29 Aug 2011

The Child - A Traumatized Victim

- By Jaya Aiyappa * 

"My mom would drop me off in the evening with her older sister (my aunt) to spend the night while she would go out. In most cases, this would be a safe haven babysitter for a child, Right? Wrong! My cousin was 18/19 years old at the time and addicted to drugs. In the small house in which they lived, I was always put in the cousin.s bed to go to sleep prior to him getting home from a "night out". I vividly remember the first time it happened. I went to bed, asleep by myself - 6 years old - only to be woken up by being raped by my cousin. I remember having my face shoved into a pillow so my screams and cries for help wouldn.t be heard by anyone. When it was over, I was told if I ever mentioned it to anyone, he would kill me - and I believed him."

I was eight when it happened. My older brother had made a bet with me and I won. He said I got to pick a dare. I thought it would be funny if I saw his underwear and sung the song "I see London, I see France, I see your underpants". He said we'd do it later. Next thing I know he's in my room when I was getting ready for bed and he said I'll show you mine if you show me yours. I said ¡°that's not fair, but he insisted I do it, and I did. The next night he came in my room while I was in bed and he reached down my pants touching me. I kept my eyes shut because I thought it would help me escape. For many weeks it would happen sometimes randomly, but then every night. He touched me, and took my hand and made me hold and stroke his penis"

These are not random cases of CSA that have been mentioned. CSA is prevalent not just in India but all around the world in alarming figures. According to the first ever National Study on Child Abuse in April 2007, covering 13 states in India and a sample size of 12,446 children, a disturbing number of 53.3% children reported sexual abuse. The survey also found that boys and girls were equally at risk. The most frightening aspect was that 50% of the abusers were known to the children and the children trusted them. 

Stages of Child Development

According to Erickson psycho social stages of development the child passes through various stages which help him to become mentally and emotionally strong as an adult. The major developmental task in infancy (0-1year) is to learn whether people, especially primary caregivers, regularly satisfy basic needs. If caregivers are consistent sources of food, comfort, and affection, an infant learns trust- that others are dependable and reliable. If they are neglectful, or perhaps even abusive, the infant instead learns mistrust- that the world is an undependable, unpredictable, and possibly dangerous place. From 2-3 years if caregivers demand too much, ridicule early attempts at self-sufficiency, children may instead develop shame and doubt about their ability to handle problems. During 4-5 years the children are realizing for themselves if they are good or bad and may develop guilty feelings for actions for which they feel they are to blame. The later stages (6-11 years), help the child develop a sense of worth self confidence, a sense of loyalty, his identity and purpose in life (12-19 years). However these ages are not fixed and can overlap and gratification in each stage effects the development of the other.

Any trauma or distress during any of the stages can result in the child being maladjusted or having a problem in some sphere of his life. CSA always impacts a child but in varying degrees. Childhood is the stage when our personalities and beliefs are being formed and any trauma at this stage does impact the psychological and emotional development. No child can be unaffected by the abuse. However not all are affected to the same degree. A child who is severely abused over many years may be affected differently from a child who has been abused once. Also a child who has been abused by a person whom he trusts and loves would be affected differently from a child abused by a stranger. 

Indicators of abuse 

There is no one single identifiable sign or symptom that all children will have. They may have very subtle or very pronounced symptoms. Most often the abusers are known to the children so there is little or no use of force. Hence the physical evidence of abuse becomes difficult to spot. There may be urinary infections, bleeding from the vagina or anus, STDs, pain in genitals specially during urination, difficulty in walking or sitting, throat infection (due to oral sex) or pregnancy. 

Behavioural changes in the child may be subtle or very prominent but will always be there. Children often do not tell with words that they have been sexually abused. Usually a child hardly talks about his abuse and even if s/he does, no one takes him seriously and that further creates more problems in the child increasing his feelings of shame, guilt and the feeling that he is responsible for the abuse. A child could show any of the followings symptoms, but having any, does not necessarily mean the child is abused. The reason for the behaviour must be explored. 

  • Waking up in the night screaming, nightmares or other sleeping problems 
  • Showing an unusual fear of certain people, places or things 
  • A reluctance to be with a certain person 
  • Loss of appetite or trouble eating, eating disorders 
  • Fear of the bathroom 
  • Excessive crying, depression, anxiety 
  • Mood changes, anger outbursts or withdrawal or fear 
  • Becomes worried when clothing is removed 
  • Wearing layers of clothing to hide injuries or provocative clothing 
  • Knowledge of sex which is age inappropriate 
  • Imitating sexual acts with other children or toys, such as dolls 
  • Withdrawing from activities they used to be involved in 
  • Academic problems 
  • Lowered self esteem 
  • Symptoms of Post Traumatic Stress Disorder such as panic attacks 
  • Regressive behaviour like bedwetting (after being potty trained) 
  • Having new words for private body parts 
  • Excessive masturbation, addiction problems.

