Preventing Child Abuse

ACTION TO END CHILD SEXUAL
ABUSE AND EXPLOITATION

Published by UNICEF Child Protection Section Programme Division 3 United Nations
Plaza New York, NY 10017 Email: [email protected] Website: www.unicef.org
© United Nations Children’s Fund (UNICEF) December 2020.
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Suggested citation: United Nations Children’s Fund (2020) Action to end child sexual
abuse and exploitation, UNICEF, New York
This publication has been produced with financial support from the End Violence
Fund. However, the opinions, findings, conclusions, and recommendations
expressed herein do not necessarily reflect those of the End Violence Fund.
Contents
Contents Section 1 Section 2 Section 3 Section 4 Section 5 Section 6 Section 7 Section 8 Endnotes
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CONTENTS
1. Introduction.............................................3 6. Service delivery....................................21
2. A Global Problem...................................5 7. Social & behavioural change.................27
3. Building on the evidence ..................... 11 8. Gaps & challenges................................31
4. A Theory of Change.............................13 Endnotes..................................................32
5. Enabling National Environments...........15
1 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

ACKNOWLEDGEMENTS
This report was commissioned by UNICEF to support the Associate Expert, UNODC; Catherine Maternowska, Lead
work of the Child Protection Section, Programme Division, Data, Evidence and Learning, End Violence Lab, Global
UNICEF Headquarters in New York. Special thanks go Partnership to End Violence Against Children; Manus
to Rocio Aznar Daban, Child Protection Specialist, and to De Barra, Child Protection Officer, Office of the Special
Stephen Blight, Senior Child Protection Adviser, for their Representative of the Secretary-General on Violence against
expert guidance, advice, patience and coordination of Children; Helena Duch, Head of Solutions Subprogramme,
consultations throughout the course of the work. Oak Foundation; Marie-laure Lemineur, Deputy Executive
Director/Programmes , ECPAT; Alessandra Guedes, Gender
The primary author of this publication is Lorraine Radford and Development Manager, Research, UNICEF Office
who is Emeritus Professor of Social Policy and Social Work at of Research; Lauren Rumble, Principal Advisor Gender
the University of Central Lancashire, UK. Equality, UNICEF; Andrew Brooks, Child Protection Regional
Advisor, UNICEF West and Central Africa Regional Office;
UNICEF gratefully acknowledges the financial support Kendra Gregson, Child Protection Regional Advisor, UNICEF
provided for this programme by the End Violence Fund. The Latin America and the Caribbean Regional Office; Rachel
End Violence Fund provides financial support to programmes Harvey, Child Protection Regional Advisor, UNICEF East
that deliver practical, innovative solutions to protect children Asia and Pacific Regional Office; Aaron Greenberg, Child
from online exploitation and abuse. Protection Regional Advisor, UNICEF Europe and Central
Asia Regional Office; Jean Francois Basse, Child Protection
Valuable feedback and advice was given by a number of Regional Advisor, UNICEF East and South Africa Regional
research and practice experts. These include: Office, UNICEF; Denise Ulwor, Child Protection Specialist,
UNICEF West and Central Africa Regional Office; Esther
Greta Massetti, Branch Chief of the Field Epidemiology Ruiz, Child Protection Specialist, UNICEF Latin America and
and Prevention Branch, US Center for Disease Control the Caribbean Regional Office; Mona Aika, Child Protection
and Prevention; Berit Kieselbach, Technical Officer on the Specialist, UNICEF East and South Africa Regional Office;
Prevention of Violence, World Health Organisation; Dina Anjan Bose, Child Protection Specialist, UNICEF New York
Deligiorgis, Policy Specialist, Ending Violence against Headquarters; Catherine Poulton, Gender-Based Violence
Women and Girls, UNWomen; Upala Devi, Senior Gender- in Emergencies Manager, UNICEF New York Headquarters;
Based Violence Advisor, UNFPA; Chrissy Hart, Senior Christine Heckman, Rapid Response Team, Information
Advisor, Together for Girls; Anna Giudice, Crime Prevention Management Specialist, UNICEF New York Headquarters.
and Criminal Justice Officer, UNODC; Wendy O’Brien,
Legal Officer - Violence against Children, UNODC; Gabriele We are also grateful for the helpful advice provided by the
Aiello, Associate Expert, UNODC; Hanna Tiefengraber, anonymous peer reviewers of this report.

Contents Section
Section 11 Section 2 Section 3 Section 4 Section 5 Section 6 Section 7 Section 8 Endnotes
1
INTRODUCTION
The sexual abuse and exploitation of children is a violation coordination of multisectoral services, in strengthening
of human rights and a public health problem with significant national child protection systems and services and scaling
consequences for global health and development1 . up violence prevention programs such as parenting support
Awareness has grown of the nature and scale of the problem community programs, school prevention programs and social
and considerable efforts are being made to prevent all forms norms change strategies. In 2019, UNICEF intensified efforts
of violence against children. Important developments include to scale up evidence-based violence prevention intervention
international agreement on targets to end violence against and institutionalize response services to child victims of
children by 2030 in the Sustainable Development Goals; the violence in 141 countries providing health, social work or
development of an inter-agency package of seven evidence justice and law enforcement services to 2.7 million children.
-based prevention strategies known as INSPIRE2; and the
establishment of the Global Partnership to End Violence Comprehensive strategies to end violence against children
against Children. To address the rapidly accelerating misuse need to include all forms of violence, whether physical,
of information and communications technologies to sexually emotional, sexual abuse or neglect. There is however a need
exploit children, the WePROTECT Global Alliance has been for a specific coordinated focus on child sexual abuse and
formed and countries are being guided by its Model National exploitation. In many parts of the world child sexual abuse is
Response. Increasingly, efforts to end violence against still a taboo, hidden and stigmatising topic. Child sexual abuse
women and children are linked and mutually reinforcing, as and exploitation have unique drivers, risks and protective
set out in the RESPECT framework3. The Oak Foundation has factors. Child maltreatment research and policies have focused
recently funded important work on preventing child sexual largely on caregivers and the family and, while much sexual
abuse4, and an important new index has been developed to abuse may occur in the home, the perpetrators and contexts
measure the completeness of national responses5. of sexual abuse and exploitation are much more varied, and
this gets accentuated within the context of online child sexual
Guided by the Convention on the Rights of the Child, UNICEF exploitation and abuse. While other strategies on violence
works with partners across the globe to prevent and respond prevention have taken childhood sexual abuse into account,
to violence against girls, boys and young people, including there are significant gaps in knowledge and practice about
adolescents, in all settings and in all its forms, supporting protecting young children and boys, and children who are
governments to achieve SDG 16.2 by 2030. In programme inter-sex or who identify as non-binary. Peers are a significant
countries, UNICEF plays a key role in supporting national proportion of those responsible for acts of sexual abuse

Contents Section
Section 11 Section 2 Section 3 Section 4 Section 5 Section 6 Section 7 Section 8 Endnotes
against other children and adolescents, but interventions online sexual exploitation within its broader offline contexts,
have been mostly designed for adult offenders. Strategies to not a new behavior arising solely due to the digital age
prevent and respond to child sexual abuse and exploitation
need evidence to address the developmental and safeguarding This report aims to address these specific issues by updating
needs of children as victims and perpetrators, recognising that two earlier publications for UNICEF7 with a recent review of
a child can be both abused and harming others. the evidence on: i. what we know about the extent, nature
and consequences of child sexual abuse and exploitation for
The last two decades have seen the rapid rise and uptake of children in different contexts, ii. the evidence on effective
digital technologies globally, which has introduced new forms of interventions and strategies to prevent and respond.
online harms while also exacerbating the offline abuse of children,
such as sexual abuse of very young children. Online grooming A recent benchmarking of national responses across 40
of children for the purpose of sexual abuse and exploitation, countries encouragingly found that combating child sexual
live streaming of sexual abuse of children over the Internet and abuse is a priority in many countries and progress is possible
distribution of child sexual abuse content have all seen significant even where resources are limited.5 The findings from the
increase. The volume of child sexual abuse materials in circulation present review are intended to aid further work by UNICEF,
both in the surface web as well as the hidden web have reached partner organisations, researchers, practitioners and policy
new highs, ranging in millions of images.6 makers on preventing and responding to child sexual abuse
and exploitation, taking into account these encouraging
There is a risk that specialised responses to online child developments and complimenting ongoing programmes such
sexual abuse are conceived in isolation of proven strategies as INSPIRE2 and RESPECT.3
to address child sexual abuse in the physical, offline world.
Technology does not cause online child sexual exploitation Building on these efforts, this short report, intended for policy
and abuse, although it enables and facilitates it at a wider makers and partners, uses key findings from a research review
scale than before. Child sexual abuse materials are evidence commissioned by UNICEF to propose a framework of action
of sexual abuse of a child offline, most often perpetrated by to prevent and respond to child sexual abuse and exploitation8.
someone within the child’s circle of trust. The unique nature
of online child sexual abuse and exploitation requires close Addressing sexual violence is a significant challenge
collaboration with the technology sector and cross border requiring informed and assertive action. UNICEF is
cooperation amongst law enforcement. It also calls for a committed to tireless work to reduce the threat and
more in depth and nuanced understanding of how children support responses for victims.
and their families use digital platforms and their online
experiences. But much can be gained through considering

