chapter 1
CHILD ABUSE—A HISTORY

OVERVIEW

The recognition of child abuse in its multiple forms (physical abuse, sexual abuse, emotional abuse, and neglect) came to the forefront in the twentieth century. Child abuse continues to be more likely recognized in economically developed countries than in developing countries. Children, however, have been beaten and abandoned for many thousands of years, based primarily on the belief that children are the property of their parents.

Early civilizations regularly abandoned deformed or unwanted children, and the ritual sacrifice of children to appease the gods took place in the Egyptian, Carthaginian, Roman, Greek, and Aztec societies. In Roman society the father had complete control over the family, even to the extent that he could kill his children for disobedience. Sexual abuse of children was common in both Greek and Roman societies. Children were also sold as prostitutes. Women often participated in abuse. Petronius (c. 27–c. 66), a Roman writer, recorded the rape of a seven-year-old girl witnessed by a line of clapping women.

During the Middle Ages (c. 350–c. 1450) in Europe, healthy but unwanted children were apprenticed to work or offered to convents and monasteries. Infanticide, or the murder of babies, was also common. The Roman Catholic Church contributed to infanticide when it declared that deformed infants were omens of evil and the product of relations between women and demons or animals. In another example of religious support for what would now be considered child abuse, the archbishop of Canterbury in the seventh century ruled that a man could sell his son into slavery until the child reached the age of seven.

In thirteenth-century England the law read, "If one beats a child until it bleeds, it will remember, but if one beats it to death, the law applies" (Albrecht Peiper, Chronik der Kinderheilkunde, Leipzig, Germany: Georg Thieme, 1966). By the child's fourth year, harsh discipline played a major role in his or her socialization. Children and parents were taught that beatings were in the child's best interest. In The Babees'Book: Medieval Manners for the Young, a primer on manners used first in the eleventh century in France to educate the upper classes, a verse in "How the Good Wife Taught Her Daughter" instructed future mothers, "But take a smart rod and beat them in a row/Till they cry mercy and their guilt well know/Dear child by this lore/They will love thee ever more" (York University, http://www.yorku.ca/inpar/babees_rickert.pdf [accessed November 2, 2004]).

Children were beaten not only by their parents but also by their teachers. In a poem written around 1500, a schoolboy admitted that he would gladly become a clerk, but learning was such strange work because the birch twigs used for beating were so sharp. The children at an Oxford school must have felt justice was served when their schoolmaster, out early one morning to cut willow twigs for a switch to beat them, slipped, fell into the river, and drowned.

The late Middle Ages and the Renaissance (roughly the fourteenth through sixteenth centuries) saw changes in how society viewed children, but abuse was still common. Neil Postman, in The Disappearance of Childhood (New York: Delacorte Press, 1982), noted that the idea that children were small adults had started to change by that time. Among the upper classes children began to receive a long, formal education, increasingly separated from adults and kept with their peers. It was becoming apparent that children were not really that similar to adults after all, but rather like mounds of clay to be molded.

In sixteenth- and seventeenth-century Europe fathers commonly placed their children in apprenticeships to provide inexpensive labor. The apprentice system was the major job training method of pre-industrial Western society. The apprentice who trained with a master frequently worked under conditions that, by today's standards, would be considered severely abusive.

The practice of paternal control was brought to the American colonies, and the father ruled his wife and children. The mother, however, was also expected to discipline her children, inflicting corporal punishment as she saw fit. A child was little more than the property of the parents. At the same time, the child was an asset that could be used to perform work on the farm.

Parental discipline was typically severe, and parents, teachers, and ministers found support for stern discipline in the Bible. Several verses in Proverbs (Proverbs 22:15, Proverbs 23:13–14, and Proverbs 29:15), summed up in the phrase, "Spare the rod and spoil the child," were cited as justification for beating children. It should be noted that the biblical "rod" referred to was a shepherd's rod, used to guide the sheep in the right direction, not to beat the sheep. Church elders taught that children were born corrupted by original sin, and the only path to salvation was "to beat the Devil out of the child." (In Christian theology, original sin is humankind's inherent tendency to sin as a result of Adam's rebellion against God.) Some colonial legislatures even passed "stubborn children laws," giving parents the legal right to kill unruly children. According to journalist Roger Rosenblatt, Massachusetts enacted a law in 1646 that allowed the death penalty for a rebellious child, though the law was never enforced ("The Society That Pretends to Love Children," New York Times Magazine, October 8, 1995).

