Global Prevalence of Past-Year Violence Against Children: A Systematic Review and Minimum Estimates
Global Prevalence of Past-Year Violence Against Children: A Systematic Review and Minimum Estimates
CONTEXT: Evidence confirms associations between childhood violence and major causes of abstract
mortality in adulthood. A synthesis of data on past-year prevalence of violence against
children will help advance the United Nations’ call to end all violence against children.
OBJECTIVES: Investigators systematically reviewed population-based surveys on the
prevalence of past-year violence against children and synthesized the best available
evidence to generate minimum regional and global estimates.
DATA SOURCES: We searched Medline, PubMed, Global Health, NBASE, CINAHL, and the World
Wide Web for reports of representative surveys estimating prevalences of violence against
children.
STUDY SELECTION: Two investigators independently assessed surveys against inclusion criteria
and rated those included on indicators of quality.
DATA EXTRACTION: Investigators extracted data on past-year prevalences of violent victimization
by country, age group, and type (physical, sexual, emotional, or multiple types). We used a
triangulation approach which synthesized data to generate minimum regional prevalences,
derived from population-weighted averages of the country-specific prevalences.
RESULTS: Thirty-eight reports provided quality data for 96 countries on past-year prevalences
of violence against children. Base case estimates showed a minimum of 50% or more of
children in Asia, Africa, and Northern America experienced past-year violence, and that
globally over half of all children—1 billion children, ages 2–17 years—experienced such
violence.
LIMITATIONS: Due to variations in timing and types of violence reported, triangulation could
only be used to generate minimum prevalence estimates.
CONCLUSIONS: Expanded population-based surveillance of violence against children is essential
to target prevention and drive the urgent investment in action endorsed in the United
Nations 2030 Sustainable Development Agenda.
bDivision of Violence Prevention; aNational Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; and cDepartment of Medicine,
Drs Hillis and Mercy conceptualized and designed the study, drafted the initial manuscript, approved the final manuscript as submitted, and are accountable for
representing all aspects of the work; Drs Hillis and Kress conducted the systematic review, abstracted relevant data, analyzed and/or interpreted the synthesized
data, revised and approved the final manuscript, and are accountable for representing all aspects of the work; and Dr Amobi contributed to acquiring, synthesizing,
and interpreting the data, drafting, reviewing, and revising the manuscript, approved the final manuscript as submitted, and is accountable for representing all
aspects of the work.
To cite: Hillis S, Mercy J, Amobi A, et al. Global Prevalence of Past-year Violence Against Children: A Systematic Review and Minimum Estimates. Pediatrics.
2016;137(3):e20154079
METHODS
5
to the corresponding 2014 reference 2 to 14 years and 15 to 17 years Latin America (Table 2). For Europe,
population age group for that experiencing violence and the sum prevalences of the more severe types
country: either the 2- to 14-year-old of corresponding regional 2014 of violence included in the base
or the 15- to 17-year-old population. populations to estimate regional case scenario tended to be lower
Disaggregated age data were and global minimum prevalences than for other regions. We largely
available for 110 of 112 abstracted and numbers of children ages 2 to computed these base case minimum
prevalence estimates, either through 17 years experiencing past-year estimates for 2- to 14-year-olds
age-related eligibility criteria for violence. Finally, we used a similar by using country-specific highest
a given survey or through age- population-weighted approach to reported prevalence for 1 type of
stratified data for surveys including estimate minimum prevalences of violence (eg, severe physical violence
ages 0 to 17 years (see Supplemental past-year violence against children by caregivers for most countries),
Material for details). While reports based on the UN classification of because most surveys reporting
measuring violent discipline (eg, developed and developing nations. exposures to any violence for this
MICS) provided most country- The use of triangulation to critically age included spanking in their
specific estimates for ages 2 to 14 synthesize data on past-year violent definitions. In contrast, the sensitivity
years, those surveys focusing on victimization across surveys allowed analyses did include prevalence
adolescents, such as VACS, GSHS, and us to combine data for children living measures of any violence; synthesis
HBSC provided most data for the 15- in nearly half the countries in the of results for 2- to 14-year-olds
to 17-year-old population.10,14,15,25 world; ∼42% of the world’s children showed minimum prevalences of
For a given country, prevalence reside in these countries. past-year violence exceeded 60%
estimates may have included only 2- in Northern America, 60% in Latin
to 14-year-olds, only 15- to 17-year- America, 70% in Europe, 80% in Asia,
olds, or both (Supplemental Table 7, RESULTS and 80% in Africa (Table 3).
Supplemental Material).
Quality of Surveys
For the base case, our estimates for
Regional Estimates of Minimum The majority of surveys in our the entire group of 2- to 17-year-
Prevalences and Projected Numbers of review were high quality (Table 1). olds indicated that a minimum of
Children Exposed to Past-year Violence We confirmed 100% (112/112) of 64% of these children in Asia, 56%
For each region, we derived reports used probabilistic sampling, in Northern America, 50% in Africa,
estimates of the minimum prevalence and 100% used standard definitions 34% in Latin America, and 12%
of children exposed to past-year of exposures to violent behaviors. in Europe experienced past-year
violence from the population- In addition, 96% (108/112) violence (Table 4). The low estimate
weighted average of the country- described training of interviewers/ for Oceania is linked to the fact that
specific prevalences, and then questionnaire administrators, 93% representative surveys measuring
applied the known prevalences to (104/112) reported weighting prevalences of violence were only
the entire region. The 96 countries findings, 100% reported whether available for ages 15 to 17 years and
with population-based data included their surveys were national (102) or thus, we assumed none of the 2- to
24 in Africa, 20 in Asia, 9 in Latin/ subnational (10), and 70% (78/112) 14-year-olds experienced violence.