Contents Section 1 Section
Section 22 Section 3 Section 4 Section 5 Section 6 Section 7 Section 8 Endnotes
2
A GLOBAL PROBLEM
The terms ‘sexual violence against children’ or ‘child sexual Children and adolescents affected may not always recognise
abuse and exploitation’ include diverse acts of abuse, in their experiences as sexual violence or abuse. Those who
different settings and relationships - situations where a live in low-income regions of the world, in conditions of
child is sexually abused by a relative or carer at home; raped insecurity, armed conflict or separation from their family
by an intimate partner; made to or left with no option but are particularly vulnerable4 but it is important to note that all
to sell sex in exchange for food, cash or favours; sexually children are at risk of sexual abuse and exploitation.
assaulted on the way to, or at, school by an adult, a gang or
a peer living in the community; sexually abused by an adult The global data on children’s experiences of violence has
in a position of trust or authority such as a pastor, police improved in recent years and several robust studies now
officer, care worker or sports coach; groomed or sexually exist using similar definitions and measures, all showing
exploited online by an adult or older child; trafficked within the widespread nature of physical, emotional and sexual
or across borders for the purpose of sexual exploitation, violence in childhood. Knowledge has been greatly advanced
sometimes by organized groups of child sex offenders; or by national surveys designed to directly ask children and
raped by a combatant or peacekeeper in the context of war, adolescents themselves, in a safe, private and ethical
displacement or disaster. manner, about their experiences of violence and abuse.
PREVALENCE OF CHILD SEXUAL ABUSE is prevalent in wealthy countries and in countries where incomes are lower.
A review of 217 studies9 , found 1 in 8 of the world’s children (12.7%) had Robust data on the prevalence rates for online abuse and for sexual
been sexually abused before reaching the age of 18. exploitation is limited and needs to be improved, although adolescent girls
report the highest past year victimisation rates (12.9% of girls aged 14-17 in
UNICEF estimates that 1 in every 20 girls aged 15 to 19 (around 13 million) the US and 15% of girls aged 12-15 in Spain)11.
have experienced forced sex during their lifetime 10 .
A review of surveys asking men in the community about their use of online
Child sexual abuse is gendered, around 90% of perpetrators being male and child sex abuse material and sexual behaviour towards children12 found
girls typically reporting rates of victimisation, 2–3 times higher, than boys. between 1 in 10 and 1 in 5 adults in studies from Finland, Germany and
Victimisation of boys has been found to be higher than for girls in some Sweden had online sexualised conversations with children in the past year.
contexts and organisational settings.
One in twenty men admitted online sexualised behaviour towards children
Although reported rates vary across and within countries, child sexual abuse who were known to be below the age of 12.

The scale, complexity and danger of online facilitated highest levels20 . For effective prevention and response
child sexual abuse and exploitation is escalating13 , with strategies, it is important to take into account the
technology enabling new modes of child abuse to emerge gendered and developmental differences in the situational,
such as the live streaming of sexual assaults of children organisational and relationship risks of sexual abuse and
and sexual extortion of children, often to coerce a child to exploitation for children and adolescents.
take part in the production of child sexual abuse material
under threat. MORE OFTEN ABUSED BY SOMEONE KNOWN Worldwide
children and adolescents are most likely to be sexually
CHILD SEXUAL ABUSE IS GENDERED. Although it is abused by a person known to them, usually a boyfriend,
important to be aware that women also sexually abuse an adult or older child who is a family member, another
and exploit children and adolescents, the majority of relative, family friend or an adult in a relationship of trust or
perpetrators, around 90% in most studies, are male14 . authority21. The child’s or perpetrator’s home is the most
Girls typically report rates of sexual abuse and exploitation frequently mentioned location for sexual assaults and
2–3 times higher than boys15 although rates for boys have rapes of children 22, with the privacy of the family home,
been found to be higher than for girls in some nations16 where this exists, providing a location where detection
and in certain organisational settings17 such as single sex is less likely. Sexual abuse by a biological parent is less
residential institutions. Girls are the majority of victims in commonly mentioned in self-report surveys in HICs
child sexual abuse materials online18 . than sexual abuse by another relative, such as a sibling
or uncle, or another member of the household 23 . Peers,
DEVELOPMENTAL ASPECTS Experiences of victimisation boyfriends/girlfriends, dating or romantic partners are
and their consequences vary over the life course for girls the most commonly mentioned perpetrators of sexual
and boys 4. Younger children are most likely to be sexually violence for adolescent girls24 , with neighbours and friends
abused by a family member or caregiver. Older children also frequently mentioned 25 .
and adolescents spend more of their time outside the
immediate family or home environment and are likely to CHILDREN ARE ABUSED IN ALL SETTINGS Although the
be exposed to a wider range of perpetrators (in addition child’s own home or the perpetrator’s home are the most
to the risks within the family): adults in positions of trust common locations, child sexual abuse and exploitation
or authority, peers, employers, neighbours and intimate can occur in all the settings in which children spend their
partners19 . Self-reported rates of sexual victimisation time 26 , from school 27 to work 28 or play and sport 29 . Settings
increase with age through childhood with adolescent and organisations that provide potential perpetrators
girls aged 17 or young women aged 18- 24 reporting the unregulated or unsupervised access to children, such

as residential care or education facilities, faith based or displaced by armed conflict or humanitarian emergency
and community youth services including sport, carry are also especially vulnerable 32 .
particular risks 30 . International organisations have noted
a worrying increase in orphanage tourism providing CHILD SEXUAL ABUSE AND EXPLOITATION IS OFTEN
situational opportunities for child sex offenders and UNREPORTED Identifying children living with sexual
additional vulnerabilities for children to sexual exploitation abuse and exploitation is a notoriously difficult task
in South East Asia 31. Children and adolescents who are and the research on children’s reporting behaviours is
separated from their families, migrating and on the move, underdeveloped.
CHALLENGES TO IDENTIFICATION INCLUDE: the abuse or enforcing silence or inaction to protect the
perpetrator or preserve reputation and honour34 .
For various reasons, not least the emotional manipulation
often involved in an abusive relationship, a sexually Professionals who work with children may lack the skills
victimised child or adolescent may not recognise their and training needed to effectively identify signs of abuse,
experiences as being sexual violence or exploitation. They engage with victims and provide effective responses.
may also be afraid or reluctant about being ‘helped’.
Opportunities to provide help or support get lost because
Shame, social stigma and fear of the consequences of of poor working together and information sharing across
telling anybody about the abuse can be considerable different sectors such as education, health, justice, child
barriers to disclosure and help seeking. welfare and community organisations35 .
Informal and family support are important for prevention, Policy contexts and organisational or service priorities
child protection and recovery33 and are usually the first conflict with or do not enable effective prevention or child
line of support sought. However, there may be poor protection responses. For example, a common policy
understanding of child sexual abuse and exploitation problems are a contradiction between laws regulating child
among family, peers and the wider community. Responses marriage and parental or judicial exceptions, differential or
can be unhelpful, disbelieving, blaming the victim for no age definitions in laws of consent36 .

