Abstract
Violence against children (VAC) is a significant international problem and, in Afghanistan, is particularly complex given the country has suffered armed conflict and extreme poverty for more than 30 years. The aim of this study was to examine the level of knowledge and observation of VAC by community leaders, professional groups, and business owners in three Afghan districts. A survey of community and religious leaders; health, socio-legal, and education professionals; and business owners from Kabul, Jalalabad, and Torkham (n = 182) was conducted. Structured interviews included qualitative and quantitative components. Questions related to knowledge and experience of VAC, and to perceptions of consequences, causes, and strategies for preventing VAC. The statistical significance of differences between participant groups and measures of association were assessed by Pearson’s chi-square test, the Mann–Whitney test, and the Kruskall–Wallis one-way ANOVA. Qualitative responses were analyzed thematically. VAC was reported to occur mostly in the home, community, and workplace. The scale of the problem varied, with religious and community leaders underreporting VAC by 30% to 40% compared with other participant groups (p < .001). Business owners also significantly underreported VAC in the workplace, despite admitting to acts of discipline that included physical contact. There were some regional differences, with lower reporting of violence in Jalalabad compared with the two other locations (p < .001). Causes of VAC were consistently attributed to poverty, lack of education, and the effects of war. The findings of this study indicate that VAC is a serious and complex problem in Afghanistan. Decades of armed conflict and entrenched poverty influence how violence is perceived and recognized. Consideration should be given to initiatives that build on the existing strengths within the community while raising awareness and recognition of the nature, extent, and burden of VAC in the community.
Introduction
Violence against children (VAC) is a significant international problem requiring urgent action (Hillis, Mercy, Amobi, & Kress, 2016). In July 2016, as part of Agenda 2030, the World Health Organization (WHO) and Global Partnership to End Violence Against Children launched key interlinked strategies to reduce VAC worldwide (World Health Organization, 2016). Child violence is defined by the United Nations as “all forms of physical or mental violence, injury and abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse” (UNICEF, 2008) and by WHO as “the intentional use of physical force or power, threatened or actual, against a child, by an individual or group, that either results in or has a high likelihood of resulting in actual or potential harm to the child’s health, survival, development or dignity” (Krug, Mercy, Dahlberg, & Zwi, 2002). These definitions are inclusive of child marriage, child labor, corporal punishment, bullying, and physical assault.
Research clearly demonstrates the devastating impact that VAC has on children, families, communities, and nations, and in particular, on children’s well-being and capacity to reach their full potential (Catani et al., 2009; Skardalsmo Bjorgo & Jensen, 2015; Skovdal, Emmott, & Maranto, 2014; Whitsel & Mehran, 2010). Studies have found an association between VAC and poor mental health outcomes (Catani et al., 2009; Jakobsen, Demott, & Heir, 2014; Mghir, Freed, Raskin, & Katon, 1995; Mghir & Raskin, 1999; Panter-Brick, Eggerman, Gonzalez, & Safdar, 2009; Panter-Brick, Goodman, Tol, & Eggerman, 2011), poor child health (Mashal et al., 2008), increased maternal mortality (Amowitz, Reis, & Iacopino, 2002), increased occupational injuries (Graves, Vaqas Ali, & Gunn, 2014), and poor school engagement (Whitsel & Mehran, 2010).
VAC in Afghanistan is particularly complex given the country has suffered armed conflict and extreme poverty for more than 30 years. The proportion of the population living below the poverty line in 2013-2014 was 39%—with rates significantly higher in rural and remote areas (Wieser, Rahimi, & Redaelli, 2017). More than half of Afghanistan’s population are under the age of 18 years and are among the highest population share in the world (Afghanistan Independent Human Rights Commission [AIHRC], 2011). In this context, children are a vulnerable part of the population, and are exposed to the risk of early and forced marriage (Amowitz et al., 2002; Mashal et al., 2008), the worst forms of neglect and exploitation, physical abuse and violence (Catani et al., 2009; Jakobsen et al., 2014; Mghir et al., 1995; Mghir & Raskin, 1999; Panter-Brick et al., 2009; Panter-Brick et al., 2011; Skardalsmo Bjorgo & Jensen, 2015; Skovdal et al., 2014), and removal from formal education to enter into child labor (Catani et al., 2009; Graves et al., 2014; Panter-Brick et al., 2009; Panter-Brick et al., 2011; Whitsel & Mehran, 2010). Estimated figures of the Afghanistan Independent Human Rights Commission in 2015 indicate that approximately 25% of Afghan children aged between 7 and 14 years are working to financially support their families (AIHRC, 2015). While Afghanistan ratified the United Nations Convention on the Rights of the Child (UNCRC) in March 1994, implementation was considered low in the concluding observations from the 2011 Committee on Rights of the Child, 56th Session (UNCRC, 2011). Similarly, Afghanistan is signatory to the organization of Islamic Cooperation’s Covenant of the Rights of the Child in Islam, which has many similarities to the UNCRC. Prevailing conditions in Afghanistan demonstrate the extreme difficulties in implementing and complying with these international agreements.
