Ritual child abuse

Rituals are a principal aspect of many cultures and subcultures. Ritualistic practices involve the cross-generational expression and transmission of the beliefs, traditions and world views of both religious and secular groups. ^[1] Ritual child abuse in particular is defined as the involvement of children in physical, psychological or sexual abuse associated with repeated activities which purport to relate the abuse to contexts of a religious, magical, supernatural, medical or cultural kind. ^[2]

The use of both religious and non-religious belief systems as a motivating factor underlying ritualistic practices is a common characteristic of ritual child abuse. ^[3] While the term ‘abuse’ has been employed due to these practices often having particularly negative physical and psychological health effects on children that are deemed a violation of human rights by the International NGO Council on Violence against Children, it must be noted that many of the cultural groups engaging in these rituals do not see them as abuse but rather significant indicators of maturation, beauty, chastity, health and social standing in their respective communities. ^[4] Regions exhibiting a prevalence of ritual child abuse include Sub-Saharan Africa, South-East Asia and the Middle-East.

The introduction to the 2006 report of the UN Secretary-General's Study on Violence against Children notes: “In every region, in contradiction to human rights obligations and children’s developmental needs, violence against children is socially approved and is frequently legal and state authorized.” ^[3]

Ritual child abuse is distinct from organized child sexual abuse and satanic ritual abuse, although the latter two forms of abuse can be included in the former as a subset. In 1991, the newly established concept of ritual child abuse was officially acknowledged as a subset of organized abuse in a revised edition of the Working Together under the Children Act produced by the Department of Health in 1989. ^[3]

Types

Birth superstitions

Certain types of births could lead to violence, abandonment and murder based on families superstition that a child born through such a birth could be an omen of bad luck, a user of witchcraft or demonic, among other beliefs. These types of births include multiple births where more than one child is born at the same time; the birth order and the sex of the child such as a boy born after multiple girl children or vice versa; premature births; quick births where the child comes out of the birthing canal very fast; and the infant having an unusual birth position during the labor period. ^[5] Such newborns can be ostracized from society and maltreated by their family and other community members.

Historical Origins

In the early 19th century, superstitions about cauls originated in Great Britain and Rome. ^[6] Superstitions regarding multiple births originated in Onitsha, Nigeria in the early 20th century. ^[7]

Regional Statistics

Twin-killing is practiced in the traditional society of Igbo in Nigeria. ^[8] A 1993 study found that 9% of 619 women interviewed in the rural areas of Efik, Ibibio and Annang tribes of South-Eastern Nigeria held a taboo against twins. 2.3% and 2.6% of mothers respectively rejected or killed their twins. ^[8] Moreover, in some African countries like Kenya, there is much superstition surrounding babies that are born with teeth. ^[9] A 1992 survey in Nigeria revealed that 4% of 622 people said that they would get rid of a child that had developed teeth prematurely. ^[10]

Health Consequences

Some physical consequences include malnutrition, deprivation and neglect, physical violence and, in extreme cases, death. Some psychological consequences include depression and post traumatic stress disorder, often arising from shame and social isolation. ^[11]

Policy Initiatives

In 2003, the Committee on the Rights of the Child in Madagascar noted: "The Committee notes that the murder or rejection of children thought to be 'born on an unlucky day' is beginning to disappear, but remains deeply concerned that such murders still occur and at the rejection or abandonment of twins in the Mananjary region." ^[11] In 2004, the Christian missionary Steven Olusola Ajayi opened a shelter called the Vine Heritage Home to house children that were abandoned due to these birth superstitions. ^[12]

Bloodletting

Bloodletting is the practice of draining a child's body of ‘bad blood’, which is believed to be a way to treat a variety of illnesses ranging from fever and headaches to rheumatism and meningitis. It is practiced through puncturing or cutting a child's arm or scalp. ^[11] Three different types of procedures used to perform the act of bloodletting are cupping, leeching and phlebotomy. ^[13]