By their teens, many children were living with other families, bound out as indentured servants or apprentices. It was common for heads of households and masters to brutalize these children without fear of reprisal except in cases involving excessive beatings, massive injury, or death.

Holding a Child Abuser Accountable

The earliest recorded trial for child abuse involved a master and his apprentice. In 1639 in Salem, Massachusetts, Marmaduke Perry was charged in the death of his apprentice. The evidence showed the boy had been illtreated and subjected to "unreasonable correction." Nevertheless, the boy's allegation that the master had been responsible for his fractured skull (which ultimately killed him) was called into question by testimony that claimed that the boy had told someone else that the injury was a result of falling from a tree. Perry was acquitted.

In 1643 a master was executed for killing his servant. In 1655 in Plymouth, Massachusetts, a master found guilty of slaying a servant was punished by having his hand burned and all his property taken away. Other early records show brutal masters being warned for abusing young servants. In some cases the children were freed because of the harsh treatment. Virginia passed laws protecting servants against mistreatment in 1700.

Most of the early recorded cases of child abuse were specifically related to offenses committed by masters against servants and did not involve protecting children from abusive parents. Society generally tolerated the abuse of family members as a personal matter while condemning abuse by strangers.

The few recorded cases involving family matters were limited to the removal of children from "unsuitable" home environments, which usually meant that parents were not giving their children a good religious upbringing or were refusing to instill the proper work ethic. In two Massachusetts cases, in 1675 and 1678, children were removed from such "unsuitable" homes. In the first case the children were taken from the home because the father refused to send them out to apprentice or work. In the second case the same offense was compounded by the father's refusal to attend church services. Physical abuse was not an issue in either case.

It was during the nineteenth century that the American legal system began to change in favor of protecting children even against their own parents. In 1840, in Johnson v. State (21 Tenn. [2 Hum.] 283), a Tennessee parent was prosecuted for excessive punishment of a child. According to the testimony, a mother had hit her daughter with her fists, pushed her head against the wall, whipped her, and tied her to a bedpost. A lower court convicted the abusive parent, but a higher court reversed the conviction, claiming that the jury was improperly instructed, but concluding:

In chastising a child, the parent must be careful that he does not exceed the bounds of moderation and inflict cruel and merciless punishment; if he do[es], he is a trespasser, and liable to be punished by indictment. It is not, then, the infliction of punishment, but the excess, which constitutes the offence, and what this excess shall be is not a conclusion of law, but a question of fact for the determination of the jury.

ABUSE DURING THE INDUSTRIAL REVOLUTION

With the coming of industrialization in Europe and the United States, the implied right of abuse was transferred to the factory, where orphaned or abandoned children as young as five worked sixteen hours a day. In many cases irons were riveted around their ankles to bind the children to the machines, while overseers with whips ensured productivity. In England the Factory Act of 1802 stopped this pauper-apprentice work system, but the law did not apply to children who had parents. Those youngsters worked in the mills for twelve hours a day at the mercy of often tyrannical supervisors.

Nonworking hours offered little relief to poor, orphaned, or abandoned children. Dependent children such as these were put into deplorable public poorhouses with adult beggars, thieves, and paupers. Not until the beginning of the nineteenth century did the public recognize the terrible abuses that occurred in these almshouses, and major efforts were begun to provide separate housing for children.

During the nineteenth century, middle-class families began to see their children as representative of the family's status. For many of these families, education for the child, rather than labor, became the goal. With this attitude, many of the labor abuses gradually came to an end. Eventually, child labor laws were passed in most industrialized countries to limit the kinds of jobs children could do and the number of hours they could work.

Private Organizations Take Action against Abuse

The first case of child abuse that caught public attention in the United States occurred in 1874. Neighbors of Mary Ellen, a nine-year-old child in New York City, contacted a church social worker, Etta Angell Wheeler, when they heard disturbances from the little girl's tenement ("The Story of Mary Ellen," American Humane Association, http://www.americanhumane.org/site/PageServer?pagename=wh_mission_maryellen_wheeler [accessed November 23, 2004]).