Any sudden changes in the behaviour of the child along with physical symptoms must be taken seriously and is a warning signal. It is necessary for the primary caretaker to be vigilant and alert to any changes in the behaviour of the child and also to be aware of what the child may be trying to convey verbally though indirectly.One common feeling that most children and adolescents have is of guilt and shame. Children usually feel a sense of guilt over the abuse that occurred. It is important to remember that under no circumstance is the child ever responsible for what happened to them. There is a sense of betrayal as the abuse is often by a person whom they trust and love. It is crucial that "re- victimization" does not happen. 

Some ways a child can be re- victimized is by saying to the child: "Uncle, or Grandpa would never do that to you, why are you lying?" or "It couldn't have been that bad or you would have told me sooner". 

The Silent Problem 

As we can see that the children are traumatized so why is it that they still don.t tell and talk about their abuse. Especially in India, the children are taught to respect their elders come what may, the elders know what is good for you and they are never wrong. 

Other reasons why the children keep quiet is because of their relationship with the offender, they do not want to put the abuser into trouble, their sense of loyalty towards the abuser or at times even to protect another who is not an abuser. The child is confused between the behaviours of the adult who is caring at times and abusive otherwise and hence cannot distinguish who the real adult is. Abusers may offer a combination of gifts and threats about what will happen if the child refuses or tells someone. Threats include physical threats or what will be lost in the form of family breaking up. The child.s fear is played upon by the abuser. At times the child may experience a physical pleasure or arousal and this confusion makes it difficult for the child to speak up. Very often the child thinks he is to blame for being bad and is being punished this way. He is too ashamed or embarrassed to tell anyone. He feels no one will believe him. The reasons may differ depending on the age of the child at the time of abuse and who the abuser is. 

Consequences of CSA 

Child sexual abuse victims usually carry this trauma with them for the rest of their lives. Depending on the seriousness, duration and type of abuse, the effects can vary in intensity but mostly do affect all victims in some aspect of their lives and are manifested in psychological, social, sexual or physical problems. ¡°I realize that I build walls between myself and people who love me, including my wife - it's the only way I know to protect myself from getting hurt. I don.t know how to let someone love me. My wife has gotten tired of running into that wall. I realize that the long term affects of child abuse has caused me to form defensive personality traits which make it difficult to have adult relationships. I feel as though I am damaged, I have no self esteem / confidence, everyone else is "better" than me. My life has been moulded by the abuse and hurt I suffered as a child and I make those around me miserable as a result.

Psychologically the person can report panic attacks, depression, fears, panic attacks, sleeping problems, nightmares, irritability, outbursts of anger and sudden shock reactions when being
touched. They have low self esteem and little confidence and respect in themselves. They may resort to self destructive behaviours like addictions, prostitution. Socially they are not able to trust others and do not have satisfying relationships. They may deliberately get into relationships where they will be abused as they see themselves as .damaged goods.. Sexually they may not want to be touched as it brings back memories, or have problems with pain and orgasms or be averse to any particular act like oral sex. This affects relationships as the partner does not understand what is happening. 

Many psychosomatic illnesses may occur which could include eating disorders, inexplicable aches and pains and may suffer from post traumatic stress disorder. 

Role of a Trusted Adult 

The foremost thing that an adult can do is to believe the child. Children rarely make up stories about sexual abuse. However vague or imaginative the narration may be, the child is entrusting you with a part of himself that is sore, painful and terrifying and embarrassing. Let the child know that you are willing to listen patiently to whatever the child has to say however painful it may be. Here is a person the child can trust, feel understood and not betrayed. Validate the child.s feelings of anger, pain, fear, helplessness as the child needs to express them and be heard. Be genuine in your response even if it is of outrage but do not make your feelings overwhelm the child.s. If for some reason you are unable to handle it and are extremely upset or defensive, it may be from a feeling you have repressed from the past, in which case you can encourage the child to speak with someone else whom they see as trustworthy. 

Most importantly, view the person as someone strong who has come for help rather than as a victim. 

