(Key messages: European report on preventing child maltreatment, World Health Organization 2013)
Child maltreatment is the physical, sexual, emotional abuse and/or neglect of children younger than 18 years.
Child maltreatment leads to the premature death of 852 children under 15 years in the European Region every year. Not all deaths from maltreatment are properly recorded and this figure is likely to be an underestimate.
National policies and practices on maltreatment vary between countries, making it difficult to take a regional view.
Analyses of community surveys from Europe and around the world have confirmed the extent of abuse in the community. They show a prevalence rate of 9.6% for sexual abuse (13.4% in girls and 5.7% in boys), 22.9% for physical and 29.1% for mental, with no real gender differences. Few studies have been done on neglect, but analyses of worldwide research shows that prevalence is also high − 16.3% for physical neglect and 18.4% for emotional.
18 million children suffer from sexual abuse
Applying these figures to the population of children in Europe suggests that 18 million children suffer from sexual abuse, 44 million from physical abuse and 55 million from mental abuse. Many cases of abuse warrants parental supportive interventions by welfare and family support services, rather than investigation by child protection agencies.
Consequences and costs of child maltreatment
Maltreatment may cause stress that affects children’s brain development, especially in the early years but also into adolescence. This can lead to cognitive impairment and the development of health-risk behaviours, harming mental and physical health.
The evidence for development of mental health, such as depression, anxiety, eating disorders, behaviour problems, suicide attempts, self-harm and illicit drug use, is strong and indisputable. Post-traumatic stress disorder has been reported in as many as a quarter of abused children.
Child maltreatment may be responsible for almost a quarter of the burden of mental disorders, especially in association with other adverse or negative experiences in childhood.
Cycle of violence
There is also a strong association with risky sexual behaviour and sexually transmitted infections, and emerging evidence for the development of obesity and other noncommunicable diseases. It affects schooling, leading to lower educational attainment and poorer employment prospects. The transmission of violence between generations, with violent behaviours passing from grandparents to parents to children – a phenomenon known as the “cycle of violence” – and the tendency for abuse victims to continue to suffer and inflict violence as they move through life are also long-term consequences of maltreatment in childhood.
Urgent need for better prevention
Emerging evidence suggests the economic and social costs are very high with heavy health care, social welfare, justice and lost productivity costs, perhaps running into tens of billions of euros: that is on a par with expenditure on noncommunicable diseases.
The extent of maltreatment, its far-reaching health and social consequences and high economic costs emphasize the importance of its prevention. There is an urgent need not only for services to lessen its consequences, but also for better preventive services.
Risc factors/Inequalities in the region
Child maltreatment is a leading cause of health inequality and social injustice. Poorer and disadvantaged populations being more at risk. Homicide rates in children below 15 years are more than twice as high in low- and middle-income countries in the Region than in highincome. Child death rates are several times higher in disadvantaged populations than wealthier communities. Children from deprived neighbourhoods are more likely to be admitted for assaults.
Child maltreatment is higher in countries in eastern Europe and in those with high levels of inequality and where there are few social safeguards to buffer families from economic stress.
Young, single and poor parents with low education levels may be more likely to maltreat their children. Parents’ mental ill health is strongly associated, as is alcohol and drug abuse in the family, parenting stress and poor parenting practice.
Risc factors are also: Intimate partner domestic violence, family conflict and poor family solidarity families in deprived communities, lack of “social capital” alcohol outlets, social and cultural acceptability of physical punishment of children, levels of inequality, economic stress and legislation.