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Research conducted on the prevalence and psychological sequelae of childhood sexual abuse (CSA) has grown rapidly in the last two decades worldwide. Prevalence studies have determined that sexual abuse in childhood is not an uncommon experience, with typical estimates between 15% to 30% of women and 5% to 15% of men exposed to some form of unwanted sexual activity.

These prevalence rates were also reported by Finkelhor in his study on the epidemiology of child sexual abuse in 19 countries. However, none of the countries listed in his study are from Asia. Literature on child sexual abuse in Asia is scarce, with physical child abuse and neglect issues prevailing in current research.

In Hong Kong, researchers warned that the sexual abuse prevalence figures for the province ought to be interpreted with care, as the rate for under-reporting in the culture remained a serious obstacle, despite a jump from 4% in 1979 to 18% in 1995 of sexual abuse cases reported by the Child Protection Registry in Hong Kong.

Further support of possible under-reporting comes from a monograph, where the number of child sexual abuse cases prosecuted in Singapore, in the four years to 2002, by the Ministry of Home Affairs exceeded the cases reported to the Ministry of Community Development and Sports.

The mean for the four years is 243.5 perpetrators prosecuted compared to 21.0 perpetrators reported respectively.

In a survey of 2,147 Chinese college students in Hong Kong, the overall prevalence rate was 6%; with females registering 7% and males 4%. A further adolescent study across four of China’s provinces, contrasted with the Hong Kong research, where the prevalence rates for the students were 16.7% for females and 10.5% for males.

In Singapore, two surveys conducted during 2003 produced widely variable rates. In one of these studies, a cohort of 88 female college students indicated a prevalence rate of 4.5%, while another batch of 325 post-graduate students reported an 18% prevalence rate for contact and non-contact abuse for women, and 17% for men.

The significantly lower rates reported across Asia may be consistent with previous research demonstrating higher rates of CSA among non-Asians, as compared to Asians or individuals with Asian ancestry, reflecting possible cultural taboos (e.g., shame, a tendency to resolve problems within the family system, and a reluctance to utilize mental health services or public agencies) and restraint surrounding sexuality.

For example, when Singaporean women were compared to U.S. women, the latter were more likely to report a history of child sexual abuse, especially the more severe forms of abuse.

The number of prosecuted sexual offence cases against children in Singapore had risen steadily in recent years, from 112 in 1994 to 256 in 2002.

However, despite increasing awareness of this reprehensible phenomenon through the media, there have been few studies on this issue during the past decade. This study hopes to contribute further to the small corpus of childhood sexual abuse literature in Singapore, and to provide counsellors with some understanding on the coping strategies employed by survivors of childhood sexual abuse for their abuse-specific consequences, so that optimal delivery of therapeutic interventions can be achieved.

Much has been learned about the potential consequences of CSA on male and female survivors, but relatively little is known about the differences or similarities of the coping strategies male and female victims use to deal with the memories of the abuse.

In Singapore, this aspect of research remains unexplored. Nor has research been consistent in establishing whether or not sexual abuse influences a survivor’s coping styles for current stressors that are not abuse-related. The identification of coping strategies used by abuse survivors may contribute to a better understanding of factors that facilitate or interfere with adaptive functioning and recovery.

Definition of Child Sexual Abuse

Although there have been some discussion in defining child sexual abuse within an appropriate cultural context rather than adopting the universal western-oriented definitions and perspectives, for the purpose of this study, it was decided that although CSA was defined in numerous ways in different countries, the general definition of childhood sexual abuse will be largely defined under Singapore law, viz., the Children and Young Persons Act.

Under the Act, a person who sexually exploits a child (i.e., those below 14 years old) or a young person under 16 years old, is further defined as one who,

• in public or private, commits or abets the commission of or procures or attempts
• to procure the commission by any person of any obscene or indecent act with any
• child or young person.

The Ministry of Community Development and Sports further clarified in their publication “Love our Children – Prevent Child Abuse” that sexual abuse is the exploitation of a young person for sexual gratification or any sexual activity between an adult and a child. It also includes exposing a child to forms of sexual acts or pornographic materials.

Given the guidelines above, the operational definition used in terms of sexual behaviour will be categorized into non-contact and contact sexual abuse. Non-contact sexual abuse broadly encompasses encounters with exhibitionists or voyeurs, the solicitation to engage in sexual activity, where no physical contact occurred, and exposure to pornographic material.

Non-contact sexual abuses will, therefore, include the following:

• Voyeurism, where a person receives sexual gratification from seeing the genitalia of children or witnessing children involved in sexual acts with other children/ adults. Cameron called it visual rape, where eyes can follow, fix on, leer, undress, pry, and probe an unwilling target, included nudity and disrobing;
• Exhibitionism where the offender exposes his/her genital to a child;
• Sexual talk or comments that are demeaning and threatening, directed at a child;
• Where the offender induces a child to undress and/or masturbate self;
• Exposing a child to pornographic material; and
• Photographing a child in various stages of undress, exposure of their genitalia, or involvement in sexual acts with self/others .

Contact sexual abuse pertains to all behaviours that involve non-penetrative and penetrative sexual contact, including,

• Touching, stroking, or fondling the child’s body or intimate parts (e.g., genitals, buttocks, breasts);
• Attempts to have the child arouse the perpetrator by touching his/her intimate parts or body in a sexual way ;
• Kissing by the perpetrator on the child's mouth or different parts of the body;
• Frottage where the offender rubs their genitals against the victim's body or clothing;
• Cunnilingus where oral stimulation of the female genitalia is performed by the child or the perpetrator;
• Fellatio where oral stimulation of the penis is done by the offender or the child; and
• Vaginal or anal penetration with the perpetrator's penis, finger or other object.

An additional criteria to define child sexual abuse, in terms of the age differential between the perpetrator and the victim, was taken from a modified version of Finkelhor’s Sexual Victimisation of Children Survey, i.e., sexual abuse is to include any sexual experience occurring at age 16 or younger, with the perpetrator being at least 5 years older and a minimum age of 16 at the time of the abuse(s).

An understanding of coping strategies employed by male and female survivors will inform implications for intervention for practitioners within the Singapore context as no research has been carried out in this area. This is especially critical as men and boys are more likely to deny that they were sexually abused.

Furthermore, Holmes & Offen concluded in their study that the apparent low number of identification of male victims is due in part to a lack of awareness in clinicians to the possibility that males, including their male clients, are sexually abused.

This is a synopsis of a segment of my postgraduate thesis. Relevant material will be summarized in this blog over the coming weeks. References and citations have been omitted to condense the article and improve readability.

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