It is important for the child to be helped to overcome the abuse by trained professionals who in an unthreatening atmosphere help the child to regain control over his life. This is done through various play methods or through the creative arts like dance, drama or drawing. No child should be made to go through the trauma and suffer all his life for a fault which is not his. 

Parents/teachers need to educate the child about CSA, how to prevent it and what the child needs to do. They need to be given age appropriate sex education and explained about appropriate touch and inappropriate touch. 

Remember - No child seduces an abuser. Children ask for attention and affection not abuse. 

* - Mrs. Jaya Aiyappa completed her MSW from Delhi University. Since 2008, she has been working with the Women Graduates Union as a counselor. In her position she handles personal counseling and individual clients as well as conducts Workshops and Seminars for men, women and adolescents.

22 Aug 2011

Medical Procedures and Protocols in Child Sexual Abuse

By Dr. Chhaya Prasad *

As far as the clinical aspect is concerned, a child is defined as one who is less than 12 years of age for obtaining medical care in a Government health facility in India. A request from Indian Academy of Pediatrics to increase the age limit up to 18 years is still under consideration by the Government of India. As the context here is child-rights and child abuse, the legal definition of the child, by age, is important. During the initial census of India, persons below the age of 14 years were defined as children and most of the Government programs on children are still targeted for the age group below 14 years. Thereafter, the UN Convention on the Rights of the Child, 1989 (Article I) defined the child as below 18 years of age. 

In India, the legal definition of child varies from seven years to eighteen years of age, but after the introduction of the Juvenile Justice Care and Protection of Children Act, for all practical purposes, a child is considered as a person below 18 years.

1. The Juvenile Justice (Care and Protection of Children) Act, 2000: “Juvenile” or “Child” means a person who has not completed eighteenth year of age.
2. Family Law (Child Marriage Restraint Act, 1929): „Child. means a person who, if a male, has not completed twenty one years of age, and if a female, has not completed eighteen years of age.
3. Criminal Law (Indian Penal Code, 1860): Nothing is an offence which is done by a child under seven years of age (Section 82). Nothing is an offence which is done by a child above seven years of age under twelve, who has not attained sufficient maturity of understanding to judge the nature and consequence of his conduct on that occasion (Section 83).
4. United Nations Conventions on the Rights of the Child, 1989 (Article I): A child means every human being below the age of eighteen years unless, under the law applicable to the child, majority is attained earlier.
5. Constitution of India, Article 24: Any one below the age of fourteen.
6. The Child Labor (Prohibition and Regulation) Act, 1986: „Child. means a person who has not completed his fourteenth year of age.

Definition of Child Sexual Abuse According to the World Health Organization (Used by Medical practitioners for all practical purposes) 

Child abuse or maltreatment constitutes all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child.s health, survival, development or dignity, in the context of a relationship of responsibility, trust or power (WHO 1999).

Physical abuse of a child is that which results in actual or potential physical harm from an interaction or lack of interaction, which is reasonably within the control of a parent or person in a position of responsibility, power, or trust. There may be single or repeated incidents (WHO 1999). Any non accidental injury resulting from the following actions done with intention to harm a child - punching, hitting, throwing, kicking, chocking, biting, shaking, heating and burning with an object, scalding, banging, etc. 

Child sexual abuse is the involvement of a child in sexual activity that s/he does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violate the laws or social taboos of society. Child sexual abuse is evidenced by an activity between a child and an adult or another child who by age or development is in a relationship of responsibility, trust or power; the activity being intended to gratify or satisfy the needs of other person. 

This may include but is not limited to: 

  • The inducement or coercion of a child to engage in any unlawful sexual activity
  • The exploitative use of a child in prostitution or other unlawful sexual practices
  • The exploitative use of children in pornographic performances and materials (WHO, 1999).

At the expense of a child, the involvement of the child in sexual activity intended to gratify the needs of another person: inappropriate kissing, unnecessary touching either directly or through clothing the private body parts of a child for reasons other than hygiene or health care purposes, fondling, exhibitionism, voyeurism, vaginal, oral and anal intercourse, pornography incest, rape, etc. 

Emotional abuse includes the failure to provide a developmentally appropriate, supportive environment, including the availability of a primary attachment figure, so that the child can develop a stable and full range of emotional and social competencies commensurate with his/her personal potential, and in the context of the society in which the child dwells. There may also be acts toward the child that cause or have a high probability of causing harm to the child.s health or physical, mental, spiritual, moral or social development. These acts must be reasonably within the control of the parent or person in a relationship of responsibility, trust or power. Acts include restriction of movement, patterns of belittling, denigrating, scapegoating, threatening, scaring, discriminating, and ridiculing.