Upon investigating the child's home, the social worker found her suffering from malnutrition, serious physical abuse, and neglect. Mary Ellen was living with Mary and Francis Connolly. The girl, who was said to be the illegitimate daughter of Mrs. Connolly's first husband, was apprenticed to the couple.

At that time there were laws protecting animals, but no local, state, or federal laws protected children. Consequently, Wheeler turned to the American Society for the Prevention of Cruelty to Animals (ASPCA) for help. The case was presented to the court on the theory that the child was a member of the animal kingdom and therefore entitled to the same protection from abuse that the law gave to animals. The court agreed, and the child, because she was considered an animal, was taken from her brutal foster mother.

In court Mary Ellen related how her foster mother beat her daily with a leather whip and cut her face with scissors. She was not allowed to play with other children and was locked in the bedroom whenever her "mamma" left the house. The court placed the child in an orphanage. She was later adopted by the social worker's family.

The court found Mary Connolly guilty of assault and battery for felonious assault with scissors and for beatings that took place during 1873 and 1874. She was sentenced to one year of hard labor in a penitentiary.

Mary Ellen Wilson's case led to the founding of the New York Society for the Prevention of Cruelty to Children (NYSPCC) in 1875. The first child protective agency in the world, the NYSPCC continues in the twenty-first century to work for the best interests of children. Similar societies were soon organized in other U.S. cities. By 1922, fifty-seven societies for the prevention of cruelty to children and 307 other humane societies had been established to tend to the welfare of children. After the federal government began intervening in child welfare, the number of these societies declined.

The Beginnings of Federal Protection for Children

In 1900 the U.S. Census found that about two million American children, representing 18.3% of children ages ten to fifteen, were working in mills, farms, factories, and on city streets all over the country. As a result of this finding, a private organization, the National Child Labor Committee (NCLC), was established in 1904 to work for child labor reforms. The committee hired Lewis Hine (1874–1940) to photograph and write about the working conditions of child laborers, some as young as three years of age, across the country.

It was also during this time that many concerned people lobbied for the creation of a federal agency dedicated solely to promoting the welfare of children. Starting in 1906 and for the next six years, legislators introduced bills proposing such an agency. In 1909 the first White House Conference on the Care of Dependent Children under President Theodore Roosevelt (1858–1919) recommended that Congress pass legislation to create the Children's Bureau. It was not until 1912 that the bill became law under President William Howard Taft (1857–1930).

The Children's Bureau promoted the passage of the Keating-Owen Child Labor Act of 1916 (39 Stat. 675), the first federal law regulating child labor. The act prohibited the interstate sale of products from any mine made by children under the age of sixteen, from any cannery, factory, and shop made by children under the age of fourteen, and from any business employing children under the age of sixteen who worked at night or more than eight hours during the day. The law did not cover youngsters employed in agriculture and domestic work. In 1918, however, the U.S. Supreme Court, in Hammer v. Dagenhart (247 U.S. 251), found the law unconstitutional. According to the Court, the law was not about regulating interstate commerce; it was designed to regulate states' manufacturing conditions over which Congress had no right to interfere. It was not until 1938, with the passage of the Fair Labor Standards Act (52 Stat. 1060), that the federal government started regulating child labor, among other provisions. The law established sixteen as the minimum age for child labor and eighteen for hazardous jobs (The Our Documents Initiative, "Keating-Owen Child Labor Act of 1916: Document Info," http://www.ourdocuments.gov/doc.php?flash=false&doc=59# [accessed November 23, 2004]).

MODERN AMERICA

The federal government first provided child welfare services with the passage of the Social Security Act of 1935 (49 Stat. 620). Under Title IV-B (Child Welfare Services Program) of the act, the Children's Bureau received funding for grants to states for "the protection and care of homeless, dependent, and neglected children and children in danger of becoming delinquent." Prior to 1961 Title IV-B was the only source of federal funding for child welfare services.

The 1962 Social Security Amendments (Public Law 87-543) required each state to make child welfare services available to all children. It further required states to provide coordination between child welfare services (under Title IV-B) and social services (under Title IV-A, or the Social Services program), which served families on welfare. The law also revised the definition of "child welfare services" to include the prevention and remedy of child abuse. In 1980 Congress created a separate Foster Care program under Title IV-E.

