HEALTH-BRAZIL: Pediatricians Against Child Abuse

By Mario Osava Reprint | | Print |

Mario Osava

RIO DE JANEIRO, Aug 20 2002 (IPS) - Domestic violence, addressed as a public health question, is the target of an army of 35,000 pediatricians in Brazil, whose ultimate aim is to reduce infant and child mortality.

Child abuse demands special treatment, due to the “wall of silence” that surrounds the phenomenon, making it difficult to measure and to combat, despite the fact that it is “an extremely serious public health problem,” Rachel Niskier, the coordinator of a campaign by the Brazilian Society of Pediatrics, told IPS.

The Brazilian Society of Pediatrics has been carrying out a “National Campaign of Prevention of Accidents and Violence in Childhood and Adolescence” for the past four years in this South American country of 162 million.

Niskier lamented that no national statistics on child abuse are available in Brazil, but only isolated studies and assessments by experts on the question, which makes it impossible to estimate the number of victims.

Health Ministry statistics indicate that 59 percent of all deaths of minors between the ages of five and 19 reported in 1999 were the result of “external causes,” including 7,162 violence-related deaths and 4,766 deaths involving traffic accidents.

The increase in reports of domestic violence in recent years is seen as a consequence of greater public awareness on the issue and on the mechanisms created to combat the problem, rather than an indication that child abuse is actually on the rise.

A government campaign against torture launched in late October by the Ministry of Justice and the National Human Rights Movement has so far received 420 reports of abuse by “private individuals” – in other words, not carried out by members of the police or other security forces.

In addition, in 300 of the cases reported, the abuse took place in the victim’s home.

In the cases called in to the hotline, family members of the victims of physical abuse or torture were the third most likely perpetrators, behind police and members of the military.

The option of calling or sending in anonymous tips that can then be verified by an independent commission has led to a rise in denunciations of abuse and torture, even in small towns, which are traditionally more conservative and where people are generally more reluctant to get involved in personal or family matters.

The Multidisciplinary Brazilian Association for Protection of Children and Adolescents uses its own hotline to receive information on even less understood phenomena, like sexual abuse and commercial sexual exploitation of minors.

Between February 1997 and December 2001, 2,498 hotline tips – out of a total of 16,870 – were verified by the Association. In 84.9 percent of the cases, the abuse had been carried out in the victim’s home, and 63.8 percent of the abuses were committed by a member of the victim’s family.

Domestic violence used to be “a taboo issue” that could not be talked about, and was restricted to the privacy of the family, said Cecilia Minayo, coordinator of the Latin American Centre of Studies on Violence and Health (CLAVES). But, she said, people have become more aware of the problem, which has made it easier for children and adolescents to reach out for help.

Pediatricians and other health professionals play a key role in efforts to reduce child abuse, because they are specially trained to look for and address the problem, which many people in Brazil still refuse to treat as a health or medical issue, said Minayo.

The Brazilian Society of Pediatrics has trained its 35,000 members in early diagnosis of the problem, using manuals, posters and courses. Certain kinds of injuries, sudden behaviour changes, loss of appetite and anxiety can all indicate abuse, said Niskier.

Doctors must first carry out a complete physical exam, find out the family’s history, and listen to the child, said the pediatrician, who is a member of the National Council on the Rights of the Child and Adolescent. She pointed out that abusive parents tend to discredit what the child says, or intimidate them into keeping silent.

For example, Niskier mentioned the case of a boy who had “small circular burn marks” on his stomach. She pointed out that cigarettes are frequently used in physical mistreatment.

Domestic and social violence feed off each other, and “international studies reveal that virtually all young criminals suffered violence and abuse in their homes,” said Minayo.

The family is a “complex” institution, she observed, which is indispensable to children as a source of affection, but which can also become a source of violence, in which parents see themselves as the “owners” of their children.

The progress that has been made in Brazil in terms of raising public awareness on the problem has largely been based on two new statutes, said Minayo and Niskier.

The Statute on the Child and Adolescent, approved by Congress in 1990, outlines the rights of minors and policies aimed at guaranteeing those rights.

The law provides for the creation of five-member Tutelary Councils elected by the local community, which have the power to intervene on behalf of children and teenagers, in order to protect them, while orienting parents and other adult guardians.

The second resolution is a policy adopted last week by the Health Ministry, aimed at reducing the number of accidental and violent deaths and injuries among children and adolescents in Brazil.