PUBH6008 Capstone A Applied Research Project in Public Health Assignment Sample
By the end of module 3, student must provide to their learning facilitator a brief review of the literature on their chosen topic. The literature review must contain key references/theorists/researchers for the public health topic chosen. The literature review assignment must be designed to address the following questions:
• Who are the key theorists/researchers in your public health topic?
• What are the key issues?
• What are the gaps in the existing body of knowledge?
The literature review should provide a basis for justifying a clear research question or hypothesis to be explored further.
You must also indicate the search strategy used for your literature review. For example, what were the key words you searched for, and which key databases or other sources did you use to conduct your literature review? (e.g. CINAHL, Proquest Public Health, Informit, Medline, Google Scholar).
• Critical and comprehensive review of the literature (70%) Clarity of research question/hypothesis (10%) General assessment criteria (20%):
o Provides a lucid introduction
o Shows a sophisticated understanding of the key issues
o Shows ability to interpret relevant information and literature in relation to chosen topic
o Demonstrates a capacity to explain and apply relevant concepts o Shows evidence of reading beyond the required readings
o Justifies any conclusions reached with well-formed arguments and not merely assertions
o Provides a conclusion or summary o Correctly uses academic writing, presentation and grammar:
- Complies with academic standards of legibility, referencing and bibliographical details (including reference list)
- Writes clearly, with accurate spelling and grammar as well as proper sentence and paragraph construction
- Uses appropriate APA style for citing and referencing research
Sexual abuse among children is considered as a widespread public health challenge, acknowledged in all levels of society worldwide. Child sexual abuse (CSA) is a key issue that has been seen to be present in most of the societies in all classes in India. The prevalence is increasing in India at an uncontrolled rate and it is not only affecting health of the victims, but also becoming a public health, social and economic challenge (Srivastava et al., 2017). In this regard, it is the high time to take strong and effective steps to eradicate the issue for safeguarding and securing children’s health. According to WHO, child sexual abuse is referred as the “the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared, or else that violates the laws or social taboos of society” (Behere, 2018). Indian government has implemented a range of preventive activities in the country. The following chapter has been developed for raising significant understanding on the particular issue, by reviewing the existing literatures.
Background of The Study
Violent behavior against women and children is a significantly known public health challenge globally. It includes “physical, psychological, sexual as well as economic violation or maltreatment” against people below 18 years old. CSA or child molestation is a type of child abuse, in which an older adolescent or adult by abusing a child for sexual encouragement (Choudhry et al., 2018). A range of activities includes different types of child sexual abuse, which involves engaging in sexual activities with a non-adult person, child grooming, indecent exposure, as well as child sexual exploitation, involving a child to make child pornography. According to UNICEF, child marriage is “represented perhaps the most prevalent form of sexual abuse and exploitation of girls” (Behere, 2018). The definition by the WHO has been accepted globally that indicates that CSA is the process involving a child through sexual activities, which the victim does not completely comprehend and is incapable to give assent to, or for which the victim is not prepared developmentally and the process that infringes legal and social regulations (Singh et al., 2014). Different types of activities are indicated under this umbrella term, including “attempted intercourse, intercourse, oral-genital contact, exposing children to adult sexual activity or pornography, fondling of genitals directly or through clothing and the abusing the child for pornography or prostitution” (Behere, 2018).
Srivastava et al., (2017) claimed that the dynamics of CSA are dissimilar from adult sexual abuse. It is because; children usually do not disclose the incident of sexual abuse after the occurrence. Thus, the disclosure of the events seems to be a long term procedure, instead of being a single episode, which is usually done in case of adult sexual violence. Thus, it is often started following a physical complaint or behavioral change (Seth, 2015). Instead of such issue, child sexual abuse is a neglected issue. The consequences of the issue are also widespread, including immediate effects like “shock, confusion, fear, guilt, hyper vigilance or dissociation”; to long term effects including “anxiety disorder, depression, suicidal tendency, antisocial personality, substance use, issues in relationship building, interpersonal issues, schizophrenia as well as eating disorder” (Saini, 2013).