It is difficult to ascertain the full extent of VAC in Afghanistan. Official reporting for all forms of VAC does not exist, and other data sources are ad hoc (UNICEF, 2012). Existing studies often rely on Afghan refugees who have relocated to recall their experience of childhood (Mghir et al., 1995; Mghir & Raskin, 1999; Skardalsmo Bjorgo & Jensen, 2015). A study by the current authors found 71% of participants aged 12 to 18 years from three regions in Afghanistan reported directly experiencing physical violence predominantly in the home or workplace (O’Leary et al., 2017). Even less is known about effectiveness of interventions to prevent and respond to VAC in the Afghan context. Generalizing international experiences to Afghanistan can be problematic given the unique and complex social environment, particularly the social structures, perceptions, and attitudes of Afghan society to VAC.
Understanding the perspectives and experiences of community leaders and key professions that interact with children and hold positions of influence is critical to our understanding of VAC in Afghanistan and to inform strategies that maximize the impact and efficiency of community interventions. This will greatly enhance the capacity of humanitarian and child welfare advocates to make compelling cases for priority resourcing on rigorously tested VAC programs. The aim of the study was to examine the level of knowledge and observation of VAC by community and religious leaders, professional staff (health, education, and socio-legal), and business owners in three Afghan districts.
Method
Study Design
This was a cross-sectional study.
Study Population and Setting
Three project areas (Kabul, Jalalabad, and Torkham) were identified. These locations were where the Terre des hommes Foundation (Tdh) had been running a Child Rights Consortium project over a 10-year period. Tdh is a child-focused humanitarian aid agency that has a long history of action and commitment to children’s safety and well-being around the world. Research sites were selected because of Tdh’s presence, knowledge, and strong acceptance by the local community.
Kabul, the capital of Afghanistan, is a destination for many displaced people. The presence of foreign organizations and military can make Kabul subject to spasmodic and unpredictable armed conflict. Jalalabad is a big eastern trading city in the province of Nangarhar. The entire province is volatile. Villages often have fighting and disruption of schools and clinics. Some districts are under the control of the Taliban or Daesh. Torkham is considered remote and rural, spread between Afghanistan and Pakistan, and largely defined by the border settings (transit of goods and people, trucks passing, etc.). The main income of the people is from agriculture, livestock, and workshops. The main road leading to Torkham is dangerous with Daesh and Taliban, and other Armed Organizations Groups (AOGs) active there.
Study Participants
The implementation of a survey in regions in which little or no census data are available is challenging, because researchers cannot devise a sampling plan beforehand. As such, participant groups were selected based on focus group consultation with key stakeholders, local social work staff, Tdh partners, and community member representatives who identified key sectors of the community with working knowledge of children in schools or the community, or potentially in contact with services. Participant groups included school principals and teachers, health care workers (doctors and nurses), business owners, juvenile justice staff, and community and religious leaders (Wahkil and shura members). An identification map of the catchment areas was developed to estimate the total eligible study population and planned proportion for sampling. Approximately 5% to 10% sampling was determined across the geographic areas and the identified professional categories for data collection.
