dissertation on child abuse

Understanding Child Abuse and Neglect (1993)

Chapter: 1 introduction, 1 introduction.

Child maltreatment is a devastating social problem in American society. In 1990, over 2 million cases of child abuse and neglect were reported to social service agencies. In the period 1979 through 1988, about 2,000 child deaths (ages 0-17) were recorded annually as a result of abuse and neglect (McClain et al., 1993), and an additional 160,000 cases resulted in serious injuries in 1990 alone (Daro and McCurdy, 1991). However tragic and sensational, the counts of deaths and serious injuries provide limited insight into the pervasive long-term social, behavioral, and cognitive consequences of child abuse and neglect. Reports of child maltreatment alone also reveal little about the interactions among individuals, families, communities, and society that lead to such incidents.

American society has not yet recognized the complex origins or the profound consequences of child victimization. The services required for children who have been abused or neglected, including medical care, family counseling, foster care, and specialized education, are expensive and are often subsidized by governmental funds. The General Accounting Office (1991) has estimated that these services cost more than $500 million annually. Equally disturbing, research suggests that child maltreatment cases are highly related to social problems such as juvenile delinquency, substance abuse, and violence, which require additional services and severely affect the quality of life for many American families.

The Importance Of Child Maltreatment Research

The challenges of conducting research in the field of child maltreatment are enormous. Although we understand comparatively little about the causes, definitions, treatment, and prevention of child abuse and neglect, we do know enough to recognize that the origins and consequences of child victimization are not confined to the months or years in which reported incidents actually occurred. For those who survive, the long-term consequences of child maltreatment appear to be more damaging to victims and their families, and more costly for society, than the immediate or acute injuries themselves. Yet little is invested in understanding the factors that predispose, mitigate, or prevent the behavioral and social consequences of child maltreatment.

The panel has identified five key reasons why child maltreatment research should be viewed as a central nexus of more comprehensive research activity.

Research On Child Maltreatment Is Currently Undervalued And Undeveloped

Research in the field of child maltreatment studies is relatively undeveloped when compared with related fields such as child development, so-

cial welfare, and criminal violence. Although no specific theory about the causes of child abuse and neglect has been substantially replicated across studies, significant progress has been gained in the past few decades in identifying the dimensions of complex phenomena that contribute to the origins of child maltreatment.

Efforts to improve the quality of research on any group of children are dependent on the value that society assigns to the potential inherent in young lives. Although more adults are available in American society today as service providers to care for children than was the case in 1960, a disturbing number of recent reports have concluded that American children are in trouble (Fuchs and Reklis, 1992; National Commission on Children, 1991; Children's Defense Fund, 1991).

Efforts to encourage greater investments in research on children will be futile unless broader structural and social issues can be addressed within our society. Research on general problems of violence, substance addiction, social inequality, unemployment, poor education, and the treatment of children in the social services system is incomplete without attention to child maltreatment issues. Research on child maltreatment can play a key role in informing major social policy decisions concerning the services that should be made available to children, especially children in families or neighborhoods that experience significant stress and violence.

As a nation, we already have developed laws and regulatory approaches to reduce and prevent childhood injuries and deaths through actions such as restricting hot water temperatures and requiring mandatory child restraints in automobiles. These important precedents suggest how research on risk factors can provide informed guidance for social efforts to protect all of America's children in both familial and other settings.

Not only has our society invested relatively little in research on children, but we also have invested even less in research on children whose families are characterized by multiple problems, such as poverty, substance abuse, violence, welfare dependency, and child maltreatment. In part, this slower development is influenced by the complexities of research on major social problems. But the state of research on this topic could be advanced more rapidly with increased investment of funds. In the competition for scarce research funds, the underinvestment in child maltreatment research needs to be understood in the context of bias, prejudice, and the lack of a clear political constituency for children in general and disadvantaged children in particular (Children's Defense Fund, 1991; National Commission on Children, 1991). Factors such as racism, ethnic discrimination, sexism, class bias, institutional and professional jealousies, and social inequities influence the development of our national research agenda (Bell, 1992, Huston, 1991).

The evolving research agenda has also struggled with limitations im-

posed by attempting to transfer the results of sample-specific studies to diverse groups of individuals. The roles of culture, ethnic values, and economic factors pervade the development of parenting practices and family dynamics. In setting a research agenda for this field, ethnic diversity and multiple cultural perspectives are essential to improve the quality of the research program and to overcome systematic biases that have restricted its development.

Researchers must address ethical and legal issues that present unique obligations and dilemmas regarding selection of subjects, provision of services, and disclosure of data. For example, researchers who discover an undetected incident of child abuse in the course of an interview are required by state laws to disclose the identities of the victim and offender(s), if known, to appropriate child welfare officials. These mandatory reporting requirements, adopted in the interests of protecting children, may actually cause long-term damage to children by restricting the scope of research studies and discouraging scientists from developing the knowledge base necessary to guide social interventions.

Substantial efforts are now required to reach beyond the limitations of current knowledge and to gain new insights that can improve the quality of social service efforts and public policy decisions affecting the health and welfare of abused and neglected children and their families. Most important, collaborative long-term research ventures are necessary to diminish social, professional, and institutional prejudices that have restricted the development of a comprehensive knowledge base that can improve understanding of, and response to, child maltreatment.

Dimensions Of Child Abuse And Neglect

The human dimensions of child maltreatment are enormous and tragic. The U.S. Advisory Board on Child Abuse and Neglect has called the problem of child maltreatment ''an epidemic" in American society, one that requires a critical national emergency response.

The scale and severity of child abuse and neglect has caused various public and private organizations to mobilize efforts to raise public awareness of individual cases and societal trends, to improve the reporting and tracking of child maltreatment cases, to strengthen the responses of social service systems, and to develop an effective and fair system for protecting and offering services to victims while also punishing adults who deliberately harm children or place them in danger. Over the past several decades, a growing number of state and federal funding programs, governmental reports, specialized journals, and research centers, as well as national and international societies and conferences, have examined various dimensions of the problem of child maltreatment.

The results of these efforts have been inconsistent and uneven. In addressing aspects of each new revelation of abuse or each promising new intervention, research efforts often have become diffuse, fragmented, specific, and narrow. What is lacking is a coordinated approach and a general conceptual framework that can add new depth to our understanding of child maltreatment. A coordinated approach can accommodate diverse perspectives while providing direction and guidance in establishing research priorities and synthesizing research knowledge. Organizational mechanisms are also needed to facilitate the application and integration of research on child maltreatment in related areas such as child development, family violence, substance abuse, and juvenile delinquency.

Child maltreatment is not a new problem, yet concerted service, research, and policy attention toward it is just beginning. Although isolated studies of child maltreatment appeared in the medical and sociological literature in the first half of the twentieth century, the publication of "The Battered Child Syndrome" by C. Henry Kempe and associates (1962) is generally considered the first definitive paper in the field in the United States. The efforts of Kempe and others to publicize disturbing medical experience with child abuse and neglect led to the passage of the first Child Abuse Prevention and Treatment Act in 1974 (P.L. 93-247). The act, which has been amended several times (most recently in 1992), established a governmental program designed to guide and consolidate national and state data collection efforts regarding reports of child abuse and neglect, conduct national surveys of household violence, and sponsor research and demonstration programs to prevent, identify, and treat child abuse and neglect.

However, the federal government's leadership role in building a research base in this area has been complicated by changes and inconsistencies in research plans and priorities, limited funding, politicized peer review, fragmentation of effort among various federal agencies, poorly scheduled proposal review deadlines, and bias introduced by competing institutional objectives. 1 The lack of comprehensive, long-term planning for a research base has resulted in a field characterized by contradictions, conflict, and fragmentation. The role of the National Center for Child Abuse and Neglect as the lead federal agency in supporting research in this field has been sharply criticized (U.S. Advisory Board, 1991). Many observers believe that the federal government lacks leadership, funding, and an effective research program for studies on child maltreatment.

The Complexity Of Child Maltreatment

Child maltreatment was originally seen in the form of "the battered child," often portrayed in terms of physical abuse. Today, four general categories of child maltreatment are generally recognized: (1) physical

abuse, (2) sexual abuse, (3) neglect, and (4) emotional maltreatment. Each category covers a range of behaviors, as discussed in Chapter 2.

These four categories have become the focus of separate studies of incidence and prevalence, etiology, prevention, consequences, and treatment, with uneven development of research within each area and poor integration of knowledge across areas. Each category has developed its own typology and framework of reference terms, revealing certain similarities (such as the importance of developmental perspectives in considering the consequences of maltreatment) but also important differences (such as the predatory behavior associated with some forms of sexual abuse that do not appear in the etiology of other forms of child maltreatment).

In addition to the category of child maltreatment, the duration, source, intensity, timing, and situational context of incidents of child victimization are now recognized as important factors in studying the origin and consequences of child maltreatment. Yet information about these factors is rarely requested or recorded by social agencies or health professionals in the process of identifying or documenting reports of child maltreatment. Furthermore, research is often weakened by variation in research definitions of child maltreatment, bias in the recruitment of research subjects, the absence of information regarding circumstances surrounding maltreatment reports, the absence of measures to assess selected variables under study, and the absence of a developmental perspective in many research studies.

The co-occurrence of different forms of child maltreatment has been examined only to a limited extent. Relatively little is known about areas of similarity and differences in terms of causes, consequences, prevention, and treatment of selected types of child abuse and neglect. Inconsistencies in definitions often preclude comparative analyses of clinical studies. For example, studies of sexual abuse have indicated wide variations in its prevalence, often as a result of differences in the types of behavior that might be included in the definition adopted by each research investigator. Emotional abuse is also a matter of controversy in some quarters, primarily because of broad variations in its definition.

Research on child maltreatment is also complicated by the fragmentation of services and responses by which our society addresses specific reports of child maltreatment. Cases may involve children who are victims or witnesses to single or repeated incidents of child abuse and neglect. Sadly, child maltreatment often involves various family members, relatives, or other individuals who reside in the homes or neighborhoods of the affected children. Adult figures may be perpetrators of offensive incidents or mediators in intervention or prevention efforts.

The importance of the social ecological framework of the child has only recently been recognized in studies of maltreatment. Responses to child abuse and neglect involve a variety of social institutions, including commu-

nities, schools, hospitals, churches, youth associations, the media, and other social structures that provide services for children. Such groups and organizations present special intervention opportunities to reduce the scale and scope of the problem of child maltreatment, but their activities are often poorly documented and uncoordinated. Finally, governmental offices at the local, state, and federal levels have legal and social obligations to develop programs and resources to address child maltreatment, and their role is critical in developing a research agenda for this field.

In the past, the research agenda has been determined predominantly by pragmatic needs in the development and delivery of treatment and prevention services rather than by theoretical paradigms, a process that facilitates short-term studies of specialized research priorities but impedes the development of a well-organized, coherent body of scientific knowledge that can contribute over time to understanding fundamental principles and issues. As a result, the research in this field has been generally viewed by the scientific community as fragmented, diffuse, decentralized, and of poor quality.

Selection of Research Studies

The research literature in the field of child maltreatment is immense—over 2000 items are included in the panel's research bibliography, a portion of which is referenced in this report. Despite this quantity of literature, researchers generally agree that the quality of research on child maltreatment is relatively weak in comparison to health and social science research studies in areas such as family systems and child development. Only a few prospective studies of child maltreatment have been undertaken, and most studies rely on the use of clinical samples (which may exclude important segments of the research population) or adult memories. Both types of samples are problematic and can produce biased results. Clinical samples may not be representative of all cases of child maltreatment. For example, we know from epidemiologic studies of disease of cases that were derived from hospital records that, unless the phenomenon of interest always comes to a service provider for treatment, there exist undetected and untreated cases in the general population that are often quite different from those who have sought treatment. Similarly, when studies rely on adult memories of childhood experiences, recall bias is always an issue. Longitudinal studies are quite rare, and some studies that are described as longitudinal actually consist of hybrid designs followed over time.

To ensure some measure of quality, the panel relied largely on studies that had been published in the peer-reviewed scientific literature. More rigorous scientific criteria (such as the use of appropriate theory and methodology in the conduct of the study) were considered by the panel, but were not adopted because little of the existing work would meet such selection

criteria. Given the early stage of development of this field of research, the panel believes that even weak studies contain some useful information, especially when they suggest clinical insights, a new perspective, or a point of departure from commonly held assumptions. Thus, the report draws out issues based on clinical studies or studies that lack sufficient control samples, but the panel refrains from drawing inferences based on this literature.

The panel believes that future research reviews of the child maltreatment literature would benefit from the identification of explicit criteria that could guide the selection of exemplary research studies, such as the following:

For the most part, only a few studies will score well in each of the above categories. It becomes problematic, therefore, to rate the value of studies which may score high in one category but not in others.

The panel has relied primarily on studies conducted in the past decade, since earlier research work may not meet contemporary standards of methodological rigor. However, citations to earlier studies are included in this report where they are thought to be particularly useful and when research investigators provided careful assessments and analysis of issues such as definition, interrelationships of various types of abuse, and the social context of child maltreatment.

A Comparison With Other Fields of Family and Child Research

A comparison with the field of studies on family functioning may illustrate another point about the status of the studies on child maltreatment. The literature on normal family functioning or socialization effects differs in many respects from the literature on child abuse and neglect. Family sociology research has a coherent body of literature and reasonable consensus about what constitutes high-quality parenting in middle-class, predominantly White populations. Family functioning studies have focused predominantly on large, nonclinical populations, exploring styles of parenting and parenting practices that generate different kinds and levels of competence, mental health, and character in children. Studies of family functioning have tended to follow cohorts of subjects over long periods to identify the effects of variations in childrearing practices and patterns on children's

competence and adjustment that are not a function of social class and circumstances.

By contrast, the vast and burgeoning literature on child abuse and neglect is applied research concerned largely with the adverse effects of personal and social pathology on children. The research is often derived from very small samples selected by clinicians and case workers. Research is generally cross-sectional, and almost without exception the samples use impoverished families characterized by multiple problems, including substance abuse, unemployment, transient housing, and so forth. Until recently, researchers demonstrated little regard for incorporating appropriate ethnic and cultural variables in comparison and control groups. In the past decade, significant improvements have occurred in the development of child maltreatment research, but key problems remain in the area of definitions, study designs, and the use of instrumentation.

As the nature of research on child abuse and neglect has evolved over time, scientists and practitioners have likewise changed. The psychopathologic model of child maltreatment has been expanded to include models that stress the interactions of individual, family, neighborhood, and larger social systems. The role of ethnic and cultural issues are acquiring an emerging importance in formulating parent-child and family-community relationships. Earlier simplistic conceptionalizations of perpetrator-victim relationships are evolving into multiple-focus research projects that examine antecedents in family histories, current situational relationships, ecological and neighborhood issues, and interactional qualities of relationships between parent-child and offender-victim. In addition, emphases in treatment, social service, and legal programs combine aspects of both law enforcement and therapy, reflecting an international trend away from punishment, toward assistance, for families in trouble.

Charge To The Panel

The commissioner of the Administration for Children, Youth, and Families in the U.S. Department of Health and Human Services requested that the National Academy of Sciences convene a study panel to undertake a comprehensive examination of the theoretical and pragmatic research needs in the area of child maltreatment. The Panel on Research on Child Abuse and Neglect was asked specifically to:

The report resulting from this study provides recommendations for allocating existing research funds and also suggests funding mechanisms and topic areas to which new resources could be allocated or enhanced resources could be redirected. By focusing this report on research priorities and the needs of the research community, the panel's efforts were distinguished from related activities, such as the reports of the U.S. Advisory Board on Child Abuse and Neglect, which concentrate on the policy issues in the field of child maltreatment.

The request for recommendations for research priorities recognizes that existing studies on child maltreatment require careful evaluation to improve the evolution of the field and to build appropriate levels of human and financial resources for these complex research problems. Through this review, the panel has examined the strengths and weaknesses of past research and identified areas of knowledge that represent the greatest promise for advancing understanding of, and dealing more effectively with, the problem of child maltreatment.

