A RESEARCH PROPOSAL FOR CLINICAL RESEARCH

ON
A DESCRIPTIVE STUDY ON CHILD SEXUAL ABUSE ACT IN INDIA

SUBMITTED TO
DR. SANJUKTA GHOSH

SUBMITTED BY
LOPAMUDRA PATRA
ROLL NO.: 03
SECOND SEMESTER
DATE OF SUBMISSION:
14/07/2023

SIDHO-KANHO-BIRSHA UNIVERSITY
PURULIA

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 DECLARATION

I, Lopamudra Patra, student of Sidho-Kanho-Birsha University, here by declared that the project
work en tled “A DESCRIPTIVE STUDY ON CHILD SEXUAL ABUSE ACT IN INDIA”. Submi ed to
the Sidho-Kanho-Birsha University, its an original work done by me under the guidance of Dr.
Sanjukta Ghosh, teacher in subject, Sidho-Kanho-Birsha University, Purulia.

Name: Lopamudra Patra

Date: Roll No: 003
LLM Second Semester

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 CERTIFICATE

This is to cer fy that the project report en tled “A DESCRIPTIVE STUDY ON CHILD SEXUAL
ABUSE ACT IN INDIA “, submi ed by Lopamudra Patra in par al fulfilment of the requirement
for the award of degree of LL.M. to Sidho-Kanho-Birsha University, Purulia is a record of the
candidates own work carried out by her under my supervision. The ma er embodied in this
project is original and has not been submi ed for the award any degree.

Date: Dr. Sanjukta Ghosh

(Teacher in subject)

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 ACKNOWLEDGEMENTS

I would specially like to thank my guide, mentor, Dr. Sanjukta Ghosh without whose constant
support and guidance this project would have been a distant reality.
This work is an outcome of an unparalleled infrastructural support that I have received from
Sidho-Kanho-Birsha University, Purulia.
I owe my deepest gra tude to the library staff of the college.
It would never have been possible to complete this study without an un ring support from my
family.
This study bears tes mony to the ac ve encouragement and guidance of a host of friends and
well-wishers.

Name: Lopamudra Patra

Date: Roll No: 003
LLM Second Semester

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 CONTENTS

 Declara on.
 Cer ficate.
 Acknowledgements.
 Abstract.
 Chapter 1: Introduc on.
 Chapter 2: Methods.
 Chapter 3: Results.
 Chapter 4: Discussion.
 Chapter 5: Limita ons.
 Chapter 6: Conclusion.

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 ABSTRACT

Background: Child sexual abuse (CSA) is a significant public health issue, and healthcare
professionals play a crucial role in iden fying and repor ng cases. This study assessed
awareness among medical ins tute doctors about CSA. Materials and Methods: This cross-
sec onal descrip ve study collected data using a closed-ended ques onnaire, analysing
percentages and frequencies. It assessed respondents' educa onal qualifica ons and the
rela onship between educa on and awareness of child abuse. Results: Nearly 70% of
respondents reported child abuse cases, with sexual abuse being the most common (58%),
followed by physical abuse (28%). Nearly 40% of cases were reported in the hospital where the
respondents worked, while 15% occurred in other areas. 81% of respondents had knowledge
about child sexual abuse, but only 34% were aware of the consequences of non-repor ng.
Nearly 64% knew about an online complaint system, and 70% were aware of a one-stop center
at a respondent's hospital. The majority (68%) were aware of the POCSO Act on sexual abuse.
36% were aware of evidence of anal sexual abuse among children and adolescents, while 13%
were partly aware. Conclusion: Healthcare professionals must undergo ongoing educa on to
enhance diagnosis and repor ng of CSA.