Historical Origins

Bloodletting is considered to have originated in Ancient Egypt and Greece. During the 3rd century B.C., physicians such as Erasistratus believed that all illnesses stemmed from a plethora of blood. ^[14] In the 2nd century A.D., Galen promoted Hippocrates' theory on the necessary balance between the 4 "humours" - blood, phlegm, yellow bile and black bile - to maintain good health. ^[15] It is suggested that the practice of bloodletting has persisted through time because it is a readily available measure to people of all socioeconomic statuses. ^[16]

Regional Statistics

The traditional practice of bloodletting through incisions and surgical methods is practiced in limited regions such as Tajikistan and Ethiopia. In Tajikistan, the practice is referred to as 'kolak', involving making small cuts on the roof of the mouth, back, chest or stomach of infants to release bad blood. ^[11] It is repeated as frequently as 3 to 4 times per week. In Ethiopia, bloodletting continues to be practiced despite communities demonstrating high rates of understanding the health consequences of the practice. ^[11]

The modern practice of bloodletting is through leeching. ^[17] Leeching, or hirudotherapy, involves the use of leeches for the practice of bloodletting or medical therapy. ^[18] Leeching is popularly practiced worldwide for a variety of medical conditions, including skin diseases, nervous disorders, pains, fissures and certain infections. ^[19]

Health Consequences

Some of the health consequences of bloodletting include severe bleeding, anemia, infections, the contraction of sexually transmitted diseases and, in extreme cases, death. In women, it could also lead to irregular menstruation. ^[13] Leech therapy could lead to infections with certain bacterial species such as Aeromonas hydrophilia, Aeromonas veronii and Mycobacterium marinum, excessive bleeding, and in some cases, thrombotic microangiopathy, leading to renal failure. ^[19]

Policy Initiatives

In 2010, the California Department of Consumer Affairs (DCA) forbid the practice of Chinese bloodletting by licensed acupuncturists on account of allegations on unsanitary methods of conducting the procedure. ^[20] In 2004, the Food and Drug Administration (FDA) cleared the first application for leeches to be used in modern medical therapy. ^[21] Medicinal leeches are regulated by Health Canada under the Food and Drugs Act and Regulations. ^[22]

Breast flattening

Main article: Breast ironing

Breast flattening or breast ironing is a procedure involving pushing or massaging hot objects such as stones or hammers into a girl's breasts to prevent them from growing. Other tools used include wooden pestles, spatulas, brooms, belts and leaves. ^[23] The girls are usually between 8 and 12 years of age. ^[24] In 58% of the cases, the act is performed by the mother. However, it may also be performed by a nurse, caretaker, aunt, older sister, grandmother, the girl herself or another member of the community, usually a female. The severity of the practice ranges from using hot leaves to massage the girl's breasts to using hot stones to crush the budding gland. The procedure is believed to reduce sexual urges in girls, preventing them from getting pregnant at an early age and also reduce the likelihood of the girl getting raped or sexually assaulted. ^[24]

Regional Statistics

Nearly 1 in 4 schoolgirls in Cameroon report been subjected to the practice. ^[25] Other regions where breast ironing is practiced are Central and West Africa. ^[24] A large scale representative study by the German Society for International Cooperation (GIZ) found a large variety of the prevalence of the practice in different regions, ranging from 53% of women having undergone breast flattening in the Littoral region of Cameroon to 7% of women in the Northern regions. ^[26]

Health Consequences

Some physical consequences include swelling, burning, irritation, pimples on the breasts, fever, extreme pain, long term overgrowth of one or both of the breasts or alternatively the failure of either breast to grow, abscesses, breast cancer and problems with breastfeeding. ^[27] Some psychological consequences include depression and psychological distress from social isolation and experiencing fear and shame. ^[27]

Policy Initiatives

The German Cameroonian Health Sector Program (GIZ) and the National Network of Aunties (RENATA) are non-governmental organizations that are campaigning on behalf of girls that have undergone breast flattening. ^[25] The Cameroonian Government signed a joint action agreement with Plan International, an organization that has been working on collecting testimonials from girls about their experiences, to encourage victims to come forward and advocate against the practice. ^[28] Some domestic and international are petitioning to criminalize the practice. ^[26]

