Child sexual abuse &  its consequences: An overview of POCSO,2012 Act

Dr. Dipayan Sarkar
MBBS, DPM(MGIMS)
Modern Psychiatric Hospital, Narsingarh

Introduction
The UN convention on the Rights of the Child (UN CRC), ratified by India in 1992, urges states to ensure the right of children to protect from abuse, violence, neglect and exploitation . There was no comprehensive law before that . However India has recently adopted The Protection of Children from Sexual Offences  Act (POCSO),2012.  This expands the scope and range of forms of sexual offences, makes reporting of abuse mandatory and defines guidelines for child friendly police and procedures. Together with the Juvenile Justice Act, POCSO has created an opportunity to ensure greater protection to children that have suffered abuse.
India caters the largest child population (41%) in World under eighteen years age . There has been a steady   increase in sexual crimes against children.

Statistics on CSA in India :
In 2007, the Government of India published one report, which showed over 53% of interviewed children, faced some form of CSA.
Over 57% of those were boys.
About 72% said that they did not report abuse to anyone .
Only 3% reported CSA to child.
In another study, out of 2211 school going children  48 % of the boys and 39 % of the girls said to suffer from CSA.
Child sexual abuse is most often a diagnosis based on history, as opposed to physical findings.

Definition :
Child Sexual Abuse (CSA) refers to the involvement of  child in any sexual activity that:

• The child does not understand ;
• The child is unable to give informed consent to ;
• The child is not developmentally prepared for and can not give consent to ;
• Violates the norms of society ;

POCSO Act:

The Protection of Children from Sexual Offences Act, 2012 (POCSO Act)

• The POCSO Act came into force in November 2012 to provide protection of children from sexual assault, sexual harassment and pornography.
• The Act defines a ‘Child’ as any person below 18 years of age . It includes child friendly mechanisms for reporting, recording of evidence, investigation and speedy trial of offences through designated Special Courts.
• It defines different forms of sexual abuse, including penetrative and non-penetrative assault, as well as sexual harassment and pornography.
• It deems a sexual assault to be ‘aggravated ’ under circumstances like an abuse in mentally ill child, or when abuse done by a person in a position of trust or authority of the child, like a family member, police officer, teacher or doctor.
• Mandatory reporting: reporting is mandatory when any adult, including a doctor or other health professional who has the knowledge of sexual assault obliged to report to police, failing of which he/she may be punished with six months imprisonment and/or fine ( section 19 and 21).
• Reporting person should give the name and address of child, caregivers(if known), and describe nature of abuse along with the involved parties (if aware of them). However, doctor or health professional is not expected to investigate the matter and this part is left for police and other investigating agencies.

Under the POCSO Act,2012 any sexual activity with a child below 18 years, whether boy or girl is  crime.
As defined by the Act, sexual offences include penetrative sexual assault (Section 3), sexual assault (i.e non-penetrative) (Section 7) , sexual harassment (Section 11) , and use of child for pornography (Section 13 ).
Types of sexual offence under POCSO Act :

• Attempted or actual penetrative sexual intercourse with a child;
• Non- penetrative sexual activity, e.g rubbing the genitals;
• Fondling a child’s sexual parts;
• Oral sex with a child;
• Forcing a child to masturbate another person;
• Masturbating a child;
• The adult showing his or her private part to the child;
• Inappropriately watching a child undress or using bathroom;
• Photographing a child in sexual poses;
• The exploitative use of a child in prostitution or unlawful sexual practice ;
• Use in pornography;
• Showing pornography to child;
• Letting the child watch or hear an act of sexual intercourse;