Child abuse is a misuse of power by adults over children that endangers or impairs a child.s physical or emotional health and development. Here we are referring to all kind of abuse, physical, sexual or emotional abuse. It is commonly believed that child abuse is a problem of lower socio-economic class and happens to vulnerable children staying in unsafe places but the truth is that most of the abuse occurs to normal children in regular homes. An episode of abuse can occur anywhere, at home, in streets, public places, foster homes, schools, etc. All children can be at risk, whether they are normal children or the vulnerable group. Vulnerable group includes destitute children, orphans, abandoned children, street children; HIV/AIDS affected children, child beggars, substance/drug abusers, child laborers and neglected children. Children of poor parents or with physical, mental or terminal illness, children with a single parent, children of refugees, migrants, construction workers and of prostitutes, rape victims, sex workers also form a part of the vulnerable group. The abusers can be parents, care-givers, teachers, neighbors, family members, frequent visitors, strangers, employers etc. Parents turn abusers if they are immature, have poor parenting skills, personality disorders, mental health problems,
social pressures, are victims of domestic violence, when they single parents or are substance abusers. 

Pediatrician's Response 

A pediatrician's response to a case of child sexual abuse in outpatient and inpatient settings is based on the following cardinal principles. 

1. Child centered and child friendly: It keeps the best interest of child in mind. Safety of the child is considered to be of utmost importance. 
2. Family supportive: Response should provide adequate support to the family as family forms the backbone of the child protection system. Keeping the child permanently in an institution is the last option in child protection. 
3. Provision of legal safety to the Pediatrician managing the caseThe management and documentation of the case should be impeccable to avoid professional litigation later. The goal of a pediatrician.s response includes:

1. Short term goal is to ensure safety and provide emergency care if needed.
2. Comprehensive medical assessment including history taking, examination and investigations. To ensure proper documentation.
3. Short term goals include providing immediate emotional (counseling) and social support to the child and family and treating physical problems like injuries, providing immunization, STD prophylaxis and emergency contraception.
4. Long term goals include complete physical and psychosocial well being of the child as well as ensuring reintegration into the family and social system.

When a child is brought with history of unexplained injury or a genital infection, a high index of suspicion should be kept in mind. A detailed medical and social history, including presenting symptoms is mandatory. Any history of fall, fracture or injury (including head injury), unexplained bruises, redness, poor growth and stunting, recurrent UTIs or abdominal/ perineal/ anal pain and mouth and genital sores or discharge should be noted. 

Behavioral History will include:

  • Fear of certain people or places, nightmares, trouble sleeping, or other extreme fears without an obvious explanation.
  • Loss of appetite, or trouble eating or swallowing or sudden changes in eating habits.
  • Sudden mood swings: rage, fear, anger, insecurity or withdrawal, unexplained abdominal pain.
  • Bed-wetting or thumb sucking, adult-like sexual activities with toys or other children, new words for private body parts, resistance to bathing, toileting, or removing clothes.
  • Talking about a new older friend.
  • Inconsistency in history, complaints not correlating with physical findings, previous or repeated similar injuries / complaints of illness but delay in seeking medical help.
  • Circumstantial evidence should be noted.

Comprehensive Medical Assessment The presence of a chaperone, preferably a nurse is a must during the assessment. The assessment should be recorded in a special Performa. History taking from the parent or caretaker should be documented separately from that of the child. History should be taken with a sensitive, empathic and nonjudgmental attitude and recorded verbatim. Repeated interviews are avoided. The child and the parents are to be treated with respect and dignity without making accusations. Points to be covered in history include place, time, witness, present and past history, noticeable behavior change, developmental and immunization history. Family history, pedigree chart and social history are extremely important. 

A psycho social history known by the acronym HEEADDSS can be taken directly from an adolescent patient. This includes details regarding home, education, eating behavior, activities and peers, drugs, depression, suicide, sexual history and sleep pattern. To make a final conclusion after discussing the case with seniors, peers, psychologists and probably even NGOs and social worker. 

The responses of a pediatrician to a child abuse case can be broadly classified into the following:

1. Urgent response is needed if the child is brought dead or with a life threatening injury or with acute sexual assault (reports within 72 hours of the abuse). The child will need emergency care and the police would require immediate forensic samples to book a strong case against the abuser. Such cases are best managed in a government hospital setting.