Title IV-A became Title XX (Social Services Block Grant) in 1981, giving states more options regarding the types of social services to fund. Today child abuse prevention and treatment services have remained an eligible category of service.

State Programs That Help Children at Risk

Under Title IV-B Child Welfare Services (Subpart 1) and Promoting Safe and Stable Families (Subpart 2) programs, families in crisis receive preventive intervention so that children will not have to be removed from their homes. If this cannot be achieved, children are placed in foster care temporarily until they can be reunited with their families. If reunification is not possible, parents' rights are terminated and the children are made available for adoption.

States use the Foster Care (Title IV-E) program funds for the care of foster children and for the training of foster parents, program personnel, and private-agency staff. Title XX funds provide such services as child daycare, child protective services, information and referral, counseling, and employment.

The Battered Child Syndrome and the Development of a Child Abuse Reporting Network

In 1961 Dr. C. Henry Kempe, a pediatric radiologist, and his associates proposed the term "battered child syndrome" at a symposium on the problem of child abuse held under the auspices of the American Academy of Pediatrics. The term refers to the collection of injuries sustained by a child as a result of repeated mistreatment or beatings. The following year The Journal of the American Medical Association published the landmark article "The Battered Child Syndrome" (C. Henry Kempe et al., vol. 181, no. 17, July 7, 1962). The term "battered child syndrome" developed into "maltreatment," encompassing not only physical assault but other forms of abuse, such as malnourishment, failure to thrive, medical neglect, and sexual and emotional abuse.

Dr. Kempe had also proposed that physicians be required to report child abuse. According to the National Association of Counsel for Children, by 1967, after Dr. Kempe's findings had gained general acceptance among health and welfare workers and the public, forty-four states had passed legislation that required the reporting of child abuse to official agencies, and the remaining six states had voluntary reporting laws. This was one of the most rapidly accepted pieces of legislation in American history. Initially only doctors were required to report and then only in cases of "serious physical injury" or "nonaccidental injury." Today all the states have laws that require most professionals who serve children to report all forms of suspected abuse and either require or permit any citizen to report child abuse.

One of the reasons for the lack of prosecution of early child abuse cases was the difficulty in determining whether a physical injury was a case of deliberate assault or an accident. In recent years, however, doctors of pediatric radiology have been able to determine the incidence of repeated child abuse through sophisticated developments in X-ray technology. These advances have allowed radiologists to see more clearly such things as subdural hematomas (blood clots around the brain resulting from blows to the head) and abnormal fractures. This brought about more recognition in the medical community of the widespread incidence of child abuse, along with growing public condemnation of abuse.

Federal Legislation against Child Abuse

In 1974 Congress passed the Child Abuse Prevention and Treatment Act (CAPTA; Public Law 93-247). The law stated:

[Child abuse and neglect refer to] the physical or mental injury, sexual abuse, negligent treatment or maltreatment of a child under age eighteen, or the age specified by the child protection law of the state in question, by a person who is responsible for the child's welfare under circumstances which indicate the child's health or welfare is harmed or threatened thereby, as determined in accordance with regulations prescribed by the Secretary of Health, Education, and Welfare.

This law created the National Center on Child Abuse and Neglect (NCCAN), which developed standards for handling reports of child maltreatment. NCCAN also established a nationwide network of child protective services and served as a clearinghouse for information and research on child abuse and neglect.

Since 1974 CAPTA has been amended a number of times. (See Figure 1.1.) In 1978 the Child Abuse Prevention and Treatment and Adoption Reform Act (Public Law 95-266) promoted the passage of state laws providing comprehensive adoption assistance. The act provided grants to encourage the adoption of children with special needs and broadened the definition of abuse, adding a specific reference to sexual abuse and exploitation to the basic

FIGURE 1.1

definition. That year the Indian Child Welfare Act (Public Law 95-608) was also enacted to reestablish tribal jurisdiction over the adoption of Native American children.

In response to the public outcry about the placement of an increasing number of children in foster care, Congress passed the Adoption Assistance and Child Welfare Act of 1980 (Public Law 96-272), with the goal of promoting family reunification. In 1988 the Child Abuse Prevention, Adoption and Family Services Act (Public Law 100-294) replaced the original 1974 CAPTA, mandating, among other things, the establishment of a system to collect national data on child maltreatment.