In conducting this review, the panel has recognized the special status of studies of child maltreatment. The experience of child abuse or neglect from any perspective, including victim, perpetrator, professional, or witness, elicits strong emotions that may distort the design, interpretation, or support of empirical studies. The role of the media in dramatizing selected cases of child maltreatment has increased public awareness, but it has also produced a climate in which scientific objectivity may be sacrificed in the name of urgency or humane service. Many concerned citizens, legislators, child advocates, and others think we already know enough to address the root causes of child maltreatment. Critical evaluations of treatment and prevention services are not supported due to both a lack of funding and a lack of appreciation for the role that scientific analysis can play in improving the quality of existing services and identifying new opportunities for interventions. The existing research base is small in volume and spread over a wide variety of topics. The contrast between the importance of the problem and the difficulty of approaching it has encouraged the panel to proceed carefully, thoroughly distinguishing suppositions from facts when they appear.

Research on child maltreatment is at a crossroads—we are now in a position to merge this research field with others to incorporate multiple perspectives, broaden research samples, and focus on fundamental issues that have the potential to strengthen, reform, or replace existing public policy and social programs. We have arrived at a point where we can

recognize the complex interplay of forces in the origins and consequences of child abuse and neglect. We also recognize the limitations of our knowledge about the effects of different forms of social interventions (e.g., home visitations, foster care, family treatment programs) for changing the developmental pathways of abuse victims and their families.

The Importance Of A Child-Oriented Framework

The field of child maltreatment studies has often divided research into the types of child maltreatment under consideration (such as physical and sexual abuse, child neglect, and emotional maltreatment). Within each category, researchers and practitioners have examined underlying causes or etiology, consequences, forms of treatment or other interventions, and prevention programs. Each category has developed its own typology and framework of reference terms, and researchers within each category often publish in separate journals and attend separate professional meetings.

Over a decade ago, the National Research Council Committee on Child Development Research and Public Policy published a report titled Services for Children: An Agenda for Research (1981). Commenting on the development of various government services for children, the report noted that observations of children's needs were increasingly distorted by the "unmanageably complex, expensive, and confusing" categorical service structure that had produced fragmented and sometimes contradictory programs to address child health and nutrition requirements (p. 15-16). The committee concluded that the actual experiences of children and their families in different segments of society and the conditions of their homes, neighborhoods, and communities needed more systematic study. The report further noted that we need to learn more about who are the important people in children's lives, including parents, siblings, extended family, friends, and caretakers outside the family, and what these people do for children, when, and where.

These same conclusions can be applied to studies of child maltreatment. Our panel considered, but did not endorse, a framework that would emphasize differences in the categories of child abuse or neglect. We also considered a framework that would highlight differences in the current system of detecting, investigating, or responding to child maltreatment. In contrast to conceptualizing this report in terms of categories of maltreatment or responses of the social system to child maltreatment, the panel presents a child-oriented research agenda that emphasizes the importance of knowing more about the backgrounds and experiences of developing children and their families, within a broader social context that includes their friends, neighborhoods, and communities. This framework stresses the importance of knowing more about the qualitative differences between children who suffer episodic experiences of abuse or neglect and those for whom mal-

treatment is a chronic part of their lives. And this approach highlights the need to know more about circumstances that affect the consequences, and therefore the treatment, of child maltreatment, especially circumstances that may be affected by family, cultural, or ethnic factors that often remain hidden in small, isolated studies.

An Ecological Developmental Perspective

The panel has adopted an ecological developmental perspective to examine factors in the child, family, or society that can exacerbate or mitigate the incidence and destructive consequences of child maltreatment. In the panel's view, this perspective reflects the understanding that development is a process involving transactions between the growing child and the social environment or ecology in which development takes place. Positive and negative factors merit attention in shaping a research agenda on child maltreatment. We have adopted a perspective that recognizes that dysfunctional families are often part of a dysfunctional environment.

The relevance of child maltreatment research to child development studies and other research fields is only now being examined. New methodologies and new theories of child maltreatment that incorporate a developmental perspective can provide opportunities for researchers to consider the interaction of multiple factors, rather than focusing on single causes or short-term effects. What is required is the mobilization of new structures of support and resources to concentrate research efforts on significant areas that offer the greatest promise of improving our understanding of, and our responses to, child abuse and neglect.

Our report extends beyond what is, to what could be, in a society that fosters healthy development in children and families. We cannot simply build a research agenda for the existing social system; we need to develop one that independently challenges the system to adapt to new perspectives, new insights, and new discoveries.

The fundamental theme of the report is the recognition that research efforts to address child maltreatment should be enhanced and incorporated into a long-term plan to improve the quality of children's lives and the lives of their families. By placing maltreatment within the framework of healthy development, for example, we can identify unique sources of intervention for infants, preschool children, school-age children, and adolescents.

Each stage of development presents challenges that must be resolved in order for a child to achieve productive forms of thinking, perceiving, and behaving as an adult. The special needs of a newborn infant significantly differ from those of a toddler or preschool child. Children in the early years of elementary school have different skills and distinct experiential levels from those of preadolescent years. Adolescent boys and girls demon-

strate a range of awkward and exploratory behaviors as they acquire basic social skills necessary to move forward into adult life. Most important, developmental research has identified the significant influences of family, schools, peers, neighborhoods, and the broader society in supporting or constricting child development.

Understanding the phenomenon of child abuse and neglect within a developmental perspective poses special challenges. As noted earlier, research literature on child abuse and neglect is generally organized by the category or type of maltreatment; integrated efforts have not yet been achieved. For example, research has not yet compared and contrasted the causes of physical and sexual abuse of a preschool child or the differences between emotional maltreatment of toddlers and adolescents, although all these examples fall within the domain of child maltreatment. A broader conceptual framework for research will elicit data that can facilitate such comparative analyses.

By placing research in the framework of factors that foster healthy development, the ecological developmental perspective can enhance understanding of the research agenda for child abuse and neglect. The developmental perspective can improve the quality of treatment and prevention programs, which often focus on particular groups, such as young mothers who demonstrate risk factors for abuse of newborns, or sexual offenders who molest children. There has been little effort to cut across the categorical lines established within these studies to understand points of convergence or divergence in studies on child abuse and neglect.

The ecological developmental perspective can also improve our understanding of the consequences of child abuse and neglect, which may occur with increased or diminished intensity over a developmental cycle, or in different settings such as the family or the school. Initial effects may be easily identified and addressed if the abuse is detected early in the child's development, and medical and psychological services are available for the victim and the family. Undetected incidents, or childhood experiences discovered later in adult life, require different forms of treatment and intervention. In many cases, incidents of abuse and neglect may go undetected and unreported, yet the child victim may display aggression, delinquency, substance addiction, or other problem behaviors that stimulate responses within the social system.

Finally, an ecological developmental perspective can enhance intervention and prevention programs by identifying different requirements and potential effects for different age groups. Children at separate stages of their developmental cycle have special coping mechanisms that present barriers to—and opportunities for—the treatment and prevention of child abuse and neglect. Intervention programs need to consider the extent to which children may have already experienced some form of maltreatment in order to

evaluate successful outcomes. In addition, the perspective facilitates evaluation of which settings are the most promising locus for interventions.

Previous Reports

A series of national reports associated with the health and welfare of children have been published in the past decade, many of which have identified the issue of child abuse and neglect as one that deserves sustained attention and creative programmatic solutions. In their 1991 report, Beyond Rhetoric , the National Commission on Children noted that the fragmentation of social services has resulted in the nation's children being served on the basis of their most obvious condition or problem rather than being served on the basis of multiple needs. Although the needs of these children are often the same and are often broader than the mission of any single agency emotionally disturbed children are often served by the mental health system, delinquent children by the juvenile justice system, and abused or neglected children by the protective services system (National Commission on Children, 1991). In their report, the commission called for the protection of abused and neglected children through more comprehensive child protective services, with a strong emphasis on efforts to keep children with their families or to provide permanent placement for those removed from their homes.

In setting health goals for the year 2000, the Public Health Service recognized the problem of child maltreatment and recommended improvements in reporting and diagnostic services, and prevention and educational interventions (U.S. Public Health Service, 1990). For example, the report, Health People 2000 , described the four types of child maltreatment and recommended that the rising incidence (identified as 25.2 per 1,000 in 1986) should be reversed to less than 25.2 in the year 2000. These public health targets are stated as reversing increasing trends rather than achieving specific reductions because of difficulties in obtaining valid and reliable measures of child maltreatment. The report also included recommendations to expand the implementation of state level review systems for unexplained child deaths, and to increase the number of states in which at least 50 percent of children who are victims of physical or sexual abuse receive appropriate treatment and follow-up evaluations as a means of breaking the intergenerational cycle of abuse.

The U.S. Advisory Board on Child Abuse and Neglect issued reports in 1990 and 1991 which include national policy and research recommendations. The 1991 report presented a range of research options for action, highlighting the following priorities (U.S. Advisory Board on Child Abuse and Neglect, 1991:110-113):

This report differs from those described above because its primary focus is on establishing a research agenda for the field of studies on child abuse and neglect. In contrast to the mandate of the U.S. Advisory Board on Child Abuse and Neglect, the panel was not asked to prepare policy recommendations for federal and state governments in developing child maltreatment legislation and programs. The panel is clearly aware of the need for services for abused and neglected children and of the difficult policy issues that must be considered by the Congress, the federal government, the states, and municipal governments in responding to the distress of children and families in crisis. The charge to this panel was to design a research agenda that would foster the development of scientific knowledge that would provide fundamental insights into the causes, identification, incidence, consequences, treatment, and prevention of child maltreatment. This knowledge can enable public and private officials to execute their responsibilities more effectively, more equitably, and more compassionately and empower families and communities to resolve their problems and conflicts in a manner that strengthens their internal resources and reduces the need for external interventions.

Report Overview

Early studies on child abuse and neglect evolved from a medical or pathogenic model, and research focused on specific contributing factors or causal sources within the individual offender to be discovered, addressed, and prevented. With the development of research on child maltreatment over the past several decades, however, the complexity of the phenomena encompassed by the terms child abuse and neglect or child maltreatment has become apparent. Clinical studies that began with small sample sizes and weak methodological designs have gradually evolved into larger and longer-term projects with hundreds of research subjects and sound instrumentation.

Although the pathogenic model remains popular among the general public in explaining the sources of child maltreatment, it is limited by its primary focus on risk and protective factors within the individual. Research investigators now recognize that individual behaviors are often influenced by factors in the family, community, and society as a whole. Elements from these systems are now being integrated into more complex theories that analyze the roles of interacting risk and protective factors to explain and understand the phenomena associated with child maltreatment.

In the past, research on child abuse and neglect has developed within a categorical framework that classifies the research by the type of maltreatment typically as reported in administrative records. Although the quality of research within different categories of child abuse and neglect is uneven and problems of definitions, data collection, and study design continue to characterize much research in this field, the panel concluded that enough progress has been achieved to integrate the four categories of maltreatment into a child-oriented framework that could analyze the similarities and differences of research findings. Rather than encouraging the continuation of a categorical approach that would separate research on physical or sexual abuse, for example, the panel sought to develop for research sponsors and the research community a set of priorities that would foster the integration of scientific findings, encourage the development of comparative analyses, and also distinguish key research themes in such areas as identification, incidence, etiology, prevention, consequences, and treatment. This approach recognizes the need for the construction of collaborative, long-term efforts between public and private research sponsors and research investigators to strengthen the knowledge base, to integrate studies that have evolved for different types of child maltreatment, and eventually to reduce the problem of child maltreatment. This approach also highlights the connections that need to be made between research on the causes and the prevention of child maltreatment, for the more we learn about the origins of child abuse and neglect, the more effective we can be in seeking to prevent it. In the same manner, the report emphasises the connections that need to be made between research on the consequences and treatment of child maltreatment, for knowledge about the effects of child abuse and neglect can guide the development of interventions to address these effects.

In constructing this report, the panel has considered eight broad areas: Identification and definitions of child abuse and neglect (Chapter 2) Incidence: The scope of the problem (Chapter 3) Etiology of child maltreatment (Chapter 4) Prevention of child maltreatment (Chapter 5) Consequences of child maltreatment (Chapter 6) Treatment of child maltreatment (Chapter 7)

Human resources, instrumentation, and research infrastructure (Chapter 8) Ethical and legal issue in child maltreatment research (Chapter 9)

Each chapter includes key research recommendations within the topic under review. The final chapter of the report (Chapter 10) establishes a framework of research priorities derived by the panel from these recommendations. The four main categories identified within this framework—research on the nature and scope of child maltreatment; research on the origins and consequences of child maltreatment; research on the strengths and limitations of existing interventions; and the need for a science policy for child maltreatment research—provide the priorities that the panel has selected as the most important to address in the decade ahead.

1. The panel received an anecdotal report, for example, that one federal research agency systematically changed titles of its research awards over a decade ago, replacing phrases such as child abuse with references to maternal and child health care, after political sensitivities developed regarding the appropriateness of its research program in this area.

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Daro, D., and K. McCurdy 1991 Current Trends in Child Abuse Reporting and Fatalities: The Results of the 1990 Annual Fifty State Survey . Chicago: National Committee for Prevention of Child Abuse.

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General Accounting Office 1991 Child Abuse Prevention: Status of the Challenge Grant Program . May. GAO:HRD91-95. Washington, DC.

Huston, A.C., ed. 1991 Children in Poverty: Child Development and Public Policy . New York: Cambridge University Press.

Kempe, C.H., F.N. Silverman, B. Steele, W. Droegemueller, and H.R. Silver 1962 The battered child syndrome. Journal of the American Medical Association 181(1): 17-24.

McClain, P.W., J.J. Sacks, R.G. Froehlke, and B.G. Ewigman 1993 Estimates of fatal child abuse and neglect, United States, 1979 through 1988. Pediatrics 91(2):338-343.

National Commission on Children 1991 Beyond Rhetoric: A New American Agenda for Children and Families . Washington, DC: U.S. Government Printing Office.

National Research Council 1981 Services for Children: An Agenda for Research . Commission on Behavioral and Social Sciences and Education. Washington, DC: National Academy Press.

U.S. Advisory Board on Child Abuse and Neglect 1990 Child Abuse and Neglect: Critical First Steps in Response to a National Emergency . August. Washington, DC: U.S. Department of Health and Human Services. August. 1991 Creating Caring Communities . September. Washington, DC: U.S. Department of Health and Human Services.

U.S. Public Health Service 1990 Violent and abusive behavior. Pp. 226-247 (Chapter 7) in Healthy People 2000 Report . Washington, DC: U.S. Department of Health and Human Services.

The tragedy of child abuse and neglect is in the forefront of public attention. Yet, without a conceptual framework, research in this area has been highly fragmented. Understanding the broad dimensions of this crisis has suffered as a result.

This new volume provides a comprehensive, integrated, child-oriented research agenda for the nation. The committee presents an overview of three major areas:

• Definitions and scope —exploring standardized classifications, analysis of incidence and prevalence trends, and more.
• Etiology, consequences, treatment, and prevention —analyzing relationships between cause and effect, reviewing prevention research with a unique systems approach, looking at short- and long-term consequences of abuse, and evaluating interventions.
• Infrastructure and ethics —including a review of current research efforts, ways to strengthen human resources and research tools, and guidance on sensitive ethical and legal issues.

This volume will be useful to organizations involved in research, social service agencies, child advocacy groups, and researchers.

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Child Sexual Abuse: A Review (unpublished dissertation)

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Dissertations / Theses on the topic 'Child abuse neglect and trauma'

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Dolson, Robyn. "Pocket ACE: Neglect of Child Sexual Abuse Survivors in the ACEs Study Questionnaire." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etd/3573.

Bigby, Janice A. "QEEG and LORETA findings in children with histories of relational trauma." Thesis, University of North Texas, 2010. https://digital.library.unt.edu/ark:/67531/metadc28394/.

Chase, Laura M. "The Impacts of the Opioid Epidemic on Child Welfare Systems in Appalachian and Non-Appalachian Ohio Counties." Ohio University Honors Tutorial College / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ouhonors1556280349718825.

Caplis, Catherine F. "Feasibility and Perceived Efficacy of the Neurosequential Model of Therapeutics." Antioch University / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1397213972.

Onions, Caryn Jane. "'This shared parenting we do is difficult to get your head around' : experiences of parents and carers during their child's first year at a residential therapuetic special school : a qualitative study." Thesis, University of Exeter, 2016. http://hdl.handle.net/10871/28082.