Data Collection
Data were collected in 2014 using face-to-face administered surveys. Qualitative and quantitative components related to participants’ direct knowledge or observation of VAC. The items included various forms of physical violence, psychological violence, sexual violence, discrimination, and exploitation, and whether those forms of violence took place at home, school, workplace, community, or other institutions. In addition, participants were asked about their perceptions of the consequences of violence toward children, causes and strategies for preventing violence, knowledge of available support services, and priorities for children affected by violence. Survey interviews were conducted in pairs by two trained local social workers, one male and one female. Male social workers conducted all community and religious leader survey interviews due to cultural sensitivity.
Data Management and Analysis
Data cleaning and analyses were undertaken using the SAS 9.4 software (SAS Institute Inc.). The statistical significance of differences between participant groups and measures of association were assessed by Pearson’s chi-square test for categorical data and the Mann–Whitney test for ordinal data. Fisher’s exact tests were used when the cell sizes were minimal. To enable comparisons between professional and community groups, a violence score was calculated by summing each of the combinations of binary responses for direct experience or observation of the different types of violence. Due to differences in number of items contributing to each of the violence types, weighting was then applied to ensure equal contribution for each type of violence to determine the most common type of violence reported. Formula = (summed score / total number of items) × 10. In addition, a total score for the most commonly reported locations for the violence to occur was calculated by summing each of the binary responses for that location, for all possible violence types. Mean ranked scores were used to compare violence types and locations, and to test group differences, using the Kruskall–Wallis analysis of variance (ANOVA) test. All tests were two-sided with a 5% level of significance. “Other” categories in quantitative questions with free text fields and qualitative questions were thematically grouped for descriptive reporting.
Ethics Approval and Authorizations
The Ministry of Labor, Social Affairs, Martyrs and Disabled, border police chief, and National Directorate of Security provided authorization to conduct the survey in the catchment areas. Authorizations to conduct interviews were additionally obtained from the Ministry of Education, Ministry of Public Health, Director of Juvenile Rehabilitation center, community leaders, hospital management, the Supreme Court, and Attorney General Office. Tdh at a national level in Afghanistan approved the research, and final organizational ethical approval was given by Tdh Headquarters in Lausanne Switzerland in March 2014. Verbal consent was obtained from all participants. De-identified data were analyzed and submitted for publication under ethical exemption by the Human Research Ethics Committee of Griffith University.
Results
In total, 182 participant interviews were conducted with community and religious leaders, teachers, health workers, business owners, and juvenile justice workers. The number of people in each professional or community group ranged from 23 to 52 with 14.3% female (education and health staff only) as shown in Table 1. Participants were interviewed from all three geographic areas, in all chosen professional or community groups, with the exception of juvenile justice workers who were from Jalalabad Rehabilitation center only.
Reported Knowledge or Observation of Types of Violence Against Children, by Different Professions and Community Members.
Note. ns = not significant.
Chi-squared or Fishers exact test.
*p < .05. **p < .001. ***p < .0001.
Location and Type of Violence Reported by Leaders, Industry, and Professional Groups
Direct knowledge or observations of physical and psychological VAC were most commonly reported by all groups (Figure 1a), particularly in the home, community, and workplace. Bullying and other forms of psychological violence were more commonly reported to take place in the community and at home, whereas sexual violence and exploitation were predominantly reported to occur in the workplace and community (Table 1).
Median scores of types of VAC reported (a) by community, professional, and industry groups and (b) by geographic region, including Jalalabad juvenile justice staff.
Religious and community leaders reported significantly less direct knowledge or observation of almost all forms of VAC, compared with the other professional and community groups (p < .0001; Table 1). The greatest difference in reporting by religious and community leaders was less knowledge or observation of VAC in the workplace, with a number of items being reported 30% to 40% less than the other groups. Teachers were found to report significantly less VAC in the school context, and similarly, business owners report significantly less VAC in the workplace (p < .001). Juvenile justice staff and health workers reported the greatest knowledge or observation of VAC in the community.
Of the 46 business owners interviewed who employ children, 63.0% reported taking discipline measures with children in the workplace if they failed to perform according to expectations or instructions. For the 29 respondents who reported using discipline measures, the most common form was to hit, slap, or pinch the child (55.2%), followed by yelling, shouting, and threatening the child (20.7%). There was a significant difference across the three geographic areas with business owners in Torkham reporting the highest use of discipline measures (86.7%) versus 16.7% of business owners in Kabul (p = .0003).
