Challenges in Supporting Survivors of Child Sexual Abuse in Kenya: A Qualitative Study of Government and Non-governmental Organizations

Abstract

Child sexual abuse (CSA) is a global, social, and health challenge. Existing literature on post-sexual assault care has focused largely on health providers’ skills and capacity to offer quality clinical, medicolegal, and psychosocial care. Services other than medical and psychosocial care provided to survivors of CSA remain poorly studied, particularly in the global south. The study aimed to explore challenges facing service providers supporting children who have experienced sexual abuse and make suitable recommendations. We triangulated different qualitative methods: in-depth interviews with 61 key informants, three focus group discussions with community leaders, and unstructured observations for data collection. Findings indicate that service providers supporting children who had experienced sexual abuse play a vital role in ensuring that survivors receive clinical and medicolegal care, psychosocial support, have access to justice, and are protected from further victimization. However, these service providers face several challenges, including poor infrastructure, the lack of effective coordination and linkage among the service providers in the continuum of care, corruption among officials, and harmful patriarchal norms that hinder reporting of abuse. To effectively support and care for survivors, we recommend government commitment to, and investments in, safe spaces, supervision, and professional development of providers. Working with community leaders and gatekeepers of all genders is critical to address harmful practices that perpetuate CSA and make it difficult to care for and obtain justice for CSA survivors.

Keywords

child sexual abuse guidelines sexual assault care

Introduction

Child sexual abuse (CSA) is a major global health challenge. The World Health Organization (WHO) defines CSA as the involvement of a child (defined as a person below the age of 18) in sexual activity that he or she does not fully comprehend, is not developmentally prepared for, and as such cannot consent to it (WHO, 1999). The definition of CSA in this study excludes non-physical sexual harassment.

The global prevalence of CSA is estimated at 18% to 20% for girls and 8% for boys (Pedera, Guilera, Forns, & Gomez-Benito, 2009; Stoltenborgh, van, Ijzendoorn, Euser, & Bakermans-Kranenburg, 2011). The prevalence of CSA in sub-Saharan Africa (SSA) is relatively high (Pedera et al., 2009; Stoltenborgh et al., 2011). In a 2010 national survey on Violence Against Children in Kenya, 23% of the girls and 12% of the boys aged between 13 and 17 reported to have experienced some form of sexual abuse (unwanted sexual touching, unwanted attempted, pressured, or physically forced sex; Mwangi et al., 2015). Among respondents aged 18 to 24 years, 32% of women and 18% of men reported that some form of CSA had occurred before age 18 (Mwangi et al., 2015).

Physical and psychological consequences of CSA include traumatic injury, unwanted pregnancies, complications in pregnancy, unsafe abortions where abortion is criminalized, vaginal fistulas, sexually transmitted infections (Reza et al., 2009), clinical depression, post-traumatic stress disorder, conduct disorders, alcohol and illicit drug use, and suicide attempts (Danielson et al., 2010; Dube et al., 2005).

Research on post-sexual assault care in SSA is biased toward clinical and medicolegal care. Medicolegal care is care that requires medical expertise to address legal problems (Wangamati, Gele, & Sundby, 2020). Studies show that survivors are subjected to delays when seeking care, provided with substandard care, and receive inadequate to no psychosocial support (Christofides et al., 2005; Ellis, Ahmad, & Molyneux, 2005; Kim et al., 2009; Kim, Martin, & Denny, 2003). In addition, services are fragmented, thereby subjecting survivors to multiple interactions with health providers, which may delay access to health care services or discourage adherence to treatment (Christofides et al., 2005; Ellis et al., 2005; Kim et al., 2009; Wangamati, Combs Thorsen, Gele, & Sundby, 2016).

Given the impact of CSA on the health of survivors and the dearth of research on this topic in Kenya, we conducted the study to explore the challenges that service providers face in supporting CSA survivors. Below we detail the nature of services available for CSA survivors.

Kenyan Context

Kenya has established laws and policies to protect children from sexual abuse and safeguard the rights of CSA survivors. The laws stipulate harsh penalties for CSA perpetrators and provide for free clinical, medicolegal, and psychosocial support (Children Act, 2001; The Sexual Offences Act, 2006). They also provide for establishment of child-friendly facilities and services to meet the needs of CSA survivors as well as prevent further victimization of children as they interact with the child protection system (Children Act, 2001; The Sexual Offences Act, 2006). The protection system comprises the children’s department, law enforcement, legal, and health systems.

A situational analysis conducted in 2003 on perceptions of service providers regarding post-sexual assault care in Kenya found that there were inadequate services and a lack of policies (Kilonzo et al., 2008). The analysis’ findings led to the development of the national guidelines on management of sexual violence in Kenya (Kilonzo et al., 2008; Kilonzo et al., 2009). The guidelines make recommendations for provision of clinical, medicolegal, and psychosocial support. Despite the availability of the guidelines, subsequent studies found that psychosocial support is poorly administered to both adult and child survivors of sexual abuse (Kilonzo et al., 2008; Wangamati et al., 2016; Wangamati et al., 2020). In addition, forensic specimen collection for both adult and child survivors is hampered by a lack of commercial specimen kits and poorly trained health providers (Kilonzo et al., 2009; Wangamati et al., 2016; Wangamati et al., 2020).