In 1994 Congress passed the Multiethnic Placement Act (Public Law 103-382), directing states to actively recruit adoptive and foster families, especially for minority children waiting a long time for placement in a home. Pursuant to the Child Abuse Prevention and Treatment Act Amendments of 1996 (Public Law 104-235), the National Center on Child Abuse and Neglect (NCCAN) created by the first CAPTA was abolished. Its functions have subsequently been consolidated within the Children's Bureau of the U.S. Department of Health and Human Services.

By 1997 the federal government had realized that reuniting abused children with their families did not always work in the best interests of the children. Congress revisited the "reasonable efforts" for family reunification originally mandated by the 1980 Adoption Assistance and Child Welfare Act. Under the 1997 Adoption and Safe Families Act (Public Law 105-89), "reasonable efforts" was clarified to mean the safety of the child comes first. States were directed to indicate circumstances under which an abused child should not be returned to the parents or caretakers.

The Promoting Safe and Stable Families Amendments of 2001 (Public Law 107-133) was enacted partly to address the rising number of children with incarcerated parents. The law provided a grant program for creating mentoring services for these children. The law also created a new program to assist youth aging out of foster care, helping them pursue an education or vocational training.

In 2003 CAPTA received reauthorization through 2008 under the Keeping Children and Families Safe Act (Public Law 108-36). The law, among other things, directed more comprehensive training of child protective services personnel, including a mandate that they inform alleged abusers, during the first contact, of the nature of complaints against them. The law called for child welfare agencies to coordinate services with other agencies, including public health, mental health, and developmental disabilities agencies. The law also directed the collection of data for the fourth National Incidence Study of Child Abuse and Neglect.

Federal Legislation Dealing with the Prosecution of Child Abusers

The Children's Justice and Assistance Act of 1986 (CJA; Public Law 99-401) offers grants to states to improve the investigation and prosecution of cases of child abuse and neglect, especially sexual abuse and exploitation. The program aims to reduce additional trauma to the child by training persons who are involved in child maltreatment cases, such as law enforcement, mental health personnel, prosecutors, and judges. CJA also supports legislation that would allow indirect testimony from children, shorten the time spent in court, and make their courtroom experience less intimidating.

Until 1995 none of the federal child abuse legislation dealt specifically with punishing sex offenders. In December of that year, with growing acknowledgment of and concern about sex crimes against minors, Congress passed the Sex Crimes Against Children Prevention Act of 1995 (Public Law 104-71). The act increased penalties for those who sexually exploit children by engaging in illegal conduct, or for exploitation conducted via the Internet, as well as for those who transport children with the intent to engage in criminal sexual activity.

Three years later Congress enacted the Protection of Children from Sexual Predators Act of 1998 (Public Law 105-314) that, among other things, established the Morgan P. Hardiman Child Abduction and Serial Murder Investigative Resources Center (CASMIRC). The purpose of CASMIRC, as stated in the text of the act, is "to provide investigative support through the coordination and provision of federal law enforcement resources, training, and application of other multidisciplinary expertise, to assist federal, state, and local authorities in matters involving child abductions, mysterious disappearance of children, child homicide, and serial murder across the country."

Congress passed the Prosecutorial Remedies and Other Tools to End the Exploitation of Children Today (PROTECT) Act (Public Law 108-21) on April 30, 2003. Among other things, the act established a national Amber Alert Program for recovering abducted children and provided that there will be no statute of limitations for sex crimes and abduction of children. (Under previous laws, the statute of limitations expired when the child turned twenty-five.) The law also provided for severe penalties for sex tourism and the denial of pretrial release for suspects in federal child rape or kidnap cases. (The Amber Alert program is named after Amber Hagerman of Texas who was abducted and murdered in 1996. She was nine years old. A witness notified police, giving a description of the vehicle and the direction it had gone, but police had no way of alerting the public.)

THE INTERNATIONAL EXPLOITATION OF CHILDREN

Cleric Abuse

Allegations of child abuse have surfaced among several religious denominations. For example, a survey of Roman Catholic dioceses in the United States commissioned by the United States Conference of Catholic Bishops and released in 2004 revealed that 10,667 incidents of alleged sexual abuse occurred between 1950 and 2002 involving 4,392 priests and deacons ("The Nature and Scope of the Problem of Sexual Abuse of Minors by Catholic Priests and Deacons in the United States," http://www.usccb.org/nrb/johnjaystudy [accessed November 1, 2004]). During most of this period, church leaders who knew of the abuse worked to keep it secret, by paying millions of dollars to victims' families and moving the abusive priests from parish to parish. Allegations of sexual abuse by priests have also surfaced in Mexico, Ireland, Canada, Colombia, Venezuela, Italy, Spain, England, Australia, and Hong Kong.