Cosmetic mutilation

Cosmetic mutilation is a secular form of ritual violence that is concentrated on females in particular due to the belief that it enhances beauty. In its mildest form, this can include things as basic as ear piercing, which is common during infancy in most countries throughout the world including west European cultures. ^[29] Neck rings are an example of cosmetic mutilation in which heavy metal rings are placed around the neck of girls at timed intervals until she has reached womanhood or a suitable age to be married. ^[29] This ritual is motivated by the belief that it enhances beauty and wealth and is most common in Asia and Southern Africa. ^[29] Lip plates involve making cuts on a girl's lips or ears and inserting a plate to stretch the lip or body part to the desired shape. ^[29] This is also done to enhance beauty. The lip plate ritual is most commonly practiced in parts of Ethiopia and Brazil. In India, it is common for people in the state Chhattisgarh to tattoo names of local deities on to the foreheads or arms of their children, at ages as young as five. ^[30]

Historical Origins

Tattooing has been practiced by humans as far back as Neolithic times, though its precise use in rituals involving children varies from region to region. Tattoos have been used as cultural and religious symbols among many tribal populations in India for hundreds of years, most notably by the Apatani tribe of Arunachal Pradesh. ^[31] In this region, young girls were tattooed on their faces to make them unappealing to the rival tribes of the neighboring districts so these tribes would not abduct them. ^[31]

Lip plates have been employed by tribes across Ethiopia, Tanzania and Mozambique for centuries. In Brazil, some tribes including the Suyá and Botocudo have traditionally seen both men and women wearing lip plates. In the late nineteenth and early twentieth centuries, African women donning lip plates were transported to Europe and North America for to be showcased for public entertainment in circuses.

Neck rings were first identified by Marco Polo in c.1300.

Regional Statistics

There are an estimated 10,000 members of the Mursi tribe from Southern Ethiopia with lip plates. ^[32]

Health Consequences

In extreme cases, cosmetic mutilation can cause severe pain to the child not just once but at regular intervals, which is the case for neck rings and lip plates. The weight of the rings alters the growth of the ribs, shoulders, and clavicles, and could potentially crush a child's collarbones. ^[33] In Myanmar, it is common for girls aged two to five in the Kayan culture to wear brass collars until their collarbone is deformed. ^[34]

Lip plates can cause infection or malnutrition as the child may not eat due to pain caused by moving her lips. ^[34]

Tattooing children can result in exposure to infectious diseases including methicillin-resistant staphylococcus aureus (MRSA), hepatitis B and hepatitis C from either the needle or open wound. ^[35]

Policy Initiatives

In 1962, due to the institution of a new government, new laws were enacted in Burma prohibiting any enactment of the neck ring ritual. In order to preserve their culture, customs, and identity, the Padaung fled to Thailand. ^[36]

In 1984, the Commission on Human Rights adopted its first resolution on “traditional practices affecting the health of women and children” (1984/48, 13 March 1984) and the issue became a regular item on the Commission's (now the Human Rights Council's) agenda. ^[34]

Cursing

Cursing is a form of ritual violence that is a subset of witchcraft. Cursing rituals usually stem from an overarching belief in some sort of witchcraft or “Juju,” in which certain deities or spirits are used as a way to coerce the child into subservience. ^[37] This subservience often results in children being involved in trafficking or sexual exploitation. ^[38] Often, children are also accused of being possessed or witches. Usually, a child will be asked to provide some of their hair, blood or personal belongings to the trafficker which will be contained in a ‘packet,’ after which he or she is taken to a shrine or graveyard to swear an oath as part of the ritual. ^[37] The oath may be designed to guarantee beauty or prosperity for the child, and is a means by which the child can be prevented from speaking out about his or her experiences, from running away, or as a method of ensuring that they work off a ‘debt’. ^[37] The ‘debt’ is often so high that the child is unable to ever pay it off. Frequent reports from victims refer to these practices as ‘voodoo’ or ‘juju’, but there are many other descriptions depending on their country of origin namely, ‘kindoki’, ‘ndoki’, ‘djinns’, or ‘obeah.’ ^[37]

Historical Origins

Cursing rituals involving both children and adults date back to ancient times, but resurfaced in a contemporary setting around 1969 with the advent of LaVeyan Satanism. Many cursing rituals around the world were largely aggravated by the Satanic panic phenomenon, which was particularly prevalent in South Africa.