Ross, Nicholas Dutra. "From Childhood Maltreatment to Depressive Symptoms in Adulthood: The Roles of Self-Compassion and Shame." Thesis, University of North Texas, 2018. https://digital.library.unt.edu/ark:/67531/metadc1157627/.

Dryden, Kyrsha M. "Child abuse and neglect a resource guide /." Online version, 2009. http://www.uwstout.edu/lib/thesis/2009/2009drydenk.pdf.

Hagen, Carol Kellerman. "Decision Making Factors in Child Caregiver Reporting of Child Abuse and Neglect." Thesis, University of North Texas, 2000. https://digital.library.unt.edu/ark:/67531/metadc2527/.

Velasquez, Jaime A. "Child abuse and neglect in the Hispanic community." DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 1989. http://digitalcommons.auctr.edu/dissertations/1319.

Lachman, Peter Irwin. "Reported child abuse and neglect in Cape Town." Master's thesis, University of Cape Town, 1997. http://hdl.handle.net/11427/26998.

Irvin, James Edgar. "Child abuse or neglect reporting requirements for education professionals : direct and indirect reporting /." abstract and full text PDF (free order & download UNR users only), 2006. http://0-gateway.proquest.com.innopac.library.unr.edu/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3221875.

Rentz, Ericka Danielle Marshall Stephen William. "Child abuse and neglect in military and non-military families an analysis of the National Child Abuse and Neglect Data System, 2000-2003 /." Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2006. http://dc.lib.unc.edu/u?/etd,233.

Dale, Corrine. "Child Neglect, Child Physical Abuse, and Relationships Among 12-Year-Old Girls." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3600.

Graves, Gary Eugene. "Inadequate substance abuse assessment as a contributory factor to child abuse and neglect." CSUSB ScholarWorks, 2003. https://scholarworks.lib.csusb.edu/etd-project/2455.

Hoft, Mary, and Lisa Haddad. "Screening Children for Abuse and Neglect: A Review of the Literature." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/8514.

Mlivic, Azra, and Ellen Nordquist. "Barn som utsätts för fysiskt våld i hemmet : - Förskolan som den trygga basen." Thesis, Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-125420.

Romero, Valeria I. "Parental substance abuse and child neglect development of a treatment manual /." online access from Digital Dissertation Consortium, 2006. http://libweb.cityu.edu.hk/cgi-bin/er/db/ddcdiss.pl?1436787.

Berner, Rachel S. "CHILD ABUSE AND NEGLECT: GENERAL STRAIN AND PROSOCIAL COPING THROUGH EMPLOYMENT." OpenSIUC, 2019. https://opensiuc.lib.siu.edu/theses/2566.

Nodelman-Niedringhaus, Marjorie. "Correlation study of methamphetamine abuse and resultant levels of child neglect." CSUSB ScholarWorks, 1996. https://scholarworks.lib.csusb.edu/etd-project/1238.

Bricker, Sandra G. "A community approach to the prevention of child abuse and neglect /." The Ohio State University, 1986. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487265555440819.

Pettypiece, Suzanne M. "A literary journalistic account of a life of abuse and neglect." Virtual Press, 2001. http://liblink.bsu.edu/uhtbin/catkey/1221312.

Strachman, Miller Marjorie. "Processing the trauma of intrafamilial child sexual abuse." Diss., Kansas State University, 2011. http://hdl.handle.net/2097/11968.

Simmons, Rosemary Velda. "Childhood sexual trauma and female prostitution /." Digital version accessible at:, 1999. http://wwwlib.umi.com/cr/utexas/main.

Goodmote, Carla Bea. "From tragedy to triumph: Developing resiliency from childhood trauma." CSUSB ScholarWorks, 2000. https://scholarworks.lib.csusb.edu/etd-project/1640.

Goldsmith, Rachel Evelyn. "Physical and emotional health effects of betrayal trauma : a longitudinal study of young adults /." view abstract or download file of text, 2004. http://wwwlib.umi.com/cr/uoregon/fullcit?p3147821.

Williams, Christa A. "A family's deadly sin : fatal child abuse in Florida, an anthropological perspective on child deaths due to abuse and neglect." [Tampa, Fla] : University of South Florida, 2006. http://purl.fcla.edu/usf/dc/et/SFE0001756.

Neider, Brandy M. "An investigation of the relationship between child welfare reform efforts and child abuse and neglect deaths." Instructions for remote access. Click here to access this electronic resource. Access available to Kutztown University faculty, staff, and students only, 2003. http://www.kutztown.edu/library/services/remote_access.asp.

Miller, Abigail D. "Attachment a look at the ramifications of abuse, neglect, and poverty /." Theological Research Exchange Network (TREN), 2007. http://www.tren.com/search.cfm?p074-0083.

Levett, Ann. "Psychological trauma : discourses of childhood sexual abuse." Doctoral thesis, University of Cape Town, 1989. http://hdl.handle.net/11427/17128.

Young, Stuart Carter. "School social workers identification training and reporting of suspected child abuse and neglect." DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 1988. http://digitalcommons.auctr.edu/dissertations/641.

Heidtke, Staci L. "Hopelessness and high risk parenting attitudes in relation to child abuse and neglect." Online version, 2001. http://www.uwstout.edu/lib/thesis/2001/2001heidtkes.pdf.

Dolson, Robyn A., Diana M. Morelen, Julia Dodd, and Andrea Clements. "Pocket Ace: Neglect of Child Sexual Abuse Survivors in the ACE Study Questionnaire." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/124.

Dolson, R., D. Morelen, Julia Dodd, and Andrea D. Clements. "Pocket Ace: Neglect of Child Sexual Abuse Survivors in the ACE Study Questionnaire." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/7222.

Egan-Sage, Elmarie. "Referrals of child abuse and neglect to an English social services department : predictors of child protection decisions." Thesis, University of Kent, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.337322.

Curilla, Kaylee L. "Resilience to Trauma throughout the Lifespan: Overcoming Child Sexual Abuse." Antioch University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1422547643.

Daniel, Veronica. "EFFECTS OF CHILD NEGLECT ON PSYCHOLOGICAL DISTRESS IN COLLEGE STUDENTS." CSUSB ScholarWorks, 2018. https://scholarworks.lib.csusb.edu/etd/713.

Faulkner, Amanda Ellen. "Do Variations in State Mandatory Child Abuse and Neglect Report Laws affect Report Rates among Medical Personnel?" Digital Archive @ GSU, 2009. http://digitalarchive.gsu.edu/iph_theses/58.

Fele, Oluropo Abiodun. "NYC Administration for Children's Services Child Abuse and Neglect Prevention Polices, Program and Laws." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/6016.

Vilches, Silvia L., Beth S. McDaniel, Haley Sherman, Brianna Burks, Allie Merritt, Terra Jackson, and Synithia W. Flowers. "Engaging with a Prevention Approach: System Supports Needed in Child Abuse and Neglect Prevention." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/secfr-conf/2020/schedule/13.

Bynum, Christian Benjamin. "The influence of prior maltreatment on physical abuse- and neglect-related mortality among children in Washington State /." Thesis, Connect to this title online; UW restricted, 1996. http://hdl.handle.net/1773/10878.

Fraser, Jennifer Anne, and n/a. "The Role of Home Visiting as an Early Intervention Strategy for Prevention of Child Abuse and Neglect." Griffith University. School of Applied Psychology, 2000. http://www4.gu.edu.au:8080/adt-root/public/adt-QGU20050915.140055.

O'Donnell, Melissa. "Towards prevention - a population health approach to child abuse and neglect : health indicators and the identification of antecedent causal pathways." University of Western Australia. School of Paediatrics and Child Health, 2009. http://theses.library.uwa.edu.au/adt-WU2010.0029.

坪井, 裕子, and Hiroko TSUBOI. "被虐待児の支援に関する現状と課題." 名古屋大学大学院教育発達科学研究科, 2005. http://hdl.handle.net/2237/9431.

Lee, Pei-Yu. "Child abuse and neglect reporting among nurses in Taiwan : professional knowledge, perceptions, attitudes, and self-efficacy." Queensland University of Technology, 2008. http://eprints.qut.edu.au/17800/.

Dorner-Zupancic, Lisa. "Art Therapy for a Child of Trauma in County Custody." Ursuline College / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=urs1210356616.

Al-Zahrani, Ali Hassan. "Child abuse & neglect : its forms, causes and consequences in the Kingdom of Saudi Arabia." Thesis, University of Edinburgh, 2004. http://hdl.handle.net/1842/24553.

Debler, Julianna. "Has the pendulum swung too far? a legal evaluation of Florida's child abuse and neglect registry." Honors in the Major Thesis, University of Central Florida, 2012. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/539.

Dunivan, Michelle. "Social Learning of Attitudes toward Deception in Adult Survivors of Child Victimization." Diss., The University of Arizona, 2012. http://hdl.handle.net/10150/242394.

Willingham, Elizabeth Upchurch. "Maternal Perceptions and Responses to Child Sexual Abuse." Digital Archive @ GSU, 2007. http://digitalarchive.gsu.edu/cps_diss/12.

Papadima, Maria. "Debates on child abuse and trauma in psychoanalysis and feminism : the shift from non-trauma to trauma-based psychotherapy discourse." Thesis, University of East London, 2010. http://roar.uel.ac.uk/2609/.

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Open Access

Peer-reviewed

Research Article

Childhood abuse and perinatal outcomes for mother and child: A systematic review of the literature

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation School of Psychology, Charles Sturt University, Bathurst Campus, Bathurst, NSW, Australia

• Robyn Brunton

• Published: May 24, 2024
• https://doi.org/10.1371/journal.pone.0302354
• Peer Review
• Reader Comments

Childhood abuse can have long-term adverse outcomes in adulthood. These outcomes may pose a particular threat to the health and well-being of perinatal women; however, to date, this body of knowledge has not been systematically collated and synthesized. This systematic review examined the child abuse literature and a broad range of perinatal outcomes using a comprehensive search strategy. The aim of this review was to provide a clearer understanding of the distinct effect of different abuse types and areas where there may be gaps in our knowledge. Following PRISMA guidelines, EBSCO, PsychInfo, Scopus, Medline, CINAHL, PubMed, and Google Scholar databases and gray literature including preprints, dissertations and theses were searched for literature where childhood abuse was associated with any adverse perinatal outcome between 1969 and 2022. Exclusion criteria included adolescent samples, abuse examined as a composite variable, editorials, letters to the editor, qualitative studies, reviews, meta-analyses, or book chapters. Using an assessment tool, two reviewers extracted and assessed the methodological quality and risk of bias of each study. From an initial 12,384 articles, 95 studies were selected, and the outcomes were categorized as pregnancy, childbirth, postnatal for the mother, and perinatal for mother and child. The prevalence of childhood abuse ranged from 5–25% with wide variability (physical 2–78%, sexual 2–47%, and emotional/psychological 2–69%). Despite some consistent findings relating to psychological outcomes (i.e., depression and PTSD), most evidence was inconclusive, effect sizes were small, or the findings based on a limited number of studies. Inconsistencies in findings stem from small sample sizes and differing methodologies, and their diversity meant studies were not suitable for a meta-analysis. Research implication include the need for more rigorous methodology and research in countries where the prevalence of abuse may be high. Policy implications include the need for trauma-informed care with the Multi-level Determinants of Perinatal Wellbeing for Child Abuse Survivors model a useful framework. This review highlights the possible impacts of childhood abuse on perinatal women and their offspring and areas of further investigation. This review was registered with PROSPERO in 2021 and funded by an internal grant from Charles Sturt University.

Citation: Brunton R (2024) Childhood abuse and perinatal outcomes for mother and child: A systematic review of the literature. PLoS ONE 19(5): e0302354. https://doi.org/10.1371/journal.pone.0302354

Editor: Abraham Salinas-Miranda, University of South Florida, UNITED STATES

Received: June 7, 2023; Accepted: April 2, 2024; Published: May 24, 2024

Copyright: © 2024 Robyn Brunton. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: This review was funded by an internal grant from Charles Sturt University. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Worldwide, millions of children suffer physical (CPA), sexual (CSA), psychological (CPY), or emotional abuse (CEA) that potentially have long-term deleterious outcomes [ 1 ]. While it is well established that the sequela of childhood abuse can be poor [ 1 , provides a review], an important consideration is the impact of abuse on perinatal women. Certain adverse outcomes consistently linked to abuse could be exacerbated by pregnancy or impact the mother’s well-being and behaviors. For example, if the risk of Post-Traumatic Stress Disorder (PTSD) and substance use is high for abuse survivors in the general population, it is important to know if this risk extends to pregnancy and postpartum. Moreover, particular experiences of pregnancy and postpartum can be exacerbated by child abuse, such as childbirth and breastfeeding [ 2 , 3 ], potentially impacting mother, child, and prenatal care.

Another consideration is that the body of knowledge regarding child abuse and perinatal outcomes needs to be collated to ensure that findings extrapolated globally are generalizable. Child abuse can exacerbate anxieties experienced during pregnancy [ 4 ], but these anxieties have wide cross-cultural variability [ 5 ]. Moreover, conceptions of child abuse can vary cross-culturally, with what constitutes physical abuse in one country deemed acceptable parenting behavior in another country [ 6 ]. Therefore, without a clear understanding of the body of knowledge, assumptions cannot be made that all findings apply to all pregnant women.

Few systematic reviews have synthesized research for all types of child abuse and a broad range of perinatal outcomes. To our knowledge, only one similar review examined CSA and pregnancy outcomes [ 7 ]. Other reviews have focused on child maltreatment more broadly [ 8 ] or specific outcomes such as mood disorders [ 9 ]. However, the distinct characteristics of different abuse types in the context of the unique developmental life stage of pregnancy, warrant separate examination. For example, the experience of CSA differs from other abuses; therefore, an individual with this history may avoid prenatal care for fear of intimate procedures, which may not be triggering for someone with a CPA history. Therefore, understanding the differential impact of child abuse on perinatal women is important in understanding their needs.

This review builds on previous reviews by expanded search criteria (i.e., all child abuse types and perinatal outcomes [i.e., conception to 12 months postpartum]) databases and gray literature. The aim is to provide a focused review of child abuse outcomes for perinatal women by collating and synthesizing the data to provide a comprehensive overview of the current knowledge. This targeted review will provide a clearer understanding of the distinct effect of different abuse types and areas where there may be gaps in our knowledge. Specifically, the following research questions were examined: Do pregnant and postpartum women with a history of child abuse have more adverse pregnancy, childbirth, and postpartum outcomes than other women? Do the offspring of pregnant women with a history of child abuse have more adverse outcomes than other children?

The systematic review and protocol were registered with PROSPERO in 2021. PRISMA and other reporting guidelines guided the review [ 10 , 11 ]. The PICOT search framework mnemonic focused the question: Population = women who experience pregnancy and childbirth; Indicator = child abuse (includes any study that examines child abuse, noting that different studies may use different age limits to define abuse); Comparison = non-abused women; Outcomes = (1) pregnancy, (2) childbirth (3) child development including neonatal and infant, and (4) postpartum maternal outcomes; Time = perinatal (conception to 12 months postpartum).

Reviewer one [RB] and reviewer two ([DC], a research assistant) extracted the data. Studies were selected if they were original quantitative cross-sectional or longitudinal research examining perinatal outcomes for women with a child abuse history. Child abuse could be a predictor or correlate of any adverse perinatal outcome in English-language peer-reviewed articles, dissertations, conference proceedings, or preprints between 1969 and 2022. Two searches were conducted, one in May 2021 and another in January 2023 to update the original 2021 search. However, the additional studies identified in 2023 were not subjected to two reviewers due to budget constraints.

Adolescent samples were excluded as they have unique psychosocial and biological challenges [ 12 ] however papers that included some adolescents in their sample [e.g., Ranchod et al., 2016] were included. Other exclusion criteria included abuse examined as part of a composite variable, editorials, letters to the editor, qualitative studies, reviews, meta-analyses, or book chapters. Databases searched included EBSCO (Academic Search Complete, Psychology and Behavioural Sciences and SocIndex), PsychInfo, Scopus (Elsevier), Medline, CINAHL, PubMed, and Google Scholar. In addition, gray literature searches included preprints (i.e., PrePubMed and OSFPreprints) and theses and dissertations (i.e., the ProQuest Dissertations and Theses Global database and EBSCO Open dissertations).