2. Admission to the hospital is needed in all cases of serious injuries. A child may be admitted incase it is felt that there is an immediate threat to his safety at home.

3. Social Services like Child Welfare Committee (CWC) and Child Helpline (#1098) or local NGOs to be contacted if the parents refuse to follow the treatment plan or if there is an immediate threat to safety of other sibs. CWC and Child Helpline can also be contacted in any case where child rights are violated like neglect, child labor, corporal punishment at school, child marriage etc.

4. Planned response is the best. Here a planned interview and examination are performed in a child friendly atmosphere with the appropriate equipment and health personnel (social worker, psychologist, gynecologist if needed). A child friendly atmosphere is one that is sensitive to the needs of the child, where he/she feels comfortable, relaxed and at ease to confide his problems.
Examination Parental and (preferably) the child.s consent are essential for a medical examination. The child may prefer to get examined by a doctor of the same sex. He/she may also choose to have a trustworthy adult during the procedure. The pediatrician may seek the expertise of a forensic physician and a gynecologist while examining a case of sexual abuse. 

The following should be recorded:

1. Resistance to examination, especially in a case of sexual abuse and dissociation (going to sleep during examination)
2. General demeanor (like unkempt appearance in neglect)
3. Vitals and tip-to-toe general physical examination, especially noting pallor, bruises, vitamin deficiencies
4. Height, weight and head circumference to be plotted on growth chart
5. Sexual Maturity Rating for adolescents
6. All injuries are to be marked on anatomical diagrams. Special sites to look for injuries include ears, inside the mouth, soles, genitalia and anus.
7. Systemic examination is done especially to look for other injuries.
8. Examination of genitalia in girls should be done in supine frog leg, knee chest prone and left 
lateral position. 

Details of hymen and injuries are to be noted. If possible, photographic evidence to be recorded. Anal dilatation on a rectal examination indicates sodomy. Presence of discharge, genital ulcers, warts and inguinal lymphadenopathy are to be noted. It is important to note that in 70-85% cases of documented sexual abuse, the physical examination is normal. Examination of clothes of victim for semen stains, struggle tears, trace material etc. should be done.
Investigations The following investigations need to be done. 

Sexually Transmitted Disease screening, including low and high vaginal (in post pubertal girls) swabs and urethral swabs in boys and serology for HIV, Hepatitis B and Syphilis are done in cases of:

  • Acute sexual assault
  • Penetrative abuse
  • Vaginal/ urethral discharge
  • STD in abuser
  • Pregnancy test is done for an adolescent girl

Forensic samples maintaining the chain of evidence include skin, hair, clothing, saliva, oral and genitourinary secretions are sent in cases of acute sexual assault. Skeletal survey can be done to explain associated multiple unexplained injuries. It is mandatory if the abused child is below 2 years. Multiple bruising entails a detailed hematological profile, including bleeding and coagulation profile. Neuro imaging and Ultrasonography of abdomen are indicated in a case of head and abdominal injury respectively. 


Management should be child friendly and should aim at achieving the short term and long term goals. The current and future plans of action should be discussed with the non offending family members. The need for breaking immediate contact with the abuser if he/she is a known person should be emphasized.

1. Accelerated Hepatitis B vaccination schedule(0,1,2, 12) should be considered if the sexually abused child is not vaccinated. DPT/ DT vaccination should be given in non vaccinated children.

2. STD prophylaxis and Emergency Contraception is to be given to an adolescent with acute sexual assault.

3. Multiple types of abuse may co exist in the same patient and should be looked for. Counseling of the child and family forms the corner stone of the management.

The immediate counselling of the child that can be done by the paediatrician focuses on the following:

1. Believe the child, reassure and absolve feelings of guilt/ blame.
2. Explain about the existence of a medical, family and social support system.
3. Listen carefully to all fears and concerns associated with disclosure.
4. Teach coping and assertive skills.
5. Referrals to appropriate specialties should be made according to the need of the child. 

These will include psychologist, psychiatrist, orthopedic surgeon, surgeon, social services and police. The family members may also need counseling and treatment from mental health professionals.

Medicolegal Aspects: Documentation and Reporting 

Most victims of child abuse are brought directly to hospitals, usually Government hospitals, for medical examination by police. They may be accompanied by Social worker (NGO), but at times are brought by parents / guardians. At times, there can be incidental recognition of child abuse when they are brought for some other medical problem for consultation. The child can also be brought merely for age determination. At present there is no uniformity in text of report, method of examination or prescribed format for documentation. 