The method that has been applied for the purpose of the study includes systematic review of literature in collecting data for the study which will use electronic academic database to find literature for the study. Therefore, the research study has been conducted using articles that have been published in different academic databases such as Google Scholar (Ghosh, 2009).
Search strategy has been formulated by using some keywords for refining the search procedure that includes “child sexual abuse, violence, harassment, prevalence, child safety, consequences, India, globally, factors, prevention, preventive strategies, measures, intervention”. Using these search terms, selected databases have been searched including the “Torrens library” for finding the most appropriate articles in the field of CSA and its preventive measure in India. The researcher mainly gathered data from the articles published in English within the last 10 years. Articles meeting these criteria have been included in the search procedure. The researcher has screened the reference list and relevant reviews of the studies included, along with citation tracking, as required (Tyagi & Karande, 2021).
Prevalence of Child Sexual Abuse Worldwide
According to the WHO, it is estimated that about 1 billion children within 2 to 17 years old have experience of abuse or violence from physical, emotional, sexual domain. Experiencing such violence has significant negative impact upon health and wellbeing of these children. Globally, prevalence of CSA is increasingly significant (Behere, 2018). In 2002, the WHO has estimated that 150 million females and 73 million males, who are under 18 years old, have experienced CSA. According to UNICEF, most of the abuses are done by people the child knows and trusts. Around 120 million girls within the age of 20, while 1 in 10 children are forced to involve in sex or perform sexual activities, as per the latest report (UNICEF, 2021). It is also revealed that around 90% teenage girls, reporting forced sex indicate that their first executor was someone they knew. Srivastava et al., (2017) highlighted that in a Meta analysis covering studies from 22 different nations, it is found that child sexual abuse is common in 19.7% girl and 7.9% boys. Prevalence is high in African and Asian countries, compared to America and Europe (Collin-Vézina et al., 2013). For instance, the prevalence found in the analysis was 34.4%, 23.9%, 10.1% and 9.2% in Africa, Asia, America and Europe respectively. The study also revealed highest percentage cases in South Africa, for both boys and girls, i.e. 60.9% and 43.7% respectively (Seth & Srivastava, 2017). Currently, for girls, sexual abuse is highly prevalent in North America and Australia, with 20.4% and 28.8% prevalence. However, in these regions, the rate is significantly low for boys. In case of Asia, the prevalence varies from only 6 per cent in Hong Kong to 41 per cent and 29.5 per cent in China for girls and boys respectively. In a study by UNICEF regarding maltreatment of children in East Asia and Pacific, it is reported that physical contact and sexual abuse is varied and it is from 1.7 per cent in Hong Kong to 11.6 per cent in Pacific Island (Jena, 2013). In a recent study on the street children trafficking and sexual abuse in Nepal, Kathmandu, and the findings revealed that 80% sexual exploitation is among friends and the enhancing tourism business in Asia is putting these children at stake regarding sexual abuse (Srivastava et al., 2017). In this regard, it is noteworthy that according to the World Health Organization, India has been reported to have the maximum number of sexually abused children in the world (Carson et al., 2013).
Prevalence of Child Sexual Abuse in India
It is estimated that around 19 per cent of World’s Children resides in India and they are contributing around 42 per cent Indian population (Srivastava et al., 2017). According to a survey by WHO, India has been reported to have the highest number of sexually abused children throughout the world. Tyagi and Karande (2021) highlighted that “Study on Child Abuse India 2007” is among the most known and wide surveys carried out in India by the Ministry of Women and Child Development. In that recent survey, it is revealed that 53.22 per cent children are having sexual abuse, within which, around 21.9 per cent are facing severe outcomes (Srivastava et al., 2017). It is also found from the survey results that the most vulnerable form of sexual abuse among children involves 7 to 13 years old children to adolescent people, including school going children. In India, recent evidences indicate that sexual abuse is faced by every second child in different forms throughout their life, while the severe form of sexual abuse is faced by 1 in every 5 children. Among these child victims, 52.94% have been reported to be boys, while 47.06% are girls (Behere, 2018).
