Child abuse is not a new prodigy to the current 21st century. In this advanced society this matter is happening all over the world. From the statistics gathered, child abuse is a matter that shouldn’t be taken lightly. Though they are many steps that have been engaged by the government, cases of child abuse continue to be on the rise. In Malaysia, nearly 5,000 children were reported to be in need of protection from abuse in 2016 alone (UNICEF,2019).
This dejected matter should be taken seriously and we need to have a way of protecting the victims and to stop it from happening. Many laws have been passed in Malaysia, with the intention of protecting the child’s welfare. At the same time, the law also tries to prevent the crime from being committed.
According to World Health Organization (WHO,2016), Child maltreatment is the abuse and neglect that occurs to children under 18 years of age. It includes all types of physical and/or emotional ill-treatment, sexual abuse, neglect, negligence and commercial or other exploitation, which results in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power. Many abuse cases are very susceptible to have an emotional disturbance which leads to low self-esteem in their daily life, while a number of severe child maltreatment cases may lead to disfigurements and higher chances of mortality.
Child physical abuse is a contributing cause of morbidity and mortality in young children. Estoff, Foglia & Fuchs (2015) mentioned that, when compared with unintentional injuries, child physical abuse is associated with increased injury severity and risk for mortality.
Ethical Issues on Child Abuse
Working on child abuse demands a multitude of ethical and legal considerations whenever formulating a research agenda for this particular area.Studies involving children with social, emotional, or behavioural issues-or their families-must follow certain study ethics requirements.The researchers’ ethical and legal responsibilities to their research subjects can be problematic, especially when research topics include humiliating, violent and illegal acts. One of the most difficult ethical problems to address in studies of child maltreatment is the extent to which the research project’s true intent is revealed and shared with the subject or parent. As Bradley and Lindsay (1987) remarked, in all areas of human research scientists must walk a fine line between protection of their subjects and procedures designed to enhance the validity and merit of scientific results.
The picture of any child concerned or any other person, place or thing which may lead to the identification of any child concerned also shall not be published in any newspaper or magazine or transmitted through any electronic medium (section 15(1) and (2) of the Child Act 2001). In regards for the safety of a child to be taken away from an abusive family, if the protector or police officer is satisfied on reasonable grounds that a child is in need of care and protection, they may take the child into temporary custody (section 18 of the Child Act 2001).(YUSOP,2020)
Autonomy on Child Abuse
The operative notion of autonomy is first and foremost the ability to preserve one’s own survival and safety, and secondly the ability to pursue the primal goals of self-actualization and wellbeing, with that being said a father of a child has no rights in evading a child’s body in conquering his sexual demands. If the abused autonomy was respected, then she might be exposed to further abuse as she would not get sufficient support, guidance and protection from her family; whereas if the incident was disclosed to her family, then her autonomy, which is her fundamental right, would be violated (GULZAR AND KARMALIANI, 2012). According to Beauchamp et al (2001), In modern medical ethics, patient autonomy is considered a major principle in making decisions about an individual’s health, and those who receive healthcare should have the right to practice their autonomy consciously and freely; healthcare providers, on the other hand, are obligated to respect this right and allow patients to practice their autonomy in the course of their treatment.
Culturally in Malaysia, it is shameful and a disgrace to the family member to report the abused cases as they rather keep the issue within the family to avoid it being the talk of the neighborhood. In 2015, Datuk Seri Rohani Abdul Karim, then women, family and community development minister, voiced concern about the lack of reports from the public (New Straits Time,2020). The social stigma and legal consequences of child abuse and neglect, as well as the possible ramifications for individuals and their families, require a careful review of fundamental principles that should guide responsible research practice in this area.
As stated by Azira (AZIZ, 2016), the biggest obstacle is the taboo and social stigma surrounding talking about child sexual abuse cases by conservative adults in general. It is due to the fact that some perpetrators are breadwinner or relatives and make existing child sexual abuse prevention ineffective as the adults around them do not take action upon disclosure. Children are still vulnerable to sexual predators due to this culture of silence.
