Canadian Academy Discover, Publish, Thrive
The global prevalence of child sexual abuse (CSA) ranges from 9.8% to 11.8%, with 1 in 5 women and 1 in 13 men having experienced CSA. In the Philippines, a national survey revealed that 17.1% of respondents aged 13–24 experienced sexual violence during childhood, with 3.2% facing forced sexual intercourse. Unlike most countries, more male than female victims were reported. From 2018-2022, there were 31,000 CSA cases managed by protection units in the Philippines, with an annual average of 6,200 cases. Laws enacted between 1990-2010 aimed to protect children from abuse, exploitation, and trafficking. Despite these efforts, challenges such as poor information dissemination, limited funding, lack of trained personnel, and the absence of a central oversight agency hinder effective prevention and management.
Studies on the legal processing of child sexual abuse (CSA) cases in the US, Australia, Kenya, and Zambia identified several factors that increase the likelihood of cases reaching court. These include the victim being female, the perpetrator being an older male, timely reporting, thorough police investigations, supportive caregivers, and multiple episodes of abuse. Conversely, cases involving younger children, close relationships between victim and perpetrator, inadequate disclosure, and insufficient evidence are less likely to reach court. In the Philippines, CSA cases proceed to court based on probable cause determined by prosecutors. Factors such as abnormal physical findings, timely evaluations, and self-referrals increase the likelihood of prosecution. In both the US and the Philippines, a significant portion of cases remain unresolved or result in acquittals due to various challenges, including trauma, fear of retribution, and inadequate legal processes.
Studies have shown that childhood sexual abuse (CSA) is linked to numerous psychological disorders, such as depression, anxiety, PTSD, social phobia, disruptive disorders, substance abuse, and suicide. The psychological effects of CSA can manifest many years after the incident, persisting into adulthood. Regional data, particularly from East Asia and the Pacific, indicate a significantly increased risk of mental health disorders and suicide among CSA survivors. In the Philippines, 28% of CSA survivors have suicidal thoughts and are five times more likely to attempt suicide.
CSA survivors are at a heightened risk of repeated sexual abuse, with a fivefold increased likelihood of experiencing subsequent sexual offenses. Nearly half of all survivors report recurrent sexual abuse, often due to avoidant coping strategies and body image issues. Factors such as sex, age at initial abuse, and psychiatric diagnoses influence vulnerability to recurrent abuse.
Survivors tend to have an earlier sexual debut, more sexual partners, lower birth control efficacy, more unintended pregnancies, and a higher likelihood of teenage motherhood. In the Philippines, CSA survivors are 12 times more likely to initiate sex early and nine times more likely to experience early pregnancy.
CSA survivors are also more likely to face criminal charges later in life, including sexual and violent offenses, especially among boys. They are frequently involved in physical and gang violence. Additionally, CSA negatively impacts academic performance, leading to more school absences, lower grades, and higher dropout rates, which can result in economic challenges and welfare dependence.
The comprehensive management of child sexual abuse (CSA) in the Philippines involves a multidisciplinary team, including police, medical doctors, mental health professionals, and social workers, ensuring continuous child protection and family support. The PGH-Child Protection Unit (PGH-CPU) offers medical, psychiatric, social, and legal services and has set a standard in multidisciplinary CSA care for nearly two decades. The PGH-CPU also trains professionals in non-traumatizing interview techniques. Despite limited local data on CSA outcomes, a study aimed to document changes in CSA cases at PGH-CPU, identify determinants for cases reaching court and obtaining guilty verdicts, and examine factors influencing legal actions and long-term outcomes of CSA survivors.
We used a mixed transdisciplinary design, combining quantitative and qualitative methods, based on a prior assessment of CSA outcomes at PGH-CPU (Sugue-Castillo, 2009). The quantitative component analyzed associations between selected determinants and legal and biopsychosocial outcomes among survivors. A case-control design studied factors influencing CSA cases reaching court and obtaining guilty verdicts, while a retrospective cohort design examined secondary biopsychosocial outcomes and follow-up effects with PGH-CPU. The qualitative component included interviews with expert key informants, parents/guardians, and CSA survivors to understand the processes influencing the filing and prosecution of CSA cases. Eligible participants were CSA survivors from 2009-2013 who met specific criteria. Expert informants were selected based on their extensive experience in CSA cases within Metro Manila. Informed consent and assent were obtained from all participants and key informants.
Over the past decade, the number of CSA cases handled by the PGH-CPU has increased, raising awareness about proper reporting and management. Despite this, the number of cases reaching court remains low. To address this, the PGH-CPU should enhance legal education for clients and collaborate with legal service providers to increase access to legal support. Financial challenges for families in filing cases can be mitigated through financial support and advocacy for reducing costs.
Reviving the role of court-appointed special advocates could help support children through the legal process. Improvements in how CSA cases are handled in court, such as reduced emphasis on physical findings and better handling of children’s testimonies, have been made through training for court personnel. Continued training for law enforcement and prosecutors is necessary for further progress.
The PGH-CPU’s multidisciplinary services are crucial for CSA survivors, improving legal and psychosocial outcomes. Scaling up these services and institutionalizing them is essential. High rates of mental health issues and teenage pregnancies among survivors highlight the need for accessible mental and reproductive health services. These should be prioritized in public health facilities to achieve universal health coverage.
The PGH-CPU’s experience suggests that a collaborative, multidisciplinary approach is effective in managing CSA. Collaboration with the judicial system and updating the knowledge of professionals involved in CSA cases are crucial. Providing survivors with support and guidance through the legal process and addressing their biopsychosocial needs are key to improving outcomes.
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