Surveys with children and young people consistently Consequences

indicate a substantial gap between the rates of child
self-reported sexual victimisation and reports made Child sexual abuse and exploitation has a significant impact
to authorities, suggesting that only a small minority of on the health and well-being of children and adolescents
victimised children and adolescents are able to access worldwide. The impact will vary in relation to the nature,
professional help or advice. severity and duration of the abuse, developmentally in
relation to the child or adolescent’s ability to understand
the abuse, their coping strategies and the responses from
For example, surveys in Finland37 and in Germany38
found that, although well over three quarters39 of victims family, friends, wider community and services.42 The harm
of childhood sexual abuse had told somebody about caused includes the impact on physical health (such as
the abuse, most often a friend, at best only 14% of the high BMI, problems in childbirth43); higher likelihood of
disclosures were passed on to authorities. contracting HIV due to sexual risk taking (such as having
Research on violence against children in the seven multiple sexual partners or inconsistent condom use)44;
countries of Cambodia, Haiti, Kenya, Malawi, Swaziland, drug or alcohol abuse45; anxiety, depression, psychological
Tanzania and Zimbabwe, similarly found in most trauma and self-harm46; offending behaviour, missing school
countries the proportion of victims who received a and lower educational attainment43. A child who is sexually
service was ≤10%40 .
abused or exploited is also at greater risk of experiencing
In Uganda 57% of girls and 53% of boys who other types of violence or abuse from adults or peers in
experienced sexual violence told someone about the a range of settings 47. Children who experience multiple
abuse. Only 16% of girls and 6% of boys sought help victimisations tend to have the poorest outcomes 48 . The
from services and only 15% of girls and 5% of boys
consequences can be life long and include issues with
received help4.
intimacy, affecting relationships with family, partners and
A review of data from 30 countries collected for children, and socio-economic consequences such as
UNICEF found that only 1% of adolescent girls who homelessness and unemployment43.
had experienced forced sex reached out for help from
services41.
Risks and drivers
Closing the gap between the large numbers of children Sexual violence against children is a diverse and complex
and adolescents who experience sexual abuse and issue and no single factor can explain why this occurs,
exploitation and the minority who have effective support although very clear risk factors are gender inequalities and
or services is an essential step towards ending violence. children’s developmental vulnerability1,4. Violence does

not happen in an isolated bubble between individuals relationships, community and broader social, economic and
unaffected by the wider social context. Most forms of cultural context will exert an influence on whether abuse
interpersonal violence disproportionality affect groups in happens and the consequences for an individual child.
a community or population who are disadvantaged as a In their multi-country study of violence against children,
result of interacting structural inequalities such as poverty, Maternowska and Fry (2018)50 distinguished between drivers
gender inequity, racism, sexual orientation together with of violence at the structural and organisational levels, that
institutional and organisation practices that do little to create the conditions in a society where violence against
challenge or even reinforce them. An adapted version of the children is more, or less, likely to happen, and risks and
socio-ecological framework of child development49 is helpful vulnerabilities at the level of the individual child, family and
for conceptualising why children are at risk and how best relationships, and in the community/country context, that
to focus prevention activities2. As with violence towards influence whether a particular child is abused.
children in general, the socio-ecological framework proposes
that interactions between risks and protective factors at, From a prevention perspective, a contextually focused
and across, the levels of the individual child, family and socio-ecological framework can alert us to the possibility
that addressing an individual risk, such as legislation to
Examples from research of drivers and risks for child sexual abuse limit adolescent access to alcohol, although helpful, would
and exploitation: not be sufficient to end child sexual abuse and exploitation
because structural drivers that contribute to the vulnerability
of adolescent girls - such as poor resources for the police
force and norms that exonerate men and boys and blame
adolescent girls for their own sexual victimisation - would
persist. It is widely recognised that to end violence,
RELATIONSHIP
COMMUNITY SOCIETY including child sexual abuse and exploitation, we need
CHILD Organisational drivers Structural drivers
Risk Factors
Risk Factors
Association
Disorganised & poorly Social norms blame to recognise the interconnectedness between different
Misuse of drugs resourced police force victims & exonerate
and alcohol
with sexually
does not protect types of violence and the multi-dimensional causes and
aggressive peers perpetrators
vulerable children consequences and take coordinated action simultaneously
across the four different levels of the system 51.
There is now an extensive literature on the risks and

drivers that influence the victimisation and perpetration of
violence against children.

Common structural drivers for child sexual abuse and organisations with poor child protection responses and lack
exploitation, victimisation and perpetration, include norms of external scrutiny are vulnerable contexts for children 53 .
in society that grant adults control over children and support
male sexual entitlement and sexual violence, weak laws that Child sexual abuse and exploitation occurs across different
blame victims and exonerate perpetrators, poverty, lack of relationships and generally the closer the relationship
protection for children who are displaced or migrating52. the greater the risk. Children and adolescents who lack
protection from the family or who have been exposed
Extensive research and public enquiries into institutional to domestic violence, child abuse and neglect or those
and organisational abuse have identified many situational who associate with sexually aggressive peers are more
and governance weaknesses in key organisations such as vulnerable to sexual violence and to revictimisation54 .
churches, residential ‘care’ facilities, schools, orphanages,
sport and youth serving organisations that have provided At the level of the individual child, individual
opportunities for adults in positions of trust or authority vulnerabilities associated with age, learning disability,
and peers to have unmonitored contact with vulnerable prior sexual victimisation, misuse of drugs and alcohol
children and adolescents, putting them at risk of sexual are examples of some of the known risks for both
abuse and exploitation. Isolated and hierarchical victimisation and perpetration4, 26.
Much of the research evidence on risks and drivers has contexts to inform priorities for action.50 A key message
developed in HICs. The UNICEF Multi Country Study of the from this work was that to successfully address violence
Drivers of Violence piloted and tested a method for working against children, we need to change the environments in
with policy makers, governments, practitioners and other which children live not just address the risks they face as
experts to assess drivers and risks in different national individuals and in their personal relationships.

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3
BUILDING ON THE EVIDENCE
As children who experience one type of victimisation has reinforced the need to ensure violence prevention is
may also experience others 47, strategies to end sexual built into the core of public health policies. It is important
violence need to include all forms of violence, whether to gather evidence on what works in different contexts to
physical violence, emotional abuse, sexual abuse, neglect end child sexual abuse and exploitation. The findings from
or living with a mother victimised by domestic violence. the evidence review are intended to aid further work by
Many nation states have adopted National Action Plans to UNICEF, partner organisations, researchers, practitioners
end violence against children and a major step forward for and policy building on current responses to violence as in
supporting their implementation has been the agreement INSPIRE and RESPECT.
between ten global organisations for a coordinated,
system focused approach to violence prevention Methods
consisting of the seven evidence-based INSPIRE
strategies 55 . The overlap between violence against women The evidence review includes 168 research studies that
and violence against children is increasingly recognized, were assessed as being high quality. New systematic
and there has been more collaboration between reviews and original research studies on ‘what works’
people working to prevent violence in these two areas. to prevent and respond to child sexual abuse and
Evidence based guidance now exists that brings together exploitation, published from 2014 to 2019 were identified
actions on preventing violence against women and the from systematic searches of ten research databases 56 ,
abuse of children and adolescents in the World Health ‘grey’ literature (such as government or research centre
Organisation’s RESPECT Framework.3 There are still reports) and publications recommended by and practice
however some significant gaps in knowledge and practice experts.57 The evidence review included experimental,
about protecting girls and boys of all ages from different quasi experimental and other quantitative evaluations as
forms of sexual violence where further collaboration and well as qualitative research on interventions and actions
gendered insights could be of benefit. against child sexual abuse and exploitation. These were
screened for relevance and quality using pre-agreed
The global impact of Covid 19 has brought increased assessment criteria. The overall quality of the findings
risks of sexual violence and gender-based violence and from studies of different interventions was graded into the
challenges for prevention and responses. The pandemic following five categories:

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Section 33 Section 4 Section 5 Section 6 Section 7 Section 8 Endnotes
1. EFFECTIVE: Programmes that have been rigorously 3. PRUDENT: where global treaties or resolutions have
evaluated through at least two high or moderate quality determined the intervention as critical for reducing violence
studies using experimental (well designed RCTs) or against children; OR the intervention has been demonstrated
quasi-experimental design (longitudinal cohort or pre- by qualitative or observational studies as effective in
post design studies with comparison groups), showing reducing sexual abuse or exploitation of children.
statistically significant impact on either attitudes or
behaviours towards child sexual abuse and exploitation 4. NEEDS MORE RESEARCH: Programmes that have a
and formalised to the extent that outside parties could limited evidence base because (a) they are new and
replicate the programme; OR the intervention was evidence is just emerging (e.g., online prevention
recommended following high quality meta-analyses education programmes); (b) they are programmes where
and systematic reviews of findings from multiple evaluation may be difficult but there is some data that
evaluations. can be used for monitoring and evaluation purposes (e.g.,
helplines). Classifying a programme as needing more
2. PROMISING: Programmes in need of further research research allows us to recognize what is being done in the
in context where there is at least one high or moderate field, particularly in settings where resources/possibilities
quality experimental or quasi-experimental study for evaluation may be severely lacking and where nothing
showing statistically significant impact on child may have been done before. Including such programmes
sexual abuse and/or exploitation; OR there is at least helps to identify areas where there is practice experience
one high or moderate quality experimental or quasi- indicating that research is clearly needed.
experimental study showing statistically significant
impact on risk or protective factors for child sexual 5. INEFFECTIVE/HARMFUL: Where the research shows
abuse and/or exploitation. no positive impact or there are findings of harmful
consequences.
Interventions and actions rated from the body of evidence The theory of change was developed through extensive
as either effective, promising or prudent are presented consultation with experts and partner organisations,
within the framework of a theory of change for preventing reading across to UNICEF’s Theory of Change
and responding to child sexual abuse and exploitation. frameworks 58 and the INSPIRE and RESPECT guidance 2,3 .