A study of challenges experienced by service providers in delivering medicolegal services to survivors of sexual violence in Kenya reported a lack of uniformity in providers’ definitions of sexual violence, flawed evidence collection, and a shortage of doctors that compromised the evidence chain and the ability of the criminal justice system to respond effectively (Ajema, Mukoma, Kilonzo, Bwire, & Otwombe, 2011). Another study, which reviewed 321 medical charts of survivors in a sexual assault center in Kenya, found that the majority of the patients were girls below the age of 16 (Ranney et al., 2010). The study indicated that only 43% of sexual assaults were reported to the police and, by the end of the chart review, none of the cases had proceeded to prosecution. Reasons for nonreporting of the other sexual assaults (57%) and lack of prosecutions are not provided. A 2014 Kenyan judiciary report on court case delays reported that the judiciary had a high number of pending cases in courts, leading to poor service delivery that reduced the public’s confidence in the system (Judiciary, 2014). Due to corruption, delays, and poor services in the legal and health system, and costly travel expenses to points of service, survivors of gender-based violence (GBV), children included, may prefer to seek remedy from traditional courts instead of the criminal formal justice systems because of accessibility, affordability of services, and compensation offered to survivors of sexual abuse.

It is not uncommon in Kenya for CSA survivors’ families to settle CSA cases using traditional courts (Ajema et al., 2011; Wangamati et al., 2016). Traditional courts were used by the Kenyan inhabitants to resolve conflicts before colonialism. The British colonialists introduced the current criminal justice system which is superior to the traditional courts (rulings made in the formal justice system, which borrow heavily from the British common law, override those made in the traditional courts); traditional courts are recognized by the Kenyan law and are allowed to preside over petty crime and civil matters. The traditional courts are usually situated in rural areas and apply customary law to different matters presented to them. Normally, they are presided over by local chiefs and village elders. The traditional courts are forbidden from resolving sexual violence cases as perpetrators are normally ordered to pay petty fines and as such not held accountable for their actions (no punishment or jail term), making sexual violence pervasive. However, their criminalization denies survivors, who prefer the use of traditional courts, access to clinical, medicolegal, and psychosocial care and justice.

Little is known about the challenges that service providers (excluding health providers) tasked with supporting survivors of CSA face and the context that they work within. The service providers include children’s officers, police officers, prosecutors, magistrates, executive officers, court clerks, probation officers, a GBV consultant, and community leaders. Such knowledge would be useful for enhancing the quality and continuity of care for survivors of CSA in Kenya and informing the development of multisectoral guidelines on management of sexual abuse. Based on a study in Homa Bay County, Western Kenya, this article explores challenges in supporting children who have experienced sexual abuse and makes recommendations for improvements. To achieve the stated aim, we explored the following issues by conducting in-depth interviews with key informants and focus group discussions (FGDs) with community leaders: (a) personal challenges related to supporting survivors of CSA, (b) organizational challenges related to supporting CSA survivors, and (c) CSA survivors’ and their families’ challenges with the service delivery system.

Method

Research Design

The study employed qualitative and ethnographic methodology to gather in-depth insight into people’s views and actions through interviews and detailed observations (Reeves, Kuper, & Hodges, 2008). We triangulated different data collection methods, that is, in-depth interviews with key informants, focus groups with community leaders, and unstructured observation of different institutions tasked with responding to reports of CSA.

Study Settings

The study was conducted from February 2016 to January 2017 in three subcounties within Homa Bay County in Western Kenya, namely, Homa Bay Town, Ndhiwa, and Mbita. The total population of Homa Bay Town, Ndhiwa, and Mbita in 2009 was estimated to be about 375,609, of which 48% were 0- to 14-year-olds (Kenya National Bureau of Statistics and Society for International Development, 2013). The poverty rate for the County is estimated at 44.1% (Otieno, 2014).

Sample

The study sample comprises key informants and community leaders. Government employees included children’s officers, police officers, prosecutors, magistrates, executive officers, court clerks, probation officers, and a GBV consultant. The non-governmental organization (NGO) staff were project officers and a manager.

Key informants in-depth interviews

Out of 65 key informants, 61 who were drawn from the three subcounties agreed to participate in the study.

Table 1 shows key informants by designation.

Table 1.

Key Informants by Designation.

Employer	Department	Designation	Study Site
			Homa Bay		Ndhiwa		Mbita		Total
			Male	Female	Male	Female	Male	Female	Total
Government	Legal	Judicial officers		1	1	1	2		5
		Executive officers (human resource)	1		1				2
		Court clerks	2	2	2	1	4	2	13
		Prosecutors	1	2		1	2		6
		Police officers	3	3	3		4	1	14
	Social	Probation officers	2			1	1	1	5
		Children’s officers	2		1		1	1	5
		Gender-based violence consultant		1					1
NGO	Social	NGO workers	3	1	1	1	3	1	10
Total									61

Note. NGO = non-governmental organization.