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 CHAPTER 1

Introduc on:
Child sexual abuse (CSA) is a significant public health issue affec ng children's health and
welfare worldwide. It requires mul -disciplinary support from medical, legal, psychological,
and sociological dimensions. Healthcare professionals play a vital role in detec ng and
repor ng cases of CSA, but they o en under-iden fy and under-report cases, leading to
con nued trauma and severe consequences. Approximately 5-10% of children die and 35-50%
have major injuries in cases where children are admi ed to emergency rooms without
thorough evalua on. Healthcare professionals face challenges such as lack of knowledge,
inadequate experience, diagnosis uncertainty, poor communica on, and fear of disconnec ng
therapeu c rela onships. However, there is a lack of literature on the awareness of healthcare
professionals about child abuse in low and middle-income countries like India.
India, a country with a youth popula on of over 40%, faces a high prevalence of child abuse,
including physical, sexual, and emo onal abuse. Ini a ves like the Indian penal code 1860,
Immoral Traffic Preven on Act, 1956, and the Protec on of Children against Sexual Offences
(POCSO) Act 2012 are being implemented to address the issue. However, a survey by the
Ministry of Women and Child Development (2007) revealed that 99% of children face corporal
punishment in schools. A study by the Na onal Commission for Protec on of Child Rights
(NCPCR) revealed that 99% of children face corporal punishment in schools. The study aims to
assess awareness among medical ins tute doctors about child abuse and negligence and
recommend solu ons for healthcare personnel.

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 CHAPTER 2

Methods
Study Design:
The study, a cross-sec onal research, was conducted in March 2018 to raise awareness about
POCSO act provisions, medico-legal examina ons, forensic evidence collec on, and social-
psychological aspects of its implementa on.
Par cipants and data collec on:
A study was conducted at the Post Graduate Ins tute of Medical Educa on and Research in
Chandigarh, India. A closed-ended structured ques onnaire in English was developed and pre-
tested for data collec on. The ques onnaire asked twenty ques ons about child abuse
experiences, awareness of the POCSO Act, medical examina ons, prac ces, signs of anogenital
injury, correlates of sexual abuse, evidence of sexual abuse, loca on of one-stop centers, and
first ac on taken when a child approaches for medical care. The researchers aimed to gather
informa on on the POCSO Act, medical examina ons, prac ces, signs of anogenital injury,
correlates of sexual abuse, evidence of sexual abuse, and first ac on taken when a child
approaches for medical care.
Ethics:
The study maintained respondent confiden ality and anonymity, was approved by an
ins tu onal ethical commi ee, and obtained consent from respondents before the interview.
They were informed about the study's aim and methodology.

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 CHAPTER 3

Results
Exposure to child abuse cases:
The majority of par cipants were Junior Residents, with 24.5% Senior Residents. Nearly 70%
of respondents reported child abuse cases, with sexual abuse being the most common (58%).
About 28% did not respond to seeking informa on on the type of abuse. Nearly 40% of cases
were reported in the hospital where the par cipants worked, while 15% occurred in other
areas. Doctors found that 40% of cases occurred less than two mes, while 19% of children
experienced abuse 2-3 mes and 19% more than five mes in their careers.
Awareness regarding child abuse:
81% of respondents were aware of child abuse, but only 34% were aware of non-repor ng
consequences. 64% knew about online complaint systems, and 70% were aware of one-stop
centers at hospitals.
Awareness regarding child abuse act:
Nearly 42% of respondents were unaware of a na onal study on child abuse, while 26% were
correct. 17% were par ally correct. The majority knew about the POCSO Act on sexual abuse,
with 11% having par al awareness and 17% having no awareness.
The study found that 72% of respondents had incorrect knowledge about medical
examina ons for child abuse vic ms. 47% were correct about the POCSO Act specifica on,
while 35% and 13% were incorrect and partly correct. 76% were incorrect about clinical
examina on findings of sexual abuse. 52% were aware of child abuse prac ces by doctors and
hospitals, while 28% had incorrect knowledge and 19% were partly correct.
Respondents had 41% incorrect knowledge about signs of anogenital injury, 30% correct, and
21% partly correct knowledge. They also assessed knowledge about correlates of sexual abuse,
with 36% incorrect and only 14% correct.
The study found that 3-4ths of par cipants were aware of sexual abuse in rela on to
communicable diseases, while 58% were unaware of it by boys. 42% were not aware of anal
sexual abuse among children and adolescents, while 36% had awareness. The study also found
that 51% of respondents were unaware of the loca on of a one-stop center within their
ins tu on, and 77% were unaware of the first ac on taken when a child approaches medical
care.