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Section 44 Section 5 Section 6 Section 7 Section 8 Endnotes
4
A THEORY OF CHANGE
There is no fixed blueprint to guide violence prevention. Much from the bottom of the diagram to the top level, it sets out
has been achieved in the 30 years since the implementation in an accessible manner common challenges in responding
of the Convention of the Rights of the Child and use of better to child sexual abuse and exploitation, identified from the
data and research, widening collaboration and partnerships evidence review, and a range of evidence based strategies
and amplifying the voice of children themselves have been and anticipated outcomes to address these. It is assumed that
among the key ingredients of change59. A theory of change that change must be internally driven and that child, family and
takes a structured and outcome focused approach to defining community level knowledge and expertise will be essential for
the problem in context alongside what needs to change. It can understanding the problem and responding to the challenges
encourage honest and evidence based collaborative dialogue to in specific contexts and for boys and girls. Responses and
identify the barriers to change, the processes for overcoming priorities for action may differ for different forms of sexual
these, and what we need to achieve. It can be used to aid abuse and exploitation against children in different contexts.
description, to get agreement about the process of change, For example, the diagram could be used as a basis for
to aid planning and the evaluation of outcomes. It can also be discussion and review by children and other stakeholders
linked to sources of evidence which can be useful in trying focusing on action against the sexual abuse of children within
to improve evidence informed approaches. Each step in the the family by relatives or trusted adults and peers. Or it
process can be shown in a diagram which can be a useful could be used to review and agree on actions and priorities
starting point for consultation when developing responses in for reducing the risk of sexual exploitation and trafficking of
different contexts with relevant partners and stakeholders. adolescent girls in a high-risk area such as a refugee camp.
The model shown in the diagram below, is not designed to Building on what is already being done under existing violence
be prescriptive but to aid consensus building for the planning, prevention strategies (such as INSPIRE2, RESPECT3 and
governance, implementation and monitoring of responses. UNICEF’s own guidance58), the theory of change sets out
It is based on a children’s rights perspective, as set out in actions across three broad, inter-related areas to: create enabling
the Convention on the Rights of the Child and international environments for prevention and response, to build capacity
standards and the understanding that violence is preventable. for services and to mobilise social and behavioural change.
It draws on socio-ecological theory, recognising that actions The next section looks in more detail at recommended actions
to end all forms of violence against children need to address under each of these three areas, drawing together findings from
individual, relationship, community, organisational and the evidence review on programmes identified as ‘effective’,
structural risks and drivers that contribute to violence. Reading ‘promising’ or ‘prudent’.

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Section 44 Section 5 Section 6 Section 7 Section 8 Endnotes
Theory of Change for Preventing & Responding to Child Sexual Abuse & Exploitation
Girls and boys of all ages a grow up with a freedom from sexual abuse and exploitation; and those who do experience
IMPACT
sexual abuse or exploitation, in all the settings and contexts in which it occurs, benefit from greater access to
care, support, justice and other services needed to ensure physical, mental and social wellbeing.
Those in contact with children Improved outcomes for Social conditions, structural Conditions and norms of
in all settings and contexts prevention and response from inequalities, beliefs, behaviours behaviour promote gender
OUTCOMES
are prevented from sexually coordinated multi sector, key and practices that allow child equity, respect for children,
abusing and exploiting children services and communities sexual abuse and exploitation their healthy development
to happen no longer exist and capacity for healthy and
equitable intimate relationships
Perpetrators are Sexually abused and Children know how Families, peers, Respect for diversity. Key population
disrupted, identified, exploited children are to recognise sexual communities & Children in situations of groups have greater
OUTPUTS
prevented from getting not criminalised, are abuse and exploitation professionals across all vulnerability are identified exposure to messages
access to children, given effectively protected and and boys & girls can sectors have knowledge, and effective interventions about preventing child
appropriate sanctions and given help for recovery access information, help resources and motivation are provided to reduce sexual abuse
stopped from committing and reintegration and support directly to take effective action to risks and prevent sexual
further offences themselves prevent & respond abuse and exploitation
Enabling Environments Service Delivery Social & Behavioural Change

Implement Regulate Create safe Build capacity for Improve Address risks Change social Support parents
national demand environments & services & invest participation, & drivers in norms and & caregivers
ACTIONS
strategies, & prevent institutions resources to advocacy & context & build behaviour to prevent &
align & enforce re-offending prevent & respond accountability to resilience that supports protect
laws with children gender inequity
international & sexual abuse
standards and of children
invest resources
Lack of political will & Limited focus on Poor coordination Limited focus on child’s, CSA/CSE risks & drivers at Social norms and
BARRIERS
evidence. Poor legal deterring offenders & & capacity of child especially victim’s, levels of individual, family, practices that support
protection, policy and bringing them to justice protection system, voice & best interests in community, organisation child sexual abuse and
resources health, education, justice decision making & policy & society exploitation & gender
& community responses based violence
PROBLEMS
Sexual abuse and sexual exploitation of male and female children and adolescents perpetrated by adults, including caregivers, other adults and
peers, in the settings of the home, school, community, workplace, media & online environment, in residential accommodation, justice system or ‘in
care’, in faith based organisations, travel, tourism, sport and leisure, and in the contexts of armed conflict, displacement, migration or emergencies

Contents Section 1 Section 2 Section 3 Section 4 Section
Section 55 Section 6 Section 7 Section 8 Endnotes
5
ENABLING NATIONAL
ENVIRONMENTS
exposure to domestic violence) often co-occur, responses
RATIONALE towards child sexual abuse and exploitation at the national
An effective system response is essential for the level must be integrated into broader violence prevention
implementation of children’s rights as set out in the responses. However, as previously argued, a specific focus
Convention on the Rights of the Child, 1989 and for on child sexual abuse and exploitation is needed in policy,
meeting the commitment of Sustainable Development planning and legislation due the particularly ‘hidden’ nature
Goal 16.2 to end violence against children by 2030. National of child sexual abuse and exploitation, the different gender
governments carry the ultimate responsibility to ensure
driven inequalities and developmental risks and drivers and the
that the rights of children are met and that resources
are provided for this purpose. Implementation and substantial gaps in knowledge and practice about how best
enforcement of laws to criminalise child sexual abuse and to address these challenges in different contexts. Around 60
exploitation and ensuring the safety of the environments countries have comprehensive laws to ban all forms of violence
in which children spend their time are strategies against children, including at home and in schools, and a
recommended by INSPIRE2 and supported by RESPECT3. growing number have adopted legal and policy frameworks to
end child marriage59. However, gaps and anomalies in law and
policy on child sexual abuse and exploitation persist in many
Three specific actions for creating an enabling environment countries. Common policy gaps are discrepancies in laws on
were identified from the evidence review: the age of consent or failure to define a specific age of consent,
parental and judicial consent exceptions to early marriage,
Î Implementing and enforcing laws & policies
laws that only criminalise the prostitution of children below the
Î Regulating demand and preventing offending ‘age of consent’, define prostitution in gender-specific terms
or exclude certain sexual acts60. The sexual abuse of boys is
Î Creating safe environments and institutions
a neglected issue in policy and child protection practice4. The
laws to regulate child sexual abuse materials online in 62 of the
Because different forms of violence against children (physical
countries surveyed by the International Center for Missing and
violence, neglect, psychological and sexual abuse and
Exploited Children were rated in 2019 as not being sufficient

