (172/399) were male and 56.9% (227/399) were females, the mean age of students was 20.2 years.
Overall, 32.6% (130/399) of students experienced one or other form of sexual abuse. Among those experiencing lifetime experience of sexual abuse, 56.9% (74/130) were female and 43.1% (56/130) were males. Fondling (44.6%, 58/130), making him/her look at pornographic pictures, films, videotapes, or magazines (29.2%, 38/130), and looking at his/her genitals (22.3%, 29/130) were three most common types of sexual abuse [Table 1].
|Table 1: Distribution of types of child sexual abuse experienced by study subjects (n=130)|
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Most instances of CSA occurred either at own house (n = 57, 43.8%), neighbor's house (n = 43, 33.1%), or at any other unknown place (n = 39, 30.0%). Sexual abuser was someone from friend (n = 47, 36.2%), some unknown person (n = 41, 31.5%), uncle (n = 13, 10.0%), neighbor, and some known person (n = 12, 9.2% each) followed by cousin brother (n = 9, 6.9%). Most (n = 111, 85.3%) of the times the sexual abuser was male. As per respondents, abuser was below 20 years in 71 (54.6%) such instances, whereas 21–30 years in 42 (32.3%) cases [Table 2].
|Table 2: Characteristics of experienced child sexual abuse in study participants (n=130)|
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Among those experiencing lifetime experience of sexual abuse, majority 78 (60.0%) did not inform or share the instance of CSA to anyone. Most (n = 53, 67.9%) of the times, instances of CSA were revealed to the friends, followed by parents (n = 30, 38.5% each). Fear of negative consequences (n = 25, 48.1%), feelings of guilt (n = 17, 32.7%), fear of not being believed by family (n = 8, 15.4%), and loyalty to the perpetrator (n = 6, 11.5%) were few factors that made them not to inform such abuse to their family members [Figure 1].
|Figure 1: Inhibiting factors for not reporting childhood sexual abuse to their family members (n = 52)|
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Psychological problems such as sense of insecurity at home, suicidal thoughts, of being not liked by parents, sense of depression, and anxiety were significantly more in subjects experiencing the CSA [Table 3].
|Table 3: Association between child sexual abuse and psychological problems in study participants (n=399)|
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[Table 4] shows logistic regression analysis, and it was observed that CSA was significantly higher among female subjects and joint families.
|Table 4: Independent association of variables and childhood sexual abuse among study participants (logistic regression analysis) (n=399)|
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| Discussion|| |
The current study among college students in Puducherry found that, overall, 32.6% of them had lifetime experience of sexual abuse. We also observed that 56.9% of CSA incidents were among girls and 43.1% among boys. Barth et al. in his systematic review and meta-analysis of more than fifty studies across various countries reported that the burden of CSA was 8%–31% among girls and 3%–17% among boys aged <18 years of age. Another meta-analysis concluded that 7.9% of males and 19.7% of females experienced one or other form of sexual abuse before attaining the age of 18 years.
Another study from south India on childhood sexual abuse conducted among a sample of college students in the domain of physical, emotional, and sexual abuse reported the prevalence of CSA 2.6%–14.3% among the study subjects. Behere et al. were of the view that, in India, every alternate child suffers from one or other form of sexual abuse at least once in his/her life. Every fifth child faces more severe forms of CSA, out of these children 52.94% were boys and 47.06% were girls. As per UNICEF (2005–2013) reports, 42% of Indian girls have faced trauma of sexual violence in their teenage life. Another study from Kerala on burden of sexual abuse among adolescents reported that 36% of boys and 35% of girls suffered from one or more incidents of sexual abuse at least once.
In this study, we observed that most instances of CSA occurred either at own house (43.8%), neighbor's house (33.1%), or at any other unknown place (30.0%). This is in contrast to the study by Krishnakumar et al. that reported majority of such incidents took place while travelling in bus or train.
In our study, it was observed that fondling (44.6%), making him/her look at porn (29.2%), and looking at his/her genitals (22.3%) were three most common types of sexual abuse. Another study by Bhilwar et al. is also in concordance with our observations. She reported that, in 6.4% of the cases of sexual abuse, perpetrator forced the study subjects to expose their private parts, whereas in around 10% of cases, someone else exposed his/her private parts to them. Krishnakumar et al. from South India reported the common methods of sexual abuse. Among them, forcibly touching the private parts, nude photography, and exhibiting pornographic pictures are common modes.