Different states follow different practices depending on local laws and procedures. Medical examination is done in a routine matter without proper clinical or forensic screening. Swabs and slides are taken only in sexual assault cases without giving due importance to minute details and injuries. Age determination, which is mandatory as per the Prevention of Immoral Traffic Act, is done only on request and done only in few hospitals. Age range given in reporting is too wide, which often goes against the victim and favors the accused. 

How and what should be documented 

All consultations with the patient should be in hand written notes, with diagrams, body charts, and if possible. 

During examination of a case of sexual abuse, the police need to be informed and consent is a must. Complete examination is necessary. Evidence collection (specimens) is to be done and samples are carefully preserved in refrigerator or suitable place. Photographic documentation should be done wherever possible. It should be understood that both age determination and complete examination requires multidisciplinary references. Their opinions either in person or telephonically should be recorded.

The examining doctor should make sure that important details are not omitted. All aspects of consultation should be documented and detailed notes must be made during the consultation, Patient.s records have to be kept strictly confidential and stored securely. The documentation should be confined to areas of health care expertise only; interpretation of the same has to be
done by a trained person if the examining Medical Officer is not trained in examination of medico-legal cases. 


Consent is a voluntary agreement, permission or compliance, it may be

1. Expressed,
2. Implied or
3. Written.

In other words, according to Section 13 of the Indian Contract Act, two or more persons are said to consent, when they agree upon the same thing in the same sense at same time. 

Follow up 

Follow up after 2 weeks is essential to reassess the child. In acute sexual assault of an adolescent girl, a repeat pregnancy test is warranted. A repeat serology for syphilis at 4-6 weeks and for HIV at 3-6 months is required. The long term after-effects of abuse on the physical and mental health are well known, but some children suffer no adverse consequences. 

The outcome is influenced by the following factors:

  • Nature, extent and type of abuse
  • Age of child, temperament and resilience of the child, relationship of abuser to the child
  • Response of the family to abuse and medical management

A single episode of non contact sexual abuse by a stranger may just need reassurance and letting out feelings in one or two counseling sessions. It usually has a good outcome. Prolonged abuse by a close family member requires longer and multiple counseling sessions to heal completely. 

Regular follow up of the abused children includes the following: 

1. To verify if abuse has stopped. 
2. To monitor physical and mental health. 
3. To evaluate development and ensure that it is normal. 
4. To refer for therapy (counseling, cognitive behavior therapy or medication) for delayed presentation of symptoms. 

Child Protection Services

The Existing Services are CHILDLINE, Child Welfare Committee, Local NGOs, National Commission for Protection of Child Rights, and the Police. There is need for a Child Protection Group for Comprehensive Services that includes a Pediatrician, Psychologist, Psychiatrist, Gynecologist, Surgeon, Forensic Expert, Social Worker, Police, and Lawyer. (Source: WHO, UNICEF, CRY, CSWB, DWCD document – 1st National Conference on Child Abuse for Multidisciplinary Professionals in Feb. 2004, Chennai organized by ICCW, Chennai and SRMC, Chennai, Manual on Recognition and Response to Child Abuse: The Indian Scenario, IAP) 

* - Dr Chhaya Prasad is a Developmental and Behavioural Paediatrician, at the Govt. Regional Institute for Mentally Handicapped, Chandigarh. She recently successfully completed her post graduation in Developmental Neurology from the Kerala Univesity.

15 Aug 2011

An opportunity to make a lasting change

"I dream of joining the police to help unfortunate girls like me stand on their feet again." These are the words of an innocent 20 year old girl who saw the light of justice 6 years after being a victim of rape and flesh trade. The story of Neha is no ordinary narration.

On 23rd February, 2006, CHILDLINE Ahmednagar received a call from an anxious father to report a complaint for his missing 14-year old daughter. In September 2010, the District and Sessions Court judge Makarand D. Keskar convicted the accused under section 376(2)(g) gang rape, 120(b), 376(rape), 120(b) and section 5(a)(1)(d) of the Prevention of Immoral Trafficking Act (PITA) and 366 (kidnapping).The convicts were given double life terms.

CHILDLINE was largely instrumental in the conviction of 20 high profile individuals exposed for their participation in a brutal case of gang rape, trafficking and commercial sexual exploitation and received the much deserved accolade and appreciation from various NGOs, Police and the Media for successfully carrying out this case.