to prevent this form of abuse and 16 countries still had no Most countries have laws that criminalise child sexual
legislation at all61. Guidance exists to help policy makers to abuse but the main issue is poor enforcement. Prosecution
address these anomalies and gaps.62 rates for child sexual abuse and exploitation are low in
many nations and there is a huge gap in knowledge and
practice about how to regulate demand and intervene early
CASE STUDY - INVOLVING CHILDREN AND to prevent sex offending. Although some countries have
YOUNG PEOPLE IN PUBLIC POLICY adopted increasingly harsh penalties for rape and child
INDONESIA: Child Forum 2P (Pioneer and Reporter) was sexual abuse, the deterrent effect of imprisonment alone
established to allow children to be involved in development is a contested issue. Indeed, evidence indicates that the
planning at village, district, city, and provincial levels. certainty of being caught is a stronger deterrent to further
Children were consulted during the development of the offending than the severity of the sentence 66 . If more
national strategy on ending violence against children63.
perpetrators of sexual abuse and exploitation are to be
CAMBODIA: Following the VACs survey in 2013, four identified and prevented from further offending, criminal law
technical working groups were set up to develop and needs to be enforced, resourced for delivery, supported by
implement the national action plan on preventing services for victims such as child friendly reporting, trauma
and responding to violence against children. Children
informed victim support and protection, with guidance and
and young people were consulted on the content,
implementation and monitoring of the national strategy training for professionals58 .
through the working groups, conferences and other
participation events held Cambodia.64 Responses to children and adolescents who commit
sexual offences should not be the same as responses
CROATIA: High school students attending a focus group
facilitated by the Office of the Ombudsman for Children towards adults. Children who commit sexual offences
suggested that a survey should be conducted in schools before the age of 18 have low rates of sex offending
to explore student’s perspectives on the age of consent, recidivism and offending in general declines with age 67.
as they had concerns that it did not provide sufficient States which have ratified the United Nations Convention
protection for children. The survey, with 2500 children and on the Rights of the Child 1989 are obliged to ensure that
young people revealed that 95% of children thought the age
children in conflict with the law benefit from diversion
of consent (14 years) was too low. The Network of Young
Advisors to the Ombudsman for Children (NYA), comprised and the use of alternatives to custody to the greatest
of 20 members aged 12-18 years from across the country, extent possible (CRC, Articles 37(b), 40.1, 40.3 (b), 40.4).
used the survey results to advocate for change. Children Children and adolescents diverted from custody need
gave their views and these were passed on to government developmentally appropriate treatments, involving parents
decision makers by adults. In 2012, the Criminal Code was and caregivers where possible 68 .
changed to raise the age of consent to 1565.

CASE STUDY – YOUNG PEOPLE WITH HARMFUL SEXUAL and empathy training, cognitive restructuring, impulse control, conflict
resolution, and acknowledging behaviour. Concepts of masculinity, male
BEHAVIOUR
sexuality, and relapse prevention are also explored. The length of the
SOUTH AFRICA: The Support Programme for Abuse Reactive Children programme for each component varies according to the child’s needs.
(SPARC) is a diversion programme established by the Teddy Bear Clinic Positive findings of on changes in attitudes, behaviours and family
in Johannesburg, South Africa. It diverts children aged 6-18 years with interactions come from a study of children and young people on the
sexually harmful behaviours and those who have committed sexual programme between 2009 to 2011. The intervention led to a significant
offences from the criminal justice system on to a therapeutic programme. increase in participants’ self-confidence, prosocial behaviour, and positive
The programme works with children with harmful sexual behaviours gender-related attitudes. Participants improved their ability to cope with
assessed as being low-to medium-risk to others. Children may be referred issues and devise constructive solutions, showed an increase in school and
directly to the programme by their caregivers, although in practice most church attendance and a decrease in substance use. There was an increase
come via court orders. The programme aims to help children and young in family engagement, communication and supervision, as well as positive
people to understand the consequences of their behaviour and equip discipline strategies. A telephone survey of 64% of caregivers from the 494
them with a range of psychosocial skills and resources. The program is families on the programme found 95% of caregivers reported their child
multi-component offering cognitive behavioural and creative therapies had not committed further sexual offenses 1-2 years after the program
in individual, group and family sessions, as well as extracurricular had ended. The caregiver reports on reoffending could not however be
activities for children and adolescents who have committed, or are at risk independently checked so further research is needed, with a comparison
of committing, a sexual offense. Sessions cover modules on social skills group design, to strengthen these encouraging findings on impact69 .
Learning from inquiries into organisational and institutional and external monitoring of institutional standards for child
abuse has shown that too often organisations that protection, including better advocacy and voice for child
have responsibility to protect vulnerable children and and adolescent victims. Evaluations of ‘whole school’
adolescents have been sites of further abuse and approaches to violence have brought promising findings on
compounded children’s vulnerabilities70. Action to creating safe institutions basing programmes for change on
create safe environments within institutions needs to what young people have said about their daily experiences.
move beyond manipulation of the physical environment These approaches aim to change the whole school culture,
(situational prevention) to include organisational and involving pupils, teachers, other school staff and often
individual responsibilities for child safety at home, school, parents in a comprehensive programme of change to
residential institutions of justice and care and other areas of create a safe learning environment. Examples are the Good
everyday life. Funders and philanthropic organisations can Schools Toolkit in Uganda and Shifting Boundaries, Safe
contribute to this work by supporting the implementation Dates and Dating Matters in the US.

SAFE ENVIRONMENTS – programme, the classroom programme alone, the building

intervention alone, or neither. It was found that students
PROMISING RESEARCH
who were exposed to both the classroom-based and
Shifting Boundaries is a school based programme that building-based interventions reported the lowest incidence
combines gender violence education with situational of sexual harassment and sexual violence perpetration
crime prevention, interventions with perpetrators and and victimisation. The building-based intervention alone
victims. The curriculum for the classroom programme was effective at reducing sexual harassment perpetration
focuses on the legal consequences of dating violence, and victimisation and sexual violence perpetration (but
gender equity and healthy relationships. This is supported not victimisation). The classroom-based intervention alone
by a building-based intervention where students and was not effective at reducing violence or harassment. A
teachers identify “hot spots” where violence and subsequent RCT found the programme to be effective for
harassment most often occurs, post signs and increase primary and secondary prevention with boys and girls.
adult supervision in these places. Students who commit A higher level of saturation for programme delivery (not
acts of violence or harassment receive temporary limiting the curriculum to just one school grade) led to
restraining orders. In a cluster-randomized trial with 20 reduced rates of sexual harassment suggesting that the
schools and more than 2,500 students, schools were multi-component approach involving the whole school is
randomly assigned to receive the building and classroom more effective.71
Lack of political will and lack of adequate resources are Table I summarises effective, promising and prudent
often cited as the reasons that systems do not work or actions to help create an enabling national environment
that children do not have access to services, however for preventing and responding to child sexual abuse
much can be achieved in contexts where resources are and exploitation. Examples of actions and programmes
scarce5. Context relevant evidence can aid decisions in are shown. These have been selected from HICs and
low resource environments about which responses may LMICs on the basis of the strength of evaluations and
be most effective. commitments to international standards. In LMICs some
examples shown are adaptations and implementations of
programmes evaluated in HICs only.

TABLE 1: Actions to support an enabling national environment

EVIDENCE KEY
1 one or more of the INSPIRE seven strategies evidence rating effective

High income countries
2 1 or more of the RESPECT seven strategies evidence rating promising
Low & middle income
3 recommended action in UNICEF strategies countries evidence rating prudent
ENABLING NATIONAL ENVIRONMENT
Actions Examples Implementation Issues Evidence
Implement Legislation that operationalises commitments under the Adequate resources – staff, training, multi 1 2 3
national United Nations Convention on the Rights of the Child sector coordination, monitoring etc - are
strategies & and other relevant commitments allocated for enforcement.
policies, align
& enforce
Minimum age of marriage laws (18 years) Remove parental or judicial permission 1 2 3
laws with
exceptions. Policies to address the root causes of
international 72
early marriage, e.g. education for girls
standards
and invest
resources. Global harmonisation of laws on online CSA/CSE as in Support collaboration between government, ICT 1 2 3
WePROTECT Model National Response sector & services working with children
73
Victim sensitive & child friendly justice e.g. trauma Monitoring outcomes in different contexts with 1 2
informed approaches in Children’s Advocacy/Barnahus attention to access inequalities (e.g. in rural
models, specialist police desks e.g. Tanzania communities), implementation challenges & 74
impact on prosecution.
National policy protocols on identification, assessment, National commitment to learn about and 1 2 3
reporting & response e.g UK & Zimbabwe 75 confront the barriers child victims face in
77
getting help. Training, resources and multi
sector coordination for service responses.
Phased, adequately resourced and monitored
introduction of mandatory reporting as evidence
of impact is mixed.76

