Prevention Is Better Than Cure: As in Many Parts of the World, Child Sexual Abuse in Swaziland Is Widespread and Goes Largely Unreported. Swaziland Is One of the Few Low- and Middle-Income Countries to Have Acknowledged the Problem

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"He started inviting me to spend the nights with him when my mother was at work," recalls Ntombi (name changed), a Swazi now in her mid-twenties who was raped by her father on a routine basis from the age of twelve. "He said if I said anything to my morn, he would kill me. He said he would protect me from her beatings." The weekly violations went on for a period of seven years until Ntombi finally got help from a teacher.

Aberrant as the case may seem, it is by no means unusual in Swaziland as revealed by a 2007 study carried out by the United Nations Children's Fund (UNICEF) in association with the Centers for Disease Control and Prevention (CDC) in the United States of America. The purpose of the study was to describe the epidemiological distribution of sexual violence against young girls in this country of just over one million people. The results were chilling. "Approximately one in three females experienced some form of sexual violence as a child, nearly one in four experienced physical violence, while three in 10 experienced emotional abuse," says Dr Jama Gulaid, representative of UNICEF in Swaziland.

"It is important to point out that child sexual abuse is a global problem," says Dr Alexander Butchart, from the Department of Violence and Injury Prevention and Disability at the World Health Organization. "Even in high-income countries, it is estimated that more than one in five females experienced some form of sexual abuse as a child, and one in five children have experienced severe parental physical abuse.

"While not unique in having a high prevalence of child sexual abuse, Swaziland is exceptional in being one of the few low- and middle-income countries in any region to have so fully acknowledged and thoroughly investigated the epidemiology of child sexual abuse as a basis for prevention," Butchart says.

The study revealed that boyfriends and husbands were the most frequent perpetrators of sexual assault, while non-sexual physical violence was typically meted out by male relatives (not including victims' fathers). Emotional abuse typically came from female relatives. Sexual violence most frequently occurred in the victim's home or the home of a friend, relative or neighbour. "There are only a few cases of children who get raped in the bushes or in areas far away from home by complete strangers," says Ncamisile Gwebu, a child protection officer in the Hhohho region in Swaziland.

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As is the case with rape all over the world, underreporting was a factor, with less than half of the incidents of child sexual violence being reported to the authorities. Remarkably, however, the primary reasons the victim did not report in this study were: fear of abandonment, a desire to protect the perpetrator or lack of awareness that what she had experienced was in fact abuse.

Not that they were unaffected by their experiences. According to Ndo Mdlalose, a clinical psychologist based in the capital Mbabane, the victims typically suffer from depression, panic attacks and anxiety, though the adverse effects are by no means limited to emotional and behavioural problems. "Child maltreatment has also been associated with broader health issues such as diabetes, ischaemic heart disease, sexually transmitted diseases and a variety of health risk behaviours including smoking," says James Mercy, from the Division of Violence Prevention at the CDC.

Swazi children subject to abuse find themselves isolated at many levels, an isolation which is often self-imposed. "Typically, they blame themselves rather than the perpetrators for what has happened," says Mdlalose. There is a tendency to suffer in silence. Those children brave enough to seek professional counselling make do with the two psychologists responsible for the needs of the entire country.

Of course, ideally, these children should never be exposed to the abuse in the first place, which is why Mercy believes that prevention is the key to dealing with the issue. …