South America, 3 in Northern reported participation rates (39%– An estimation of the total minimum
America, 38 in Europe, and 2 in 99% range). Although nearly half numbers of children exposed, which
Oceania. We computed estimates of the countries in the world have is a function of both prevalence and
separately for 2- to 14-year-old published population-based data on size of the population-at-risk in 2014,
and 15-to 17-year-old populations, at least 1 type of violence, this also shows Asia has the highest number,
by using 2014 Census data53 to means that half of the countries in with over 700 million children
provide minimum prevalences of the world do not have such data. exposed; Africa follows with over 200
childhood violence by age (Table 2 million children; then Latin America,
and Supplemental Material). Next,
Synthesized Estimates Northern America, and Europe
we used the estimates of regional For the base case analysis of combined show over 100 million
prevalences from abstracted data minimum prevalences of past-year children exposed. The synthesized
to develop projected total minimum violence among 2- to 14-year olds findings for the base case scenario
numbers of children exposed to and 15- to 17-year-olds, we found indicate that, globally, a minimum of
violence in the corresponding that synthesized estimates for both over 1 billion children were exposed
region by age group. We then age groups approached or exceeded to violence during 2014 (Table 4).
used the sum of the minimum 50% for Africa, Asia, and Northern For the sensitivity analysis, we found
regional numbers of children ages America, and exceeded 30% for that a minimum of over 1.4 billion
Affected by VAC
j = (g/f) × (i)
36 691 983
101 949 939
10 943 618
6 967 841
8 006 772
640 197
2 to 17 years experienced physical,
emotional, and/or sexual violence in
the previous year (Table 4). Though
Total Population at Risk
Minimum prevalences and projected minimum estimates of total numbers of children affected. Excludes children exposed to moderate physical violence, which is defined as spanked, slapped in the face, hit, or shook.
estimated as suffering victimization
71 989 161
212 833 830
32 906 540
22 775 007
13 699 268
1 617 154
in the developing world in 2014
i
DISCUSSION
Ages 15–17 y
With Past-
year VAC
h = g/f
40
15 723 230
68 854 329
4 482 313
6 590 651
8 005 173
399 949
1 010 283
Not available
193 071 746
612 606 832
47 485 696
8 224 160
32 187 659
Minimum n
7 090 890
Census Data
Past-year
c = b/a
% With
50
68
34
8
56
Not available
From Reports
35 958 876
18 429 032
32 175 318
1 359 251
71 876 435
393 844 643
53 738 988
16 686 939
57 837 970
Census Data
Oceania
Europe
Region
TABLE 4 Regional and Global Projections of Minimum Prevalences of Past-year Violence, and Minimum Numbers of Children Exposed to Past-year Violence
Region Base Case Sensitivity Analysis
Children-at-Risk: Census Past-year Projected No. of Children Ages Past-year Estimate Projected No. of Children Ages 2–17
Population Ages 2–17 y Estimate of 2–17 y Exposed to Any Violence of Any Violence, y Exposed to Any Violence, Moderate
Any Violence or Severe Violence Moderate Violence, Violence, or Severe Violencea
or Severe or Severe Violence,
Violence, % %a
Africa 457 910 818 50 229 763 729 82 373 660 785
Asia 1 116 627 158 64 714 556 771 80 887 821 353
Latin 171 374 655 34 58 429 315 58 99 426 824
America
Europe 123 739 478 12 15 192 001 65 80 622 608
Northern 71 559 422 56 40 194 431 61 43 706 144
America
Oceania 8 708 044 7 640 197 7 640 197
World 1 949 919 575 54 1 058 776 444 76 1 485 877 910
“Any violence” includes, depending on survey type, exposure to 1 or more of the following: physical violence, emotional violence, sexual violence, bullying, or witnessing violence.
a Includes children exposed to moderate physical violence, which is defined as spanked, slapped in the face, hit, or shook.
TABLE 5 Global Projections of Minimum Prevalences of Past-year Violence and Minimum Numbers of Children Exposed to Past-year Violence by UN
Economic Groupings
Region Base Case Sensitivity Analysis
Children-at-Risk: Census Past-year Estimate Projected No. of Children Ages Past-year Estimate Projected No. of Children Ages 2–17 y
Population Ages 2–17 y of Any Violence or 2–17 y Exposed to Any Violence of Any Violence or Exposed to Any Violence or Moderate
Severe Violence, % or Severe Violence Moderate Violence or Violence or Severe Violencea
Severe Violence, %a
Developing 1 730 914 508 59 1 025 119 052 78 1 347 185 177
Countries
Developed 219 005 067 44 97 052 628 60 131 184 841
Countries
“Any violence” includes, depending on the survey type, exposure to 1 or more of the following: physical violence, emotional violence, sexual violence, bullying, or witnessing violence. Based
on UN developing countries, including least developed countries in: Africa, Asia excluding Japan, the Caribbean, Central America, South America, and Oceania excluding Australia and New
Zealand; and developed countries in: Northern America, Europe, Japan, Australia, New Zealand.
a Includes children exposed to moderate physical violence, which is defined as spanked, slapped in the face, hit, or shook.
The findings and conclusions in this paper are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and
Prevention.
DOI: 10.1542/peds.2015-4079
Accepted for publication Dec 7, 2015
Address correspondence to Susan Hillis, PhD, MSN, CAPT, U.S. Public Health Service, National Center for Injury Prevention and Control, Centers for Disease Control
and Prevention, 1600 Clifton Rd, Atlanta, GA 30333. E-mail: [email protected]
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2016 by the American Academy of Pediatrics
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: No external funding.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
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