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 CHAPTER 4

Discussion:
The World Health Organiza on emphasizes healthcare professionals' responsibility to
diagnose, protect, and maintain suitable treatment condi ons for abused and neglected
children. Child protec on law requires physicians and healthcare personnel to report
suspected cases of abuse and negligence in many countries.
Child abuse preven on is crucial, as it can lead to significant injuries and death. It is essen al
for physicians and nurses to recognize those exposed to abuse, ini ate legal proceedings, and
protect abused children. They should consider the possibility of abuse, request consulta ons,
and keep the child under observa on in cases where defini ve decisions cannot be made. In
cases of suspected abuse or negligence, repor ng the case and protec ng the child is the
correct approach.
The study evaluates doctors' awareness and knowledge of CSA, offering valuable insights for
improving healthcare professionals' training, especially in iden fying and repor ng suspected
cases.
The study found that 81% of doctors had knowledge about child abuse, with healthcare
professionals having good theore cal knowledge of various forms of child abuse (CSA). This is
consistent with previous studies, where den sts had adequate knowledge. Experienced
physicians were more knowledgeable and likely to report child abuse and negligence. In China,
Li et al. reported insufficient knowledge of healthcare providers towards child abuse, possibly
including all health professions.
Garrussi et al. found that 65% of physicians experienced child abuse and negligence, but only
4.5% reported cases. A study found that 85% of physicians believed they would report abuse
if they ever encountered one. In the present study, 70% encountered child abuse cases, and
34% were aware of the consequences of non-repor ng. Nearly 64% of respondents had an
idea about an online complaint system for child abuse, and 70% were aware of a one-stop
center at a respondent's hospital.
Kraus and Jandl-Jager found that most physicians recognized common child abuse symptoms,
but most family physicians had inadequate knowledge about iden fying and managing cases.
Studies like Hynniewta et al. found that 84% of school teachers had average knowledge of child
abuse, while 10% and 6% had good and poor knowledge. Raising awareness among physicians
and teachers as caregivers and contact caregivers with children is crucial for detec ng and
preven ng child abuse and neglect.

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 CHAPTER 5

Limita ons:
The study lacks capturing risk factors of child abuse, which could inform government and
policymakers. Preven ve strategies should be promoted to avoid specific risk factors for
effec ve child protec on service delivery. Addi onally, the small sample size (53) may not be
generalizable.

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 CHAPTER 6

Conclusion:
The evalua on of a child abuse case should priori ze the benefits to the child. A mul -
disciplinary team with trained personnel from various fields is crucial for evalua ng cases.
Procedures should be followed in polyclinics and emergency departments, and physicians and
nurses should have prac cal educa on on the subject. Research on the economic impact of
child abuse, such as child trafficking, child labour, and commercial sexual exploita on, as well
as the financial implica ons of abused children presen ng to healthcare providers, can
convince governments to re-source local child protec on and preven on services. The study
highlights the urgent need for con nued educa on and advancement of healthcare
professionals to improve diagnosis and repor ng of child abuse. Raising awareness and
knowledge about child abuse through con nuous educa on programs is essen al for
addressing problems faced during diagnosis and repor ng. Addi onally, focusing on preven ve
strategies is essen al for managing child abuse cases.