Reviewer one searched databases using the following search strategy to identify relevant articles: Child* AND (abuse OR maltreatment OR neglect) AND (Pregnan* OR antenatal OR Childbirth OR labour OR labor OR Neonat* OR Postpartum OR postnatal OR Perinatal). In addition, “history of violence against children” was also searched alongside the perinatal search terms, as it is used by many researchers globally [e.g., 13 ]. Consistent with ‘back-in-time’ pearling, reviewer one searched the reference list of each identified article using the ‘find’ function in the pdf viewer and the words child* and pregnan*. This search was conducted on articles after full-text screening. Data from the search results were downloaded into Endnote, which identified exact duplicates. All extracted records were imported into an Excel spreadsheet where reviewers independently used the inclusion/exclusion criteria to screen the records by title, abstract, and full text.

Quality assessment

Once inter-rater agreement was achieved, the sample was quality assessed. An assessment tool developed from previous studies [(provided as S1 Appendix , 11 , 14 ] evaluated the methodological quality and risk of bias. Each study was rated on 1) selection procedures, 2) data collection methods, 3) study design, and 4) statistical analyses. Ratings were scored from 4 ( weak ) to 12 ( strong ). Consistency of ratings was confirmed by no substantial differences in the review of an initial ten articles. The remaining studies were individually assessed due to budget limitations. Consistent with Huang et al. [ 15 ], articles rated weak for all four domains were excluded from the review. In addition, the sufficiency of any sample ≤ 200 was checked using G*Power [ 16 ] relative to the analyses conducted (i.e., < 5% chance of a Type 1 error). Those with insufficient power were excluded.

Meta-analysis assessment

The homogeneity of the data was assessed using predefined criteria. Given the heterogeneity of the studies in terms of samples, design, predictors, and outcomes, no studies were deemed suitable [ 17 ]. S1 Table provides the criteria, full details of this assessment, and associated reasons for the unsuitability of the studies.

Fig 1 shows the PRISMA flow diagram. From 12,384 records identified, a sample of 555 studies was derived. For the initial search, the inter-rater agreement was 96.8% (disagreements resolved by discussion). For each iteration of pearling, the inter-rater agreement was 100%. Common reasons for exclusion were duplication of theses with published articles (theses retained for their detail), lifetime or current abuse examined, or using a summary/composite score. The final sample consisted of 95 articles.

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https://doi.org/10.1371/journal.pone.0302354.g001

The data extracted included the type of abuse, the child abuse measure, study details (e.g., longitudinal, country, participant age), perinatal outcomes, and findings. The outcomes were categorized as pregnancy, childbirth, postnatal for the mother, and perinatal for mother and child. Records extracted represented studies from 25 countries with 643,241 participants (excluding duplicate samples); 59 studies were cross-sectional, 36 were longitudinal, and most were conducted in North America or other developed countries. Child abuse was commonly assessed using customized measures and the Childhood Trauma Questionnaire (CTQ) was the most used validated measure. The studies were of good quality ( M = 9.05 SD = 1.42); most were rated low to medium bias (see S2 Table ). S3 Table provides a detailed overview of the studies’ characteristics (e.g., sample, abuse measure, prevalence, outcome measures, and quality rating).

Consistent with Brunton and Dryer’s [ 7 ] approach, prevalence estimates excluded samples < 200 (could lack external validity), with a high risk of abuse (may overestimate) and that utilized the same cohort as another included study. The prevalence of child abuse overall ranged from 5–25% with wide variability for the abuse types: CPA 2–78%, CSA 2–47%, and CEA/CPY 2–69%. The child abuse measure, conceptualization of abuse, and study location contributed to this variability.

Findings from studies

For each subsection of the four main categories of findings, the main findings are summarized (in italics) when multiple studies are reported. Then, the more detailed findings are provided. S4 Table provides the main findings of each study.

Pregnancy outcomes

Unhealthy behaviors..

Disordered eating

Two studies had findings related to pregnancy weight gain or control. The evidence indicates that all abuse types (i.e., CPA, CSA, and CEA) are related to weight or shape concerns or disordered eating. However, in adjusted analyses only CSA significantly predicts lifetime eating disorders and shape and weight concerns .

Ranchod et al. [ 18 ] noted that at least two occurrences of CPA were independently associated with an increased risk of excessive gestational weight gain. Senior et al. [ 19 ] identified that CPA, CSA, and CEA independently predicted lifetime eating disorders and shape and weight concerns. However, only CSA remained significant after adjustment for other childhood factors (e.g., parental depression, support). In addition, CSA and CEA predicted antenatal eating disorder symptoms (e.g., self-induced vomiting), whereas CPA did not. However, these associations were not significant after adjusting for other childhood factors. In addition, all three abuse types were independent risk factors for shape and weight concerns during pregnancy (ORs = 1.56–1.78); however, after adjusting for childhood factors, only CSA remained significant for antennal shape and weight concerns.

Substance use

Four studies examined smoking during pregnancy and predominantly identified CPA and CEA as risk factors for continued smoking. CSA, CSA with force, or CSA and depressive symtoms also predicted antenatal smoking. Fewer studies examined alcohol or drug use during pregnancy, and these indicate that CSA is a risk factor for antenatal drug use, and a history of any CPA or CSA increases the likelihood cocaine use (cf. no abuse) .

Blalock et al. [ 20 ] identified that smoking within five minutes of waking was more than twice as likely for pregnant women who experienced CPA and CEA ( cf . women who reported low/no trauma). Depression did not mediate these relationships. Cammack [ 21 ] identified that non-parental CSA motivated by physical force was associated with continued pregnancy smoking among women with a smoking history. Individuals with depressive symptoms and a history of caregiver CPA or non-caregiver CSA had the same risk level for continued smoking; however, those with 0–1 depressive symptoms and a CPA history were less likely to continue smoking. Nerum et al. [ 22 ] noted that, pregnant women subjected to CSA were more likely to smoke ( cf . adult rape or no child abuse). Racine et al. [ 23 ] found that childhood family violence (i.e., CPA, CEA, and exposure to domestic violence) increased the odds of antenatal smoking, binge drinking, and drug use. A history of CSA was also a risk factor for antenatal drug use. Jantzen et al. [ 24 ], was the only study to examine illicit drugs and showed that women with a history of any CPA or CSA were more likely to use cocaine during their lifetime or perinatally ( cf . no abuse).

Maternal wellbeing.

Psychosocial risks

Psychosocial risks were examined in six studies. Findings suggest that the individual abuse types alone or experienced jointly increased the risk of psychosocial difficulties (e.g., single parenting, being unsupported) relative to no abuse. However, the evidence relating to unplanned pregnancy is mixed with one study identifying child abuse as increasing the risk of unplanned pregnancy yet two studies failed to identify any dose-response relationship related to severity of abuse and unplanned pregnancy .

Racine et al. [ 25 ] noted that women who experienced both CPA and CEA were more likelier to enter pregnancy with health risks and psychosocial difficulties than women who had not suffered abuse. However, no single abuse type significantly increased pre-pregnancy or reproductive health risks. Madigan et al.’s [ 29 ] study of 501 Canadian women identified that CPA or CSA increased the psychosocial risks (e.g., single parent) of pregnant women. One study [ 26 ] identified that women with a CSA history were less likely to participate in childbirth classes and, if they did participate, were unlikely to have a partner with them ( cf . no abuse). These women also felt less prepared for labor and were less likely to have a trusted person with them during labor or feel they could participate in medical decisions. Similarly, Nerum et al. [ 22 ] found thatwomen with a CSA history were more likely to be unemployed or unsupported during pregnancy ( cf . adult rape or no abuse).

Three studies examined unintended pregnancy. Dietz et al. [ 27 ] identified that less frequent abuse attenuated the risk of unintended pregnancy for CPA and CPY with multiple instances of abuse increasing the risk by 50%. Similarly, Drevin [ 28 ] noted that all abuse types, either individually or experienced jointly, and more frequent abuse was associated with an increased risk of unplanned pregnancy. This risk remained even when controlling for other abuses. Finally, Lukasse et al. [ 29 ] identified that CPA, CSA, and child abuse (any CPA, CSA, or CEA) predicted a high incidence of unintended pregnancy but no dose-response effect for severity was identified.

Biomedical risks

Five studies examined five different biomedical risks. CSA was identified as a risk for persistent bacterial vaginosis and increased inflammation in pregnancy. Child abuse history predicted C-reactive protein and increased the risk of gestation diabetes mellitus (GDM). CPA increased the odds of thyroid dysfunction in postpartum women .

Cammack et al. [ 30 ], in a sample of 312 pregnant US women, compared those who suffered CPA, CSA, or CEA to non-abused women and identified only CSA as a risk for persistent bacterial vaginosis (aOR = 3.07). Moreover, when stratified by race (a known risk factor for various adverse perinatal outcomes), the magnitude of this association was stronger for non-black people than black people. Finy and Christian’s [ 31 ] study identified child abuse history as a predictor of C-reactive protein. Pre-pregnancy body mass index (BMI) statistically explained this relationship.

Mason et al. [ 32 ] examined GDM with a large sample ( N = 45,500). In adjusted analyses, different severities, and combinations of exposure of CPA and CSA increased the risk of GDM ( cf . no abuse). Adjustment for pre-pregnancy BMI attenuated these associations slightly. Also, adjustment for not being overweight at 18 years also attenuated these associations and only severe CPA and CSA remaining significant predictors of GDM. CPA was more strongly associated with GDM if it occurred in adolescence than in childhood. Conversely, CSA was more strongly associated with GDM if it occurred in childhood than adolescence. Severe CPA and being overweight at 18 years increased the risk of GDM in a smaller subsample but no similar interaction for CSA was found.

Madigan et al.’s [ 33 ] study identified that CPA or CSA increased the biomedical (e.g., gestational diabetes) risks of pregnant women. Plaza et al. [ 34 ] found that only CPA increased the odds of thyroid dysfunction in postpartum women ( cf . no abuse). Finally, Bublitz et al. [ 35 ] showed that a CSA history was linked to a greater change in the Neutrophil-lymphocyte ratio (NLR, a measure of systematic inflammation) over pregnancy.

Four studies examined cortisol with the evidence indicating that CSA is associated with elevated cortisol awakening response (CAR) in later pregnancy (cf. other or no abuse) and that this association may be moderated by family functioning and abuse severity. Also, experiencing joint CSA and CPA is linked to increased hair cortisol levels however this association was only evident among black women .

CSA was associated with elevated CAR at 30 and 60 minutes after waking after controlling for proximal stressors in a small US study [ 36 ]. Bublitz and Stroud [ 37 ] found that 30 women with CSA histories had higher CAR at 35 weeks gestation than women reporting other or no abuse. In a second study of a similar size drawn from the same cohort, Bublitz et al. [ 38 ] identified that among participants with more experiences of CSA, those with poorer perceived family functioning had increased CAR at 35 weeks but not at 25 or 29 weeks compared to women with fewer CSA experiences and better-perceived family functioning. Schreier et al. [ 39 ] noted that women who experienced joint CPA and CSA had higher hair cortisol levels ( cf . no abuse). When stratified by race/ethnicity, the association between child abuse and hair cortisol levels was only evident for black women.

General health

Seven studies examined aspects of general health or pregnancy-related health. Findings show that CPA or CSA are associated with poor past year health, hospitalization during pregnancy and more pregnancy complications. Also, CPA, CSA or CEA may increase the risk of current (e.g. migraine) or pregnancy-related health complaints or complications (cf. no abuse) .

In a study of postpartum women, Ansara et al. [ 40 ] noted that CPA or CSA did not predict bad headaches (cf. no abuse), however, CSA independently predicted backache, but this was no longer significant in adjusted analyses (e.g., depression). Perineal pain, hemorrhoids, fatigue, or bowel problems were not associated with CPA or CSA. Barrios et al. [ 41 ] identified that a history of child abuse increased the odds of reporting poor past year health or during the current pregnancy ( cf . no abuse history). Similarly, women who reported CPA or CSA were more likely to have poor past year health and over twice as likely to have a poor past year and pregnancy health even after adjustment for current intimate partner violence (IPV).

Drevin [ 28 ], in a large cohort study, identified that women with self-reported CPA reported sacral and pelvic pain more often than those with no CPA. Lukasse et al. [ 42 ] examined 55,776 Norwegian women and found that women with CPA, CSA, or CEA were likelier to report seven or more common pregnancy complaints (e.g., heartburn, backache, cf . no abuse). In addition, joint exposure to different abuses increased this likelihood. Sociodemographic characteristics and other risk factors did not explain this graded association. Finally, Littleton [ 43 ] found that those with a CSA history were more likely than nonvictims to report high levels of past month somatic complaint severity (e.g., headaches, indigestion). Depressive symptoms mediated this relationship (medium effect size). Controlling for sociodemographic variables resulted in similar findings.

Two studies [ 44 , 45 ] found that women exposed to CSA were more likely to be hospitalized during pregnancy ( cf . no abuse). One study identified a link between CSA and reduced antenatal consultations after controlling for demographic and other key factors (e.g., dissociation, adverse childhood experiences). Women with a CSA history also presented more often with complications such as cervical insufficiency than other women. In adjusted analyses, women with a CSA or CPA history were likelier to have pregnancy complications.

Gelaye et al. [ 46 ] identified that any child abuse, CPA, or joint exposure to CPA and CSA increased the likelihood of migraine. In addition, a higher frequency of child abuse increased this risk. Adjusting for lifetime IPV attenuated these associations slightly. Yampolsky et al. [ 47 ] found that CSA survivors were almost twice as likely to have gynecological problems ( cf . other trauma) after adjusting for depression and post-traumatic stress. However, a history of CSA or other trauma was not statistically significant in contributing to high-risk pregnancy.

One study examined sleep and found that child abuse was related to stress-related sleep disturbance. Child abuse or CPA increased the odds of poor pregnancy sleep quality with a dose-response relationship relative to the frequency or joint exposure .

Gelaye et al. [ 48 ] noted that women who experienced child abuse, multiple occurrences of abuse or jointly experienced CPA and CSA were more likely to have stress-related sleep disturbance than non-abused women. These associations remained after adjustment for age, ethnicity, and lifetime IPV. Experiencing CPA or CSA alone was not related to increased odds of stress-related sleep disturbance. When examining sleep quality, women reporting child abuse or CPA were around twice as likely to have poor sleep quality during pregnancy than other women. This risk increased relative to the frequency of abuse or if there was joint exposure to CPA and CSA. In separate analyses, antepartum depression and IPV mediated the relationship between child abuse and stress-related disturbance and sleep quality.

Zhang et al. [ 49 ] examined memory impairment in a community sample. CPA, CSA, and CEA all predicted greater prospective and retrospective memory impairment. In adjusted analyzes, only CEA was independently related to both types of impairment. Women reporting both CEA and CPA had a higher prospective impairment, and those reporting both CEA and CSA or CEA and CPA had higher retrospective memory impairment. Women reporting all three types of child abuse also had higher prospective and retrospective memory impairment.

Miscarriage, stillbirth, and termination

Atkinson [ 50 ] failed to find a relationship between CPA and stillbirth, miscarriage, or termination. Similarly, Freedman et al. [ 51 ] found no association between CPA, CSA, or CEA and stillbirth. However, in a smaller study [ 22 ] of women referred to mental health services, a history of CSA increased the likelihood of a previous termination or miscarriage ( cf . adult rape or no abuse).

Psychological and mental health disorders.

Antenatal depression

Nine studies examined antenatal depression. Findings strongly indicate that child abuse, CPA, CSA or a history of both CPA and CSA are risk factors for depression in pregnancy (cf. no abuse). In addition, race and a positive maternal relationship may influence the severity of depression. Only one study did not find significant results for CSA and depression .