Experience of VAC by Geographic Region
With the exception of sexual violence and physical violence in institutions, where cell sizes were small, all groups from the community or professions from Jalalabad consistently reported lower VAC than respondents from Kabul or Torkham (p < .0001; Figure 1b). This lower reporting from Jalalabad was consistent for physical and psychological types of violence, and the locations in which the violence was reported to occur. In contrast, the level of knowledge or observation of VAC reported by Jalalabad juvenile justice staff was significantly higher than that reported by all other community and professional groups in Jalalabad (p < .001).
Perception of Main Causes and Effects of VAC
Perceived causes of VAC were most commonly attributed to poverty (78.0%), lack of education and illiteracy for the population (64.4%), and general insecurity from the effects of war (36.2%; Figure 2a). The most common theme from the qualitative responses indicated lack of job opportunities in the community, and a lack of awareness or respect for children’s rights was also a key issue.
(a) Main causes of VAC and (b) main effects of VAC, reported by all professional, industry, and community groups.
All community and professional groups reported the perceived main effects of VAC in Afghanistan were school dropout (65.8%) and smoking, alcohol, and drug abuse (62.4%; Figure 2b). However, community and religious leaders were significantly less likely than all other groups to perceive depression, anxiety, emotional disorders, or social stigma as childhood consequences of violence (p < .001).
Responding to VAC
All participant groups reported having a part to play in intervening and preventing VAC. Primary themes from the qualitative responses (not presented) included providing guidance, advice, or counsel and raising awareness of child rights. A range of strategies across the government, nongovernment, and community sectors was identified by respondents as attempting to address the main causes of VAC. Examples included the work of international nongovernmental organizations (INGOs), community agencies, and the media in raising awareness of children’s rights; the establishment of educational facilities by Government and the prohibiting of violence in schools; the establishment of hospitals for addiction; and the establishment of programs to address poverty. The role of Community and Religious Leaders in solving problems was also highlighted by respondents from all disciplines. Identified barriers to change included the longstanding effects of war, problems implementing laws, corruption, inefficiency by Government authorities, and broad-reaching social issues such as poverty. For all business owner respondents, facilitating access to education was the main action suggested to increase protection of children in the workplace (81.4%), followed by reducing working hours (30.2%) and meeting basic needs of food and water requirements (25.6%). Feedback from teachers suggested that some positive reforms were occurring in the school system to reduce violence against students, including education department mandates, which specifically prohibit the beating of children in schools. Qualitative responses indicated that unless steps were taken to reduce poverty and general insecurity in the community, children would remain unable to attend school as they were required to support their family.
Discussion
This is one of the first studies to examine key community, industry, and professional stakeholder’s knowledge or observation of VAC in Afghanistan. This is particularly significant in light of the complex social and political environment within this region. The findings highlight both the seriousness and complexity of VAC in these areas, and provide vital information to guide the development of programs and community responses to this issue.
High levels of violence were reported to occur at home, in the workplace, and in the community. These findings are consistent with research generally on VAC; however, some specific Afghan studies have reported higher levels of VAC in workplaces and schools (Skardalsmo Bjorgo & Jensen, 2015). Participants did vary in their reporting of experience of VAC, often underreporting in their own professional domain. For example, when compared with other groups, teachers reported lower levels of violence in schools, and business owners reported lower levels of VAC in the workplace.
The complexity of commercial, family, and civil duties may create propensity for participants to minimize VAC in their own professional domain. For example, workplaces are often intermingled with family and home life for children. In this environment, business owners do not view child labor or their acts of discipline (which include physical acts such as hitting, slapping, and pinching) as a form of VAC. This is especially true when they are relatives of the child in their employment. This finding is consistent with previous research that reported that adults and children saw physical punishment as a necessary action at home, school, and work to address failures and maintain discipline (Skardalsmo Bjorgo & Jensen, 2015; Skovdal et al., 2014).