Perpetrators:
It can take place even in the family- by the parent, step-parent, sibling of other relative. It is almost always by someone the child knows. Like friend, neighbour, childcare giver, teacher, etc.
Actually children are always innocent and they can be easily confused and in adolescent age they are  curious, rebellious and the perpetrators takes the advantage. Some high risk factors for CSA are isolation (such as children in institution, children on street, working children, children of families in transition, with disabilities, from dysfunctional families etc. )
Perpetrators uses a method called grooming by building trust with child and adults around the child in an effort so that the sexual act is not considered as offense or improper.
Consequences:
CSA leads to a range of physical as well as emotional/ mental health consequences. Affects may be for short duration or may appear after years together when the child becomes elder.
Physical symptoms are like sexually transmitted diseases, pregnancy, itching genitals, difficulty in walking or sitting, repeated unusual injuries, pain in urination /fedeacation, frequent yeast infection etc.
Behavioural symptoms are very important in view of personality development or future mental well being . There are  some definite  behavioural indicators  which are  difficult to assess at the correct time and  also difficult in the part of parents or even at the level of therapists. Most important is that there are sudden change in the behaviour without any specific reason.

Below some of the important behavioural  indictors are discussed:

1. Abrupt change in behaviour . 2. Refuses to physical examination. 3. Report of sexual involvement with an adult or child. 4. Excessive fear of specific places, men or women. Fearful or startled response to touching. 6. Recurrent physical complains without physiological basis. 7. Tendency to self-harm. 8. Wearing many layers of clothing regardless of the weather. 9. Poor peer relationships. 10. Eating disturbances. 11. Negative coping skills, such as substance abuse and/ or self harm. 12. An increase in irritability . 13. Disrespectful behaviour and aggression towards others. Poor school performance. 14. The child may hate his/her own genitals or want privacy in aggressive manner. 15. The child may dislike being own gender. 16. The child may carry out sexualised play.

Emotional affect:
Children who suffer from CSA often continue to suffer even after the abuse has ended. The affects of abuse may take the form of confusion, guilt, shame, fear, grief, anger, helplessness, depression .
Sexual abuse is an extremely traumatic experience that can affect body as well as mind at any level of age leading to moderate to severe mental health problem . These include anxiety, depression, Post-traumatic Stress Disorder, self-destructive behaviour, dissociation, substance abuse, sexual maladjustment, and a tendency towards re-victimization in subsequent relationships. The survivors of abuse are also more likely to suffer from heart disease, obesity , and other potentially fatal physical condition.
Disclosure of CSA is a process when child gives hints first and notices how the guardian react to that. Generally the adults try to suppress the matter in view of future of the child. This is the worst thing where the incidence goes to the inner suppressed mind which causes a bundle of mental illnesses . So it is always better in the part of the guardian to discuss the matter  with the child to prevent long term stress to the child .
How to prevent CSA:
Teach the child about personal space and privacy by 3 years.  Teach the child the concept of “OK ” and “NOT OK” touch and tell the child to inform is someone touches his/ her private part. Encourage the child not to keep secrets. Teach the child the appropriate names of the private parts so that they have the language to communicate. Talking to other colleagues about CSA.
Role of  the doctor :
Obtaining medical history in a non-judgemental and empathetic manner. They should do detailed examination to diagnose acute and residual trauma and STD and to collect forensic evidence. Doctor also should make differentl diagnosis for the condition . Assessing the child’s emotional and physical well-being and referring to appropriate authority in an essential part. They should formulate a complete report and testify in the court when required.
Medical examination is to be done preferably by a lady doctor in case of female patients, if available.
Doctor should give ampoules of time as the  child may be guarded for various reason. 
Consent:
According to the Indian Penal Code, if the child is above 12 years he/she can give consent and below that guardian may give consent.
Management:
Treat STD cases and other  injuries with appropriate medicines.
Consider for pregnancy and if needed start emergency contraception.
A referral to mental health specialist should be made in all cases. Mental health professionals should evaluate and treat acute stress reaction , and post traumatic stress disorder(PTSD).
As we have seen CSA is a major offence and cause for enormous mental health hazard this should be dealt very strictly. We have to discuss the topic in public and in mass media so that the perpetrators become warned and the victims also get more courage in understanding and reporting to the relatives and legal authorities. This also will help the parents and relatives to understand the behavioural consequences which are mostly preventable.
Lets make a child friendly environment in the aim of a prosperous  society.

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