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References:
1) Paul V, Rathaur VK, Bhat NK, Sananganba R, I oop AL, Pathania M. Child abuse: A social evil in Indian
perspec ve. J Fam Med Prim Care 2021;10:110-5.
2) Maul KM, Naeem R, Khan UR, Mian AI, Yousafzai AK, Brown N. Child abuse in Pakistan: A qualita ve
study of knowledge, a tudes and prac ce amongst health professionals. Child Abuse Negl
2019;88:51–7.
3) Flaherty EG, Sege R. Barriers to physician iden fica on and repor ng of child abuse. Pediatr Ann
2005;34:349–56.
4) Jain AM. Emergency department evalua on of child abuse. Emerg Med Clin North Am 1999;17:575–
93.
5) Azizi M, Shahhosseini Z. Challenges of repor ng child abuse by healthcare professionals: A narra ve
review. J Nurs Midwifery Sci 2017;4:110.
6) Na onal Ins tute of Urban Affairs. Status of Children in Urban India: Baseline Study 2016. Available
from: h ps:// smartnet.niua.org/sites/default/files/resources/statusl.pdf
7) Ministry of Women and Child and Government of India. Study on child abuse India. 2007. Available
from: h ps://cjp. org.in/wp-content/uploads/2017/11/MWCD-Child-Abuse Report.pdf
8) A g r a s a . C h o k i n g C h i l d h o o d - S c h o o l C o r p o r a l Punishment,” 2018. Available from:
h ps://agrasar.org/ corporal-punishment/.
9) World Health Organiza on. Child Maltreatment. 2020. Available from:
h ps://www.who.int/news-room/fact-sheets/detail/child-maltreatment.
10) Açık Y, Deveci SE, Oral R. Level of knowledge and a tude of primary care physicians in Eastern
Anatolian ci es in rela on to child abuse and neglect. Prev Med (Bal m) 2004;39:791–7.
11) Hadley J, Moore J, Goldberg A. Sexual Abuse as a Cause of Prepubertal Genital Bleeding: Understanding
the Role of Rou ne Physical Examina on. Elsevier; 2021.
12) Broaddus-Shea ET, Sco K, Reijnders M, Amin A. A review of the literature on good prac ce
considera ons for ini al health system response to child and adolescent sexual abuse. Child Abuse Negl
2021;116:104225.
13) Olatosi O, Ogordi P, Oredugba F, Sote E. Experience and knowledge of child abuse and neglect: a survey
among a group of resident doctors in Nigeria. Niger Postgrad Med J 2018;25:225-33.
14) Thomas JE, Straffon L, Inglehart MR. Child abuse and neglect: Dental and dental hygiene students’
educa onal experiences and knowledge. J Dent Educ 2006;70:558–65.
15) Cairns AM, Mok JYQ, Welbury RR. The dental prac oner and child protec on in Scotland. Br Dent J
2005;199:517–20.
16) Sonbol HN, Abu-Ghazaleh S, Rajab LD, Baqain ZH, Saman R, Al-Bitar ZB. Knowledge, educa onal
experiences and a tudes towards child abuse amongst Jordanian den sts. Eur J Dent Educ
2012;16:e158–65.
17) Al-Jundi SHS, Zawaideh FI, Al-Rawi MH. Jordanian dental students’ knowledge and a tudes in regard
to child physical abuse. J Dent Educ 2010;74:1159–65.
18) Alnasser Y, Albijadi A, Abdullah W, Aldabeeb D, Alomair A, Alsaddiqi S, et al. Child maltreatment
between knowledge, a tude and beliefs among Saudi pediatricians, pediatric residency trainees and
medical students. Ann Med Surg 2017;16:7–13
19) Li X, Yue Q, Wang S, Wang H, Jiang J, Gong L, et al. Knowledge, a tudes, and behaviours of healthcare
professionals regarding child maltreatment in China. Child Care Health Dev 2017;43:869–75.
20) Garrusi B, Safizadeh H, Bahramnejad B. Physicians’ percep on regarding child maltreatment in Iran (IR).
Internet J Health 2007;6:1–6
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Annexure 1: Ques onnaire related to Sexual Abuse among Children

Name: JR/SR: Semester:

Joined Ins tute:

Please note that there can be mul ple answers to a ques on

1) Ministry of Women and Child Development, in collabora on with UNICEF and Save the
children, conducted the first ever Na onal Study on Child Abuse on 17,220 children (child
defined as < 18 years) in the year 2007 to develop a comprehensive understanding of the
phenomenon of child abuse, with a view to facilitate the formula on of appropriate policies
and programmes meant to effec vely curb and control the problem of child abuse in India.
Tick the correct statement related to sexual abuse among children (as per the report)
I. Nearly 25% of children reported having faced one or more forms of sexual abuse
II. Nearly 50% of children reported having faced one or more forms of sexual abuse.
III. Nearly 10% of child respondents reported facing severe forms of sexual abuse
IV. Nearly 20% of child respondents reported facing severe forms of sexual abuse
V. Out of the child respondents, approximately 5% reported being sexually assaulted.
VI. Out of child respondents approximately 1% reported having been sexually assaulted
2) Sexual abuse is inappropriate sexual behavior with a child. Tick the appropriate statements
used Aggravated/sexual assault as per POCSO Act
I. Aggravated sexual act is the sexual abuse commi ed by a stranger
II. Aggravated sexual assault is the term used, when the abused child is mentally ill or
when the abuse is commi ed by a person in a posi on of trust or authority vis-ã-vis
the child.
III. Aggravate sexual assault is violent and sudden.
IV. Aggravated Sexual Assault is undesirable sexual behavior on a longterm basis
3) Child sexual abuse laws in India have been enacted as part of the na on’s child protec on
policies. The Parliament of India passed the ‘ - ‘Act regarding child sexual abuse in ________
I. Preven on of children from Sexual offences Act, 2012
II. Protec on of children from Sexual offences Act, 2012
III. Protec on of children from Sexual offences Act, 2010
4) A 12 year-old girl presents to the pediatrician with the inability to walk. The pediatrician refers
the child to a Pediatric neurologist, who finds that the child has muscular spasms of the leg.
On probing, the child gives a history of sexual abuse by a close family member. Parents request
the doctor not to report to anybody as the accused is a close family member. What are the
consequences for not repor ng the case under the Act?
I. The resident/doctor can be punished with imprisonment, which may extend to three
years or with a fine or with both
II. The resident/doctor can be punished with imprisonment, which may extend to one
year or with a fine or with both
III. The resident/doctor can be punished with imprisonment, which may extend to two
years or with a fine or with both
IV. The resident/doctor can be punished with imprisonment, which may extend to six
months or with a fine or with both

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6) If the medical examina on is required for the vic m, the resident will examine the child
I. In the presence of parent of the child
II. Person in whom the child reposes trust or confidence.
III. Any woman nominated by the head of the medical Ins tute
IV. Does not ma er
7) Which of the following is NOT a specifica on of the POCSO Act?
I. Recording the statement of the child at the residence of the child or at the place of his
choice
II. Recording to be done preferably by a woman police officer, not below the rank of
sub-inspector.
III. Evidence has to be recorded within 30 days
IV. No child is to be detained in the police sta on at night for any reason.
V. Police officer to be in uniform while recording the statement of the child
8) Whenever clinical examina on for sexual abuse is done, there are three types of findings:
Adam I: normal findings or findings with a medical explana on other than abuse
Adam II: findings of unclear significance that arouse the suspicion of sexual abuse
Adam III: findings of injury that establish the diagnosis of sexual abuse
Which of the following perianal findings may cons tute (Adam II) evidence of sexual abuse in
a child older than five years
I. Erythema
II. Increased pigmenta on
III. Venous engorgement (which may be circular)
IV. Polyp-like tags
V. Condyloma acuminata 6. Smooth, wedge-shaped areas in the midline (“diastasis ani”)
9) Which of the following prac ces (s) with respect to doctor/hospital is/are INCORRECT:
I. The medical examina on shall be conducted by a woman doctor.
II. The medical examina on shall be conducted in the presence of a woman nominated
by the Child Welfare Commi ee.
III. The medical prac oner, hospital or other medical facility centre rendering
emergency medical care to a child shall demand any legal or magisterial requisi on or
other documenta on as a pre-requisite to rendering such care.
IV. The medical prac oner rendering emergency medical care shall a end to the needs
of the child, including treatment for cuts, bruises, and other injuries, including genital
injuries, treatment for exposure to STDs, treatment for exposure to HIV, etc.
V. No forensic evidence should be collected in the course of rendering emergency
medical care.
10) Which of the following signs are most sugges ve of anogenital injury in a sexually abused girl?
I. A polyp-like hymenal tag
II. A complete, V-shaped notch in the peripheral edge of the hymen
III. Bumps on the hymenal edge
IV. Pigmenta on
V. External hymenal ridges

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