Further, as per the National Crime Record Bureau 2016 statistics, 106 sexual abuse cases are reported daily in India, with highest number of cases in Delhi (1196), then Mumbai (712), Pune (354) and Jaipur (330). The highest sexual abuse cases reported among girls within the age of 0 to 12 years. Madhya Pradesh has reported the highest number of cases yearly, for continuously 6 years, with around 13 cases daily and thus identified as the “rape capital” of India, followed by UP and Maharashtra. In another study including samples from Kerala, it is found among 1614 teenagers, 36% males and 35% females have experience of sexual abuse at some point of their entire life (Choudhry et al., 2018).
Child Sexual Abuse: A Hidden Issue
Chopra et al. (2020), child sex abuse is one of the most prevalent issues in the world and the society, economic status, culture, awareness and other factors are predominantly involved in this issue. In terms of India, the child sex abuse is very much an issue and it is mostly covered, polished or neglected in the country due to the norm of accusing the victim for the situation It has been seen that in India the social structure has changed with time and the situation of joint family to the nuclear families are comprising of parents who are earning both for the family (Tomori et al., 2016). However, Joseph and Bance (2019), when the changes in the attitude or physical conditions develop among these children the parents or other individuals try to hide it to reduce the media exposure or social exposure as the victims are mostly accused in this country or the development of a situation where the child or the victim is stigmatized or unnecessarily harassed by different questions of people (Agarwal et al., 2013). Thus, the situation of awareness is still lacking in the country which develops a huge gap in the process of the reduction of the negative situations for people. However, it is necessary to highlight that the Protection of Children from Sexual Offences 2012 act has been put forward by the government of India and cases after this act have been considered with priority and a number of cases were properly registered under this act and awareness of people has also been changed (indiacode.nic.in, 2021). Though, the covering of these incidents and lack of access in the remote places let the issues run as the past (Edwards et al., 2020). Hence, in India child sexual abuse is prominent though action against these issues have not been properly considered yet and people try to hide it with proper knowledge to maintain the social reputation which ignites the crime ore and more in the country.
Factors Influencing The Issue of Child Sexual Abuse in India
Child sexual abuse in India is a predominant issue and it should be considered for the change in the society. It has been seen that the numbers of child sexual abuse cases in India is high and it is very much concerning for the society as well (Nebhinani et al., 2019). The factors involved in the child sexual abuse are not strictly confined in the psychological abnormality of people. The issues of lack of awareness and proper social functioning can also be marked as the factors that influence the issue (Cockbain & Reynald, 2016). It should be highlighted that the lack of awareness among people about the negative consequences of the post abusive activity is one of the most impacting factors in this process (Seth & Srivastava, 2017). On the other hand, the issue of the patriarchal societal culture developed the situation of hiding and covering the sexual abuse incidents in a higher magnitude. This issue lingers the consideration of not acknowledging human rights and not following the legal and social rules and regulations (Dhawan et al., 2016). Though, the Protection of Children from Sexual Offences 2012 act is present in India, the implementation of the act is very less impactful and the issues are not reducing as well (Indiacode.nic.in, 2021). Moreover, the reporting or registering the child sexual abuse cases are very less as hiding the incidents are the common norm in the country along with the accusation towards the victims. On the other hand, the consideration of the remote places and lack of awareness among people to report the incidents are also prominent factors that let the people who are actively abusing the children roam freely (Sowmya et al., 2016). This is a social issue along with an economic issue as well (Sharma, Bhattacharya & Singh, 2018). The economic instability and imbalance in the society, the child labor is one of the prominent issues of the country and the children working for money are also vulnerable to the child sexual abuse situations (Malhotra & Biswas, 2005).
Moreover, these children are threatened to their lives and the power of the economic support let people influence society. There are different corruptions and legal issues also present which induces the child sexual abuse along other abusive activities to be increased in the country. It is necessary to highlight that despite of a large amount of media exposure and awareness build up processes the abnormal fetish of people and negligence to the social structure or function induces the negative activities of people (Seth & Srivastava, 2017). Thus, it is necessary to highlight that the development of positive awareness among people and strict legal actions can change the situation along with changing the norm of hiding the incidents as well (Chattoraj, 2006). Other than all these, political factors are also involved in this factor as the political leaders linger these issues according to their need and these incidents and legal actions remained inactive when the political leaders are not interested anymore to these incidents and justice for the victims (Tiwari et al., 2018). Thus, the mental support to the victims is not there and people will harass them in a higher magnitude which is also humiliating. All these factors, involve in the negative consequences and people hiding after being abused let the criminal roam freely and the increase in this social crime is also prominent due to this situation (Sharma, 2007).
