Indian Pediatrics 2001; 38: 1163-1170
Physical Abuse of Street and Slum Children of Kolkata
Maltreatment of children is an age-old phenomenon. Over the generations, children from all societies, in the process of normal upbringing, have been neglected, maltreated, abused intentionally or otherwise by their parents(1). However, the awareness in these aspects has recently caused concern among professionals and enlightened citizens, specially in the advanced countries where the problem has been reported to have increased to ten fold in the last decade(2). In the third world countries with poorer societies, continuous socio-economic stress induces the parents to abuse their children(3). In India, references to child labor in earlier times and well regulated tolerance of child abuse by parents have been documented as an integral part of the cultural ethos of family units(1).
Physical abuse of children involves inflicting bodily injuries or forcing them to engage in physically harmful activities(4). In USA, specially, "Ohio Revised Code" indicates that endangering a child includes violating duties of care, support or protection. Physical abuse in Indian situation includes torture, cruel abuse, excessive punishment and restraint that creates substantial risk of physical harm to the child(5,6). Child abuse also poses substantial risk to the childs mental health and development, even causing death(7). This is now a focus of public attention in the society. Cases of suspected abuses are often featured in the news media. Physicians and others in medical community play an important role in identifying possible victims of child abuse. Most researchers and authorities agree on the basic issue of child abuse resulting from parental misuse or exploitation of the rights of parents or of other guardians to control and discipline children under their care, which is detrimental to the childs health and well being(8,9).
Recent Indian studies on physical abuse of children reveal that the problem of child abuse is more prevalent in metropolitan cities and urban sectors than in rural areas of the country. However, incidence and nature of such physical abuse are largely unrecognized and are under-reported in general. A systemic study on child abuse on a larger scale in our country is rather difficult, because in many cases children are constrained to abuse by dire economic distress, and the real situation is kept under wraps both by the accused and the abused for fear of social stigma. In this context, at least a small-scale regional or local study might help to understand the extent and the nature of physical abuse.
This study attempts to investigate the extent and type of physical abuse and its associated factors among the street and slum dwellers of Kolkata metropolitan city.
Subjects and Methods
The study area was selected near the proximity of a commercial and business center of the city. The slum and pavement dwellers near Howrah Bridge are located near the hub of business locality and near to the Howrah Railway Station, where a variety of business enterprises and small-scale industries thrive. The location provides ample opportunities for a variety of manual and skilled or technical jobs. The selected field location is a section of the northern part of Strand Road and a section of slum dwellers near Howrah Bridge on the Eastern bank of Hoogly River. The study was conducted during April 1998 to May 1999. All the families who volunteered and cooperated, were selected. Data on demographic particulars, family and other relevant health information were collected by interviewing the subjects and/or their family members (parents, relatives, etc.), especially in case of children who could not provide such details about their experience or family particulars. Overall 751 children aged 4-15 years were enlisted from 190 families. The age of children was verified from their parents (or relatives). Physical examination was carried for every child by the author in the field spot for indications of injury, etc. Parents and guardians were interviewed for the cause and time of such injuries. All those cases of injuries, which were due to physical abuse during last one month were recorded. The types of physical abuse were recognized by the identification of visible physical markings or changes on the skin and the body due to injury or inflictions.
The data were analyzed by age, working status, family size, income, nature and type of physical abuse. Working status of children was considered in two categories - full time and part time worker. A child who was employed at least for a period of eight hours per day was considered as "full time worker". A child who worked less than eight hours per day was considered as "part time worker"(1). Family size was also classified in two types-small size which consisted of parents and one or two children. Rest of them (three or more children or other relatives) were considered as large family. The family income per capita per month below Rs. 247.53 was considered as below poverty line as per the National Standard(11). As far as place of living status is concerned, about 60% belonged to pave-ment and 40% to slum areas. More than half of the total sample (53.8%) were Hindu and the rest were Muslims.
Working Status and Family Background
There was full cooperation from the subjects and family members. We did not encounter any refusals in this regard. Inter-views with the children and family members revealed the situation or intention(s) or reasons for physical abuse. Some of them were due to impulsive and unintentional behavior on the part of the parents or employers. Some physical abuses were inten-tional, in the sense, that due to reasons of non-obedience to complete the work, mistakes committed by the children in performing the work assigned to them, and stealing or due to undesirable social activities (e.g., drugs, smoking, etc.). A few of them became the victims due to the result of alcohol intake by the parents and also loose temper over stubborn crying child, etc.