ENABLING NATIONAL ENVIRONMENT
Regulate Prosecution and criminal sanctions on adult offenders e.g. Resources for enforcement. 1 2 3
demand remove exceptions from criminal prosecution for rape and
& prevent sexual offences by offenders who are married to or who
re-offending offer to marry the victim while ensuring protection of victims
from secondary victimisation
Divert children who commit sexual offences Resources for enforcement and alternatives to 1 2 3
from custody custody for juveniles.
Treatment for children with sexual harmful behaviours MST requires high level of professional resource 1 2 3
e.g. multi-systemic therapy (MST), targeted support so piloting & monitoring targeted support likely to
78
involving juvenile & caregivers be more practical where resources are scarce
Create safe Manipulation of physical environment to increase safety Needs young people’s participation in mapping 1 2 3
environments – e.g. combined IPV and sexual violence prevention and unsafe hot spots & integration with service
and institutions situational/building strategies Shifting Boundaries, US, child responses such as school response to peer 79 80
friendly spaces & camp design in humanitarian contexts perpetrators
Whole-school approaches, targeting not only peer & Longer term monitoring is needed as reports 1 2 3
partner violence but also violence perpetrated by teachers of sexual abuse may rise at first as victim
and other educational staff and general building safety e.g confidence to report increases. Needs
Good Schools Uganda Doorways III Ghana and Malawi. coordination and resources in schools and the 81 82
Effective for violence prevention but too little data on self- wider community to implement an effective
reported sexual violence to evaluate impact. response.
Use of technology to detect & online report abuse buttons, Requires continued international efforts to 1 2 3
lead to increase in public reports and identification of & identify materials reposted on different sites or
83
take down of CSAM or harmful materials in unregulated areas
Safeguarding policies and systems for children’s and Needs integration into broader prevention 1 2 3
community organisations, faith groups & sports – e.g strategies to address risks and organisational
Child Safe Standards, Australia; guidance on child drivers. Currently low evidence on impact 84
safeguarding in sport
Involving private sector and communities in creating safe 1 2 3

environments e.g. codes of conduct in travel and tourism. 85

Contents Section 1 Section 2 Section 3 Section 4 Section 5 Section
Section 66 Section 7 Section 8 Endnotes
6
SERVICE DELIVERY
Two specific actions to improve service delivery were
RATIONALE identified from the evidence review:
Articles 19, 20, 34 and 39 of the United Nations Convention
on the Rights of the Child (UNCRC) set out a state’s Î investing resources and building the capacity of services
obligation to protect children from all forms of violence,
to prevent and respond
neglect, maltreatment, sexual abuse and exploitation
and to establish procedures and social programmes for
prevention and response, including the identification, Î improving the participation of, advocacy for and
reporting, referral, support and care of children. accountability towards children
Improving access to good quality health, social care,

justice and support services for all children is one of the
All child protection systems need responses to be
seven INSPIRE strategies. This can reduce the long term developed in context and make sense to the communities
impact of sexual abuse and exploitation thereby also that use them 59 . Many countries face challenges in
helping to prevent abuse in the next generation. ensuring there are services that are accessible and
CRC Article 12 sets out state responsibilities to protect,
relevant to the needs of children and young people at risk
promote and respect the rights of children to participate or experiencing different types of sexual abuse and/or
in decisions that affect them. Taking into account the best sexual exploitation 33, 34, 40, 53, 59 . Friends, family and informal
interests of the child, participation work with children support are the first port of call for many children seeking
should be ethical, safe and meaningful. help 86 . Lack of trust and frustration with inaccessibility or
SDG 16.7 aims to ensure responsive, inclusive, participatory poor responses from formal services can leave children
and representative decision-making at all levels. and families with little option other than seeking informal
solutions. Some community responses, such as requiring
the rapist to marry an adolescent victim, may be unhelpful
in tackling the underlying causes 87. Services are more
likely to be effective where:

1. children are meaningfully and ethically involved directly in

multi-sector efforts from the community level upwards CASE STUDY: INVOLVING CHILDREN
in mapping needs and the availability of services. Direct AND YOUNG PEOPLE IN SERVICES
inclusive and ethical consultation with young people can DEMOCRATIC REPUBLIC OF THE CONGO (DRC): To improve
improve service delivery and this is a clear area of priority the relevance of services in humanitarian and conflict
for child sexual abuse and exploitation88; settings, Save the Children conducted a consultation
via focus groups with 2,437 children and young people
aged between 7 to 17 years and 234 adult caregivers of
2. formal services build on the strengths and gaps in
children below the age of 5 years living in five areas of the
existing child protection mechanisms to prevent,
DRC. A dot voting system was used to identify children’s
identify, report and respond to sexual abuse and and adolescents’ needs and priorities. Priorities ranked
exploitation in specific communities 59; highest were access to education, food security, health
and safety and protection from exploitation. It was found
3. help is accessible and appropriate to the needs of that girls as young as 6 years rated protection from sexual
abuse and exploitation among their priorities. Save the
younger and older girls and boys 4;
Children has published helpful guidance on meaningful
and ethical child participation91.
4. delivery is guided by the principles of trauma
informed care 89 .
Multi-component and multi-agency services, such as well
In low resource settings frontline services may be resourced ‘one stop shop’ style services with effective
concentrated in urban areas or unevenly available in coordination and links with other services are likely to be
areas of past conflict or emergency, making accessibility more effective, although research on child and adolescent
a particular challenge for children in rural areas. Many safety and wellbeing outcomes needs to be further
nations have set up free and confidential child helplines developed. One stop sexual violence services, such as
providing advice and support directly to children gender and child abuse police desks in Tanzania and
themselves as a first step response 90 . Sudan or South Africa’s Thuzulela services and SARCs
in the UK, typically bring together professionals from
Resources are needed to respond to children in health, forensic and legal services, counselling and victim
communities who are identified as vulnerable and children support to provide more holistic and coordinated care.
and adolescents themselves are best placed to express One stop services with a specific child protection focus
their views on which services are helpful. typically bring together child welfare and advocacy, health
and justice professionals in a child friendly environment

to provide holistic care from identification, assessment, violence related referrals and services provided, improved
protection and prosecution through to treatment and prosecution processes and child and parent/caregiver
recovery. There is evidence from services such as satisfaction with the service.74 Service standards and
Children’s Advocacy Centers in the US and from Children’s guidelines for Barnahus have been developed 92 .
Houses/Barnahus across Europe of a growth in sexual
CASE STUDY : MALINDI CHILD PROTECTION CENTRE and coordinated services primarily for children and their families, supported
by norms changing programmes of activities in the local community. The
KENYA: In 2009 a participatory assessment in the Malindi Sub-County CPC provides: preventive community education, individual assessment
was conducted to identify the issues hindering community members of children; child and family counselling and psychosocial support, legal
reporting cases of child abuse, violence and exploitation to the Department assistance, tracing, reunification and reintegration of separated children,
of Children Services. The survey identified the following main problems: and referrals to other service providers such as health care centres,
abuse cases were frequently settled at community level by local authorities rehabilitation centres, police, judiciary or vocational training schools. The
bypassing the law; the community were not aware on how the reporting centre staff include a manager, appointed by the Director of the Department
system was working; the survivors and their families were giving up during of Children’s Services, four social workers, a child counsellor and a legal
the reporting due to lack of funds to follow all the scattered services; lack of officer. The district children’s officer and a police officer from the Police
trust from the community limited cases coming in to the justice system and Gender and Children’s Desk are also co-located at the centre to help
very few cases were concluded. Findings from the survey and international collaborative working. The centre oversees each case from beginning to
research were used to inform a new approach to Child Protection Centres, end. It is supported by a free and confidential helpline so anyone can report
with a detailed operational plan. In 2010, the community led model was a case of child abuse. Evaluation data shows an increase in the average
adopted by the Government of Kenya and the first Child Protection Centre caseload of 100 per month in 2009 to 250 per month during the period
(CPC) was built in Malindi to provide a hub of quality, coordinated and 2012-2014 and 340 in 2017-2018. From 2010 to July 2018 the CPC in Malindi
inclusive services to ensure that children and their families had access to provided quality and integrated services to 27,607 children (51% girls). 90%
immediate support and guidance to respond to abuse, exploitation and of cases reported to Malindi CPC in the 2017- 2018 were successfully solved.
violence and to improve their lives in order to reach their full potential. Cases reported for child ‘defilement’, sexual abuse and exploitation have
The CPC aimed to strengthen case management through coordinated and grown slowly and made up almost 6% of all cases referred in 201893 . There
effective psychosocial and legal services. It is “a one stop shop” where, are four CPCs operating and more scheduled to open in Kenya. The CPCs
when any abuse, neglect or exploitation is reported and essential services are supported by government efforts to improve service capacity, plug gaps
can be offered in a child friendly space. It is also a community resource in policy and legislation, set up a national case management database and
centre, open to all community members, providing a hub of information improve the national systems of child protection.