Health Outcomes of Child Sexual Abuse in India
Child sexual abuse can be seen in India in an extensive amount on the remote area population and even in the urban population along with the rural people as well. The age of the victims are mostly around 3 to 12 years and under the age of 18 years. Thus, it is visible that the inhumanity and cruelness among people to abuse a child below the age of puberty even. However, the health outcome of the children being abused is different (Gaidhane et al., 2016). In most of the cases due to the hiding and covering on the incidents the sexual trauma is developed in case of girls and also the impact of the negative physical pain the trauma regarding intercourse would develop as well. It has also been seen that the impact of the negative physical and mental trauma due to the abusive incidents the children also develop negative abusive behaviors and this impacts on the mental and social activities as well (Dayal et al., 2018). The substance abuse cases increase due to the negative impact of the sexual abuse among the adolescent population as well. In this manner, it is necessary to highlight that the mental impact is more than the physical impacts among the children who are affected with these abusive incidents. On the other hand, the physical trauma and pain is also very much prevalent as there are multiple cases of STDs and pain or other issues regarding the reproductive system among both girls and boys who are affected with any kind of sexual abuse (Roy & Madiki, 2020). Moreover, it is necessary to highlight that the lack of awareness and hiding the incidents lead to other physical issues which can be chronic and develop severe health issues as well. Most importantly, the children under the age of puberty can die as well due to the child sexual abuse cases (Joseph & Patel, 2020). Hence, it is necessary to state that the awareness development and strict legal actions should be considered to improve the situation. However, a large number of cases of child sexual abuse in India are found among the adolescent population and the impact found to be mostly on the mental health state such as depression, anxiety, trauma regarding sexual intercourse and relation development issues along with a higher magnitude of social isolation (Chandran, Bhargava & Kishor, 2018). Thus, the health outcomes of child sexual abuse can be different for different age groups and the awareness regarding all these issues should be considered with higher priority.
Child sexual abuse in India is mostly increased due to the silence and the negative social norms of accusing the victim and their family. It is necessary to state that the consideration of the change in the situation is very much required (Damodaran et al., 2014). The aspect of the awareness among the family members and the society needed to be expanded and the government of India is developing different awareness programs to improve the education and responsibilities of people regarding the prevention of the child sexual abuse cases. The awareness to people to provide support to the family of the victims and also helping them to find justice and voice against this kind of cruel activity (Ramaswamy & Seshadri, 2020). Thus, it is necessary to state that the preventive measures of awareness development can be effective and it is impacting as well. On the other hand, the Children’s Homes, work places and schools are other institutions are the places where the children are being abused mostly and thus the respective institution authorities are provided with the regulations of proper supervision and reduction of these activities as well. Finally, the Protection of Children from Sexual Offences Act, 2012 is developed to penalize the abuser with appropriate process (Indiacode.nic.in, 2021). Furthermore, 1098 is the Childline telephone number for the Indian citizens to inform any kind of child abuse activities to the government and the necessary actions will be taken by the government officials if required. All these preventive measures are now carried to reduce the number of child sexual abuse cases in India and make the country healthy (Neherta et al., 2015).
Role of Health Promotion
Child sexual abuse I India is dominant due to the silence and covering up the incidents. In this context, it can be stated that the social norm and culture regarding not speaking about sexual intercourse and these are taboo. Thus, the lack of communication and education among people from the childhood develop the gap and impact negatively on the behavioral and psychological point of view of people. Thus, the health promotion considering the awareness development and providing the social structural and functional factors to the people would be effective in reduction of these malpractices. Thus, the whole idea of health promotion in this context is to develop awareness and educate people to reduce the malpractices and take responsibilities of their actions (Ramaswamy & Seshadri, 2020). It should be highlighted that the Protection of Children from Sexual Offences Act, 2012 will be effective on any kind of child sexual abuse case (Indiacode.nic.in, 2021). Furthermore, the people should be aware regarding the reporting of these kinds of activities or incidents to reduce the criminal offense. Thus, the health promotion play the role in awareness and education development regarding the activities, behaviors, legal and regulatory along with reporting related factors. Hence, the health promotion for the reduction of child sexual abuse can be effective.