Not surprisingly our study shows that majority (60.0%) did not inform or share the instance of CSA to anyone. Probably, it could be due to conservative nature of Indian society where conversation and discussion on topics related to sex and sexuality is considered a taboo. This could be the reason why sexual offences often go unreported.
We observed that fear of negative consequences (48.1%), feelings of guilt (32.7%), and fear of not being believed by family (15.4%) were few factors that made them not to inform such abuse to their family members.
Not sharing the CSA incidents parents, reason could be anything, as seen in the present study, shall aggrevate the situation. On the other hand, parent's attitude and reactions to their child's complaints were not appropriate either. This ignorance on the part of the parents could probably add fuel to the problem of CSA. Such callous parental attitude probably boosts the confidence of the perpetrator that the event will go unreported and that he/she will flee. At the same time, such parental attitude might negatively impact the child's morale and child may indulge in other antisocial activities if he/she comes in contact with antisocial elements while searching the support outside home that is required at that stage.
We also observed that the psychological problems such as sense of insecurity at home, suicidal thoughts, of being not liked by parents, sense of depression, and anxiety were significantly more in subjects experiencing the CSA. Clear evidence is available in literature about a link between CSA and psychiatric symptoms.,,
An important correlate is family structure which has a specific meaning in the Indian society. The system of joint family found in India has grandparents, parents, children, and/or other extended family members living under one roof with a common pool of resources for survival and growth. Traditionally, its nature is strictly hierarchical and patrilineal. While the debate on pros and cons of the breakdown of joint families into nuclear family units continues, a study by Charak and Koot on child victimization indicated that children from joint/extended families are sexually more victimized than their counterparts residing in a nuclear family and was in coherence with the present study but opposed by study done by Deb and Modak, where CSA was higher in children from nuclear families.,
Finally, the present study also addressed the association of parental education with CSA. While higher levels of maternal education appeared to be associated with lower levels of adolescent reported CSA, paternal level of education was not associated with CSA. The result pinpoints the importance of a higher level of maternal education in curbing incidents of CSA. Importantly, this finding can play a vital role in primary level interventions. On the other hand, the apparent absence of influence of fathers' level of education on the prevalence of CSA may be due to a general lack of direct involvement of fathers in child care in the Indian society. Since the father is ascribed the role of a breadwinner and not of child care, his level of education may fail to effect CSA.
On legal part of CSA, our legal system is not flawless regarding protection of rights of children. Laws in India under POCSO act 2012 write in detailed description of different forms of sexual abuse. It also lists down the procedure of reporting and recording of evidence keeping children in mind. Provision of relief and rehabilitation of the child is also made in the act. Soon after receipt of the complaint, police have to make necessary arrangements of shifting the child to shelter home or nearby hospital within 24 h of lodging the report.
There were several strengths of this study. First and foremost, questionnaires were made anonymous so that the respondents can respond with clarity. Second, we chose students for the purpose of this study as openness to talk on such issues and better recollection of past incidents were required. Children may not recognize the diverse aspects of CSA. This aspect motivated us to fetch the desired information from a sample of students, thus adding strength to the study. Third, we tried to probe CSA, a problem with limited available literature. Regarding limitations, first the sole dependence on self-report for assessing abuse and neglect and family correlates is a methodological limitation as associations found in this study may to some extent reflect source overlap, also possibility of recall bias is definitely an evident limitation. Second, the results of this investigation are from only two colleges which limit the generalizability of the findings. Multicentric studies with bigger sample size are warranted. Third, in the present study, joint family may have been a proxy for household density, and additional questions on the number of people sharing a bed/room, size of the house, or neighborhood density could have been more informative. The present results regarding the joint family setup and its association with CSA may be marred by this limitation.
| Conclusion|| |
Approximately one-third of students reported an incident of sexual abuse at least once in his/her life in Puducherry; thus, roots of CSA are deep in the society, in which we live. In contrast to the socially prevalent belief that girls are more sexually abused compared to boys, this investigation interestingly highlights that even boys are equally facing the brunt of this issue. Discussion on topics related to sex and sexuality is still considered a taboo. Therefore, this is need of an hour to evolve methods of protecting our children from CSA and it should cater need of both boys and girls.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]