Children experience the legal system as victims, witnesses, when they are at odds with the law, or as parties to a course of justice, such as custody. According to (UNICEF 2011) the establishment of child sensitive courts and police procedures that give primary consideration to a child’s right to protection and are consistent with the Convention on the Rights of the Child and other non-binding international standards, guidelines, and rules.
By using Beattie’s model on health promotion, a four-quadrant element is given on two axes. Each quadrant represents different methods in how health could be promoted by individuals, professionals and government through health persuasion, counselling and reaching out to the community. A mode of intervention was used either for the mode of intervention, a top down approach which can be authoritative or a bottom up approach which could be negotiated (IVORY RESEARCH, 2010)
Governments and health care workers usually work in a “top-down” manner, using policy intervention and strategies for encouragement of health .The Child Act 2001 brought major changes in the law relating to the protection of the child in Malaysia where the rights of the child were recognized openly by the government. The preamble of the Act recognized children as an important component of the society and since the children are not mature, protection and special care should be given to them.
In 2009, the government of Malaysia, through the ministry of Women, Family and Community Development, formulated Nation Child Policy 2009 (NCP) and National Child Protection Policy 2009 (NCPP). The 2009 NCP was structured to comply with the principles of the Convention on the Rights of the Child (CRC) which highlighted six key goals: survival, protection, development, participation, advocacy, and research and development. Strategies were formulated through specific programs that are to be implemented by various agencies dealing with children in Malaysia.
Data on reported child abuse was collected annually primarily by the Department of Social Welfare, the Royal Malaysian Police and various hospitals for all cases of alleged child abuse by physicians, family members and childminders under the Child Act 2001. Efforts by diverse agencies to set up a structured data collection system between agencies are still undergoing.
The Ministry of Health has also developed a guideline for hospital management on child abuse and neglect by Suspected Child Abuse and Neglect (SCAN) teams in hospitals as well as the One Stop Crisis Centers (OSCC) in emergency Departments. Table I shows the annual data from reports to the Department of Social Welfare according to the various types of child abuse, showing increasing numbers of reports. Since the law makes it compulsory for the family member and child care provider to report abuse, failure to comply with the duty is an offence under section 28 of the Act and if convicted is to be released on bond on conditions to be determined by the Court. Failure to comply with the bond will render the person liable to a fine not exceeding RM5,000.00 or to imprisonment for a term not exceeding two years or both. This is proposed that the reporting responsibility should be extended to neighbours as well as teachers, since they are the ones who usually communicate with the child and who may have seen the signs of violence.
Several services were also established in place under the Ministry of Women, Family and Community Development under the Department of Social Welfare to protect the children’s interests by providing care and shelter, rescue and to provide assistance to those who have been abused, mistreated or neglected by their families.
Selective child maltreatment prevention intervention programs are on the drawing board or early phase of implementation– such as antenatal home visits for young or single mothers and outreach to those at risk for child neglect and substance abuse; training of home visiting nurses to recognise and refer families at risk for child maltreatment; parenting education programs in antenatal clinics for the prevention of inflicted traumatic brain injury and adolescent child health clinics and program with emphasis on abstinence, safe sex and prevention of teenage pregnancy.
Child sexual abuse prevention educational modules have been developed by non-government organisations and delivered in some preschool and primary schools. Although school authorities are open to the program, there is parental resistance to it similar to parental concerns towards sex education programs in schools.
The approach to personal therapy and community development are also geared at inspiring and improving awareness, understanding and skills. It is done through the personal counselling therapy approach by a health practitioner who helps the client grow and accomplish their goals, rather than acting as an advisor who instructs them how to improve. There are multidisciplinary child protection teams and Suspected Child Abuse and Neglect (SCAN) hospital-based teams that aim to organize care and follow-up, as well as OneStop Crisis Centers in hospitals and a specialized police force in major cities to respond to children sexually assaulted.
In Malaysia, a health promotion initiative for child abuse cases has been developed whereby the entire community could step up and help the children by looking out for signs such as a change in behaviour or physical appearance. The community is given a helpline to call the authorities via Talian Kasih 15999 or the police to report child abuse cases. The laws and procedures alone can’t fix the problem. More measures should be introduced to make society aware that child abuse is a crime and can contribute to the loss of human potential in a country.