Journalists are welcome to write news stories based on what they read here, but should acknowledge their source as "an article published on the Internet by The Medical Journal of Australia".
|Objective: To ascertain the prevalence of childhood sexual
abuse (CSA) in a community sample of Australian women.
Design: Retrospective study, done in 1994, of cross-sectional data on the prevalence of CSA, collected as part of a larger two-stage case-control study of the possible relationship between CSA and alcohol abuse. Data were appropriately weighted to adjust for the different selection probabilities of cases and controls.
Participants: 710 Women randomly selected from Australian federal electoral rolls.
Conclusion: The high rates of CSA (estimated to be 20%
of all women) and low rates of reporting (10%) indicate the need for general
practitioners and other health professionals to be aware that a history
of such abuse may be common in women in the general population.
|Community-based studies in North America, the United Kingdom and New
Zealand have shown that, for women, the prevalence of at least one incident
of sexual contact with an adult before age 18 years ranges from 6% to 62%.
1-8 In an Australian study examining
the extent of childhood sexual abuse (CSA) among social science students,
28% of the female students and 9% of the male students reported at least
one such incident before the age of 16 years. 9
Official figures on the incidence of child abuse (including physical and sexual abuse and neglect) show that, in 1992-93, 59 122 cases were reported and investigated throughout Australia. Of these cases, 27 196 (46%) were officially substantiated, and the number of child sexual abuse cases was 5979 (22%). 10 Because of the secrecy and shame surrounding sexual abuse, the criminal sanctions against it, and the young age and dependent status of the child, it is likely that official statistics seriously underestimate its true extent. 11
To determine the true extent of CSA, prevalence studies that rely on retrospective reports of adult subjects are needed; this study presents epidemiological data on the prevalence of CSA in a community sample of Australian women.
|The current study was part of a larger two-stage case-control investigation (conducted in 1994) into the relationship between CSA and alcohol abuse in women. Stage 1 of the study involved a postal questionnaire sent to 6000 women randomly selected from Australian federal electoral rolls. Approval for the study was provided by the ethics committee of the Australian National University. A total of 3958 (66%) valid responses were received. Women who had an alcohol problem were identified as cases from their answers to this questionnaire. Stage 2 of the survey involved sending all women identified as having an alcohol problem ( n= 184) and a random selection of controls (i.e., women identified as not having an alcohol problem [ n= 910]) a second questionnaire, which explored childhood sexual experiences. This paper reports the results of analysis of the responses to this second questionnaire.|
|The questions used to ascertain the prevalence of CSA were based on
those developed by Wyatt 2 . In addition to the questions on sexual experiences shown, questions were also asked about other areas, including family background
and physical abuse.
Women who said they had had sexual experiences before age 16 were asked about the sexual experience, including information on the type of abuse; age at the time of abuse; relationship to the abuser; age of the abuser; frequency and period of the abuse (the period being obtained by subtracting the age at first episode from age when the abuse stopped); whether coercion was used; whether the abuse was disclosed to anyone; and the self-perceived short- and long-term effects of the abuse. The effects of the abuse are dealt with in Fleming et al. (unpublished data) and Fleming et al. 12
If the women had told anyone about the abuse, they were asked whom and when they had told.
|CSA was defined as all experiences of sexual contact occurring
before the age of 12 with a person five or more years older, irrespective
of consent , and all experiences of sexual contact occurring between
age 12 and 16 years with a person five or more years older that were not
wanted or were distressing.
Sexual contact was defined as: touching or fondling the child's body; attempts to have the child arouse the adult, or touch his/her body in a sexual way; the adult rubbing his/her genitals against the child's body in a sexual way; touching the child's genitals with the mouth, or having the child touch the adult's genitals with the mouth; attempts to have anal or vaginal intercourse with the child; and completed anal or vaginal intercourse.
For each episode, there was a progressive range of possible experiences, such as touching of the genitals or breasts to intercourse.
|A response rate of 65% ( n = 710) was obtained, with the final sample comprising 124 of 184 women identified as cases (67%) and 586 of 910 women (64%) as controls. To estimate the underlying prevalence of CSA in the population, the data were weighted to account for the different probabilities of selection for cases and controls. The controls received higher weighting than the cases (who were more likely to be selected in the sample because of the original design). The HLOGIT and HREG procedures in STATA Release 4 for Windows 13 were used to perform logistic and ordinary regressions on the weighted data and to obtain Huber standard errors, which were then used to obtain Wald statistics and corresponding P values. The significance testing thus allowed for individuals in the sample having different probabilities of selection.|
|Respondents to the survey showed a demographic distribution similar to that recorded in the Australian Bureau of Statistics (ABS) census data. 14|
Childhood sexual experiences
|Two hundred and ninety four of the 710 women (41%) responded that they
had had at least one of the sexual experiences at least once before the
age of 16 years. For 45 (6%) of these
women, the experiences were categorised as consensual sexual experiences
with peers (a peer being defined as a person less than five years older
than the subject). Accordingly, 249 (35%) women reported some sexual abuse
or experience that was unwanted or distressing during childhood.