Other religious denominations have also been involved in sexual abuse allegations. Some members of the Jehovah's Witnesses spoke out against their church's policy of handling reports of child sexual abuse. The church follows biblical standards to resolve problems. A group of church elders meet in secret to decide each sexual abuse allegation. The elders require two credible witnesses, including the accuser, to determine whether or not the allegations are true. William Bowen, a former elder and founder of silent-lambs, a group that monitors sexual abuse in the Jehovah's Witnesses, claimed that it is usually impossible for a child victim to have a witness to the incident. Without the witnesses to attest to the abuse, the alleged perpetrator is considered innocent and the charges are kept confidential (http://www.silentlambs.org [accessed November 13, 2004]). According to church officials, they do report suspected abuse if the state law requires it.

In June 2000 former Hare Krishna children sued the International Society for Krishna Consciousness (ISKCON), a sect of Hinduism that became popular in the United States during the 1960s. The parents left the children in boarding schools while they went out to recruit new members and to solicit donations. The plaintiffs alleged physical, emotional, and sexual abuse, including being deprived of food and sleep, being severely beaten, being locked up in roach-infested rooms, and being offered in marriage to older men who were patrons of ISKCON. ISKCON officials, while substantiating that the abuse had occurred, denied that hundreds of children were involved.

The lawsuit attempted to use a federal law, Racketeer-Influenced and Corrupt Organizations (RICO) chapter of the Organized Crime Control Act of 1970 (Public Law 91-452), which was originally intended to curb organized crime. The lawsuit sought $400 million in damages from ISKCON congregations and individuals. In September 2001 the U.S. District Court of Dallas, Texas, permanently dismissed the case.

Child Soldiers

In wars past and present throughout the world, government armed forces and opposition groups have forced children to serve as soldiers. According to the Human Rights Watch World Report 2004: Human Rights and Armed Conflict (New York, 2004), the number of child soldiers remained constant at about three hundred thousand in at

TABLE 1.1

least twenty countries in which they were used both by government and nongovernmental forces. As wars ended in such places as Angola and Sierra Leone in 2003, children were recruited, many by abduction, by other countries, including Liberia, Côte d'Ivoire, Burundi, the Democratic Republic of Congo, Myanmar, Sudan, and Uganda.

The Coalition to Stop the Use of Child Soldiers, in Child Soldier Use 2003: A Briefing for the Fourth UN Security Council Open Debate on Children and Armed Conflict (London, 2004), reported that the government of Myanmar had an estimated seventy thousand children serving in the armed forces in 2003. Child soldiers in the Democratic Republic of the Congo reportedly were forced to commit atrocities and were raped and beaten. Children in Sri Lanka and northern Uganda continued to be abducted by rebel forces. In Colombia children as young as twelve underwent training in the use of explosives and weapons. Colombian girls also fought on the frontlines. Many served as sexual slaves to military officers.

trauma reported among former child soldiers. Since 1986 children in Uganda have been recruited in an ongoing war. In 2004 child soldiers were used by both the Ugandan People's Defense Forces and the rebel forces, the Lord's Resistance Army. Ilse Derluyn, Eric Broekaert, Gilberte Schuyten, and De Temmerman Els interviewed former child soldiers of the northern Ugandan Lord's Resistance Army (LRA) to determine the nature of trauma the children experienced during abduction by the army. Derluyn et al. also investigated the children's post-traumatic stress symptoms ("Post-Traumatic Stress in Former Ugandan Child Soldiers," The Lancet, vol. 363, no. 9412, March 13, 2004). As of 2004 about twenty thousand children had been abducted by the LRA over a period of eighteen years. A total of 301 children who were in contact with a rehabilitation center participated in the study. During the time of abduction the children had a mean age of 12.9 years, with nearly two-thirds (64%) abducted from their homes. They spent a mean period of more than two years with the LRA.