Regional Statistics

In Nigeria, thousands of children are accused of witchcraft by their families per annum and abused or killed as a result. ^[39] According to a UN report on voodoo rituals, hundreds of children have been kidnapped and brought to the UK for religious rituals, with thousands more being smuggled in for sexual exploitation and slavery. ^[40] The 2012 UNODC Global Report on Trafficking in Persons presented the following gender and age profile of victims across the world in 2009: girls − 17% and boys − 10%, a large portion of which is concentrated in Europe. ^[41]

Health Consequences

In extreme cases, cursing rituals can result in physical injury or death due to the requirement of the child to hurt himself or herself as part of the ritual oath. ^[37] Such rituals can also result in lifelong trauma, inducing depression or PTSD. ^[42]

Policy Initiatives

The state governor of Akwa Ibom state in Nigeria passed a law making it illegal to accuse a child of witchcraft in 2012. ^[43] The European Parliamentary Research Service has suggested that the use of multiple identities for small children in child trafficking is facilitated through the fact that EURODAC does not require the fingerprints of children under five years of age to be taken, and could be altered. ^[43]

Dowry and bride price

Bride price describes any practice where commodities, money, or services or some combination of all three are exchanged in return for a bride, provided by one of the families daughters. Dowry typically refers to what a bride's family pays, while bride price refers to what the groom's family pays. Many of the same factors that push families to perform FGM on their daughters are present here as well, so there is a high correlation between the two practices. ^[44] Some relevant cultural forces to practice dowry and bride price are:

• Increases the odds that a woman will maintain her premarital virginity and martial fidelity.
• Has been practiced for generations as a cultural tradition.

This treatment or preparation may start in early childhood for women, since it is important to safeguard the daughter's virginity as early as possible, but also to shift the “burden” that the daughter represents to the other family. Some families may not be able to afford the dowry or are forced to pay greater amounts over time, which may force other members of the family to begin working. ^[4] This disproportionately puts young girls at risk, not to mention precludes poor young men from being able to marry. Currently, the bride price system is more widely practice in parts of Africa, while the dowry system exists primarily in South Asia.

Historical Origins

This is a phenomenon that has its roots all over the world and across time periods, to as early as before 0 CE. In some form, this practice existed in Babylon, Greece, the Roman Empire, and various other societies in East Asia, Europe, and the Americas. ^{[45] [46] [47]}

Regional Statistics

The use of dowry and bride price continues to be active around the Indian subcontinent. In 2006, there were 7600 dowry-related deaths in India, however, some there is wide variation in estimates given, because of how prevalent dowry and dowry abuse can be, not to mention the amount of resources that would be required to compile a comprehensive survey of the practice. In India, for 2001, there were 163,000 fire-related deaths of women aged 15–44; this figure collected by the World Health Organization is six times the amount given in the national crime statistics. ^[48] In Southeast Asia, fire-related deaths is the third most common cause of death for women aged 15–44, while for women worldwide, it is the seventh most common. ^[48]

Health Consequences

Dowry demands when left unsatisfied, often translate into violence being perpetrated against the new wives by the husbands and his families. Dowry-related violence can consist of acid burning, fire burning, physical abuse, or even the murder of newly married women when conflicts arise regarding the fulfillment of the dowry. This violence and practice is born from communities that practice son preference or preferentially value males over females. This practice reinforces other forms of abuse, such as the previously mentioned son preference or child marriage, ^[49] as parents attempt to rid themselves of the burden of having a daughter.

