Responding to children and adolescents who have been sexually abused
WHO publishes new guidelines
19 October 2017 Millions of children and adolescents across the globe are subjected to sexual abuse, including sexual assault or rape. A 2011 study estimates that 18% of girls, and 8% of boys worldwide have experienced sexual abuse. This abuse is a major public health problem and a grave violation of human rights. Health care providers have an important role in identifying abuse and providing child or adolescent-centred care to disclosure of abuse. They also have an important role in connecting survivors to other services that they may need.
For the first time, WHO has published guidelines to help (primarily) front-line healthcare providers give high-quality, compassionate, and respectful care to children and adolescents (up to age 18) who have or may have experienced sexual abuse, including sexual assault or rape.
About the guidelines
The new WHO Clinical Guidelines for responding to children and adolescents who have been sexually abused are grounded in human rights standards and ethical principles. They recommend that healthcare providers put the best interests of children and adolescents first by assessing and promoting their safety; ensuring confidentiality and privacy; offering choices in provision of care; respecting their autonomy and wishes; and addressing the specific needs of boys and girls with additional vulnerabilities, such as LGBTI adolescents, children and adolescents with disabilities, and those from low socio-economic groups and indigenous populations, and ensuring provision of care to them without discrimination.
Consequences of sexual abuse
Girls and boys who experience abuse often face a number of short and long term negative consequences for their mental, physical, sexual, and reproductive health and well-being. Boys and girls who are sexually abused face higher risks of lifetime diagnoses of post-traumatic stress disorder, anxiety, depression, externalizing symptoms, sleep disorders, and having thoughts of suicide and self-harm. They are more likely to engage in unsafe-sex, abuse of drugs and misuse of alcohol, placing them at higher risk for STIs and HIV and for other negative health outcomes that last into adulthood. For girls there is also increased risk of pregnancy and gynaecological disorders.
Adolescents and children at the centre
The new guidelines address an important gap in providing quality and trauma-informed care to survivors by placing emphasis on the safety, wishes, autonomy of children and adolescents.
Health care providers are recommended to:
- Provide first line support that is child or adolescent-centred and gender sensitive in response to disclosure of sexual abuse.
- Minimize additional trauma and distress while taking medical history, conducting the examination and documenting the findings.
- Offer HIV post-exposure prophylaxis and adherence support to those who have been raped and who present within 72 hours.
- Offer emergency contraception to girls who have been raped and who present within 120 hours/ 5 days.
- Consider STI presumptive treatment or prophylaxis in settings where laboratory testing is not feasible.
- Offer Hepatitis B and HPV vaccination as per national guidance.
- Consider cognitive behavioural therapy (CBT) with a trauma focus for those have PTSD symptoms and diagnosis and where safe and appropriate to do so involve at least 1 non-offending caregiver.
- Where required to report child sexual abuse to designated authorities, health care providers should inform the child or adolescent and their non-offending caregivers about the obligation to report the abuse and the limits of confidentiality before interviewing them.
Helping countries worldwide
The new guidelines will assist WHO Member States to ensure the health and wellbeing of children and adolescents and implement the Global Plan of Action on strengthening the health systems response to violence against women and girls and against children, endorsed by the World Health Assembly in May 2016.