The social work workforce is thinly spread and poorly have run away from a residential care facility and lack trust
supported in many countries and there is a need for further in welfare services. Outreach and advocacy programmes
investment. UNICEF have recently published guidance on are often linked with one stop shop or shelter services
strengthening the child protection social work workforce.94 and increasingly tend to draw on trauma informed
There are encouraging early research findings that suggest practice and case management methods. Consultations
that in low resource settings, capacity of services can also with adolescents, qualitative evaluations and practice
be developed through specialist task force or mobile hub experience favour specialist outreach or advocacy models
and spoke models of service development 95 . that respond to immediate practical needs (food, health
care etc) and build trust, taking a staged approach on
Sexually exploited adolescents may be resistant to the journey to safety, recovery and reintegration 96 . These
traditional child protection responses, particularly if they approaches warrant further research and attention.
TRAUMA FOCUSED RECOVERY : a trauma focused treatment (N= 131) with outcomes for
a comparison, wait list/treatment as usual group (N=126).
PROMISING RESEARCH
Due to the low resource setting, treatment was delivered
‘What works’ for children and adolescents who have by lay counsellors recruited, trained and supervised by
behavioural or mental health problems as a consequence experienced professionals in the community. Statistically
of sexual abuse will depend upon the diagnosis, so not greater reductions in trauma symptoms and functional
all survivors of sexual abuse will benefit from the same impairment were found for children in the CBT with a trauma
therapeutic intervention. Research indicates the importance focus group than for those in the comparison group. There
of involving the client in treatment choices97 . One third to were reductions of 81.9% in trauma symptoms and 89.4% in
a half of all school aged children who report experiences of functional impairment for the CBT with trauma focus group
sexual abuse also have clinical levels of Post-Traumatic Stress compared with reductions of 21.1% for trauma symptoms and
Disorder (PTSD)98 . On the basis of several robust studies, the 68.3% for functional impairment in the comparison group99.
WHO has endorsed CBT with a trauma focus as treatment for In the Democratic Republic of the Congo (DRC), another
sexually abused children and adolescents with Post Traumatic trail compared outcomes for 52 girls aged 12 to 17 years
Stress Disorder1. CBT approaches with a trauma focus have randomly assigned to CBT with trauma focus (N=24) or to a
been evaluated in LMICS in a small number of experimental wait list comparison group (N=28)100. Girls in the CBT with
trails. An RCT in Zambia aimed to compare trauma symptoms trauma focus group showed significantly greater reductions
in orphans and vulnerable children provided with CBT with in trauma symptoms.

TABLE 2: Actions to Support Service Delivery
EVIDENCE KEY
1 1 or more of the INSPIRE seven strategies evidence rating effective

evidence rating promising
2 1 or more of the RESPECT seven strategies
evidence rating prudent
Low & middle income
3 recommended action in UNICEF strategies countries
needs more research
SERVICE DELIVERY
Build the capacity of Child helplines or report abuse lines for adults e.g. Resources needed for implementation, training, 1 2 3
services and invest Childline Kenya, Tanzania, UK. Bring an increase in policy, procedures & governance framework and
resources calls and children’s access to services. Follow up links with multi sector responses, resources and
research on outcomes is limited. awareness raising. Many helplines also provide 102
online services.101
Training professionals to identify and report child Further monitoring is needed to assess the 1 2 3
sexual abuse/sexual exploitation e.g. Darkness to impact of reporting on child outcomes.
Light Stewards of Children, US. Reported cases 103
rise. Training has to be reinforced and repeated.

SERVICE DELIVERY
Build the capacity of Cross-national police collaboration on online Requires implementation of WeProtect guidance, 1 2 3
services and invest victim and CSAM perpetrator identification, a framework of legislation, resources to develop
resources reporting & prosecution. Increases reports, expertise for collaboration in national police,
(continued) prosecutions and take down of CSAM collaboration with private sector online service 83
providers, supported by preventive education
with children in schools & parents
One stop coordinated services to respond to Service design is appropriate and accessible to 1 2 3
gender-based violence and child abuse e.g. children & adolescents in the community
Thuzulela centres South Africa, Malindi CPC 104
Kenya, SARCs UK
Outreach and advocacy providing trauma Multi sector coordination with formal services & 2 3
informed, staged approaches to care for sexually community.
exploited children & adolescents e.g Barnardo’s 105 106
4 A model UK, advocacy for trafficking victims
Services for recovery e.g. Cognitive behavioural In low resource settings mentorship and trained 1 2 3
therapy with a trauma focus paraprofessionals can provide therapy. 108
107
EMDR (eye movement desensitization and Other modes of delivery may be better in low 1 2 3
processing) – found to be effective for treating resource areas e.g. use of volunteers, online
trauma symptoms in older children and adolescents therapy 109 110
especially if below the clinical level for PTSD.
Improve participation Children and adolescents have a meaningful Requires organisational structures and 1 3
of, advocacy for role in public policy and in the design, delivery processes for children’s voices to be heard
and accountability and monitoring of services eg Congo, identifying
towards children priorities in conflict contexts, influencing law of
consent Kosovo

Contents Section 1 Section 2 Section 3 Section 4 Section 5 Section 6 Section
Section 7 Section 8 Endnotes
7
SOCIAL & BEHAVIOURAL CHANGE
All three areas of action work best if they involve children,
RATIONALE
families or caregivers (where appropriate) and communities.
All seven of the INSPIRE strategies for action are Efforts to change social norms for example will not succeed
founded on the recognition that ending violence against
without the involvement of people in the community, including
children requires both primary prevention and effective
men and boys. Community participation aids coordination and
responses. Primary prevention addresses the underlying
beliefs, attitudes and behaviours, inequalities, risks and working together and supports local capacity to respond, and
drivers for violence at the levels of the individual, family also contributes to more sustainable outcomes.
and relationships, community, organisation/institution
and broader social and political context. The general messages for best practice are:
1. good quality, interactive, gender and age appropriate

programmes work best for targeting the behaviour and
attitudes of children and young people. For example, as
Three areas of inter-related activity were identified in the
part of making environments safe for younger children,
review of evidence:
safety education in home, school and community settings
for parents and their children aged 4 to 9 years may focus
Î addressing the risks and drivers and enhancing
on safety in relationships with adults and peers, including
protective factors for child sexual abuse and exploitation
trusted adults, body parts, recognising inappropriate
in context, some of which differ from those associated
touching or other forms of sexual behaviour, including
with other forms of violence
online, and who to talk to about this. Programmes for older
children (aged 10+) might address sexual victimisation and
Î changing social norms and behaviour that support
perpetration, issues of consent and respect and gender
gender inequality and discrimination and the sexual
equality in peer, family and intimate relationships.
abuse of children and adolescents
2. comprehensive approaches that combine risk reduction
Î supporting parents and caregivers to keep their children with education, behaviour changing and broader
safe from child sexual abuse and exploitation. asset, skills building and empowerment strategies are
showing the most promising results.

CASE STUDY : I HAVE THE RIGHT TO FEEL SAFE the programme by members of Fundacion Azulado. The
programme aims to increase children’s self-esteem, help
ECUADOR: I have the right to feel safe is a 10 week child them identify a personal safety net of trusted adults,
sexual abuse self protection programme for children aged distinguish between good and bad touches, appropriate
7 to 12 years in use in Latin America and Africa. It was and inappropriate touching, avoid risky situations, practice
adapted and established in Ecuador for use in schools by the right to say ‘no’, disclose abuse and recognise that
the NGO Fundacion Azulado, who work with teachers, abuse is never a child’s fault. An RCT of the programme
parents and children to prevent violence and sexual abuse delivered to 4932 children which compared score results
and support recovery. Teaching children self-protection and for children who received the programme with those in a
where to find help is an important part of a wider response wait list control group at baseline, immediately after and
to reduce the risks of child sexual abuse. The programme at 6 months later found significant improvements in levels
uses a train the trainer approach, where teachers are of knowledge for children on the programme. These gains
trained by a psychologist and mentored in delivering were retained 6 months later111.
THE EMPOWERMENT AND LIVELIHOOD vocational training, micro financing and help to become
self-supporting. A randomised control trial in Uganda tracked
FOR ADOLESCENTS PROJECT (ELA):
4,800 participants over two years, comparing outcomes
PROMISING RESEARCH for girls in 100 communities randomly assigned to receive
UGANDA: The ELA project combines microfinance and life the ELA programme with outcomes for girls in 50 control
skills training and was set up initially by BRAC in 2003, communities without the ELA programme. At the time the
a development organisation which has been involved in Uganda ELA programme had no microfinance scheme.
microfinance activities in rural areas since 1974. It has Relative to adolescent girls in the control communities,
reached over 290,000 young people worldwide and is the combined intervention of simultaneously providing
running in six countries - Bangladesh, Uganda, Tanzania, vocational training and information on sex, reproduction
Sierra Leone, South Sudan and Liberia. In Uganda the ELA and marriage, showed that two years later girls had a
project targets adolescent girls and young women aged 13 to 72 per cent increased likelihood of engaging in income
21, especially those who are out of school. It aims to reduce generating activities, driven by increased self-employment.
risky behaviour and improve girls’ health and wellbeing by Girls also had a 41 per cent increase in monthly spending
socially and financially empowering them, providing them on consumption. There was a 26 per cent decline in teenage
with a safe space away from home in which to socialise pregnancies and a decline in girls reporting having had
and build social networks, receive mentoring, life skills, unwilling sex from 14 per cent to 8 per cent112.