In Kenya, children officers are responsible for documenting abuse, referrals to points of service, and securing safe spaces for children in need of protection. Police officers are tasked with recording CSA incidents, collecting evidence, making arrests, and filing a case against the perpetrator. The prosecutors present facts of the case to the magistrates and protect witnesses. The magistrates listen to both parties and make judgments as stipulated within the law. If offenders are minors, the probation officers are tasked by the court to provide background information of both parties. The executive officers assist magistrates in supervising the junior court staff. The court clerks are in charge of filing cases and translating for witnesses and the magistrates. The County GBV consultant is responsible for mentoring and empowering young children through informal skills training. Non-governmental workers mainly assist survivors to access the health and legal services. Of the seven NGOs involved in our study, four were child protection agencies and three worked with young people and facilitated education on sexual and reproductive health.

Focus groups with community leaders

Community leaders were recruited because the children officers informed the research team (first author and research assistant) that they worked together with community leaders who assisted them in implementing their activities. They include chiefs, assistant chiefs, village elders, community health workers, paralegals, and beach workers’ and motorbike riders’ leaders. Twenty-five respondents participated in the FGDs in the following locations: Homa Bay Town (n = 8, three women and five men—FGD 1), Mbita (n = 9, two women and seven men—FGD 2), and Ndhiwa (n = 10, five women and five men—FGD 3). Their ages ranged from 28 to 67 years.

The chiefs, assistant chiefs, and village elders are in charge of maintaining law and order in their administrative units. In addition, they create awareness on CSA, its consequences, and the need for medical and legal services after abuse and refer survivors to points of service. Community health workers sensitize community members on the consequences of CSA and the importance of seeking care and make referrals. Paralegals are community members trained by the children officers to identify sexual abuse survivors and assist them in accessing health and legal services. The beach workers’ and motorbike riders’ leaders are responsible for informing their members on CSA, its consequences, and stipulated penalties. All the discussants resided in the same location and interacted frequently with each other in local meetings.

Sampling Strategy

We used purposive and snowball sampling to recruit the key informants and discussants, respectively. Key informants were approached by the first author at their workstations and requested to participate in the study. Participants were chosen because they were responsible for either helping CSA survivors in accessing and receiving health care and legal services or supporting their quest for justice. For the FGDs, we asked the children officers to introduce the research team to the community leaders, so that we could inform them about the study and request their participation.

Data Collection

We used several data collection methods: in-depth interviews, FGDs, and unstructured observations. In-depth interviews are a conversational partnership in which the interviewer and the participant work toward a shared goal of understanding (Rubin & Rubin, 1995). The interviews, held in private rooms chosen by participants between April and November 2016, were conducted by the first author. The interviews, which lasted for an average of 30 min, were conducted in English although key informants had the option of having the interview either in Swahili or English (official Kenyan languages). Sixty of the 61 interviews were audio recorded and transcribed verbatim by the research team. One participant was uncomfortable with the recorder and therefore notes were taken during that interview. After a few days, 10 to 20 min informal discussions were held with key informants for member checking.

FGDs are sessions organized on a particular topic facilitated by a moderator (Bloor, Frankland, Thomas, & Robson, 2001). We held FGDs in hired halls within the subcounties under study between August and November 2016 and took 60 to 80 min. The first author (fluent in English and Swahili) and a research assistant (fluent in English, Dholuo, and Swahili) conducted the discussions in English, Swahili, and Dholuo. The first author moderated the session while the research assistant operated the audio recorder and translated questions and responses. The discussions were conducted in English, Swahili, and Dholuo and took 60 to 80 min. A team of two persons conducted the FGDs. The FGDs were transcribed verbatim by a skilled transcriber fluent in English, Dholuo, and Swahili.

We used semi-structured interview guides to conduct both the in-depth interviews and the FGDs. In the development of the themes, we started out by stating the research question, and then developed key concepts that we wanted to explore further, for example, challenges related to survivors, personal, and organizational challenges. The main themes (key concepts) explored in both the interviews and FGDs were the different challenges experienced by service providers with regard to protection of children against sexual abuse. For both the interviews and FGDs, we started with general questions, such as “What are the challenges you experience as you support survivors of CSA?” We probed answers, delving into issues that were raised. For example, if someone said many cases were not being reported, we would ask him or her to state the reasons for nonreporting.

Observations are important for understanding people’s roles, actions, and their behavior and how they change in response to situations and over a period of time, as well as the contexts in which actions take place (Walsh, Ewing, & Griffiths, 2011). We carried out unstructured observation between March 2016 and January 2017. Field notes (based on observations) were written at the end of each day and the notes were shared among the researchers for verification and also to fill in gaps. During observation, we sought to find out if the facilities in all the three subcounties, that is, the courts and police stations, were child-friendly. We also observed court processes.

Our data collection and analysis stopped when we achieved saturation. In our study, saturation was defined as the point at which no new codes or concepts emerged from our participants and the collected data (Drisko, 1997).

Data Management and Analysis

During the study design, the authors agreed on inductive and deductive thematic data analysis. Thematic analysis is defined as a process of identifying, analyzing, and reporting patterns within the data during analysis (Braun & Clarke, 2006).

From review of existing literature, authors discussed possible codes and listed them a priori, for example, delays at health facilities. The first author went through audio recordings and field notes to ensure that research questions had been answered and came up with follow-up questions for issues that had been underexplored. Field notes were typed at the end of the day and stored in a word file. The key informant interviews were transcribed verbatim by the research team (first author and the research assistant) and the FGDs were transcribed verbatim by a skilled transcriber. Thereafter, the research team went through all the transcripts while checking them against the original audio to ensure accuracy (Braun & Clarke, 2006).