More than three-quarters (77%) of the former child soldiers witnessed someone being killed, with 6% seeing their father, mother, or sibling killed. Nearly two-thirds (65%) were forced into military training, while 64% were forced to participate in combat. About 39% had to kill another person, and 2% had to kill their own father, brother, or another relative. More than half (52%) were seriously beaten, and 48% were injured. Among the female child soldiers, 35% served as wives to the adult soldiers. Nearly one-fifth (18%) reported giving birth to one or more children while in captivity. Of seventy-one children who agreed to be tested for post-traumatic stress disorder, sixty-nine showed clinical symptoms.

Trafficking in Children

Trafficking in women, men, and children is a worldwide problem. The U.S. Department of State reported in the 2004 Trafficking in Persons Report (Washington, DC, June 2004) that an estimated six hundred thousand to eight hundred thousand men, women, and children were trafficked across international borders in 2003 (trafficking is generally defined as the transport of a person against his or her will, usually for the purpose of exploitation). An estimated 80% of the victims were female, and 70% of those females were trafficked for sexual exploitation. Experts believed that if trafficking within countries were counted, the total would be between two million and four million.

The Trafficking Victims Protection Act (Division A of Public Law 106-386), enacted in 2000, defines "severe forms of trafficking in persons." (See Table 1.1.) In October 2001, as authorized by the act, the Department of State established the Office to Monitor and Combat Trafficking in Persons. The office works with other governments in prosecuting traffickers and in assisting domestic and global victims. According to the 2004 Trafficking in Persons Report, between 14,500 and 17,500 people were trafficked into the United States in 2003.

Organized criminal groups in many countries work with one another in procuring or abducting young girls for the prostitution business, which makes millions of dollars. Very young children are forced into prostitution because clients mistakenly believe that a nine- or ten-year-old will not be infected with AIDS. In many Asian countries, in what is known as debt bondage, girls are traded for money to brothels by their parents or guardians. Many never leave prostitution because they cannot afford to pay for the additional debt added for food and rent.

Child Labor

In 1989 the United Nations General Assembly adopted the Convention on the Rights of the Child as an international human rights treaty. Article 32 of the Convention defines child labor as any economic exploitation or "work that is likely to be hazardous or interferes with the child's education, or is harmful to the child's health or physical, mental, spiritual, moral, or social development" (http://www.unhchr.ch/html/menu3/b/k2crc.htm [accessed November 23, 2004]).

In 2003 the International Labour Office (ILO) published global estimates of working children, using data from national household surveys collected from various countries in 2000 and from 2003 surveys. Overall, the data gathered were extrapolated to 152 countries, which were divided into five regions (Investing in Every Child: An Economic Study of the Costs and Benefits of Eliminating Child Labour, International Programme on the Elimination of Child Labour (IPEC), Geneva, Switzerland, 2004). The ILO uses "economic activity" and "child labor" to describe children's work. "Economic activity" encompasses paid and unpaid work, including the production of goods in a market-oriented business owned by a relative in the same household. "Child labor" refers to the following:

• Ages five to eleven: Children who are economically active
• Ages twelve to fourteen: Children who are economically active, except those performing light work
• Ages fifteen to seventeen: Children in hazardous work and other worst forms of child labor

The ILO reported that in 2003 about 182 million children ages five to fourteen were engaged in child labor, representing 18.5% of that age group worldwide. Asia (60.6%) had the largest proportion of child laborers, followed

TABLE 1.2

by Sub-Saharan Africa (20.8%), and Latin America (9%). (See Table 1.2.)

In Investing in Every Child: An Economic Study of the Costs and Benefits of Eliminating Child Labour, the ILO categorized labor that exploits children into two types: hazardous work and the unconditional worst forms of child labor. Hazardous work is defined by the ILO as "any activity or occupation which, by its nature or type, has, or leads to, adverse effects on the child's safety, health (physical or mental), and moral development." Hazards can also come from too much work, very long hours, and physical conditions of the job. Hazardous work includes mining, construction, and the work that exposes the children to pesticides or heavy machinery. About 10.8 million children ages five to fourteen were engaged in hazardous work, led by Asia and the Pacific (5.1 million) and Latin America (4.6 million).