It has been a great year for CHILDLINE. We have extended our service from 83 to 162 cities/districts since December 2010 and aspire to reach out to many more in the next few months. CHILDLINE remains single mindedly focused in its endeavour to be present and accessible to all children across all 596 cities/districts of India.

Today, after 15 years of our existence, having responded to 18 million calls and rescued 8 lakh children, we stand proud. We have managed to contrive and sustain relationships with corporates and individuals who have become an integral part of the CHILDINE family. Each one of you has helped us move forward in achieving our set goals.

Once again, we seek your assistance in raising sustainable funds for our project titled ‘Rescuing a child is just a phone call away’. Your support ensures that we are able to continue reaching children and providing them a safer haven.

Support us and to know more visit

Thank you.
CHILDLINE India Foundation 

8 Aug 2011

Police Procedures and Protocols in Child Sexual Abuse Cases

By Trishla Jasani & Sneha Kupekar 
(Edited by Sheela Sail- DCP Enforcement, Mumbai Police) *

1. Receipt of Information Under Section 154 of CRPC a complaint of any cognizable offence can be made telephonically or through an application or in person by the victim or a person familiar with the facts of the case. If the victim is present at the time of lodging a complaint, then the FIR can be filed immediately. However, if the complaint is made by a third party or telephonically or through an application, then the police firstly visit the place of occurrence and speak with the victim to ascertain the facts of case and then record the FIR. If the complaint is lodged out of jurisdiction, then the FIR can be filed and then transferred to the relevant police station. 

2. Registration of FIR The child victim is interviewed by a police officer, sometimes in presence of a social worker. A lady officer/constable is present throughout all the process if a female victim is involved. If a lady constable is unavailable then the police have a list of NGO?s, Social Workers, Doctors and the Mahila Dakshata Committee through which a lady witness is made available. If urgent medical/ psychological attention is needed, then it has to be done before the FIR is registered. However, a precise station diary entry has to be made. While filing an FIR, it is important to ensure that all the ingredients mentioned in the relevant section of the IPC and other acts are recorded in the FIR. 

First Information Report (FIR) 

First Information Report (FIR) is a written document prepared by the police when they receive information about the commission of a cognizable offence. It is a report of information that reaches the police first in point of time and that is why it is called the First Information Report. 
Anyone can file an FIR as long as they have knowledge about a cognizable offence. When an oral report of an offence is given, the police are required to write it down and read it back to you if you want them to. The FIR must be signed by the person giving the complaint. It is your right to get a copy of the FIR free of cost. If it is not given to you please ask for it. The FIR must include the name and address of the person filing the complaint, date, time and location of the offence, true facts of the incident and names and descriptions of people involved as well as witnesses. 
Please ensure that you never make a false complaint, give wrong information, exaggerate or distort facts or make unclear or vague statements. 

In the case that your FIR has been refused or not lodged you may write a complaint to the Superintendent of Police, file a private complaint in a court having jurisdiction. 21 

3. Concurrent action to be taken at the time of registration of FIR Steps that are taken after a complaint is lodged : 
1) FIR is registered 
2) A separate team takes the victim to the hospital 
3) Another team is sent to the place of occurrence 
4) A team is sent to pursue the offender 
5) If the accused is absconding, neighbouring police stations are informed 
6) Either manually or computer generated sketch of the accused is dispatched 
7) In case of serious offences, immediately all the details are conveyed to the control room, so that the information can be relayed throughout all the police stations in the city 
8) If required legal aid is offered. 

4. Medical examination of the Victim This usually takes place at government hospital. The medical officers are instructed to immediately arrange for this examination as soon as requisition is received. A lady has to be present at the time of the medical examination of the victim. Consent has to be obtained, along with a signature of a witness. The victim of 12 years and above is eligible to give valid consent for such examination. However, if the child isn?t in the mental state to give the consent, then the guardian?s signature is obtained. An FIR is not required for conducting the medical examination. 

5. Examination of place of occurrence Immediate visit to place of occurrence is necessary for collecting physical & oral evidence. A police team is deputed to ensure that the evidence isn?t tampered. After that, collection of the physical evidence like samples of blood, sperms, pubic hairs, nail clipping, clothes on body for forensic tests is done & panchanama is drawn. The police officers will also gather other information including statements from witnesses & also about the alleged offender. 

