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January, 2017 >>

Survellience system for child abuse: Bridging the gap between actual and hidden cases

Maryam Pyar Ali Lakhdir  ( Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan. )

Yasmin Parpio, Salima Farooq  ( Department of School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan. )


The dynamics of child abuse have been recognised as a global emerging social issue which is highly associated with child humiliation. The Government of Pakistan has taken many initiatives for addressing issues regarding child abuse and neglect and has designed laws to protect children against exploitation, abuse and violence; however, most of them are not enforced at all or poorly implemented due to lack of proper definition of child abuse and related terms, and different ways of reporting child abuse cases. Most of the non-governmental organisations (NGOs) in Pakistan target extreme cases of child sexual abuse such as child rape or commercial sexual exploitation of children, but cases of physical and psychological abuse are under-reported by the NGOs most of the time. A proper surveillance system is therefore required to identify the hidden cases of all types of child abuse that can lead to effective policy formulation and implementation.

Keywords: Surveillance, Child abuse, Cases.



The term "child abuse" is defined as a criminal act that often results in underestimation of those conducts which come underneath the definition of child abuse but are flouted due to no apparent hasty harm.1 Children are subject to harmful traditional parenting practices such as disciplining strategies in the Tribal Areas and the remote interior areas of Sindh, Punjab and Baluchistan. 2 Surveys conducted in different parts of Pakistan have concluded that 2% of the children in Khyber Pakhtunkhwa (KPK) were physically abused and 1.5% of the children were found to be emotionally abused and neglected. 3 A report from the Society for the Protection of the Right of the Child (SPARC) (2012) reported that there were 5659 cases of child abuse with the highest number of abuse reported from Punjab followed by Sindh. In Multan, Sahiwal, and DeraGazi Khan, 23000 children suffered from different forms of abuse, and 500 cases of child sexual abuse was perpetrated by clerics in religious schools in Pakistan in 2004.4-6

The Government of Pakistan has promulgated laws for the protection of children such as the Juvenile Justice System Ordinance 2000. The Provincial Assembly of the Punjab has approved a historic bill for the protection of destitute and neglected children. 2 Moreover, the Government of Pakistan has passed a law against child abuse in a clause of Pakistan Penal code (PPC) 1860, section 332, which defines the notion of hurt as whoever causes pain, harm or injury without causing death. 5 The punishment for committing hurt can either be in the form of compensation or qisas, that is, punishment by causing similar hurt. 5 Furthermore, section 90 states that child sexual abuse is a criminal act, and according to the Act of Anti-Terrorism 1997, child molestation is referred to as an act of terrorism and violence.4 In addition, Article 37(a) of the Convention states that "no child shall be subjected to torture or other cruel, inhuman or degrading treatment or punishment".5 The National Assembly of Pakistan has also passed the Prohibition of Corporal Punishment Bill in 2013. In contradiction, the Punjab Destitute and Neglected Children Act 2007 has allowed a reasonable degree of punishment for disciplining a child with good sufficient reason and has not been revised by government as yet, creating legal ambiguities and hence, a failure to implement the laws effectively.4

The aforementioned points compel the following thought-provoking questions: Does the reported data reflect the actual burden of child abuse in Pakistan? If not, what are the reasons of under-reporting in Pakistan? Why there is a failure in implementing the current laws and regulations regarding child abuse in Pakistan? What strategies could be adopted to improve reporting of child abuse cases in Pakistan?



The Government of Pakistan has taken several initiatives for addressing issues regarding child abuse and maltreatment. They have signed and ratified international and regional treaties obliging it to protect children from all acts of violence and discrimination.

However, these laws and regulations are not enforced or are poorly implemented due to lack of proper definition of child abuse and related terms, and cultural variations of reporting of child abuse cases. The United Nations Convention on the Right of the Child signed by the Government of Pakistan is following the definition of child abuse given by international territories hence causing major deterrent in the labelling of such cases at societal level. The cultural variation of such related terms including abuse and harm is vague, resulting in hampering and obstructing the correct pathway to identify such cases at community level.

Most of the non-governmental organisations (NGOs) in Pakistan target extreme cases of child sexual abuse such as child rape or commercial sexual exploitation of children, but cases of physical and psychological abuse are under-reported by the NGOs most of the time. Furthermore, the lack of reliable information in the form of under-reporting or over-reporting extreme cases of number of child abuse cases has been identified as a serious limitation in accommodation of an effective public health response.6 Different NGOs are performing data collection on various types of abuse with their own definition of the problem. In addition, they are not well-structured to be fully independent to carry out surveys. By developing a proper system, different NGOs in collaboration will be able to gather the data in the same way, hence ensuring that consistency and comparability can be established.7 There is therefore a dire need to build a proper surveillance system for child abuse in Pakistan so as to reduce the problem of under-estimation of such cases and serve as a chief source of gathering data related to child morbidity and mortality. A proper surveillance system would aid in gathering accurate information on all necessary aspects of child maltreatment including the magnitude of the problem, characteristics and trends of child abuse. It will use a uniform definition to increase the sensitivity of the system and will help to identify the hidden cases of child abuse and trigger the way to control and prevent child abuse in our society. Some of the potential problems while implementing a surveillance system for child abuse are contradiction policies within legislation.

The surveillance system will be devised and monitored in close partnership with different NGOs and child right protection agencies, such as Rozan, Konpal, Sahil, SPARC, and Madadgar helpline. The Ministry of Health can introduce a performance based incentive mechanism in order to improve the collection of high quality data and enhance sustainability. A separate team can be made for collecting data at provincial level on child abuse. This can include a representative member from each NGO, a member from each child protection agency, a member from the Ministry of Health, representative counsellor from provincial, district, sub-district and community level, data collectors, translator, field experts (law, criminology, child social welfare, child advocate, child specialist) and a government-employed statistician.

The role of involving the Ministry of Health will not be to contribute directly to the information system. Rather, they will allocate funding and monitor the progress of the system and will collaborate with global agencies. The field expert will be integral for the management of the detected cases. Local NGOs and trained data collectors will participate in the data collection and can provide the referral. Government statistician will ensure that the data are analysed correctly and ready for publication in a timely manner.


Due to cultural variation and inconsistent definition of child abuse, there is a discrepancy between actual and hidden cases of child abuse. There is a dire need for the modification and implementation of current policies on this subject. Building up a surveillance system will halt the tolerability of such issue at a society level and will also raise the awareness, helping to detect the true burden of child abuse. Moreover, the system will assist policymakers for future directions and formulation of preventive strategies.


Disclaimer: None.

Declaration of Conflicting Interests: None.

Sources of Funding: This work was not sponsored by any agency or organization.



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2.Cabinet. National Plan of Action for Children. Pakistan: Ministry of Social Welfare, 2006.

3.Ali N, Ali F, Khuwaja A, Nanji K. Magnitude and Factors Associated With Child Abuse in a Mega City of a Developing Country Pakistan. Iran J Pediatr. 2014; 24:140-6.

4.SPARC. Violence against children. Society for the protection of the right of the child, Faisalabad:2012.

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7.Salman H. Cruel Number: A Compilation of Statistics on Child Sexual Abuse of Reported Cases in Pakistan, Islamabad: Sahil, 2015.




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