The iterative inductive thematic analysis process entailed familiarization with the data, generation of initial codes, search for, review of, defining, and naming of the themes (Braun & Clarke, 2006). After data collection, the first author read and reread all the transcripts and field notes from observations several times to familiarize herself with the data and understand it to derive meaning (Malterud, 1993). Two of the authors randomly selected a few key informant and focus group transcripts, coded them by identifying emerging themes for purposes of categorizing respondents’ accounts, and then together developed a list that was used to code the rest of the data using QSR NVIVO Version 10 software. In addition, predefined codes were applied to the collected data by selecting text that supported them; those that were unsupported were deleted. The research team then discussed the coded material extensively and agreed on subthemes and themes. An example of a theme is moral challenges supported by accounts of demands for bribes from some health providers. Inductive and deductive analysis ensured rigor as the authors looked for data that supported the predefined codes while allowing other codes to emerge directly from the data (Fereday & Muir-Cochrane, 2006).

Ethical Considerations

The study adhered to WHO ethical and safety recommendations for researching sexual violence (WHO, 2007). Research approval was obtained from the Norwegian Centre for Research Data and the Maseno University Ethics Review Committee in Kenya. We sought informed oral and written consent from the participants. For observations, we sought consent from heads of the institutions that we visited and participants whom we directly interacted with. During FGDs, discussants were advised not to share confidential information.

Results

The study produced an in-depth understanding of challenges experienced by the service providers. The challenges raised involved the following: reporting of CSA incidents, poor infrastructure, poor service, and corruption.

Challenges in Reporting of CSA

Disparities between the ideal and actual reporting system

From interviews with all the policemen and the five children officers, we were able to conceptualize an ideal reporting system.

Ideal system

Ideal reporting starts with a report of CSA to the police station where the incident is filed and then the child is referred to the health facility for medicolegal care or vice versa. Afterward, the police, in consultation with the prosecutor, file the case in a law court for prosecution. Two key informants elaborated,

If a case of defilement has been reported to parents, they are supposed to report to the police before the lapse of 72 hours. . . . The police investigate, consult with the prosecutor and go to court with enough evidence to prosecute a person. (R20: Police officer Ndhiwa)

. . . They (incidents of CSA) are supposed to be reported within 72 hours to the police station so the child is supposed to be taken to hospital for examination and filling of the P3 forms. . . . and then the matter is taken to court. (R38: Children’s officer, Mbita)

In cases where the child needs protection, the police, through the children’s office, apply for a protection order which is issued by a judicial officer to place the child in custody. If the perpetrator is a child offender, the judicial officers involve probation officers in deciding the case and placement of the child if found guilty.

Actual practice

As gathered from all the FGDs and interviews with all the children officers and some police officers, few individuals reported incidents immediately to the police or health facility. Instead, most people reported the abuse to community leaders who are the closest administrative structure. A community leader explained,

They normally report to us then I tell the parent of the child to report to the health facility then to the police and the children department. (P8: Paralegal, FGD 1)

In some cases, these leaders would then refer them to the children’s office, the police, or the hospital as indicted in Figure 1. Figure 1 provides a summary of services offered to minors who have experienced sexual abuse as they move through different institutions. The dashed black arrows present the ideal procedure to follow when reporting CSA. The thick black arrows present the other routes (common practice) used to report CSA.

Figure 1.

Movement of sexual abuse survivors within different institutions.

In all the FGDs, discussants emphasized that many reports made to chiefs and assistant chiefs delayed care seeking. They explained that if one goes to report CSA to the chief’s office and finds it locked, he or she might opt to go home and return the next day. Discussants, and the GBV consultant, divulged that such experiences increased the likelihood of the case being settled informally through traditional systems. A discussant stated,

The challenge is sometimes people find it easier to report cases to us. But sometimes I am away attending meetings or barazas, so it may take time before they get help. . . . Some may just decide to go to Kangaroo (traditional) courts. . . . (P4: Community health worker, FGD 2)

NGO workers (n = 4) complained that despite having no legal authority, community members reported the CSA incidents to them in an attempt to seek legal counsel and money to cover transportation costs. An NGO worker said,

Almost on daily basis we receive these cases. . . . We have realized that most of the communities, because of our advocacy programs. . . . most people prefer reporting to us cases and they think reporting to us is enough. . . . (R5: NGO worker, Homa Bay)

Lack of and late reporting

Forty-eight of the key informants reported receiving at least one report of CSA in a week. However, this was only the tip of the iceberg as some key informants (n = 20) and discussants in all the FGDs divulged that most of the CSA cases were not reported. A child officer explained,

Now, we only deal with cases [CSA] that are reported. Sometimes, what is happening down there is just too much. But now we don’t get the reports, they are covered [settled through informal justice systems]. (R7: Children’s Officer, Homa Bay)