The sexual experiences were divided into four categories: non-contact (exposure and masturbation) (n = 87, 12%), consensual with peers (n = 45, 6%), unwanted with peers (n = 18, 3%), and unwanted sexual experiences with an adult that involved at least genital contact (which is defined as CSA and is the group on which the analyses are based) (n = 144, 20.3%; 95% CI = 17.3%-23.5%). A total of 13 women (2%) did not answer any of the questions on childhood sexual experiences.
There was no significant difference (t = 1.63; P = 0.11) in mean current age between women who stated that they hadexperienced CSA (38.6 years; 95% CI, 36.7-40.4; range, 18 to 74 years) and women who had had no experience of CSA (40.3 years; 95% CI, 39.2-41.5; range, 17 to 79 years).
To gain a measure of severity of abuse in the women (n =144) with CSA, sexual experiences were classified according to the most invasive act perpetrated. As shown in Box 2, 10% of these 144 women stated that intercourse had occurred and a further 17% stated that the abuser had attempted intercourse. From the sample group of 710 women, this extrapolates to 2% of the total Australian population of women having experienced CSA involving intercourse.
Frequency and period of CSA
|The Figure shows the number of abuse episodes
and Box 3 shows the frequency in women abused more than once. The period
of abuse was less than one year for 57% of episodes, less than two years
for 14% of episodes, and more than two years for 29% of episodes.
Characteristics of individuals who experienced CSA
|CSA was rarely stated to have occurred before age five years. Most
abuse (102/144 [71%]) occurred up to age 12 years, with the mean age at
first abuse being 10 years (SD, 3.5 years). No significant differences
were found for age at first abuse and relationship to the abuser.
The rate of CSA reported in this study was two to four times higher for women who worked part-time (OR, 2.15; 95% CI, 1.24-3.71) or were students (OR, 4.44; 95% CI, 1.56-12.44) than for women who were either unemployed or at home. Women who were separated or divorced were more likely to have experienced CSA than women who were not separated or divorced (OR, 2.27; 95% CI, 1.12-4.64). There was evidence for a quadratic relationship with age (chi-squared = 4.1, df=1, P = 0.04), with prevalence increasing to approximately age 38 and then decreasing. There was no significant relationship for country of birth (Australia versus other), highest qualification, whether or not they had children, or number of children.
Characteristics of the abuser
|Men were by far the most frequent abusers -- women accounted for only
two reports. The mean age of abusers was 33.5 years (95% CI, 31.0-36.0;
range, 11-70 years). Almost two-thirds of the abusers (83/144 [58%]) were
more than 20 years older than the abused individual at the time of the
abuse. The median age difference between the abused and the abuser was
24 years (range, 5-64 years).
Most respondents (120/144 [83%]) stated their relationship to the abuser. Only 8% (11/143) of abusers were strangers. ( Note: Discrepancies in total group numbers arise from missing data.) Forty-one per cent of abusers (58/143) were family members (biological relatives, such as fathers, grandparents, uncles, siblings, and cousins, as well as stepfathers and adoptive fathers). Although biological fathers were more often stated to be abusers than step fathers, more women grew up with a biological father.
Children who grew up without any father were the most likely to have experienced CSA (OR, 3.8; 95% CI, 1.1-13.8), followed by children with stepfathers (OR, 1.9; 95% CI, 1.0-3.6) and children who grew up with their biological father (reference group).
The frequency of CSA was significantly different in women abused by relatives and those abused by non-relatives. For the 55 women who were abused once, 37 (70%) were abused by someone outside the family. When the abuser was a relative, the abuse was significantly more likely to have occurred regularly (daily or weekly, 14/25 [56%], and fortnightly, monthly or annually, 27/40 [68%]) (chi-squared = 13.7, df = 2, P = 0.001). Those abused by a relative were significantly more likely to have been abused more often (two to five times, 15/27 [56%]; six to 10 times, 6/12 [50%]; more than 10 times, 21/24 [88%]) than those abused by non-relatives (chi-squared = 16.6, df = 3, P = 0.001).
|Most women (102/143 [72%]) stated that some form of coercion was used; most commonly, they were frightened into compliance. The data were re-coded to provide a measure of the severity of force used: 92/143 (64%) said there had been verbal threats and threats of violence; 10/143 (7%) said there had been actual violence; and 41/143 (29%) said no form of coercion was used.|
|More than half (75/144 [52%]) of the women had disclosed the abuse.