Barrios et al. [ 41 ] identified child abuse, CPA, or a history of both CPA and CSA as more than doubling the risk of depression in early pregnancy ( cf . no abuse). This risk remained after adjusting for current IPV. CSA alone was not a significant risk factor. Likewise, Corona et al. [ 52 ] found a two-fold risk of depression in a sample of 382 low-income Hispanic/Latina women who reported child abuse. However, when stratified by country of birth, foreign-born Hispanic/Latina women had a lower depression risk (aOR = 1.96) than US-born women (aOR = 2.40).

Rich-Edwards et al. [ 53 ] also identified that a history of CPA or CSA increased the risk for antenatal depression in mid-pregnancy after adjusting for age and race. In addition, Yampolsky et al. [ 47 ] found that CSA survivors had a higher risk of depressive symptoms than others. Similarly, Chung et al. [ 54 ] noted that CPA and CSA increased the risk of depression ( cf . no/other abuse). Of note, for CSA survivors without a positive maternal relationship, their risk of depressive symptoms more than tripled compared to women with no CSA and a positive maternal relationship.

Benedict et al. [ 55 ] found that contact or non-contact CSA was unrelated to antenatal depression symptoms but when they examined severe depressive symptoms, women who experienced CSA had a two-fold risk. Samia et al.’s [ 56 ] Kenyan study demonstrated that contact CSA predicted antenatal depression, consistent from early to mid-pregnancy. Galbally et al. [ 57 ] identified moderate-to-severe forms of child abuse increased the risk of an early pregnancy depression diagnosis but when examined separately, CSA posed over a four-fold risk. Only one study did not find a relationship between CSA and depression [ 58 ].

Anxiety, worries and common mental disorders (CMDs)

Four studies had findings related to pregnancy-related anxiety, worries, and CMDs. Brunton et al. [ 4 ] demonstrated that CPA, CSA, and CPY all independently predicted pregnancy-related anxiety mediated by resilience and social support. Eide et al. [ 59 ] noted that women who reported CPA, CSA, or joint exposure were more likely to have strong worries about the baby’s health than other women. Samia et al. [ 56 ] had no significant findings concerning CSA, pregnancy-related anxiety, and stress. Lydsdottir et al. [ 60 ] showed that CSA nearly tripled the odds of CMDs in pregnancy (i.e., depression or anxiety) after controlling for other traumas (e.g., poverty, being bullied). For CPA, however, the risk of CMD diagnosis was over five-fold.

Suicide ideation

Two studies examined suicide ideation finding that pregnant women who experienced any child abuse, CPA, CSA, or CEA had an increased risk of suicide ideation. The severity and frequency of abuse increased the risk exponentially. For women with a history of child abuse, depression or IPV potentially moderates this risk .

Zhang et al. [ 61 ] identified that pregnant women who experienced any child abuse had over a three-fold risk of suicide ideation; controlling for depression slightly attenuated this. When examined independently, child abuse was associated with an increased risk of suicide ideation during pregnancy ranging from around a three-fold risk for CPA and CSA to close to five-fold for CEA. The severity and frequency of abuse increased the risk exponentially. Of note, women with a history of child abuse and depression had the greatest risk of suicide ideation (aOR = 17.78) than women without abuse or depression or women with only depression and no abuse history. Likewise, Zhong et al. [ 62 ] noted that any CPA or CSA nearly quadrupled the risk of suicide ideation in pregnancy compared to other women. This risk was attenuated by controlling for IPV and depression. Experiencing only CPA or only CSA increased the risk more than two-fold; however, joint exposure to CPA and CSA or multiple instances of abuse increased the risk more than four-fold, even after controlling for IPV and depression. The lack of a depression diagnosis did not reduce the risk of suicide ideation for those with a child abuse history.

Post Traumatic Stress Disorder (PTSD)

Five studies examined PTSD during pregnancy. A history of CSA, CPA, CEA or joint CPA and CSA increased the risk for PTSD or related symptomology and this risk increased exponentially for those who experienced child abuse and IPV. Only one study failed to find any significant findings related to the individual abuse types and PTSD .

Yampolsky et al. [ 47 ] found that a history of CSA doubled the risk for high post-traumatic stress symptoms. Sanchez et al. [ 63 ], in models adjusted for age, ethnicity, and lifetime IPV, showed that women who experienced CPA or CSA had an increased risk of PTSD ( cf . other women). This risk increased eightfold when CPA and CSA were experienced together. Also, women who experienced child abuse were more than five times more likely to have PTSD and experiencing child abuse and IPV increased the odds of PTSD to more than twenty-fold.

Seng et al. [ 64 ] examined primiparous women using cluster analysis. CPA was associated with an increased likelihood of affect/relational dysregulation, and CSA doubled the odds of comorbid PTSD. In addition, the odds of being in the healthy cluster for both abuse types were low (aOR < 0.62). Huth-Bocks’ [ 65 ] smaller study examined women in late pregnancy. After controlling for age and income, there were no significant findings related to the individual abuse types and PTSD. Finally, Diestel et al. [ 66 ] examined child abuse and PTSD symptoms with women from an IPV and epigenetic risk study. All types of child abuse were associated with PTSD symptomology, with the strongest findings for CEA. This abuse type was strongly associated with social isolation with weaker associations for intrusive thoughts and negative emotionality.

Childbirth outcomes

Birth complications..

Four studies examinend bith complications with the findings indicating that women with a CPA or CSA history had increased risk of perinatal and obstetrical complications and more likely to have a difficult birth, medical interventions during birth, or their child transferred to intensive care. CPA and CSA were also independent risk factors for complicated delivery .

Shamblaw et al. [ 67 ] found that women with a CSA or CEA history ( cf . no abuse) had around a two-fold increased risk of perinatal and obstetrical complications. However, after adjustment for lifetime psychiatric disorders, only CSA was significant. Heimstad et al. [ 68 ] noted that CPA and CSA were independent risk factors for complicated delivery (i.e., operative vaginal delivery or caesarean); both posed around a 2.5 increase in risk than women with no abuse history. Leeners et al. [ 26 ] showed that pregnant women with a history of CSA were more likely to have a difficult birth and less likely to deliver spontaneously. Finally, Nerum et al. [ 22 ] found that relative to women who experienced adult rape or no abuse, women with a CSA history were more likely to have obstetric risks, induced or augmented labor, epidural analgesia, or their child transferred to intensive care.

Fear of childbirth.

Three studies had findings related to a fear of childbirth. Consistently, child abuse survivors have been shown to have more childbirth fear than other women regardless of parity. A previous negative birth experience increases the risk exponentially. CSA history increases the likelihood of intense fear of delivery, negative birth perceptions, and a greater fear of delivery .

Lukasse et al. [ 3 ] found that regardless of parity, child abuse survivors feared childbirth more than other women. However, primiparas with a CPA, CSA, or CEA history were more likely to fear childbirth severely ( cf . no abuse). The severity of abuse also increased the odds of the severity of fear of childbirth. Experiencing simultaneous abuse increased the odds, and a collective history of all three abuse types posed the greatest risk for severe fear of childbirth (aOR = 5.30). For multiparas, only non-contact, and mild CSA (e.g., humiliation) increased the odds of severe fear of childbirth. CPA, severe CPA, CEA, and any child abuse likewise were risk factors. Also, when adjusted (e.g., demographics, adult abuse, previous negative birth experience), the association between child abuse and severe fear of childbirth attenuated slightly for primiparas but was not significant for multiparas. However, multiparas who experienced any child abuse and had a negative birth experience were nearly six times more likely to have a severe fear of childbirth than women with a history of child abuse and a positive birth experience. However, no child abuse and a negative birth experience posed a much higher risk (nearly nine times) for severe fear of childbirth.

Lukasse et al. [ 69 ] examined multiparas (second pregnancy). Child abuse increased the risk for fear of childbirth after adjusting for sociodemographics, adult abuse, previous birth experience, and perception of first pregnancy. However, only CEA was a significant risk factor for fear of childbirth. Finally, Leeners et al. [ 26 ] demonstrated that women with a CSA history were more likely to have an intense fear of delivery than other women, twice as likely to have a negative birth perception, and nearly three times more likely to fear delivery.

Low birthweight.

Hyle’s [ 70 ] study of low-income women found that a history of CSA (broadly defined), predicted birth weight, whereas CPA did not ( cf . no abuse). Additionally, specific abuse characteristics (e.g., onset age) predicted birth weight. Leeners et al. [ 45 ] identified that women with a CSA history were more likely to have a low birthweight baby (< 2800 grams) than non-abused women. In contrast, Benedict et al. [ 55 ] did not find differences in birth weight or baby characteristics for women exposed to CSA compared to those who were not.

Mode of delivery.

Five studies examined the mode of delivery. The finidngs show that regardless of parity, a history of abuse was not associated with operative delivery, but CPA was associated with a significant increase in emergency cesareans for multiparas. Moreover, any child abuse or CSA was linked to increased cesarean during labor and women who suffered CPA or CSA were more likely to desire a cesarean before their second pregnancy birth .

Schei et al. [ 71 ] utilized data from a multi-country study, finding that regardless of parity, a history of abuse was not associated with any operative delivery. However, for multiparas, a history of CPA was associated with a significant increase in emergency cesareans, and this association attenuated after controlling for previous cesarean. There was no association between CPA and non-obstetrically indicated cesarean. In contrast, Nerum et al. [ 22 ] found that women with a CSA history were no more likely to have an operative vaginal delivery or cesarean than women with a history of adult rape or no abuse. Benedict et al. [ 55 ] failed to find significant differences between CSA and no CSA for the type of delivery (e.g., caesarean, induction). Lukasse et al. [ 72 ] identified that more women with an abuse history had an increased chance of caesarean during labor than other women. However, none of the distinct categories of child abuse was significantly associated with a cesarean before childbirth; however, any child abuse and mild CEA were associated with increased cesarean during labor compared with women with no child abuse. After adjustment, only any child abuse remained a risk factor for cesarean during labor. Using a smaller subsample from the same cohort [ 69 ], women who suffered any CPA or CSA were more likely to desire a cesarean before their second pregnancy birth than women with no abuse.

Preterm birth (PTB).

Six studies have findings related to PTB however most have failed to identify child abuse or specific types (e.g., CPA or CSA) as risk factors for PTB. In contrast one study found that a CSA history was associated with an increased risk of PTB (cf. no abuse), and this risk was heightened for women from a race other than Hispanic, black, or white. Only one study identified that the frequency of child abuse or exposure to child abuse and IPV, doubled the risk of placental abruption .

Cammack [ 21 ] found that women with CSA perpetrated by a non-parent and motivated by non-physical threats had nearly double the risk of very PTB (before 34 weeks) than women with no child abuse. Further, women from a race other than Hispanic, black, or white were nearly eight times more likely to have a very PTB. Moreover, the risk for ‘other race’ and birth before 37 weeks nearly quadrupled when they had experienced the same type of CSA ( cf . no abuse). Leeners et al. [ 44 , 45 ] conducted two studies with the same sample. Women with a CSA history were more likely to have a PTB or premature contractions.

In contrast, studies have more consistently not identified child abuse or specific types (e.g., CPA or CSA) as risk factors for PTB [ 70 , 73 , 74 ]. However, Hyle [ 70 ] showed specific abuse characteristics (e.g., more than three incidents) predictive of lower gestational age in a sample of low-income women. Specifically, there was an associated decrease in gestational age for each additional abuse incident. Only one study found that any child abuse and CSA increased the chances (1.5 times) of late PTB at 35–36 weeks [ 74 ].

Mitro et al. [ 75 ] conducted the only study on placental abruption. Child abuse did not increase the odds of placental abruption in adjusted models for demographics and parity. However, experiencing three or more instances of child abuse increased the odds of placental abruption by just over 1.5 times. In addition, joint exposure to severe child abuse and IPV doubled this risk compared to rare or no abuse. When examined among women delivering preterm, experiencing three or more child abuse events almost doubled the risk for placental abruption. Similarly, among women delivering full-term babies, experiencing joint and severe exposure to childhood abuse and IPV was associated with close to a three-fold risk of placental abruption.

Postnatal outcomes for mothers

Mother-child relationship..

Five studies examined attachment/bonding with the evidence suggesting that CEA and CSA are associated with less maternal-fetal attachment or bonding disturbances. However, postpartum no specific abuse types predict mother-infant bonding impairment .

Two studies identified CEA as a predictor of lower maternal-fetal attachment [ 76 ] and mother-infant bonding disturbances [ 77 ]. Also, Nieto et al. [ 78 ] found that CSA ( cf . no CSA) nearly tripled the odds of lower maternal attachment. In contrast, Lehnig et al. [ 79 ] did not identify specific abuse types that predicted mother-infant bonding impairment at two months postpartum. However, their result may reflect their sample’s low prevalence of abuse. Choi’s [ 80 ] study of South African mothers did not identify any abuse type significantly affecting maternal-infant bonding in analyses controlling for other abuse types.

Parental practice.

Self-efficacy and parenting morale

Two studies examined parenting outcomes. Kunseler et al. [ 81 ] identified that postpartum women who reported child abuse did not differ in parenting self-efficacy or changes in their efficacy after positive feedback (than other women). However, for those who reported child abuse, their parenting self-efficacy decreased after exposure to a difficult-to-soothe infant ( cf . non-abused women). Malta et al. [ 82 ] noted that women with a child abuse history were nearly twice as likely to have low parenting morale.

Child abuse harm or potential

Three studies examined child abuse potential or harm. Findings indicate that a history of CPA, CSA or CEA are associated with an increased likelihood of harm to the infant/toddler and this association may be mediated by substance abuse or depression. Moreover, for first-time mothers those with a history of CPA or CEA, they may be less responsive or have reduced empathic awareness in parenting, have harsher punishment attitudes and be more accepting of child abuse/neglect .

Appleyard et al. [ 83 ] demonstrated that a maternal history of CPA or CSA increased the likelihood that the mother would victimize their infant/toddler. Maternal substance abuse mediated this relationship. Bert et al. [ 84 ] noted that CEA predicted less responsivity/empathic awareness in parenting, harsher punishment attitudes, more acceptance of child abuse/neglect, and greater child abuse potential in first-time mothers. CPA predicted the same outcomes except for child abuse potential, which was only significant for mothers older than 21 with some college education. Choi [ 80 ] identified CEA as indirectly influencing child harm exposure through postpartum depression (PPD). CPA or CSA were not significant contributors.

Postpartum psychological outcomes.

Postpartum depression (PPD)

Ten studies had findings relating to PPD. Women who experienced child abuse may be more likely to have PPD with the risk increasing exponentially for multiple types of abuse or experiencing child abuse and pregnancy IPV. Three studies found that CEA increased the risk of PPD. In contrast, one study failed to find any association between CPA, CSA, and CEA and PPD but may have been limited by its sample .

Mahenge et al. [ 85 ] identified that women who experienced child abuse were between 2.5 and over five times more likely to have PPD. The risk nearly quadrupled for those with a joint history of CSA and CPY and increased to more than nine times if they experienced child abuse and IPV during pregnancy. Bahadur et al. [ 86 ] noted that CEA increased the risk of PPD nearly seven-fold after adjusting for sociodemographic factors, whereas CPA and CSA were not significant. However, a larger Australian study [ 87 ] showed a similar but lower risk for CEA (aOR = 1.4). Nagl et al. [ 88 ] found that women with severe CEA were nearly 20 times more likely to have PPD. Severe CPA or CSA, slight and moderate CPA, or CEA were lesser risk factors. Most of these associations remained even after controlling for other abuses. One Ethiopian study [ 89 ] identified that a history of CSA was a stronger predictor of PPD than other sociodemographic variables. In studies that examined all abuse types, CPA, CSA, and CEA independently predicted PPD; however, only CPA remained significant when controlling for other abuses [ 34 ]. CEA and CSA were also risk factors for early-onset PPD, and CEA, CPA, and CSA were all risk factors for late-onset. The risk remained for CSA and early-onset PPD and CEA and late-onset PPD after adjusting for sociodemographic factors and other abuse types [ 90 ]. In contrast, a South African study showed that only CSA and CEA predicted PPD [ 80 ]. Finally, Cohen et al. [ 91 ] demonstrated that CPA, CSA, and CEA was not predictive of PPD however insufficient participants with abuse experiences may have impacted this result.