Children engaged in forced and bonded labor, armed conflict, prostitution and pornography, and illegal activities (for example, working in poppy farms and trafficking in drugs) are considered in unconditional worst forms of labor. Since these activities are typically carried out in secrecy, the ILO considered the figures provided by fifty-six countries conservative minimum estimates. Table 1.3 shows low, medium, and high estimates of this problem, bringing the number of children ages five to seventeen who were performing unconditional worst forms of labor from 8.2 million on the low end to 20.4 million on the high end. Asia and the Pacific region (80% to 90%) accounted for the largest proportion of children engaged in unconditional worst forms of labor.

children as domestic workers. In the 1990s public attention became focused on the problem of illegal child labor in such industries as the production of clothing.

TABLE 1.3

However, the largest group of child laborers in the world—domestic workers—had not received much attention at all. The United Nations Children's Fund (UNICEF) refers to these children as the "invisible workforce," because they usually work by themselves in private homes. The majority (approximately 90%) are girls ages twelve to seventeen, but they can be as young as five years old. These children receive very low or no salaries and put in long hours, sometimes seven days a week. In many cases the children's parents or other guardians collect the salaries. Most child domestic workers do not attend school. Those who live with their employers may not have contact with their families and peers.

In 2004 the ILO reported that as many as ten million children or more were engaged in domestic labor globally (Dr. June Kane, Helping Hands or Shackled Lives? Understanding Child Domestic Labour and Responses to It, Geneva, Switzerland, 2004). The report gives estimates of child domestic workers in various countries, including 700,000 children in Indonesia, 559,000 in Brazil, 300,000 in Dhaka, Bangladesh, 264,000 in Pakistan, 250,000 in Haiti, 200,000 in Kenya, and 100,000 in Sri Lanka. Many children were very young. About 22% of domestic child workers in Senegal were under fourteen years of age, 70% in Morocco were under twelve, and 10% were under ten in Haiti.

According to Dr. Kane, due to the hidden nature of domestic child labor, children are at risk of physical abuse and violence, as well as sexual abuse. They may be beaten and tortured, not only by the adults in the house but also by the children in the family who consider domestic workers as their inferiors. They may also suffer beatings at the hands of the other domestic workers in the house. Girls are especially at risk for sexual abuse by their male employers, visitors to the house, and other domestic laborers. In addition, children in domestic service may be exposed to dangers associated with their jobs. They may have to handle hazardous substances, such as cleaning fluids and machinery with which they are not familiar. Poor working conditions, such as rooms lacking in proper ventilation and heating, are also detrimental to their health.

Child Mutilation

Actions considered abusive in some cultures are often celebrated as rites of passage by others. According to the World Health Organization (WHO), female circumcision is practiced by followers of many religions, as well as by animists and nonbelievers. An estimated 100 million to 140 million women and girls have been circumcised worldwide. Each year about two million more girls are at risk of undergoing the procedure ("Female Genital Mutilation," http://www.who.int/mediacentre/factsheets/fs241/en [accessed November 23, 2004]).

Female circumcision was first called female genital mutilation in the international document Programme of Action, from the International Conference on Population and Development in 1994 in Cairo, Egypt. Female circumcision may be performed as early as infancy, although the procedure is usually done between the ages of four and twelve. It involves the partial or complete removal of the female genitalia, usually performed without anesthesia. In its most severe form, called infibulation, after the major mutilation of the external genitalia and the joining of the scraped sides of the vulva across the vagina, a small opening that may be as tiny as a matchstick is kept for urination and menstruation. Because of the small vaginal opening, sexual intercourse is quite painful, and the infibulation scar may have to be recut to relieve penetration problems.

Female circumcision is practiced in many African countries, as well as in certain countries in Asia and the Middle East. People who migrate from these regions to the United States, Canada, and Europe bring the practice with them.

Some of the health implications of female circumcision include hemorrhage, shock, injuries to the surrounding tissues, and death. Infections may lead to sterility and chronic pelvic pain. If a woman has been infibulated, she may have to undergo a series of cutting and resewing procedures during her childbearing years. She may also develop cysts, abscesses, and incontinence as a result of damage to the urethra. The risk of being infected with the human immunodeficiency virus (HIV) that leads to acquired immunodeficiency virus (AIDS) is also possible because the circumciser typically uses the same knife for other procedures, thus potentially spreading HIV from patient to patient.