WHO guidelines for care of sexually assaulted children and adolescents

WHO has issued clinical guidelines (2017) for care of children and adolescents who have been sexually abused. These guidelines are grounded in human rights standards and ethical principles. Sexual abuse in childhood and adolescence is the involvement of a young individual in a sexual activity that she/ he does not fully comprehend or is not developmentally prepared for, or violates the law or social taboos of society. Unfortunately, child sexual abuse is more prevalent than childhood cancer, juvenile diabetes and congenital heart disease combined and it is estimated that 18% of girls and 8% of boys worldwide have experienced sexual abuse.

Sexual abuse is a serious problem at multiple levels— individual, family, social as well as mental—and can have lifelong consequences, such as anxiety and depression, post- traumatic stress disorder, substance misuse, sleep disorder, self-harm and suicide. Thus, prevention should be a public health priority, especially as many children and adolescents in low- and middle-income countries have little or no recourse to assistance.

According to the guidelines, frontline healthcare providers must give high-quality, compassionate and respectful care to children and adolescents (up to 18 years of age) who have or may have experienced sexual abuse, including sexual assault or rape. The WHO guidelines also address the specific needs of boys and girls with additional vulnerabilities, such as LGBT (lesbian, gay, bisexual and transgender) adolescents as well as children and adolescents with disabilities. The guidelines focus on the provision of psychological support and recommend cognitive behavioural therapy for the child or adolescent as well as for the non-offending caregiver as part of the standard package of care.

Worldwide, sexual abuse is a serious, under-recognized problem on the rise. The issue cannot be solved merely by responding to the abuse after it has been perpetrated. While the criminal justice and related systems offer punishment, efforts to foster community safety are evoked only after the crime. Efforts of public health prevention encourage us to shift our focus from intervention and treatment to prevention of the mishap, which transfers the responsibility to adults instead of putting it on the child to learn to protect himself/herself from sexual abuse.