Postnatal anxiety, stress and PTSD

Three studies examined postnatal anxiety or stress finding that child abuse was not linked to postnatal anxiety or stress. However, when examined by subtype CPA, CSA and CEA were independent risk factors for postnatal anxiety. One study failed to find any association between CSA and PTSD symptoms hypothesising an indirect effect .

Malta [ 82 ] did not identify any association between child abuse and postnatal anxiety or stress. In contrast, Nagl et al. [ 88 ] identified CPA and CEA as independent risk factors for postpartum anxiety with severe CSA associated with a nearly seven-fold risk. These associations were lower after controlling for other abuses. Mayhew and Thomas [ 92 ] noted that prenatal anxiety was the strongest predictor for postnatal anxiety. CEA and distressing childbirth were also significant predictors in the same model.

Oliveira et al. [ 93 ] conducted the only study of postnatal PTSD symptoms noting that CSA was related to other traumatic events such as IPV and fear of childbirth but not directly related to PTSD symptoms suggesting an indirect effect.

Swanson et al. [ 94 ] found that women with a CPA or a joint history of CPA and CSA had greater difficulty falling asleep. Of interest, the risk was greater for CPA alone (aOR = 9.20) than for experiencing CPA and CSA jointly (aOR = 5.95). In addition, women with a history of CPA or those who experienced CPA and CSA simultaneously were more than three times more likely than other women to have difficulty staying asleep.

Perinatal outcomes for mothers and newborns

Offspring asthma and autism..

Only one study examined asthma but did not identify significant associations with maternal CPA or CSA [ 95 ]. Roberts et al. [ 96 ], the only study to examine autism risk, found that severe CSA doubled the risk for offspring autism, with severe joint exposure to CPA and CEA a lesser risk ( cf . no abuse). In addition, experiencing multiple instances of child abuse tripled the risk of autism regardless of the child’s biological sex. In adjusted models, gestational diabetes, previous abortion, and smoking mediated the relationship between child abuse and autism.

Breastfeeding.

Breastfeeding was examined by three studies with the findings indicating that women who experienced child abuse were more likely to stop breastfeeding earlier than other women. Also, a history of CSA increased the likelihood of mastitis or painful breastfeeding which may be a contributing factor to early cessation .

Sorbo et al. [ 97 ], using a large sample, noted that women who experienced child abuse or CSA were more likely to stop breastfeeding before four months. The odds of breastfeeding cessation by four months were lower for CPA and/or CEA. Coles et al. [ 2 ] identified CSA survivors as less likely to breastfeed for longer than six months however, this result was no longer significant after adjustment for adult violence and other factors (e.g., smoking, partner status). Elfgen et al. [ 98 ] noted that a history of CSA nearly tripled the likelihood of mastitis or experience painful breastfeeding (OR = 5.77). However, there was no difference in breastfeeding prevalence between these women and those with no CSA history.

Intimate Partner Violence (IPV).

Three studies examined IPV identifying that CPA, CSA, and CEA increased the likelihood of IPV in the past-year with specific abuse types linked to specific IPV subtypes. Child abuse, CPA, and CSA were risk factors for any IPV with joint exposure (i.e. CPA and CSA) increasing the risk. However, when other types of violence are controlled, the results were non-significant suggesting a mediating effect. Only one study did not identify child abuse (CPA and CSA) predictive of IPV in a sample of HIV-positive women .

Barnett’s [ 99 ] longitudinal study (pregnancy and postpartum) demonstrated that CPA, CSA, and CEA increased the likelihood of high past-year IPV. When specific IPV subtypes were analyzed, a CPA history was a higher risk for moderate emotional and sexual IPV and high physical IPV ( cf . women with low/no child abuse). CSA and CEA were associated with high emotional or physical IPV and high/moderate sexual IPV.

Barrios et al. [ 41 ] identified that child abuse, CPA, and CSA were risk factors for any IPV and physical lifetime IPV; joint CPA and CSA posed the highest risk. Child abuse also predicted lifetime sexual IPV, and a history of both CPA and CSA posed a five-fold risk of this IPV type. Child abuse and CSA predicted both physical and sexual lifetime IPV. A history of CPA and CSA increased this risk more than seven-fold. Comparable results were evident for IPV in the past year. CPA and CSA were associated with greater odds of revictimization of physical IPV. CSA was also related to sexual IPV revictimization. Experiencing both CPA and CSA increased the risk of physical and sexual lifetime IPV revictimization. However, the greatest risk of revictimization was for those who experienced CPA and CSA and combined physical and sexual IPV, aOR = 6.88.

Castro et al. [ 100 ] identified a higher prevalence of pregnancy IPV for those who experienced moderate to high CPA or CEA ( cf . no/low abuse). Both abuse types more than doubled the risk of IPV; however, when other types of violence were controlled, the results were non-significant. Only one study did not identify child abuse (CPA and CSA) predictive of IPV in a sample of HIV-positive women [ 101 ].

Maternal psychological outcomes.

Depression and anxiety

Seven studies examined depression across the perinatal period. The findings show that child abuse, CPA, CSA, and CEA all increased the risk of antenatal or postnatal distress or depression or high depressive symptoms. One longitudinal examination showed that women who experienced CSA had higher anxiety symptoms during pregnancy and postpartum than non-abused women.

Kang et al. [ 102 ] demonstrated that child abuse nearly doubled the risk of peripartum depression in a large Turkish study. Li et al. [ 103 ] found that women who experienced CSA or CEA were more than four times more likely to have antepartum depression than non-abused women. Also, women with a CEA history had higher depression scores in pregnancy which lessened over the perinatal period than women with no CEA, whose scores started lower but increased postpartum. In fact, the depression scores for women with a CEA history, while higher in pregnancy, were much lower than those with no CEA by four weeks postpartum. Also, no significant effects for any abuse or frequency of abuse was found for PPD scores, or between abuse types and chronic depression risk.

Akinbode’s [ 104 ] study showed that CSA predicted PPD symptoms in pregnancy, six and 12 weeks postpartum. CPA predicted depression in pregnancy and 12 weeks postpartum but not six weeks postpartum. Experiencing both CPA and CSA also predicted antenatal depression, but there was no significant finding for PPD. In contrast, Robertson-Blackmore et al. [ 105 ] found that women who reported CSA were more likely to report antenatal depressive symptoms than other women but were not more likely to report PPD. CPA/parental neglect was not significant for antenatal depression or PPD.

Khanlari et al. [ 106 ] compared women with a maternal history of abuse with other women, noting that child abuse increased the risk for antenatal and postnatal distress and depression. The highest risk was for antenatal depression (aOR = 3.2). Similarly, Ogbo et al. [ 107 ] examined a large sample of culturally and linguistically diverse (CALD) Australian women. Those with a child abuse history had nearly double the risk for antenatal distress and were more than twice as likely to have antenatal or PPD than non-abused CALD women. Giallo et al. [ 108 ] noted that CPA and CSA independently increased the risk for subclinical and persistently high depressive symptoms for nulliparous women. However, CPA was the only significant risk factor for subclinical and persistently high depressive symptoms after controlling for sociodemographic factors.

Akinbode [ 104 ] conducted the only longitudinal examination of anxiety, noting that women who experienced CSA had higher anxiety symptoms during pregnancy, six and 12 weeks postpartum, than non-abused women. CPA and experiencing both CPA and CSA were not significant predictors.

Three studies examined PTSD. The evidence shows that women with a CSA history or those who experienced CPA and neglect have a higher risk of lifetime PTSD. Greater exposure to child abuse also predicts antenatal PTSD symptoms and a history of CSA predicts greater PTSD symptomology, postpartum .

Robertson-Blackmore et al. [ 105 ] showed a higher risk of lifetime PTSD for women with a CSA history (aOR = 9.21) or those who experienced CPA and neglect (12.16) in models adjusted for demographics. Also, in adjusted analyses, Sumner et al. [ 109 ] found that higher exposure to child abuse predicted antenatal PTSD symptoms but not postpartum symptoms. Finally, Lev-Wiesel et al. [ 110 ] noted that a history of CSA predicted greater disassociation at two months postpartum and more birth-related PTSD symptoms, avoidance, and arousal levels at seven months postpartum.

Summary of findings

Despite some variability in the findings, predominantly studies confirm that a history of child abuse is a significant risk factor for poor pregnancy outcomes. CSA was the most examined abuse type consistently linked to pregnancy and childbirth outcomes. These outcomes included substance use (i.e., alcohol, smoking) which is of critical concern given the harmful teratogens introduced into the prenatal environment. However, none of the studies examined alcohol as an independent outcome; this area requires more attention. Poor mental health was the focus of several studies conducted in various countries, supporting the generalization of the findings. There were consistent findings that CPA and CSA, independently or jointly, represent a greater risk of antenatal depression and PTSD symptoms during pregnancy.

Studies examining biomedical outcomes confirm that child abuse increases the risk for certain conditions (e.g., enhanced inflammatory states) linked to poor maternal and neonatal health and perinatal complications. Also, CSA was associated with higher cortisol levels, whereas child abuse overall or different subtypes had less consistent findings. High cortisol levels may increase the HPA axis’ sensitivity to maternal distress, shorten gestation and increase antenatal health problems such as preeclampsia or gestational diabetes [ 38 ]. For the child, increased prenatal cortisol is associated with poor developmental outcomes [e.g., restricted growth, 111 ]. However, the findings should be viewed cautiously, given the small samples used.

Several studies established a link between child abuse and aspects of poor general health but not all types of poor health were linked to abuse, suggesting that the type of health condition may play a pivotal role. For example, a history of CSA is linked to gynecological problems in areas consistent with the foci of that abuse type. In contrast, CPA is associated with greater pelvic or sacral pain; these are areas that could be targeted during physical abuse. Also, findings that abuse survivors can have more common health complaints are consistent with trauma leading to a vulnerability for poorer mental and physical health and, for some, unexplained complaints [ 112 ]. Related to health is sleep disturbance, with studies establishing that women with a history of child abuse are more likely to have poorer sleep quality. Despite sleep disruption normative during pregnancy, poor sleep can contribute to poor outcomes [ 113 , provides a review]. Finally, findings regarding care indicate that women with a CSA history are more likely to be hospitalized during pregnancy or have reduced consultations. While these results may seem contradictory, it is conceivable that a lack of standard care may lead to more serious problems requiring hospitalization. However, caution is warranted in interpreting these findings due to the small effect sizes.

All abuse types increase the risk of delivery complications, and these have largely been studied for CSA. Child abuse survivors also have a greater preference for a cesarean; however, while this preference exists, the chances that it occurs are low. Multiparous women with a CPA history are also more likely to have an emergency cesarean which may be related to previous abdominal trauma. The finding that controlling for any previous caesarean attenuated this risk supports this proposition.

PTB and low birthweight have attracted the most interest from North American researchers using obstetric data (than self-report), which adds certainty to the findings. Predominantly CSA is associated with low birthweight more than other abuses. However, studies are limited by not considering the influence of other related factors identified in this review (e.g., self-care, eating disorders, and substance use) which could contribute to less nourishment for the fetus. Therefore, the mechanisms by which low birthweight occurs are unclear. Likewise, the association between CSA and PTB is inconsistent, suggesting there may be significant mediators or moderators of this relationship. However, again there are limited studies in this area.

Bonding and attachment are critical developmental tasks of motherhood [ 114 ], yet findings are inconsistent and require cautious interpretation (from single studies with small effects or unrepresentative samples). Given that several factors have been identified that result in a woman psychologically distancing from her pregnancy and newborn [e.g., anxiety and depression, 115 ], an examination of other indirect influences is needed.

Child abuse is a risk factor for low parenting morale [ 82 ] and predicts less parenting self-efficacy after exposure to a difficult-to-soothe infant. This large effect size for self-efficacy in nulliparous women indicates that these mothers may lose belief in themselves more readily in stressful parenting situations [ 81 ]. Relatedly, CPA, CSA, and CEA predicted exposure or potential to harm their child. Of note, substance use and PPD mediated the relationship between CEA and child harm exposure between the ages of five and 12. The authors explained that this delayed onset of maltreatment of abused mothers’ offspring is due to the persistence of depression beyond the postpartum period. These findings are particularly important given that vicarious learning may model later parenting behaviors [ 116 ], contributing to a generational cycle of violence.

Similarly, there are consistent links between CPA, CSA, and PPD. Less consistent are the findings for CEA, CPY and PPD. Only one study [ 91 ] did not find a relationship between CSA and PPD and CEA and PPD; however, their smaller sample and modified abuse measure may have limited findings. There were some consistent findings that CPA, CSA or CEA increase the risk of perinatal anxiety, with contradictory findings likely due to the purpose-created abuse measures used [e.g., 82 ].

Only one study examined CSA and postnatal PTSD symptoms, with the results trending toward significance ( p = .07), consistent with longitudinal studies across pregnancy and postpartum. Of interest, while identifying that PTSD symptoms have a downward trajectory from pregnancy to postpartum, Lev Weisel and colleagues’ comprehensive study also showed that CSA predicts significant PTSD symptoms seven months postpartum. Prima facie, this downward trajectory does not seem consistent with theorizing that childbirth for abuse survivors is retraumatizing; however, symptoms relating to intrusion and arousal, which had a time interaction, may indicate a delayed response to childbirth. Alternatively, the thought of childbirth may be retraumatizing for some abuse survivors, and the effects of this may lessen if the experience was not traumatic.

CSA posed the greatest risk for breastfeeding cessation, with CEA or CPA also identified as a risk for earlier cessation. One study identified that a history of CSA was related to painful breastfeeding, which may contribute to decisions to stop breastfeeding earlier, although this outcome was not examined. In addition, the link between child abuse, particularly CSA and breastfeeding, could be related to breastfeeding involving skin-to-skin contact, triggering memories of abuse. Given the importance of breastfeeding for at least six months to optimize an infant’s growth, development, and health and the benefits for the mother [e.g., reduces cancer risks, 117 ], this is an understudied area that requires more attention.

The risk of revictimization of survivors of child abuse is high with consistent links between child abuse, its subtypes and lifetime, past year, or current IPV [ 41 , 99 , 100 ]. These findings are consistent with child abuse, a known risk factor for adult revictimization [ 118 ]. The one study that did not identify abuse as a risk of revictimization utilized an HIV-positive sample and a comparison of no or low abuse, possibly limiting their findings [ 101 ]. During pregnancy, this risk for IPV may increase, potentially endangering the expectant mother and the unborn baby. This risk is explained by experiential avoidance, which proposes that dissociation and PTSD symptoms influence revictimization [ 119 ].

Results indicate that CSA may be a more consistent predictor of depression across the perinatal period than CPA or CEA. One study identified an interaction between CEA and time with women who experienced emotional abuse; their depression scores decreased across the perinatal period compared to women who had not suffered this abuse, whose scores increased. There was no similar interaction for other abuse types. No studies examined CPY.

Methodological issues and implications for research

The CTQ was the most common child abuse measure utilized by 24% of studies. This questionnaire has adequate psychometric data; however, the short-form version, used more frequently, needs further validity evidence [ 7 ]. Many studies relied on purpose-created measures or tools without documented reliability and validity to assess child abuse. This significant issue potentially impacting findings and cross-study comparisons.

Despite consistent findings across the studies, effect sizes were small or negligible in some cases, likely due to the samples used or the methodology employed. Some studies used small convenience samples that can amplify effects or are unrepresentative of the population. In contrast, several studies analyzed data as part of large-scale projects. Despite the common belief that larger sample sizes are superior to small samples, excessive sample sizes can exaggerate small or even non-significant effects [ 120 ]. To provide more certainty for future findings, researchers should determine the sample size a priori to ensure it is adequate for the planned analyses. Indeed, this review excluded 36 studies with insufficient sample sizes relative to the power to conduct their analyses. Also, it is important to acknowledge that some of the pathways between child abuse and the outcomes reported are complex. However, few studies identified in this review examined mediation/moderation or interact effects, focussing instead on the direct relationship however the influence of other variables needs to be considered when examining the sequalae of child abuse.