Policy Initiatives

In Pakistan, like India, despite the prevalence of the dowry practice and associated violence and murders, related cases are rarely seen in the justice system, with convictions being even rarer. ^[50] In India, the first nationwide anti-dowry law, the Dowry Prohibition Act, was passed in 1961. ^[51] There have been other anti-dowry laws since to support this legislation, however, dowry continues to be a common practice. Many Middle Eastern and Southeast Asian nations may legally permit dowry and even for those who do not, the state is still developing and unable to efficiently restrict it.

Female genital mutilation (FGM)

The most common form of cosmetic mutilation focused on females is Female Genital Mutilation or FGM. This involves surgical removal of parts of sensitive female genital organs. Often, this ritual represents a rite of passage, marking a female child's coming of age. It is also conducted to ensure a woman's virginity and decrease prospects of her engaging in sexual activity before marriage. ^[4]

Historical Origins

The practice of FGM is said to predate Christianity and Islam. ^[52] In ancient Rome, metal rings were passed through the labia minora of slaves to prevent them from having children and in medieval England, metal chastity belts were worn by women to mitigate promiscuity during their husbands' absence. ^[52] Examination of mummified bodies have shown that in ancient Egypt, both excision and infibulation were carried out. ^[52] In addition to nineteenth century England, tsarist Russia, France and America have experienced the widespread practice of clitoridectomy. ^[52] In England and America, FGM was performed on women as a "cure" for numerous psychological ailments. ^[52]

Regional Statistics

According to a 2013 UNICEF report covering 29 countries in Africa and the Middle East, Ethiopia has the region's highest total number of women that have undergone FGM (27.2 million), while Somalia has the highest percentage (prevalence) of FGM (98%). ^[53] Data also shows that girls 14 and younger represent 44 million of those who have been cut, with the highest prevalence of FGM among this age in Gambia at 56%, Mauritania at 54% and Indonesia where around half of girls aged 11 and younger have undergone the practice. Countries with the highest prevalence among girls and women aged 15 to 49 are Somalia (98%), Guinea (97%) and Djibouti (93%). ^[53]

Health Consequences

Contrary to popular belief, there are no health benefits to FGM. FGM can lead to a series of health complications including blood-transmitted diseases like HIV/AIDS. ^[52] Haemorrhage, infection and acute pain are the immediate consequences. ^[52] Keloid formation, infertility as a result of infection, obstructed labour and psychological complications are potential long-term effects. In rural areas where untrained traditional birth attendants perform the operations, complications resulting from deep cuts and infected instruments can cause the death of the child. ^[52]

Policy Initiatives

In July 2003, at its second summit, the African Union adopted the Maputo Protocol promoting women's rights and calling for an end to FGM. The agreement came into force in November 2005, and by December 2008, 25 member countries had ratified it. ^[52] The Convention on the Elimination of All Forms of Discrimination against Women was ratified by 136 States as of January 1995 and classifies FGM as a primary concern. The Convention obliges States parties, in general, to "pursue by all appropriate means and without delay a policy of eliminating discrimination against women." ^[52]

Male Circumcision

Male circumcision involves the removal of the foreskin from the penis. ^[54] It is a surgical procedure in which the foreskin is opened and separated from the glans. ^[55] The procedure is most commonly performed on children for religious and cultural reasons. ^[56] It can also be performed for the treatment of certain medical conditions such as urinary tract infections, phimosis and balanoposthitis. ^[57]

Historical Origins

The origins of circumcision date back to 2400 B.C.E. in Egypt, where an engraving of an adult male being circumcised was found in the tomb of Ankh-Mahor at Saqqara. It is believed that the Egyptians practiced circumcision for hygiene and also because of their obsession with purity, which was associated with intellectual and spiritual development. ^[58] During the 4th millennium B.C., circumcision was practiced by the Sumerians and Semites in the Arabian Peninsula. ^[59] Circumcision features in the narrative of Genesis Chapter 17 of the Hebrew Bible, where the circumcision of Abraham and his relatives is described. ^[60] The practice is thought to have been brought to Africa by the Bantu-speaking tribes. ^[59]

Regional Statistics

39% of males worldwide are circumcised, out of which 50% undergo the procedure for religious or cultural reasons. ^[61]

Region	Prevalence (as of 2007) [56]
United States	75%
Canada	30%
Europe	<20%
Australia	58.7%
Taiwan	9%
South Africa	20%
North and West Africa	~100%

In 2007, the World Health Organization (WHO) estimated that out of the 30% of males under 15 that had been circumcised globally, 70% were Muslim.