Interestingly, religious and community leaders’ underreported direct knowledge or observation of VAC by 30% to 40% compared with other participants. One possible explanation for this finding is that religious leaders may have a more sanitized experience of children and families who may not behave or talk in such a way that indicates the occurrence of VAC. It might also be their view that some acts of violence are part of “normal” parental discipline. Raj, Gomez, and Silverman (2014) report similar findings regarding religious leaders’ perspectives on child marriage and a tendency to minimize the effect of VAC. In 2011, the United Nations Committee on the Rights of the Child raised concerns that the application of customary or sharia law infringed the principles and rights contained in the ratified Rights of the Child Convention (UNCRC, 2011).
The main causes of VAC attributed by participants were poverty, lack of education, and the effects of war. This is consistent with previous studies on child labor, which have attributed the cause of VAC to an interplay of poverty, poor educational and job opportunities, and the complexity of Afghan society (Catani et al., 2009; Panter-Brick et al., 2009; Panter-Brick et al., 2011). Thus, the etiology is likely to be multivariable.
Overall, participants from Jalalabad reported lower knowledge of VAC than participants from the other geographic regions. This may mean that people living in Jalalabad have different perceptions of what VAC is, and this most likely needs to be interpreted in the context that the region is often exposed to more frequent incidents of armed conflict. However, contrasting reports were evident within the region with the Juvenile justice staff reporting much higher VAC than all other Jalalabad participants, in all contexts except institutions. Juvenile justice staff also appeared to have a more in-depth understanding of VAC, reporting more causes and describing interrelationships in their qualitative responses.
Participants had some important insights into their potential roles in stopping violence and supporting affected children. Most importantly, all participant groups recognized that they had a role to play in both the prevention and intervention of VAC. For example, teachers saw their role as changing attitudes toward VAC and creating a safe environment for children. Religious and community leaders also articulated that they had a role in changing community attitudes and behavior through education. The importance of raising awareness among the community, and the integral role of religious leaders and religious interpretation in fostering awareness, has been highlighted in existing research (Raj et al., 2014; Skovdal et al., 2014). Religious sensitivities can be addressed through dialogical partnerships with religious leaders, INGOs, and government (Hutchinson, O’Leary, Squire, & Hope, 2015). While efforts to engage community and religious leaders in reducing violence in the community are essential, the fact that these groups simultaneously underreport violence within the community means that intervention efforts will need to incorporate education programs that raise awareness and recognition of the nature and extent of VAC in the community.
This study was done in a complex environment, conducting interviews with members of the community living in urban, rural, and remote communities in Afghanistan, often in highly volatile regions with unstable security, and with some districts under the control of the Taliban or Daesh. Collecting primary data in this context on sensitive issues around VAC is particularly challenging; however, significant attempts were made to obtain data from a diverse and representative range of participant sources using robust research methods. However, this study is not without limitations, some of which stem from the difficulties conducting sensitive research in a conflict-affected country such as Afghanistan. Sample sizes were small and further reduced when stratified by participant groups and geographic location, which may have underpowered detecting differences for some factors. Most participants were male due, in part, to the ethical challenges of contacting women in larger numbers in the Afghan context. Further insight from Afghan women would provide a valuable perspective on VAC in this area. The results are specific to three districts, and while some cautious inferences can be made to Afghanistan as a whole, to be confident, these would need to be verified by future research.
Conclusion
The findings of this study indicate that VAC is a serious and complex problem in Afghanistan. Decades of armed conflict and entrenched poverty influence how violence is perceived and recognized. While the reporting of VAC varied across professions and geographic regions, overall, reported VAC was still substantial. All participant groups expressed a desire to be part of the solution, and this provides a positive area of focus for policy and programming. Consideration should be given to initiatives that build on the existing strengths within the community while raising awareness and recognition of the nature, extent, and burden of VAC in the community. To achieve this community partnership, participation and collaboration are essential for sustainable change to eliminate VAC.
Footnotes
Acknowledgements
This research is a collaborative effort between Terre des hommes (Tdh) and Griffith University. In addition to the authors, numerous others contributed to the formulation and implementation of this research, including Tdh staff in Kabul and Nangarhar, and staff of partner organizations: the Afghan Education Production Organization (AEPO), Afghan Women’s Educational center (AWEC), and the New Society Reconstruction and Development Organization (NSRDO).
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Terre des hommes (Tdh) supported this research with funding from the European Union, in the scope of its “Investing in People” project.