Eighteen studies examined only one type of abuse, yet child abuse is rarely isolated, with many victims subjected to multiple maltreatment [ 121 ]. In contrast, when examining multiple types of abuse, there was a failure to partition other abuse types statistically [e.g., 40], which could overestimate findings as it cannot be assumed that the effects noted are specific to the abuse examined. Moreover, the propensity to examine abuse as a combined variable limits our understanding of the impacts of certain abuses in the perinatal period. Relatedly, few studies included adequate control of other variables, such as socioeconomic status or family environment previously identified as risk factors for child abuse [ 122 ]. These variables could interact or account for some of the variance, and when not included, effect sizes may be overestimated. This highlights that the design of child abuse studies requires careful consideration to ensure that the findings reflect the population of interest.

The studies captured by this review were predominantly North American, with an over-focus on CSA. This focus is likely an artifact of historical understandings of abuse, with CSA considered part of battered child syndrome some 45 years ago [ 123 ]. However, child abuse is a worldwide phenomenon with wide variability in the prevalence of abuse types across different countries. Generally, CPA is more prevalent in countries such as South America and Africa, CSA in North America and Australia, and CEA and CPY in South America and Australia [ 124 ]. While this disparity may relate to differing conceptualisations of abuse (e.g., [punitive parenting practices may be acceptable in some cultures and not others), or differing methodologies for assessing abuse [ 125 ] they also highlight the disparity between the countries where child abuse is predominantly studied and the absence of studies in countries with a higher abuse prevalence (e.g., Africa and South America).

Also, CPY and CEA are often treated as synonymous, likely stemming from cognition and emotion considered interdependent [ 126 ]; examining them independently or statistically controlling them may clarify inconclusive findings. Indeed it can be argued that CPY and CEA are inherent in all abuse types and may even be more prevalent than CPA or CSA [(see 42, for example].

Implications for policy

Child abuse outcomes related to pregnancy (e.g., poor physical and mental health and unhealthy behaviors), highlight the importance of early prenatal screening. Australian, UK, and US guidelines recommend screening for abuse or trauma, but not all specifically name child abuse [ 127 ]. However, given the identified barriers and challenges of child abuse screening (e.g., the need for sensitive inquiry), many researchers and clinicians advocate trauma-informed care for perinatal women [ 127 , 128 ].

The Multi-level Determinants of Perinatal Wellbeing for Child Abuse Survivors model [ 129 ] provides a framework for this care using these principles that engender empowerment, safety, and trust. All women can have a supportive environment through universal screening, leading to referral and intervention. Importantly this model includes the needs of both the survivor and clinician. For example, a child abuse survivor requires a safe and appropriate environment to help facilitate disclosure, whereas a clinician needs training, time, and setting considerations. Therefore, policies around screening need to be based on trauma-informed principles that address the needs of the clinician, survivor, and environment [ 127 – 129 ].

While identifying women with a history of child abuse is important in affording more sensitive antenatal care, for many women, postpartum care is focused on physical recovery and less on psychosocial or psychological factors [ 130 ]. However, child abuse is also a risk factor for postpartum outcomes such as poor mental health, child abuse potential, and IPV. However, there is limited opportunity to identify child abuse and intervention without continuity of care extending to the postpartum period.

Strengths and limitations of the review

The strength of this review was its comprehensive examination of a wide range of databases and grey literature. In addition, the double screening of search results and rigorous quality assessment contributed to the accuracy of the data. This search strategy enabled a wide range of evidence to be synthesized, thus contributing to the body of knowledge. Notwithstanding this, the review was potentially limited by excluding non-English language studies limiting the generalizability of the findings. Also, the quality assessment was mostly conducted by one rater (due to budgetary constraints) which is a limitation that should be noted. Furthermore, as detailed above, many studies reviewed had methodological limitations and used retrospective and self-report data for child abuse/maltreatment, limiting the ability to draw causal conclusions.

This comprehensive review examined outcomes related to child abuse for perinatal women. Notwithstanding this, this review demonstrated that maternal child abuse has implications for perinatal women. Perinatal women may be at higher risk for poorer mental health, difficulties with childbirth, and the experience of prenatal care and motherhood. For the child, their mother’s previous history may have implications for their healthy growth and development and intergenerational implications through the transmission of violence. Identifying women at risk is the first step in positive interventions, which may best be achieved through care based on trauma-informed principles.

Supporting information

S1 appendix. data extraction sheet for quality assessment and risk of bias..

https://doi.org/10.1371/journal.pone.0302354.s001

S1 Table. Assessment of the studies for inclusion in the meta-analysis.

https://doi.org/10.1371/journal.pone.0302354.s002

S2 Table. Overview of the included studies.

https://doi.org/10.1371/journal.pone.0302354.s003

S3 Table. Characteristics of included studies.

https://doi.org/10.1371/journal.pone.0302354.s004

S4 Table. Main findings of included studies.

https://doi.org/10.1371/journal.pone.0302354.s005

Acknowledgments

Author note.

Dr Robyn Brunton was the sole contributor and responsible for all aspects of this manuscript. The contribution of Dr Denise Corboy, who assisted with the data extraction and quality assessment, is acknowledged.

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Search for dissertations about: "Child abuse"

Showing result 1 - 5 of 67 swedish dissertations containing the words Child abuse .

1. Child Physical Abuse : Characteristics, Prevalence, Health and Risk‐taking

Author : Eva-Maria Annerbäck ; Per A Gustafsson ; Grete Dyb ; Linköpings universitet ; [] Keywords : Child physical abuse ; prevalence ; risk factors ; associations with health-problems and risk-taking behaviors ; multiple abuse ; MEDICINE ; MEDICIN ;

Abstract : The home is supposed to provide support and safety for children but can also be the place where children suffer abuse and other adverse treatment by their parents. Violence against children in homes has been banned in Sweden for more than 30 years but it is still a considerable problem in the society and a threat to public health. READ MORE

2. Child physical abuse : Reports and interventions

Author : Charlotta Lindell ; Carl Göran Svedin ; Staffan Jansson ; Linköpings universitet ; [] Keywords : MEDICINE ; MEDICIN ;

Abstract : This thesis was begun in 1998 at a time when increased numbers of police reports regarding child physical abuse was presented. The increase had been overshadowed by the research on the sexual abuse of children and showed that child physical abuse in Sweden had only been scarcely investigated since the institution of the Swedish anti spanking law in 1979. READ MORE

3. Child protection through an abuse-focused lens : Adolescent victimization and Swedish social services responses

Author : Hanna Linell ; Astrid Schlytter ; Evy Gunnarsson ; Elisabeth Näsman ; Stockholms universitet ; [] Keywords : SAMHÄLLSVETENSKAP ; SOCIAL SCIENCES ; child abuse ; adolescent victimization ; child protection ; honour-related violence ; compulsory care ; disclosure ; Social Work ; socialt arbete ;

Abstract : Knowledge concerning the social services’ use of the Care of Young Persons (Special Provisions) Act 1990:52 (CYPA) is relatively scarce, especially when it comes to the protection of adolescents victimized by abuse. The overall aim of this thesis is to investigate and discuss different conceptualisations of abuse, adolescents’ agency regarding abuse, victimization and social intervention, and how abuse and adolescent victimization are responded to, primarily by the social services. READ MORE

4. Technology-assisted child sexual abuse

Author : Malin Joleby ; Göteborgs universitet ; [] Keywords : SAMHÄLLSVETENSKAP ; SOCIAL SCIENCES ; technology-assisted child sexual abuse ; offender strategies ; psychological health ; trauma ; online child sexual abuse ; children’s experiences ;

Abstract : Internet communication technology has created new ways for adults to sexually abuse children, and as the world becomes more and more digitalized and children are increasingly connected, reports about online child sexual abuse are increasing. The aim of this thesis was to broaden the thus far limited knowledge about technology-assisted child sexual abuse (TA-CSA) and its consequences by using mixed methods to analyze cases (Study I: N = 122, Study II: N = 98) from Swedish courts (children aged 7–17, offenders aged 16–69), and by performing in-depth interviews with victims of TA-CSA (Study III: N = 7, aged 7–13 at the first occasion of TA-CSA, aged 17–24 at the time of the interview). READ MORE

5. Child labour in Addis Ketema, Ethiopia : a study in mental health

Author : Daniel Fekadu Wolde-Giorgis ; Bruno Hägglöf ; Atalay Alem ; Marianne Cederblad ; Umeå universitet ; [] Keywords : MEDICIN OCH HÄLSOVETENSKAP ; MEDICAL AND HEALTH SCIENCES ; child labour ; child abuse ; psychiatry ; Ethiopia ; Child and adolescent psychiatry ; Barn- och ungdomspsykiatri ;

Abstract : Background: Child labour is a very common global problem. There are an estimated over 250 million in the world, and about 7.5 million child labourers in Ethiopia. Most of the studies available to date focus on the social, political, and economical issues, but very little on mental health or psychosocial problems of child labourers. READ MORE

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127 Captivating Child Abuse Essay Ideas, Research Questions & Essay Examples

Child abuse is one of the crucial problems that has been overlooked for many centuries. At the same time, it is an extremely sensitive issue and should be recognized and reduced as much as possible.

In this article, you will find child abuse research topics and ideas to use in your essay.

Let’s start!

📝 The Child Abuse Essay Structure

🏆 best child abuse topics & essay examples, 👍 good essay topics on child abuse, 📌 simple research topics about child abuse, 💡 interesting topics on child abuse, ❓ child abuse research questions.

Child abuse is one of the most problematic topics in today’s society. Writing child abuse essays may be challenging because it requires analyzing sensitive issues.

The problem refers to physical, psychological, or sexual mistreatment of children. It is vital to discuss this acute issue in studies and essays on child abuse.

Before working on your essay, you should select a topic for discussion. Here are some child abuse essay topics that we can suggest:

• The problem of child abuse in the US (Canada, the UK)
• Child abuse: Types and definitions
• Child neglect crimes and their causes
• Current solutions to the problem of sexual abuse of children
• The importance of child maltreatment prevention programs
• Child abuse: Legal implications
• Consequences of child abuse and neglect

If you are looking for other possible titles for your paper, you can check out child abuse essays samples online. Remember to only use them as examples to guide your work, and do not copy the information you will find.

One of the most important features of an outstanding essay is its structure. Here are some tips on how you can organize your essay effectively:

• Do preliminary research before writing your paper. It will help you to understand the issues you will want to discuss and outline which of them you will include in the essay. Remember to keep in mind the type of essay you should write, too.
• An introductory paragraph is necessary. In this paragraph, you will present background information on the issue and the aspects that you will cover in the paper. Remember to include a thesis statement at the end of this section.
• Think of the main arguments of your paper. You will present them in the body paragraphs of the essay. What child abuse issues do you want your reader to know about? Dedicate a separate section for each of the arguments. Remember to make smooth transitions between the paragraphs.
• Remember to dedicate a paragraph to identifying the problem of the essay and explaining the main terms. For example, if you are writing a child labor essay, you can discuss the countries in which this practice is present. You can also reflect on the outcomes of this problem.
• Include a refutation section if you are writing an argumentative essay. Discuss an alternative perspective on each of your arguments and prove that your opinion is more reliable than the alternative ones.
• Remember that you should not make paragraphs and sentences too long. It is easier for the reader to comprehend shorter sentences compared to complex ones. You can write between 65 and 190 words per paragraph and include at least 10 words in a sentence. It is a good idea to make all sections of the body paragraphs of similar length.
• A concluding paragraph or a summary is also very important. In this paragraph, you will discuss the arguments and counter-arguments of your paper.
• Do not forget to add a reference page in which you will include the sources used in the paper. Ask your professor whether you need a title page and an outline too.
• If you are not sure that the selected structure is good, check out child abuse essay examples online. Pay attention to how they are organized but do not copy the facts you will find in them.

For extra help, see our free samples and get some ideas for your paper!