The lack of reporting mainly occurred in cases of incest as reported by the police officers, children officers, court clerks (n = 17), and discussants in all the three FGDs. As gathered from the FGDs, the community viewed reporting of relatives to the police as deviating from social norms and as a matter that attracted bad luck and led to misfortune. Thus, such cases are supposed to be handled within the clan. The lack of reporting is explained in the excerpt below:

There are those who say if my son impregnates or has sex with a minor and we come from the same clan. . . . People say that if he is jailed or dies in the jail, then the girl will not have a bright future as she is likely not to get married. (P8: Assistant chief, FGD 2)

According to discussants in all the three FGDs, marriage in the community under study gives status to both the girl and her family. Some parents would not report the case to authorities to protect their children from shame. A discussant explained,

The reason why some cases go unreported is that there are people who see that if they report the issue. . . . the child will get shame, it can keep men away from marrying her. . . . so the parent will try to cover up the case. (P4: Community health worker, FGD 3)

From informal discussions with all the children officers, we established that some of the young mothers whom we observed seeking the children’s department intervention for child support from the fathers of their children would be considered as having been sexually abused. This is because they bore children while below the age of 18 with partners who were much older. However, such incidents may have not been reported as child marriages were common.

According to some police officers in all the three subcounties (n = 3), a child officer, and an NGO worker, most of the registered cases were reported late, as stated below:

. . . A case [child rape] is not reported at the time it was supposed to be reported . . . it is discovered when the girl goes back to school. . . . You see at that moment . . . you will not get it [evidence] automatically and at the same time you cannot tell the victim to wait until she gives birth so that a DNA test can be carried out. (R41: Police officer, Mbita)

Police officers complained that late reporting of cases affected collection of forensic evidence, which, if collected in good time, could strengthen the prosecution’s case.

Uncooperative witnesses

All the police officers, prosecutors, and magistrates explained that when perpetrators of CSA are arraigned in court, they are supposed to take a plea. Those who entered a plea of not guilty were naturally eligible for bond terms. On meeting the bond terms, they would be freed. According to half of the key informants (n = 32) and discussants in all FGDs, in most cases when the accused person had been given bail, the accused would offer money or an animal as compensation to the caregivers of the survivors to persuade them to withdraw the case. Key informants (n = 23) and discussants in all the FGDs stated that it was common for families to agree on compensation and send the survivors to stay with relatives in nearby villages or towns (to prevent them from testifying because the Kenyan law does not allow for withdrawal of such cases). An NGO worker explained about disappearance of survivors in the following excerpt:

. . . most of the time, the perpetrator and the victim and their families are back to the community together . . . families are compromised, maybe they receive some money and then they (survivors) just disappear. . . . (R4: NGO worker, Homa Bay and Ndhiwa)

According to key informants from all the subcounties (n = 10) and discussants in all the three FGDs, some of the survivors were threatened by perpetrators and thus ended up not testifying in court or changing their testimony. A police officer explained,

We’ve seen instances where the witnesses are coerced [threatened] by the accused person and they end up not cooperating in court or when they come to court they shift their testimony. . . . probably due to fear. (R56: Police officer, Homa Bay)

Due to poverty, some underage girls engaged in transactional sexual relations with men (above the age of 18). As gathered from key informants (n = 7) and discussants in all the FGDs, some girls hoped to escape poverty and gain social status through marriage. Discussants explained that when parents found out about the marriages, they would report the men to the police. The girls are the prosecution’s first witness but, discussants explained, these girls often refuse to testify in court and run away or change previously recorded statements, when they realize that their male partner or husband could be imprisoned. This frustrated the children officers, police officers, prosecutors, and magistrates, who explained that despite the fact that the perpetrators were guilty of sexually abusing the girls, they could not be charged in the absence of statements from the complainants (girls).

Infrastructure Challenges

Gender desks

Despite the requirement for police stations in Kenya to have a department referred to as a gender desk that specifically deals with GBV, Homa Bay County police stations lacked gender desks. We observed that there were no gender desks in all the three police stations that we visited. The lack of gender desks interfered with the reporting process of CSA as the environment did not encourage disclosure. A paralegal stated,

There should be a desk for these cases to be reported. When you go to the police station in Homa Bay and ask for a GBV office, the office is not there. . . . Children are interviewed in the crime office and the child will not feel free to give information. (P4: Paralegal, FGD1)

Temporary shelters

All the children officers explained that sometimes they require temporary accommodation for placement of children in need of protection. Key informants (n = 32) and discussants in all the FGDs expressed the need for a rescue center in the County to accommodate survivors in need of protection. A child officer said,

. . . lack of a rescue center [shelter]. . . . I depend on privately owned charitable children institutions. . . . Suppose they are full, do you allow the child to return to the same home where she was abused? Maybe she was abused by the father. . . . He will be arrested, taken to court, then given bond. . . . and go back home. . . . (R7: Children’s officer, Homa Bay)

As gathered from informal conversations with all the children’s officers, the nearby rescue center was at least an hour away by car situated in a different County and children could only be allowed in if an order was given by the court through a request from the children’s department. They further explained that, if a case is reported outside working hours, and the child is in need of protection, the child had to spend the night in police cells. While visiting police stations, we observed that two of the three police stations (i.e., in two of the three subcounties) did not have children’s cells and the one with a cell had an empty room with no mattress and blankets.