Health Consequences

The opinion of major health organizations on the practice of circumcision varies due to its potential health benefits. ^[62] For example, the World Health Organization recommends the practice of circumcision in Sub-Saharan Africa to prevent HIV. ^[63] However, the controversy over legal rights and informed consent arises when the practice of circumcision is performed for non-medical reasons. ^[64] In 2010, a review found that practitioners have complications regarding the procedure 1.5% of the times when the patient is an infant and 6% of the times when the patient is a child. ^[65] Complications include bleeding, the removal of too much or too little foreskin and infections. ^[65] The procedure on infants could lead to heightened pain responses, such as during vaccinations, later on. ^[66] Infants may also experience changes in sleeping patterns, irritability, caretaker-bonding and changes in feeding. ^[67]

Policy Initiatives

The World Health Organization (2010) and the International AIDS Society-USA (2007) recommend the use of circumcision in regions with high HIV rates. ^[68] Regarding general circumcision, the British Medical Journal published an article in 1949 stating that there was no medical benefit from generally circumcising males. ^[56] The Canadian Pediatric Society released a statement in the 1970s stating that the procedure of male circumcision was not medically indicated. ^[56] Such initiatives have been seen to reduce circumcision rates in the UK and Canada respectively. ^[56]

Swaddling

Swaddling, or the binding of an infant, involves wrapping them in a cloth to restrict the physical movements of their body, except the head. The materials used to wrap infants usually include cotton blankets and cotton muslin wraps. Swaddling is believed to help soothe irritable infants and reduce the frequency of awakenings while the infant is sleeping. ^[69]

Historical Origins

It is a common notion amongst several authors that swaddling began in the Paleolithic period. ^[70] The earliest depictions of swaddling are votive statuettes of swaddled babies found in the tombs of Ancient Greek and Roman women who died during the process of childbirth. These have been found in Crete and Cyprus and date back around 4500 years. ^[71]

Another popular record of swaddling is in the New Testament about the birth of Jesus in Luke [2:6-2:7]: And so it was, that, while they were there, the days were accomplished that she should be delivered. And she brought forth her firstborn son, and wrapped him in swaddling clothes and laid him in a manger; because there was no room for them in the inn. The swaddling clothes described in the Bible were bandage-like strips.

Regional Statistics

Studies from the Human Relations Area Files show that 39% of all documented, contemporary, non-industrialized cultures practice swaddling. ^[72] 93/1% of infants in Turkey are swaddled. ^[73] In Britain, 19.4% of infants are swaddled. ^[74] Research indicates the growing popularity of swaddling in the United States, Great Britain and the Netherlands. ^[75]

Health Consequences

Some of the prominent health consequences of swaddling are mentioned below. Swaddling increases the risk for hip dysplasia. ^{[76] [77] [78] [79] [80] [81] [82]} Tight swaddling can lead to hyperthermia. ^[83] The risk of developing respiratory infections is increased. ^[84] There is also a delayed recovery from post-natal weight loss. ^[85]

Policy Initiatives

There are no direct policies regarding the practice of swaddling. The American Academy of Pediatrics (AAP) claims that when done correctly, swaddling serves to calm babies. The AAP has released a document on safe sleep recommendations. ^[86] The Government of South Australia has also provided guidelines on how to safely swaddle infants. ^[87]

See also

Wikisource has original text related to this article: Investigator's guide to allegations of 'ritual' child abuse

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