• Daniel Valerio Child Abuse In the end, it was an electrician who identified the typical signs of abuse in Daniel that finally led police to investigate, thereby exposing the weakness and ineffectiveness of the Dual Track System; the child […]
• Ethical Dilemma of Child Abuse In the above example, a nurse has to apply rational judgment to analyze the extent and threats when making decisions in the best interest of the victim of child abuse.
• Child Abuse: Preventive Measures My artifact is an infographic that communicates the various forms of child abuse and how to report them to the necessary authorities.
• Child Abuse in the Victorian Era in Great Britain This was unacceptable in the eyes of the factory owners resulting in the implementation of the practice of children being sent into the mechanisms of machines while they were still operating since they were supposedly […]
• Problem of Child Abuse The most common form of child abuse in America and in most parts of the world is child abuse. The cost of child abuse is dire to both the children, healthcare organizations, parents, and the […]
• Physical Child Abuse Usually the child is unaware of the abuse due to the na ve state of mind or innocence. Physical abuse also lowers the social-economic status and thus high chances of neglect or abuse due to […]
• The Prevention of Child Abuse From the interview conducted with the school administrator of the local elementary school and the director of a local preschool, it is clear that both institutions have some advocacy plans for the prevention of child […]
• Hidden Epidemic of Child Abuse and Neglect Child abuse should be perceived as a form of deviant behavior to which researchers give different explanations: biological, psychological, socio-cultural.
• Child Abuse: History and Causes The purpose of this paper is to explore the history, and causes of child abuse as well as the legislation implemented to address its cases.
• The Causes and Effects of Child Abuse The main problem of the project is the presence of a number of effects of child abuse and parental neglect on children, their development, and communication with the world.
• Effects of Child Abuse and Neglect Antisocial behaviour is one of the outcomes of child abuse and parental neglect that may be disclosed in a variety of forms.
• Child Abuse: A Case for Imposing Harsher Punishments to Child Abusers While harsh punishments appear to offer a solution to the problem, this measure may be detrimental to the welfare of the child in the case where the abuser is its guardian.
• Child Abuse Issues and Its Effects The recognition of child abuse signs is a very important step as it is wrong to believe that child maltreatment takes place because of the presence of a single sing or poor understanding of child […]
• Child Abuse Versus Elder Abuse The second distinction is that older people frequently encounter issues that might lead to abuse or neglect, particularly in nursing homes, such as mental disability, loneliness, and physical limitation.
• The Relationship Between Child Abuse and Embitterment Disorder Some emotions, like the dread of tests in school or sibling rivalry and conflicts, are a regular part of growing up.
• Trafficking Causes Child Abuse and Neglect The dissociation of children from their families and the exposure to intense trauma they are subjected to during and after trafficking may cause the minors to have attachment problems.
• Child Abuse and Maltreatment Discussion Additionally, this may cause a child’s behavior to change, such as making a sad or melancholy face or becoming furious with parents or other adults. When it comes to emotional abuse, a child may feel […]
• Impact of Child Abuse on Adulthood: An Idea Worth Spreading A frequent argument of those who do not want to recognize the scale of the problem of abuse in the world is “Beating is a sign of love!”.
• Effects of Child Abuse on Adults Second, she was so irrationally averse to the idea of having children that I knew immediately that it would be a contentious point in her future relationships.
• Domestic Violence, Child Abuse, or Elder Abuse In every health facility, a nurse who notices the signs of abuse and domestic violence must report them to the relevant authorities.
• Child Abuse: Screening Methods and Creating Financial Programs When the reporting is mandatory, it is easy to follow its guidelines which should be carefully elaborated not to be harsh on parents and at the same time offer protection to a child.
• Mandated Reporter Statute in Case of Child Abuse The mandated reporter statute recognizes such steps of reporting child abuse, abandonment, and neglect: The signs of abuse, abandonment, or neglect should be reported immediately to the Florida Department of Children and Families through the […]
• Discussion of Child Abuse: Case of COVID-19 In Cincinnati, 3-year-old Nylo Lattimore was missed in December 2020, and only after 143 days, the child’s body was discovered in the Ohio River.
• Child Abuse Allegations: Multidisciplinary Team Approach In children with allegations of child abuse, what is the effectiveness of the multidisciplinary team approach compared to the non-multidisciplinary team approach on prosecution rates, mental health referrals, and provision of medical examinations?
• Criminal Justice System: Child Abuse During the consideration of cases as part of a grand jury, citizens perform some functions of the preliminary investigation bodies.
• Promoting Child Abuse Prevention Services in Oahu, Hawaii, and the US The primary goal the Hui Hawaii organization is trying to achieve is to improve the well-being of American children by preventing abuse, neglect, and depression.
• Child Abuse in Singapore The second reason for child abuse in Singapore to continue being one of the most underreported illegal offenses is the country’s collectivist culture.
• Protocol for Pre-Testing the Child Abuse and Neglect Public Health Policy Based on the above, it is necessary to identify the conditions of child abuse like the quality of family relations and improper upbringing.
• Child Abuse: Term Definition However, there is a component that is not so clearly represented in other crimes: a third party, who has observed the abuse or the consequences of abuse has the legal obligation and reasonable cause of […]
• Discipline and Child Abuse: Motivation and Goals The first proof of the justice and reasonableness of discipline is that it is permitted by law to be considered to be the most authoritative source to consult.
• Sociological Perspective on “Punishment” as a Major Contributor to Child Abuse This is done with the aim of ensuring that the child is disciplined and is perceived as a legitimate punishment. This has offered a loophole to parents to abuse the child in the name of […]
• Critical Statistical Data Regarding the Issues Related to Child Abuse Due to acts of abuse children suffer greatly and it will not be wrong to say that these experiences are definitely engraved into the child’s personality.
• Socio-Economic Standing and Propensity for Child Abuse Physicians were the first to notice and report evidence of child abuse and neglect in the 1960s. The UNICEF corroborates the relationship of poverty with child abuse, neglect, and maltreatment.
• Child Abuse and Culture: Juan’s Case Analysis The following is the list of reflective insights that I came to while getting myself familiarized with Juan’s case and analyzing this case’s discursive implications: When addressing the issue of children being suspected to have […]
• Child Abuse: Altruistic Behavior Intervention plays a crucial role in the prevention of child abuse, as it helps to eliminate the possibility of the recurrence of events.
• New Jersey’s Bill on Child Abuse and Neglect The legislation’s impact is expected to be large because it is targeted at raising awareness of the pervasive issue of child abuse and encouraging the public to stay active and not to disregard any signs […]
• Child Abuse in the UAE and Explaining Theories The interest of carrying out the study on child abuse is based on the fact that it is a critical issue in any society, especially due to the actual and possible consequences on the child […]
• Child Abuse and Neglect and Family Practice Model Also, psychological violence can be either the only form of violence or the consequence of psychological or sexual abuse or neglect. Inadequate evaluation of the child’s capabilities and overstated requirements can also be a form […]
• Child Abuse and Protective Act in Idaho Also, abandonment is recognized in Idaho’s definition of child abuse, and, according to the Act, it means the failure of the parent or the guardian to foster a normal relationship with the child.
• Child Abuse and Neglect: Drug and Alcohol Problems The families of individuals who have committed a drug related offense should be investigated in order to ensure the practice is acceptable and capable of supporting the needs of more societies.
• Child Abuse as a Result of Insufficient Policies According to Latzman and Latzman, child abuse may be manifested in the use of excessive physical force when disciplining a child or an adolescent.
• Child Abuse and Neglect A church/synagogue/mosque retreat activity for parents and they children can be beneficial in strengthening parents to deal with the issues of child abuse and neglect.
• Child Abuse Problem The study of the problem of child abuse has begun in the 60s with focusing attention to children problems. In such a case the early recognition of child abuse is of great importance.
• A True Nature of the Effects of Child Abuse and Neglect in a Society The outcomes of child abuse usually depend on a variety of factors like the age of a child, the type of relation between a child and a perpetrator, and, of course, the type of maltreatment.
• A True Nature of the Effects of Child Abuse A society is in need of powerful and effective research that can prove the necessity to introduce the issue of child abuse and its effects as a leading problem the solution of which requires the […]
• Child Abuse Problems and Its Effects on a Future Child’s Life In fact, there were the three main challenges in writing the literature review just completed that were overcome due to the ability to organize the work, follow the suggestions of the experts, and keep in […]
• Effects of Child Abuse The nature of the effects of child abuse, their consequences in a society, and the most appropriate preventive methods should be considered.
• Child Abuse and Capstone Project This is why the problem of child abuse remains to be crucial for analysis, as people have to understand its urgency and effects on human behavior.
• The Effects of Child Abuse: Capstone Project Time Line The development of a Capstone Project will become a new step in solving the problem and thinking about the possible ways of improvement the situation and creation the most appropriate living conditions for children.
• Introducing Improvements to Children Abuse Reporting System The paper is connected with the analysis of the quality of the current child abuse report systems because of the serious problems in the sphere of childcare.
• Biological Underpinnings Behind Child Abuse The dimension of the baby’s head is also seen to decrease in quantity from on third of the whole body at birth, to a quarter at the age of two years and to an eighth […]
• Cause and Effect of Child Abuse Parental response to the children is also presented in a form of abuse of the rights of the children, as they feel neglected or disowned.
• Abuse in Childhood Common Among Alcohol Addicts Dwelling upon the impact of the violence and abuse during childhood, the connection with the further disabilities and disorders is obvious.
• Child Abuse and Neglect Children in Court The objective of this paper was to determine the level of knowledge and nature of attitudes among maltreated children who appeared in court during their detention case hearings.
• Randomized Trial of Cognitive-Behavioral Therapy for Chronic Post-Traumatic Stress Disorders in Adult Female Survivors of Childhood Sexual Abuse However, in spite of the fact that there exist a wealth of clinical literature on treatment methodologies of victims of sexual abuse, the evidence base concerning the treatment of victims of childhood sexual abuse exhibiting […]
• Child Sexual Abuse: Impact and Consequences Due to the adverse consequences of sexual abuse, efforts to have Jody share her ordeal and get immediate help would be my priority.
• Educational Program on Child Abuse The report “Initial reliability and validity of a new retrospective measure of child abuse and neglect” by Bernstein, Fink and Handelsman provides the findings of the consistency and validity of some of the conservative measures […]
• Public Health Media Campaign Proposal for Child Abuse
• Child Abuse and Lack of Communication in Marriages the Main Factors of Failed Family
• The Reasons and Three Most Common Factors Contributing to Child Abuse in Our Society
• Child Abuse and Its Effects on Social and Personality Development
• Neo-Liberal and Neo-Conservative Perspectives on Child Abuse
• Physical and Behavioural Indicators of Possible Child Abuse
• Defining Child Abuse and Its Different Forms in the 21st Century
• Child Abuse and Neglect: Recognizing the Signs and Symptoms
• Behind Closed Doors: The Correlation Between Multiple Personality Disorder and Child Abuse
• Child Abuse and Later Maladjustment in Adulthood
• Modern Beliefs Regarding the Treatment of Child Abuse Victims
• Neighborhood Poverty and Child Abuse and Neglect: The Mediating Role of Social Cohesion
• The Connection Between Child Abuse, Child Discipline, and Adult Behavior
• State the Possible Types, Signs and Symptoms of Child Abuse and Why It Is Important to Follow the Policies and Procedures of the Work Place
• Child Abuse and Its Effects on the Physical, Mental, and Emotional State of a Child
• Child Abuse, and Neglect and Speech and Language Development
• Social Issue: Child Abuse and How It Affects Early Childhood Development
• Child Abuse Scandal Publicity and Catholic School Enrollment
• Physical Abuse: The Different Types of Child Abuse
• Promoting Help for Victims of Child Abuse: Which Emotions Are Most Appropriate to Motivate Donation Behavior
• Describing Child Abuse, Its Different Forms, and Solutions to the Problem
• Child Abuse: The Four Major Types of Abuse, Statistics, Prevention, and Treatment
• Causes and Risk Factors Behind Child Abuse
• Child Abuse, Cause, and Effect on the Rest of Their Lives
• Child Abuse Has Severe Negative Psychological Effects on Children
• Child Abuse and the Professional Network Working Within the Child Protec
• Child Abuse Prevention and Control: Can Physical, Sexual or Psychological Abuse Be Controlled Within the Household?
• Child Abuse and the Effect on Development Into Adulthood
• Child Abuse: Victim Rights & the Role of Legal Representative
• Child Abuse and the Legal System – Developmental Forensic Psychology: Unveiling Four Common Misconceptions
• Parent Stress Factors and Child Abuse: A Tutoring Proposal
• Approaching Child Abuse From a Multi-Dimensional Perspective
• Child Abuse, Alcoholism, and Proactive Treatment
• Adverse Effects and Prevention of Child Abuse
• Suspected Child Abuse and the Teacher´S Role in Reporting It
• Child Abuse and Its Correlation to Poverty
• Sexual Child Abuse Exploring the Mind of the Perpetrator
• Relationship Between Domestic Violence and Child Abuse and How to Protect the Children From It
• Child Abuse Saddest and Most Tragic Problem Today
• Child Abuse and Academic Performance of Children
• Why Should People Care About Child Abuse?
• Why Should Child Abuse Be Addressed as a Social Problem?
• How Child Abuse and Neglect Affect Childhood?
• How Has Child Abuse Been Conceptualised and Addressed in Policy and Law?
• How to Protect Children From Abuse and Neglect?
• What Are the Negative Effects of Child Abuse?
• How Is the United States Dealing With Child Abuse Problem?
• How Can Therapy Help Victims of Child Abuse?
• How Can the Community Stop Child Abuse and Neglect?
• When Should Teachers Report Child Abuse?
• What Cause Child Abuse?
• Does Child Abuse and Neglect Lead To Bullying?
• How Do the Government and Society Have a Responsibility to Help Child Abuse Victims?
• Parent Support Groups Can Reduce Child Abuse?
• When Child Abuse Overlaps With Domestic Violence: The Factors Influencing Child Protection Workers’ Beliefs?
• How Can Spanking Lead to Child Abuse?
• How the Government and Society Have a Responsibility to Help Child Abuse Victims
• What Does Victimology Say About Child Abuse Data?
• Are There Any Biomarkers for Pedophilia and Sexual Child Abuse?
• When Does Discipline Cross the Line to Child Abuse?
• How Child Abuse Affects a Hero, a God, and a Monster in Greek Mythology?
• Does Child Abuse Create a Psychopath?
• Does Not Get Noticed Enough Around the World Is Child Abuse?
• How Can Sexual Child Abuse Affect the Child’s Psychological Development?
• How Child Abuse Effects Students Education?
• How Do Abuse and Neglect Impact a Child’s Whole Life?
• Should Pregnant Drug Abusers Be Charged With Child Abuse?
• How Children Carry the Weight of Child Abuse?
• Does Child Abuse Cause Crime?
• Childhood Essay Topics
• Attachment Theory Essay Topics
• Child Development Research Ideas
• Mental Health Essay Ideas
• Child Welfare Essay Ideas
• Childcare Research Topics
• Alcohol Abuse Paper Topics
• Foster Care Titles
• Chicago (A-D)
• Chicago (N-B)

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May 27, 2024

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Opinion: I want to keep my child safe from abuse—but research tells me I'm doing it wrong

by Melissa Bright, The Conversation

Child sexual abuse is uncomfortable to think about, much less talk about. The idea of an adult engaging in sexual behaviors with a child feels sickening. It's easiest to believe that it rarely happens, and when it does, that it's only to children whose parents aren't protecting them.

This belief stayed with me during my early days as a parent. I kept an eye out for creepy men at the playground and was skeptical of men who worked with young children , such as teachers and coaches. When my kids were old enough, I taught them what a "good touch" was, like a hug from a family member, and what a "bad touch" was, like someone touching their private parts.

But after nearly a quarter-century of conducting research —15 years on family violence , another eight on child abuse prevention, including sexual abuse—I realized that many people, including me, were using antiquated strategies to protect our children .

As the founder of the Center for Violence Prevention Research , I work with organizations that educate their communities and provide direct services to survivors of child sexual abuse. From them, I have learned much about the everyday actions all of us can take to help keep our children safe. Some of it may surprise you.

Wrong assumptions

First, my view of what constitutes child sexual abuse was too narrow. Certainly, all sexual activities between adults and children are a form of abuse.

But child sexual abuse also includes nonconsensual sexual contact between two children. It includes noncontact offenses such as sexual harassment , exhibitionism and using children to produce imagery of sexual abuse. Technology-based child sexual abuse is rising quickly with the rapid evolution of internet-based games, social media, and content generated by artificial intelligence. Reports to the National Center for Missing & Exploited Children of online enticements increased 300% from 2021 to 2023 .

My assumption that child sexual abuse didn't happen in my community was wrong too. The latest data shows that at least 1 in 10 children, but likely closer to 1 in 5, experience sexual abuse . Statistically, that's at least two children in my son's kindergarten class.

Child sexual abuse happens across all ethnoracial groups, socioeconomic statuses and all gender identities. Reports of female victims outnumber males , but male victimization is likely underreported because of stigma and cultural norms about masculinity .

I've learned that identifying the "creepy man" at the playground is not an effective strategy. At least 90% of child sexual abusers know their victims or the victims' family prior to offending. Usually, the abuser is a trusted member of the community; sometimes, it's a family member .

In other words, rather than search for a predator in the park, parents need to look at the circle of people they invite into their home.

To be clear, abuse by strangers does happen, and teaching our kids to be wary of strangers is necessary. But it's the exception, not the norm , for child sexual abuse offenses.

Most of the time, it's not even adults causing the harm. The latest data shows more than 70% of self-reported child sexual abuse is committed by other juveniles . Nearly 1 in 10 young people say they caused some type of sexual harm to another child . Their average age at the time of causing harm is between 14 and 16.

Now for a bit of good news: The belief that people who sexually abuse children are innately evil is an oversimplification. In reality, only about 13% of adults and approximately 5% of adolescents who sexually harm children commit another sexual offense after five years . The recidivism rate is even lower for those who receive therapeutic help .

By contrast, approximately 44% of adults who commit a felony of any kind will commit another offense within a year of prison release .

What parents can do

The latest research says uncomfortable conversations are necessary to keep kids safe. Here are some recommended strategies:

Avoid confusing language. "Good touches" and "bad touches" are no longer appropriate descriptors of abuse . Harmful touches can feel physically good, rather than painful or "bad." Abusers can also manipulate children to believe their touches are acts of love.

The research shows that it's better to talk to children about touches that are "OK" or "not OK," based on who does the touching and where they touch. This dissipates the confusion of something being bad but feeling good.

These conversations require clear identification of all body parts, from head and shoulders to penis and vagina. Using accurate anatomical labels teaches children that all body parts can be discussed openly with safe adults. Also, when children use accurate labels to disclose abuse, they are more likely to be understood and believed.

Encourage bodily autonomy. Telling my children that hugs from family members were universally good touches was also wrong . If children think they have to give hugs on demand, it conveys the message they do not have authority over their body.

Instead, I watch when my child is asked for a hug at family gatherings—if he hesitates, I advocate for him. I tell family members that physical touch is not mandatory and explain why—something like: "He prefers a bit more personal space, and we're working on teaching him that he can decide who touches him and when. He really likes to give high-fives to show affection." A heads-up: Often, the adults are put off, at least initially.

In my family, we also don't allow the use of guilt to encourage affection. That includes phrases like: "You'll make me sad if you don't give me a hug."

Promote empowerment. Research on adult sexual offenders found the greatest deterrence to completing the act was a vocal child —one who expressed their desire to stop, or said they would tell others.

Monitor your child's social media. Multiple studies show that monitoring guards against sexting or viewing of pornography , both of which are risk factors for child sexual abuse. Monitoring can also reveal permissive or dangerous sexual attitudes the child might have.

Talk to the adults in your circle. Ask those watching your child how they plan to keep your child safe when in their care. Admittedly, this can be an awkward conversation. I might say, "Hey, I have a few questions that might sound weird, but I think they're important for parents to ask. I'm sure my child will be safe with you, but I'm trying to talk about these things regularly, so this is good practice for me." You may need to educate them on what the research shows.

Ask your child's school what they're doing to educate students and staff about child sexual abuse . Many states require schools to provide prevention education; recent research suggests these programs help children protect themselves from sexual abuse .

Talk to your child's sports or activity organization. Ask what procedures are in place to keep children safe . This includes their screening and hiring practices, how they train and educate staff, and their guidelines for reporting abuse. The Centers for Disease Control and Prevention provides a guide for organizations on keeping children safe .

Rely on updated research. Finally, when searching online for information, look for research that's relatively recent—dated within the past five years. These studies should be published in peer-reviewed journals.

And then be prepared for a jolt. You may discover the conventional wisdom you've clung to all these years may be based on outdated—and even harmful—information.

Provided by The Conversation

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