Table I shows age wise distribution of children according to their working status. Thirty two per cent of all the children (n = 751) were part time workers, whereas a majority (65.1%) of them worked on full time basis. Age wise classifications indicate that 78.4% of children aged 4-5 years worked as part time jobs whereas almost all the children between 6-10 and 11-15 years worked either part time or full time jobs. The results show sex differences in working status. In the age group 6-10 years, a greater number of girls (68.9%) worked as part time than boys (24.8%). But in case of full time workers, an opposite trend was observed, i.e., 45.1% boys (6-10 years) worked on full time job as against 29.6% girls. But in the age group 11-15 years about an equal percentage of boys and girls worked as full time basis. In the total sample of 751 children, more boys (36.2%) than girls (28.9%) worked on full time jobs.
Table I - Distribution of Children by Age, Sex and Working Status
The details of part time and full time job categories are shown in the Tables II and III. The children were employed in eight types of part time and eleven types of full time jobs. Out of 239 children working on part time basis, 33.9% were employed in domestic houses and 28.9% in tea stalls. The results also show age and sex differences in nature and type of part time work. In the age group 6-10 years, 44.1% girls were employed in domestic houses and in the age group of 4-5 years, 34.3% of boys worked at tea stall. In case of full time workers, 19.7% of girls in the age group 6-10 years and 31.2% girls in 11-15 years of age worked in domestic service and 8.9% of them were employed in leather factory. In the age group 11-15 years, out of 337 children a greater percentage of boys worked in garages (15.7%) and in cloth shops (11.9%), road side restaurant (5.9%), tea stall (4.5%), etc. Age wise distribution of children according to family size, health of the parents, economy and employment criteria revealed that more than half of the children (61.1%) belonged to large families. About 31.3% children belonged to families who had reported frequent illnesses. The results show that about 68.7% of children belonged to families whose monthly income were below Rs. 247.53 or below the poverty line(11), while 25.3% of children belonged to families where parents did not have a regular job or income. And a meager 6% of children had either single or no parents at all, as the parent(s) had abandoned the children with their relatives and left the dwelling places.
Nature and Type of Physical Abuse
A physical examination of the children, consequent enquiry and interview with the parents or relatives revealed physical abuse among 202 (26.9%) of the 751 children of the study. The age-wise distribution of the children as per location of physical injury or infliction on different parts of their body (Table III) and nature and type of injury or infliction (Table V) had been separately investigated. Age wise distribution shows that a majority of physically abused children were between 6-10 (39.6%) and 11-15 (41.6%) years. However, the affected parts of the body were chest (19.2%), face (16.3%), upper extremities (16.3%), abdomen (14.8%) and less frequent affected body parts were head and neck (5.4%), eyes (3.5%) and genitalia (6.0%)
In case of nature and type of injury (Table V), the children showed high frequency of bruises and ecchymosis (23.3%), pain and tenderness (21.4%) and lowest frequency of internal injury (2.5%). Age preponderence was observed for hematoma (25%) and bruises and ecchymosis (20%) in 6-10 years while pain and tenderness (21.4%), burns (17.9%), bruises and ecchymosis (17.9%) and internal injury (3.6%) were observed in the age group of 11-15 years.
Table II - Distribution of Part Time Working Children
According to Nature/Place of Work
Table III - Distribution of Full Time Working Children According to Nature/Place of Work
Table IV - Distribution of Physically Abused Children by Age and As Per Location of Physically Observed Injury in Different Parts of the Body
Table V - Distribution of Physically Abused Children by Age and As Per Type and Nature of Injury or Infliction
The present study shows high frequency of physical abuse among the slum and pavement dwellers but the severity was of mild nature. These abuses were of short term and very few were violent. Enquiry for the details of physical abuse revealed that the abusers used belts, cords or ropes, which was also recognized by the characteristic skin injuries such as bruising, ecchymosis, abrasions, lacerations and hematoma. The most common sites of injury were buttocks or hips as observed in other studies(12,13). In general, bruises change color with time and different colors were detected in different age groups and this was also seen in other studies(14,15). Bleeding into the under lying tissue resulted in hematoma due to injury caused by blunt trauma (fist). The study documentes 2.5% cases of mild internal injury inside the nose and abdomen (liver and spleen) as was also observed by other workers(16,17). In some cases hot metal objects and burnt cigarette butts caused burns in some children but the frequency of such cases were very few. Hobb found fracture due to physical abuse in 5-10% or less(18).
In the present study, fractures were detected in 4.5% children and were limited to upper and lower extremities. The study also shows lower percentage (18.8%) of physical abuse between 4-5 years children but higher and about equal percentages among the age group 6-10 years (39.6%) and 11-15 years (41.6%). The observed percentages are very high in metropolitan city when compared to such other studies from abroad(18). Apart from the physical injury, psychological impact of physical abuse is also a very important dimension and sometimes it can severely impede the psychological develop-ment of the growing child, which might manifest at a later stage as mentioned earlier(19,20). A possible follow up should be continued on a wide canvas.