Children courts

These are courts of law mandated by the Kenyan government to solely handle matters affecting children (child custody, child maltreatment, and offenses committed by children). There were no children courts in Homa Bay County as gathered from our observations. We observed several cases being conducted in adult courts. When the time came for hearings, the magistrate would clear the court so that anyone who is not party to the case leaves the room. Some magistrates opted to hear the cases in their private chambers. Three out of five magistrates complained about the lack of a children’s court. One magistrate said,

We need courts where a child can be comfortable. The court that we have is not able to do that. Sometimes it’s quite difficult; sometimes it would force us to bring a child to chambers to be able to hear her and that will not be enough. (R32: Magistrate, Mbita)

From observations, there were no screens within the courts to protect the minor from seeing the perpetrator while he or she was testifying. Furthermore, there were no separate waiting rooms for the minors and perpetrators.

Service-Related Challenges

Adjournment of cases

Respondents (all except for the magistrates and prosecutors) complained about delays that survivors of CSA were subjected to at the judiciary. They lamented that CSA cases were adjourned a lot and this dampened the morale of survivors and their families who ended up not following through the legal process. A court clerk explained,

. . . The travelling expenses makes them [complainants and their guardians] lose morale to come to court. Because they are told the accused is unwell. . . . come on this date, when you come the trial court is not sitting, so they can come even thrice. When the fourth time the case has not started they will lose hope and disappear. (R30: Clerical officer, Mbita)

Distance

According to some key informants (n = 5) and discussants in Ndhiwa and Mbita, courts were situated in the town centers and therefore survivors residing in the interior traveled long distances to attend court sessions. Consequently, the costly distances discouraged survivors’ families from following up on the court processes. A magistrate explained,

Challenges that may affect the court process are distances from the villages, you find in Ndhiwa a case can collapse just because witnesses are not able to come from the rural homes to court. . . . (R18: Magistrate, Ndhiwa)

As divulged by magistrates (n = 5), there is a provision in court for witnesses to be reimbursed for their travel expenses but the amounts provided to courts were unable to be catered to all the witnesses. When asked about the reimbursement, a magistrate stated,

. . . Even though we get monies for witness expenses, it’s a small amount that is impractical to apply because I don’t think it goes beyond KES 10,000 (USD 100). It’s a very small amount that comes erratically; you can’t bank on it. . . . (R18: Magistrate, Ndhiwa)

Delays

Police officers (n = 4) and community leaders in Homa Bay subcounty stated that postsexual assault care services are delayed despite the Ministry of Health prioritizing the services. One community leader stated,

. . . there are delays when you take a defiled child to the hospital, you go there at 10 a.m. . . . You are going to stay there till 7:00 p.m. (P4: Paralegal, FGD 1)

These delays caused loss of forensic evidence, which could weaken the prosecution’s case against the alleged perpetrators as explained in the excerpt below:

. . . You take a child to a hospital and spend more than 8 hours. The doctor is not always around and at times we end up coming back without the child being examined. These may make us to lose the case because if they don’t examine the child early enough you may lose evidence and we may end up losing the case. (R47: Police officer, Homa Bay)

There were also complaints of delays in law courts from key informants (n = 13) and discussants in all the groups:

. . . Sexual offences cases should end in six months; you find it takes 2 to 3 years. . . . (P25: Probation officer, Homa Bay)

Staffing

Inadequate numbers of staff contributed to delays in courts as explained by judicial officers (n = 5) and prosecutors (n = 6) in all the subcounties. A prosecutor explained,

The delays could be due to a backlog of cases in the courts. Like now we have a shortage of prosecutors. In Ndhiwa one of the courts has not been sitting for almost 6 months because there is no prosecutor. (P58: Prosecutor, Homa Bay)

Police officers (n = 5) in all the subcounties also stated that they were understaffed. A police officer from Mbita Sub County said,

There is a problem with staffing . . . what they say about this station (is that) we are supposed to be 108. But we are only 38! That is the station and the patrol base. . . . (P41: Police officer, Mbita)

We asked all the key informants whether they had been trained to handle cases of CSA and GBV. Out of 61 participants, only 37 had received training. These were mostly magistrates, prosecutors, NGO workers, and senior ranking police officers. Some of the prosecutors expressed frustrations on the quality of investigations done by police officers. They blamed the poor investigative skills on the poor training of police officers. A prosecutor explained,

There is no way you will take an officer from Kiganjo (a training center for police officers) after 6 months, give him a defilement case and expect a good job. They don’t know what to look for. . . . There should be special trainings on sexual offences for officers. . . . (R51: Prosecutor, Homa Bay)

Of the trained police officers (mostly senior ranking officers), most of them complained that the training had occurred a long time ago and that they needed refreshers.

