violence against children WORLD REPORT ON - CRIN

54Violence against children in the home and familyNeglectNeglect is an important contributor to deathand illness in young children. Neglect meansthe failure of parents or carers to meet a child’sphysical and emotional needs when they havethe means, knowledge and access to servicesto do so; or failure to protect her or him fromexposure to danger. However, in many settingsthe line between what is caused deliberatelyand what is caused by ignorance or lackof care possibilities may be difficult to draw.The degree to which neglect influences childmortality rates in many parts of the worldis unknown (with exceptions, including the‘missing girls’ phenomenon; see below).Cases of neglect are difficult to interpret in circumstancesof poor public health and undernutrition.In some industrialised countries,neglect constitutes the largest proportion of childmaltreatment cases reported to the authorities.Studies in these countries confirm that forms ofviolence and neglect interconnect. 43 All of theRegional Consultations for the Study expressedconcern about neglect of children with disabilities;although there is little quantitativeevidence, it is known that these children are athigh risk of neglect, from deliberate withholdingof basic physical necessities to emotionalisolation and lack of stimulation.Research on sex differences in neglect inIndia suggests that girls suffer relatively moreneglect than boys throughout early childhood.They are breast-fed less frequently thanboys and for shorter duration; once weaned,they are given food of an inferior quality andquantity. 44 Girls are also taken to health servicesless often, and later in the course of anyillness. 45 A study from Nepal into outcomes ofpolio infection in the population found thatseveral years later, the survival rate of boys wastwice that of girls, despite the fact that polioaffects equal numbers of males and females,thus suggesting gender bias in care. 46 In China,the sex ratio is unbalanced in favour of boys(117 to 100), with this being contributed to byinfanticide. 47Sexual violenceThe WHO estimates that 150 million girlsand 73 million boys under 18 have experiencedforced sexual intercourse or other formsof sexual violence involving physical contact, 48though this is certainly an underestimate.Much of this sexual violence is inflicted byfamily members or other people residing inor visiting a child’s family home – people normallytrusted by children and often responsiblefor their care.A review of epidemiological surveys from 21countries, mainly high- and middle-incomecountries, found that at least 7% of females(ranging up to 36%) and 3% of males (rangingup to 29%) reported sexual victimisationduring their childhood. 49 According to thesestudies, between 14% and 56% of the sexualabuse of girls, and up to 25% of the sexualabuse of boys, was perpetrated by relatives orstep-parents. In many places, adults are outspokenabout the risk of sexual violence their childrenface at school or at play in the community,but rarely do adults speak of children’s risk ofsexual abuse within the home and family context.The shame, secrecy and denial associated