Legal and Regulatory Interventions
Child sexual abuse is very much prominent in India and it should be controlled properly through legal interventions. In terms of the legal regulations for the child sexual abuse or any kind of child rights are comprehended by the Protection of Children from Sexual Offences Act, 2012 (indiacode.nic.in, 2021). However, in terms of cultural and social norms of India the reporting of child sexual abuse have not been done in most of the cases. Thus, the awareness and regulatory mandate should be considered for the improvement in the reporting rate. However, the reported or registered cases are very much effectively considered for the legal actions and the victims would be provided with justice in many cases. However, the legal intervention can provide justice to the victims in terms of legal factors, though the mental and physical trauma due to the abusive incident cannot be healed through this (Seth & Srivastava, 2017).
Gap in Literature
In terms of the child sexual abuse in India there are many data regarding the cases and statistical factors as well. However, in case of the preventive measures, it has been seen that the preventive possible strategies have been identified in several literatures through the impacts of the preventive measures have not been identified in the literatures. It should be stated that the impacts of the preventive measures should be evaluated considering the awareness regarding the issues and also the reporting about the child sexual abuse should be considered as well. The impacts of the cultural and social impacts should be prevented as well. Moreover, sometimes the victims also die due lack of capability to withstand against the incident and the impacts or health issues and thee cases cannot be justified with only legal interventions as the loss cannot be repaid. On the other hand, the legal regulations also included with the reporting facility through telephone as well. Though, the rate of reporting from the victim’s end is very low in India due to social taboo and negative impacts on the mental and social factors. Thus it should be stated that the further researches should be conducted to properly evaluate the preventive factors and their possibilities in reduction of the child sexual abuse in India. The health promotion can develop awareness regarding the consequences of the malpractice among people. The school based health promotions can provide the idea of ‘good touch’, ‘bad touch’ and the private body parts among the children and they can act appropriately. Moreover, teaching the children of different age according to their need of knowledge regarding the abuse related activity, their rights and required activity from their end. Moreover, the parents should focus on supervising their children considering their safety and communicate with them and teach them appropriately to reduce the victimization of the child sexual abuse issues.
Brief Recap of What We Know About the Topic and What We Don’t
The literature review provided a deep understanding regarding the statistical factors of India considering the child sexual abuse. On the other hand, it should be stated that the literature review also effectively highlighted the social impacts on the child sexual abuse cases and also helped in the understanding about the negative impacts on the life style. It should also be highlighted that the preventive measures and the ideas regarding prevention and awareness development have been discussed in the literatures as well. However, the impacts of the preventive measures have not been properly highlighted in the studies. The literatures effectively pointed out the influencing factors of the child sexual abuse and the possible processes that can change the situation for the country has been identified in this review. However, the in depth research should be conducted for better understanding. Thus, in this situation the children needed to be take care of themselves or they are put under some known people to be taken care of. In this situation, the lack of awareness regarding the consequences and psychological issues of some people makes the children vulnerable and the negative sexual or other kinds of abusive situation develop for these children.
Summary of Key Points
The urbanization and the unstable economic flow in India still encouraging the child labor situations and these children who are working in different shops or other places far from their home or the orphan children as well are vulnerable to the physical and mental along with sexual abusive situations. Furthermore, in India the norms of accusing the victim and also developing a negative impact of neglecting or covering the sexual abuse incidents lead to the non-reporting of the child sexual abuse incidents immediately. The children who are abused mostly hide the incidents and bear with the trauma of mental and physical burden.
• How economic inequality as well as rapid urbanization contributes towards child sexual abuse in India?
• What preventive strategies have been implemented in India for preventing incidence of child sexual abuse?