A further five women had tried to disclose the abuse, but their attempts
to do so were unsuccessful. Of these 80 women, almost one-third (23 [28%])
disclosed, or tried to disclose, at the time of the CSA, seven (9%) within
the first year, and 14 (18%) between one and 10 years later; almost half
(36 [45%]) did not disclose until at least 10 years after the first abuse
episode. There were no significant differences between age at first abuse
experience and whether or not the women disclosed the abuse (chi-squared
= 1.0, df = 1, P = 0.3). However, there were significant
differences in the timing of disclosure (within one year, one to 10 years,
more than 10 years) by age at time of abuse. Girls aged under 12 years
at the time of the abuse were less likely to tell someone within a year
of the abuse than were girls aged over 12 years (chi-squared = 7.8, df
= 2, P = 0.02).
Mothers were the most frequently told (39/80 [49%]), followed by friends (25/80 [32%]), and siblings (23/80 [29%]). Fewer than 10% of women (7/80) reported or had the abuse reported to either the police, a doctor or a helping agency (e.g., community organisations, such as sexual abuse services). Twenty-three per cent (17/75) stated that disclosure had stopped the abuse, compared with 22% (16/75) who said it had not. ( Note: More than one answer was possible for the questions about who was told and the reasons for prevention of disclosure.)
When the women were asked what prevented disclosure, by far the most common reason given was embarrassment or shame (47/80 [46%]), followed by the belief that the other person would not be able to help them (23/80 [23%]), or would somehow blame or punish them for the abuse (19/80 [18%]). No significant differences in disclosure rates were found by relationship to abuser.
Rates of disclosing abuse, examined by current age of the women, showed a significant decrease with age (chi-squared = 6.9, df = 1, P = 0.008), with 10/12 (83%) of young women (aged 17-24 years) having disclosed the abuse, compared with 26/44 (59%) of women aged 25-35 years, 23/45 (51%) aged 35-44 and 16/42 (38%) aged 45 or more. The timing of disclosure after abuse (within compared with more than one year) was not significantly different between the current 10-year age groups (chi-squared = 0.9, df = 4, P = 0.9).
|Although Australians have become increasingly aware of the existence
and frequency of CSA, its prevalence in the community is not known. This
study, the first national survey of Australian women on the prevalence
of CSA, demonstrates a high rate of CSA.
A rate of 20% for sexual abuse by an adult involving at least genital contact closely parallels the levels in a New Zealand study that used a comparable method of ascertainment. 7 The figure of 35% for any sexual abuse or unwanted sexual experience during childhood found in the present study is comparable to other reports which suggest that more than 50% of women had experienced sexual abuse or an unwanted sexual experience during childhood, but nearer to 10% to 15% had experienced CSA involving genital contact or intercourse. 2,4,7,8,15,16
A consistent finding from studies of CSA is that most of the reported abuse occurs in prepubescent girls. In this study, the mean age at first abuse experience was 10 years. This is within the range of ages of greatest risk, 8-12 years, reported by other studies. 3,7,15,17,18
It is important to note that, although few of the respondents stated that they had experienced sexual abuse before the age of five, it may be that such victims cannot remember the abuse. Australian Institute of Health and Welfare figures for sexual abuse by age group show that the rate of sexual abuse per 1000 children is similar in the two- to five- and six- to 10-years age groups (2.7 and 2.6 per 1000 children). 10 This suggests that abuse in this survey may have been under-reported because abuse that occurred before the age of five was not remembered.
Another finding in this study is that only 10% of abuse experiences were ever reported to authorities. This supports claims that official figures may seriously underestimate the extent of the problem. Relatively high rates of abuse and low rates of reporting suggest that general practitioners, teachers, police and health and welfare personnel need to be aware that sexual abuse may be behind a range of interpersonal, behavioural and psychological problems in children. 19 Children will rarely disclose the abuse, but may have other symptoms which should arouse suspicion. This study indicates that young girls aged eight to 10 years are most at risk.
Because of the usual closeness of the perpetrator to the victim and the victim's fear of being blamed or not being believed, our community as a whole needs to be mindful of the possibility of childhood sexual abuse.
|This paper is based on data gathered for a PhD dissertation. The results presented represent stage 2 of the project. I am especially grateful to all the women who responded to this survey. I would like to thank my supervisors, Dr Gabriele Bammer, Dr Bev Sibthorpe and Dr Aileen Plant, for their advice and assistance. I would also like to thank Professor Paul Mullen for his editorial comments and suggestions and for his ongoing advice in the area of CSA, and Ms Robyn Attewell for her statistical advice. Financial support for this project was provided by the National Campaign Against Drug Abuse and by the National Centre for Epidemiology and Population Health, Australian National University.|
(Received 15 Jul, accepted 20 Sep 1996)
National Centre for Epidemiology and Population Health, Australian
National University, Canberra, ACT.
Jillian M Fleming, BSc, PhD. Current position: Coordinator, ACT Alcohol and Drug Service, Canberra, ACT.
No reprints will be available. Correspondence: Dr J M Fleming, ACT Community Care, GPO Box 825, Canberra, ACT 2601. E-mail: jmf868 AT nceph.anu.edu.au
<URL: http://www.mja.com.au/> © 1996 Medical Journal of Australia.
Received 15 November 2018, accepted 15 November 2018
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.