6. Medical examination of accused The accused is examined for collection of physical evidence. 

7. Role of Child Welfare Committee Production of child victim before CWC is important. Parallel enquiry is conducted by the probation officer, who submits enquiry report to CWC which help the police to investigate the case. CWC keep a child in protection home if he/she is in need of care & protection. Child guidance clinics provide necessary counseling and other services for the protection of the child. 

8. Submission of the charge sheet. All evidence relating to the IPC sections mentioned in the FIR has to be submitted along with the charge sheet. FIR, panchanama, witness statements, medical experts opinion, forensic experts opinion are the primary documents of evidence. If the accused is already in police custody, then the charge sheet has to be submitted within 60/90 days depending on the Penal Section, otherwise the permission of the court has to be obtained for extension. The evidence & statement gathered by the police will be reviewed by the Public Prosecutor. He will decide whether there is enough evidence to file charge sheet. The documents on which the public prosecutor is relying will also be provided to the accused. 

9. The Role of Media  Disclosure of identity of the rape victims is an offence U/s 228 (A) of the Indian Penal Code. Under trial offences should not be given exposure in media as it creates negative impact. Media should be used to make public awareness & to create fears in the minds of wrong doers. 

* Mrs. Sheela Sail is the present Deputy Commissioner of Police, Enforcement, Crime Branch, Mumbai City, Maharashtra. She has 10 years experience as a police officer and 7 years experience as a research officer. 

* Trishla Jasani was  working as a Consultant Program Coordinator at CHILDLINE India Foundation. 

* Sneha Kupekar is currently working as Assistant Program Coordinator at CHILDLINE India foundation.

1 Aug 2011

Role of the Child Welfare Committee

By Trishla Jasani*

As per the provisions of the Juvenile Justice (Care and Protection of Children) Act 2000 (amended in 2006) State governments are required to establish a CWC or two in ever district. Each CWC should consist of a chairperson and four members. The chairperson should be a person well versed in child welfare issues and at least one member of the board should be a woman. The CWC has the same powers as a metropolitan magistrate or a judicial magistrate of the first class. A child can be brought before the committee (or a member of the committee if necessary) by a police officer, any public servant, CHILDLINE personnel, any social worker or public spirited citizen, or by the child himself/herself.

The CWC usually sends the child to a children's home while the inquiry into the case is conducted for the protection of the child. Children‟s homes are government funded institutions that provide temporary shelter, food and clothing to children in need of care and protection. Children in the homes are meant to receive basic education and life skills lessons. The CWC meets and interviews the child to learn his/her background information and also understand the problem the child is facing. The probation officer (P.O) in charge of the case must also submit regular reports of the child. The purpose of the CWC is to determine the best interest of the child and find the child a safe home and environment either with his/her original parents or adoptive parents, foster care or in an institution. A final order must be given within four months of the admission of the child before the CWC.

The CWC also has powers to hold people accountable for the child such as in the case of child labour, the employers are fined or made to give bonds to the children. CWC also has the power to transfer the child to a different CWC closer o the child's home or in the child's state to dispose of the case and reunite the child with his family and community. In the case of individual child sexual abuse, reporting the abuse can be difficult, since it is often a family member or a known adult that is the abuser. The CWC will instruct the local police station to file a report against the abuser(s) under the relevant IPC clause. Children who have been sexual abused require special attention and tact on the part of the CWC. The case needs to be handled very sensitively and should allow for the child to express their emotions and concerns.

The child‟s statement should be recorded in great details so that the report can be used in a court of law. The child needs counselling and guidance from a clinical psychologist or social worker. The CWC must issue a memo for the medical examination of the child. Medical reports are vital to the prosecution and conviction of the abuser. In the case of pregnancy as an outcome of the sexual abuse, the CWC can issue request a medical termination of pregnancy with the consent of the parents. If the pregnancy is too advanced, the girl can be taken to a girls‟ home for counselling and care until delivery. Once born, DNA testing of the baby, can be used in evidence of the crime. 

Note: This article has been adapted from “Child protection and juvenile justice system: For children in need of care and protection” by Dr Nilima Mehta, 2008, published by CHILDLINE India Foundation, Mumbai

Dr. Nilima Mehta is an Honorary Consultant with several organisations like UNICEF, CRY, CHILDLINE, ICSW, ICCW, IAPA, FSC, VATSALYA FOUNDATION, as well as with the State and Central Government and the Planning Commission for Policy Development, Research and Review of National Legislations. She is a visiting faculty member at the TISS, SNDT & NN colleges in Mumbai. 

* Trishla Jasani  was a Consultant Program Coordinator at CHILDLINE India Foundation.