Lack of psychosocial support

Interviews with key informants (n = 26) revealed that psychosocial support was not offered to CSA survivors as the County lacked counselors. Magistrates lamented about the difficulty in dealing with traumatized children. One explained,

. . . a young child is brought here, we are in chambers, you start asking questions and she starts crying . . . she keeps silent, what do you do? . . . That day we did not proceed, I had to adjourn the case. . . . (R54: Magistrate, Mbita)

Despite this difficulty, little effort was put in by the prosecution in prepping the children before their court appearance. As observed during court proceedings, most of the prosecutors from all the counties advised the children about to testify not to fear the court and tell the truth. We asked magistrates if there were any provisions for trauma counseling. A magistrate stated,

It’s there [provisions for counselling within the law], but in the law court we don’t have trauma counsellors. . . . (R55: Magistrate, Homa Bay)

According to key informants (n = 26), some of the girls who were rescued from child marriages were sometimes emotionally attached to their abusers and were unwilling to leave those relationships. A child officer explained,

You rescue a child from early marriage and take the case to the court. This person is given bond and then you hear they are reunited. We need to do a lot of counselling to these girls while removing them from the marriage. (R7: Children’s officer, Homa Bay)

Moral Challenges

Corruption at the health facility and police stations was reported to be a challenge by the community leaders in all the subcounties and key informants (n = 20). According to the community leaders, the health providers were notorious for demanding money before attending to survivors of CSA. A paralegal stated,

You take it (Standard form issued by the police used to report medical and forensic examination findings) to the hospital, the doctor wants payment . . . two thousand [USD 20] or above. That is the major reason for dropping out of most cases. (P9: Paralegal, FGD 2)

Demands of money discouraged the survivors of CSA from following through the legal system, thereby disheartening the community leaders who were advocating for justice on behalf of the survivors. Corruption also affected prosecution of cases as prosecutors had a hard time prosecuting cases where a police officer had been bribed. A prosecutor said,

We get the summons and give the investigating officer. . . . So the investigating officer will go and bond the witnesses but at times this becomes tricky. . . . The investigating officer is compromised, so she will just come and say no witnesses, no witnesses, no witness then we withdraw. (R51: Prosecutor, Homa Bay)

If witnesses do not appear in courts to testify against the alleged perpetrator, the prosecutors said that they are left with no choice but to withdraw the cases against him or her.

Discussion

This study documents challenges in supporting CSA survivors. Reporting CSA is a complex process because there are large disparities between the ideal reporting system and actual practice. Service providers reported that cases are not always directly reported to the health providers or police officers. Consequently, access to health care is delayed, placing the children at risk of contracting sexually transmitted infections and unwanted pregnancies.

We were informed by key informants and discussants that many cases go unreported. Of the reported cases, most were reported late. This finding is supported by a literature review on CSA, which found that sexual abuse of minors often goes undisclosed and unrecognized (Murray, Nguyen, & Cohen, 2014). Of the reported cases, most were reported late. A survey of 288 American women who had experienced CSA found that the majority of them waited several months before disclosing the abuse and only 18% disclosed within a day of the abuse (Smith et al., 2000). Our study suggests that, in Kenya, late reporting denies survivors of CSA access to health care that would otherwise minimize consequences of CSA, such as unwanted pregnancies, HIV infection, and trauma. It is therefore important to raise awareness in the community on the consequences of CSA, the need for immediate clinical, medicolegal care, and psychosocial support to encourage reporting.

During our study, we found that some of the cases reported to the police were compromised through payment of fines by perpetrators to the families of the survivors as stipulated by the informal justice systems. Parallel justice systems do not prioritize medical care (Ajema et al., 2011). Some of the survivors were dissuaded from following the judicial process through threats or the fact that they were in a relationship with the perpetrator. Cases involving minors in relationships with perpetrators pose challenges to the judiciary system as it is hard to prove beyond reasonable doubt that an offense occurred, especially when the minor is not forthcoming (Kisanga, Nystrὄm, Hogan, & Emmelin, 2013).

Our study found that Homa Bay County offered poor services to CSA survivors. First, CSA survivors were subjected to long delays in health facilities. These results are in line with research in Kenya, which reported survivors of CSA being subjected to long delays at a health facility in Homa Bay County (Wangamati et al., 2016). Delays have the probability of compromising the strength of forensic evidence as well discouraging survivors from following through the continuum of care. The government should put in place supervisory measures to ensure that medical officers who do not prioritize post-sexual assault care are held accountable.

Second, we found that at the judiciary, CSA cases were often subjected to delays due to adjournment of hearings, backlog of cases, and shortage of prosecutorial staff. According to a Kenyan judiciary report on court case delays, the judiciary has a high number of pending cases in courts, which has resulted in suboptimal service delivery to its clients leading to low public confidence (Judiciary, 2014). Although children were required to recount their abuse in hearings when testifying in law courts, the study found that children were not informed by the prosecutors on what to expect within the court. Studies from elsewhere have found that testifying in law courts for children is associated with emotional distress, fear, and frustration (Hutton, Cranson, & Clarke, 2012; Müller, 2003). Survivors of CSA may find testifying in court to be intimidating if they do not fully understand the purpose of their testimony (Berliner & Conte, 1995). Children should be prioritized and prepped before their participation in any legal proceedings.

We found that Homa Bay County lacked safe spaces for housing CSA survivors leading to their temporal accommodation in police cells which were unfit for occupancy and had the likelihood of further traumatizing the children. In addition, there were no children courts, which indicate that little thought is given to CSA survivors’ predicament. There are few children courts in Kenya; these courts are mainly located in big cities and towns and rarely found in rural and peri-urban areas. Child-friendly hearing spaces facilitate children’s process of sharing their ordeals and as such enhance their participation in the judiciary proceedings (European Union Agency for Fundamental Rights, 2015). There is need for the Kenyan government to develop and enforce multisectoral guidelines on child-friendly spaces and services for CSA survivors.