TABLE 3: Actions to Support Social & Behavioural Change
EVIDENCE KEY
1 1 or more of the INSPIRE seven strategies evidence rating effective

evidence rating promising
2 1 or more of the RESPECT seven strategies
evidence rating prudent
Low & middle income
3 recommended action in UNICEF strategies countries
needs more research

114
Address risks & School & nursery based keeping safe education for Impact influenced by the quality of the 113
drivers in context children e.g. Who Do You Tell? Canada; I Have The Right To programme, longer duration, interactive
& build resilience Feel Safe, Ecuador. Improves children’s knowledge about format that allows children to practice
sexual abuse, safe and unsafe touches, who to tell/what skills (such as role play) & involvement of
to do without adverse consequences such as increasing parents and teachers. Data on disclosure
fears. There is no evidence of impact on victimisation often not collected.
rates after programme exposure.
115
Empowerment and self defense for adolescent girls- no Delivered in the context of a wider Safe
evidence on impact on under 18s in HICs found. RCTs in Schools programme, not as a standalone.
Malawi and Kenya found IMPower programme, brought
reduced self reported sexual victimisation, increased
self confidence and self reported successful use of
defensive behaviour. Analysis at the individual level was
not possible.
116
Economic strengthening for women & girls & vulnerable If combined with other prevention efforts
children such as orphans, e.g. social security, conditional may have potential to address associated
or non-conditional cash transfers as in Zomba risks of sexual abuse and exploitation for
programme, Malawi. adolescents.
112
Combined gender, economic empowerment & vocational Programmes vary in different contexts
life skills programmes for adolescent girls e.g. ELA but usually involve safe spaces for peer
programme Uganda groups, health education, life skills
& confidence building & economic
empowerment


118
Change social Community or school-based education to target Programmes for adolescents that involve 117
norms & entrenched norms and values of males & females that parents seem to be more effective.
behaviours that support gender inequality and violence. Most programmes
support gender have IPV focus & no direct evidence of impact on CSA/
inequality & CSE e.g. Safe Dates US & South Africa.
sexual abuse of 119
children Sex education/HIV prevention programmes for males May work better for females if combined
& females. Lower rates of transactional sex and IPV with economic empowerment
perpetration reported by men after intervention but no impact
on women’s victimisation. E.g. Stepping Stones, South Africa
Involving men and boys and communities in violence Evaluations show changes in attitudes and 120
prevention, e.g. mentoring, community engagement & bystander intentions but impact on child
bystander programmes. sexual abuse has not been measured.
122
Support parents Targeted home visits with vulnerable families and Although effective for reducing associated 121
& caregivers structured programme to develop positive parenting. E.g. risks, data specific to child sexual abuse
to prevent and Family Nurse Partnerships UK, Netherlands, US. Effective and exploitation is limited and could be
protect children at reducing child protection registrations & addressing improved.
from sexual abuse risks related to child sexual abuse.
& exploitation
Parenting programmes to prevent maltreatment and physical Most effective if resources exist for 123
punishment, few report impact on CSA/CSE & none address coordinated child protection system
risk of children developing harmful sexual behaviour. responses.
E.g. Head Start RCT in US found reduction in child sexual
abuse. Effective at reducing child protection registrations
& addressing risks related to child sexual abuse such as
perceptions of punitive parenting.
125
Improving parent child communication about sex and Communication improves but impact 124
safety E.g. Parents Matter! US; Families Matter! Botswana, on sexual abuse and young people’s
Côte d’Ivoire, Kenya, Mozambique, Namibia, South Africa, behaviour needs to be measured
United Republic of Tanzania, Zambia

Contents Section 1 Section 2 Section 3 Section 4 Section 5 Section 6 Section 7 Section
Section 88 Endnotes
8
GAPS & CHALLENGES
The purpose of this review is to build on, and hopefully Î BROADENING THE FOCUS ON PERPETRATORS to reduce
take forward, existing system focused work to end child the demand for child sexual abuse and exploitation,
sexual abuse and exploitation. Much is already being done. including online facilitated abuse and the production of
child sexual abuse materials. Recent research on social
Because there are some common risks and drivers for
norms and sexual violence127 and ongoing cross regional
violence against women and violence against children126 ,
work in Africa on creating baselines to measure and
interventions that aim to reduce these (such as life skills, track changes in social norms is welcome. Too little
gender equity and economic and social empowerment is known about the social norms that fuel demand for
programmes) will have an impact on some forms of child different types of child sexual abuse and exploitation in
sexual abuse and exploitation (such as transactional sex different contexts and relationships. Too little is known
or adolescent partner abuse). Findings from this review about policies that may regulate demand.
endorse recommendations for further collaboration Î PREVENTION FOR YOUNG PEOPLE WITH HARMFUL
and coordination of efforts to address violence against BEHAVIOUR Research and practice on the prevention,
children and violence against women. Gathering data primary and secondary, of harmful sexual behaviour
from this work to show the specific impact on child sexual among children and adolescents living in the community
abuse and exploitation is a necessity although likely to is very limited especially in the global south.
be challenging given the hidden nature of the problem Î EFFECTIVE RESPONSES TO ONLINE ABUSE where
for both girls and boys and widespread under reporting. programmes exist but research on their effectiveness is
Further research on safe schools would be helpful. still limited
Î REACHING ALL CHILDREN including groups of children
There are areas where research evidence indicates that to end who have been neglected in research, policy and practice
child sexual abuse and exploitation, a change in approach is such as boys, children with physical disabilities and
needed. Efforts to confront child sexual abuse and exploitation learning difficulties and children in marginalised groups.
and help children affected will not succeed unless founded
Î BUILDING ON STRENGTHS IN THE INFORMAL SECTOR
on what children and young people themselves need and this Informal and community support from peers, family and
requires continued effort to support children’s meaningful community groups, including faith groups, are often the
participation. There are many gaps in knowledge and first or main source of help but too little is known about
challenges for practice to confront including: what this involves.

Endnotes
ENDNOTES
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ACTION TO END CHILD SEXUAL

ABUSE AND EXPLOITATION

Permission is required to reproduce any part of this publication. Permission will be

Cover photo: © UNICEF/UNI303881/Zaidi

Design and layout by Big Yellow Taxi, Inc.

Click on section bars to

2. A Global Problem...................................5 7. Social & behavioural change.................27

3. Building on the evidence ..................... 11 8. Gaps & challenges................................31

4. A Theory of Change.............................13 Endnotes..................................................32

5. Enabling National Environments...........15

1 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

2 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

3 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

4 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

5 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

6 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

7 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

Surveys with children and young people consistently Consequences

8 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

There is now an extensive literature on the risks and

9 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

10 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

11 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

12 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

13 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

Enabling Environments Service Delivery Social & Behavioural Change

14 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

15 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

16 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

17 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

SAFE ENVIRONMENTS – programme, the classroom programme alone, the building

18 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

TABLE 1: Actions to support an enabling national environment

1 one or more of the INSPIRE seven strategies evidence rating effective

ENABLING NATIONAL ENVIRONMENT

Actions Examples Implementation Issues Evidence

19 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

ENABLING NATIONAL ENVIRONMENT

Actions Examples Implementation Issues Evidence

Involving private sector and communities in creating safe 1 2 3

20 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

Improving access to good quality health, social care,

21 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

1. children are meaningfully and ethically involved directly in

22 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

23 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

24 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

TABLE 2: Actions to Support Service Delivery

1 1 or more of the INSPIRE seven strategies evidence rating effective

Actions Examples Implementation Issues Evidence

25 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

Actions Examples Implementation Issues Evidence

26 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

1. good quality, interactive, gender and age appropriate

27 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

28 Ending Child Sexual Abuse and Exploitation: A Review of the Evidence

TABLE 3: Actions to Support Social & Behavioural Change

1 1 or more of the INSPIRE seven strategies evidence rating effective

SOCIAL & BEHAVIOURAL CHANGE

Actions Examples Implementation Issues Evidence