Childhood sexual abuse and bullying are serious problems societies now encounter. It is established that it has a wide range of long-term psychiatric, psychosocial, and physical health outcomes (5). According to the literature review we conducted, studies on CSAB prevalence rates are primarily descriptive or cross-sectional in sub-population, and longitudinal trends are not well documented. This study assessed the trends of CSAB prevalence rates across 204 countries and territories in 25 years from 1990 to 2019.
Our results demonstrate that an overall significant increase in CSAB prevalence over time has been observed during the past decades in developed and low developed countries. Although, CSAB generally has been more accruing and has a more increasing rate in low developed countries versus developed ones in both genders. Other research also supports our results that the prevalence rate in low developed countries is more than in developed ones. There are multiple factors involved, including the socioeconomic state in these populations, instabilities resulting from armed conflicts, uncontrolled natural hazards and widespread political violence (15). These results might contrast with the fact that there have been endeavors to educate people, families, and even the children themselves in recent decades, so we expected a decline in this era, but we saw otherwise (4). This might be because of the disclosure rate that is increasing as a result of these efforts. Furthermore, as D.Russell et al. suggest, these prevention strategies, although valuable, might not be as effective because they are mostly school-based, and a significant gap in knowledge of the CSAB is visible at a population level(16).
In our data, the prevalence of CSAB in boys was more than in girls, which is in line with the study published by Biswas et al. (17) This finding might be for various reasons, first that there is less protection against CSAB happening to boys since people expect it less, and secondly again it might be due to the disclosure rate that is more in boys versus girls because families often do not report the event happening to their girls because of social stigma. Furthermore, another reason is that boys also undergo sexual violence in sports and exercise (18). As other analyses also show, this result demonstrates the importance of engaging boys and men in the fight against CSAB because other than these numbers, they have various roles in this problem they undergo this tragedy, are more likely to be the perpetrators, and they are the viable champions of change (16). In line with our study, being a girl is associated with an increase in sexual violence (15). According to our results, African girls and boys had the most rates and increasing trend among regions. This may be due to the wars, unstable living situations, and increasing poverty in those regions (15).
Finally, we determined which countries had a similar trend of CSAB during past decades. Our finding showed that boys and girls in Chile, boys in Sweden and Spain, and girls in the Netherlands and Lithuania were the only cases with decreasing rates. Due to shame and guilt and lack of support in Chile, both girls and boys have trouble revealing the CSAB. This is especially true for boys in macho cultures (19). We found that Sweden has a published National Action Plan for Safeguarding Children from Sexual Exploitation. Its effectiveness shows the necessities of a plan being considered by every country (20). Shila et al. also, in their research, said that there had been a decrease in CSV prevalence in some groups in the Netherlands, but there is still much work needed to be done (21). As some research shows, there is high child abuse prevalence in Lithuania, and they have mentioned some reasons too. However, it is not in contrast to our results because in the period of our data Lithuania went through the first decade of their Independence 1990–2001, and the regime change, as Kabašinskaitė et al. say, was a transient reason that happened, and after a while now the situation is progressing (22, 23).
The majority of countries had an increasing trend of CSAB, which is essential and needs more epidemiological studies. For example, Bhutan, Botswana, Canada, Egypt, Estonia, Ghana, Greenland, Nicaragua, Pakistan, Turkey, and Zambia have the most increasing male childhood sexual abuse rates. Also, Bangladesh, Bhutan, Canada, Egypt, Ghana, Greenland, Nepal, Nicaragua, Pakistan, Sweden, Turkey, the United States of America, and Zambia have the sharpest increasing female childhood sexual abuse rates. Most of these countries are undergoing all kinds of wars like civil and political ones (15). These countries do not share significant similarities. They are from different continents, and we can see different cultures and religions from Buddhism and Islam to Christianity; they are developing, developed, and underdeveloped countries in this list, emphasizing how the factors are associated with CSAB can be different. It seems that the prevention programs and education cause children can more easily express sexual violence. School enrollment, for example, is a factor decreasing the CSV, which can be a reason for more disclosure and an increasing trend over the previous decades (15, 24).
This study embodies some limitations. The lack of data for CVAB prevalence rate in some countries at a specific time makes GBD report the estimated rates. Also, it should be noted that the definition of CSAB may be different in various populations, and its disclosure is not the same in all countries. We found this study essential to help obtain future targeted programming and prevention on a more holistic and population-based level.