Shortage of prosecutorial staff contributed to a backlog of cases in court. Understaffed, overworked, and poorly trained service providers are likely to compromise quality of care. For provision of quality services to survivors of CSA, policy makers and managers should ensure that institutions reduce workload through adequate staffing and training, increase supervision, and find ways to motivate employees (Osakwe, Oreagba, Adewunmi, Adekoya, & Fajolu, 2013).

The study found that health providers demanded money before attending to CSA survivors. Similar findings have been reported elsewhere where medical staff demanded bribes for every service that they provided, for example, registration and provision of care (Lewis, 2006; Vian, 2008). Health providers in Kenya were on strike for 100 days in the year 2016/2017 citing poor pay and working conditions. Poor remuneration and working environment demotivates health providers, thus compromising the quality of care for patients using public health facilities (Bouchard, Kohler, Orbinski, & Howard, 2012; Transparency International, 2006b). According to study participants, families of CSA survivors often lose faith in the judicial process due to corrupt law enforcement officers and seek alternative forms of justice. In a survey conducted by Transparency International on bribery in Kenya, the police were ranked as the worst government department (Transparency International, 2006a). Corruption within legal systems interferes with successful prosecution of individual cases as well as deterring sexual abuse reports (Johnson, Ollus, & Nevala, 2008; Lievore, 2003).

Strengths and Limitations of the Study

The strength of the study lies in its novel focus and rigorous investigation process. The study triangulated different data collection methods to achieve credibility. In addition, the first author conducted member checking and reflected on how her background, values, preconceptions, and assumptions affected the research process on a daily basis. The study is limited because the study findings are specific to the study context and the research period. However, given that challenges we found relate to institutional resources, standards of training, corruption, legal pluralism (the existence of multiple legal systems within one population and/or geographic area), as well as underreporting and delayed reporting, these challenges are likely to be experienced by service providers in similar resource poor settings. If these challenges are addressed, CSA survivors may receive quality care in such settings and have better health outcomes. Another limitation of the study is that, during interviews, key informants may have given a more positive impression of the system’s functioning than is the reality. However, we believe that by asking informants to focus on challenges and also by having community leaders discuss about their roles and challenges, we avoided this pitfall.

Implications of the Study

As previously indicated, within the Kenyan criminal justice system, the focus is on the alleged perpetrator, with the victim merely playing the role of a witness and receiving no restitution. For this reason, traditional justice systems are preferred by some members of the community due to accessibility and compensation offered to the family of the survivor (Ajema et al., 2011). By focusing on the family, traditional justice systems neglect the physical and emotional needs of the survivor. This situation is partly created because the Kenyan law prohibits the pursuit of CSA cases outside the criminal justice systems. Families avoid contact with the government institutions and hide their pursuit of CSA cases outside the criminal justice systems, which means that the survivors of CSA rarely access formal systems of medical care and psychosocial support. As both the systems (criminal and traditional) do not adequately meet the needs of CSA survivors, we propose that research is conducted on how the two systems can coexist, with reforms on either side, to ensure due process for survivors of CSA and restitution. As there are disparities between the ideal and actual reporting system, it is important for community members to be sensitized on the consequences of CSA and importance of reporting the incidents directly to the police and the health facilities.

Conclusion

CSA is ubiquitous. Although laws and policies exist in Kenya to protect children from sexual abuse and care for CSA survivors, government facilities and institutions are ill equipped to accommodate the needs of survivors. To promote quality postsexual assault services, service providers should be trained to offer proper care. Child-friendly facilities and services should be established to meet needs of CSA survivors. In addition, corrupt officials should be dealt with firmly to improve reporting of CSA cases and encourage survivors to follow through the legal process.

Footnotes

Acknowledgements

The authors would like to thank the key informants and discussants for their contribution to the study.

Authors’ Note

Chimaraoke Izugbara is now affiliated with International Center for Research on Women, Washington DC, United States.

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: The research was funded by the Research Council of Norway.

ORCID iD

Cynthia Khamala Wangamati

Author Biographies

Cynthia Khamala Wangamati is a PhD student in the Department of Community Medicine and Global Health at the University of Oslo, Norway. Her research interests include sexual and reproductive health and rights, gender studies, universal health care, and medical anthropology.

Johanne Sundby is a professor in the Department of Community Medicine and Global Health at the University of Oslo, Norway. Her research interests include sexual and reproductive health and rights, maternal and child health, gender studies, and global and migrant health.

Chimaraoke Izugbara is the director of Global Health, Youth and Development at the International Center for Research on Women in Washington, D.C., USA. His research interests include gender, youth, sexuality, and maternal, sexual, and reproductive health.

Erick Otieno Nyambedha is an associate professor at Maseno University in Kenya. His research interests include HIV/AIDS, anthropology, and child and social protection.

Ruth Jane Prince is an associate professor in the Department of Community Medicine and Global Health at the University of Oslo, Norway. Her academic interests include social protection and welfare in the Global South, anthropology, global health, environmental toxicity, and temporality and materiality in Africa.

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