Sexual violence against children in South Africa: A nationally representative cross-sectional study of prevalence and correlates

Background We could identify no nationally representative South African studies of sexual violence against children. Methods A multistage sampling frame, stratified by province, urban/rural and race group, selected households. Within households, children aged 15-17 years were interviewed after obtaining parental consent. The final sample was 5,631 (94.6% participation rate). Findings 9.99% (95%CI 8.65-11.47) of boys and 14.61% (95%CI 12.83-16.56) of girls reported some lifetime sexual victimisation. Physical abuse, emotional abuse, neglect, family violence, and other victimisations, were all strongly associated with sexual victimisation. The following were associated with greater risk of sexual abuse (adjusted OR); school enrolment (OR 2.12; 95%CI 1.29-3.48); urban dwelling (OR 0.59; 95%CI 0.43-0.80); having a flush toilet (OR 1.43; 95%CI 1.04-1.96); having a substance-misusing parent ( OR 2.37; 95%CI 1.67-3.36); being disabled (OR 1.42; 95%CI 1.10-1.82); female but not male caregivers’ poorer knowledge of the child’s whereabouts, friends and activities (OR 1.07; 95%CI 0.75-1.53) and poorer quality of the relationship with the child (OR 1.20; 95%CI 0.55-2.60). Respondents’ own substance misuse (OR 4.72; 95%CI 3.73-5.98) and high-risk sexual behaviour (OR 3.71; 95%CI 2.99-4.61) were the behaviours most frequently associated with sexual abuse, with mental health conditions far less prevalent but nonetheless strongly associated with sexual victimisation (PTSD OR 2.81, 95%CI 1.65-4.78; depression OR 3.43, 95% CI 2.26-5.19; anxiety OR 2.48, 95%CI 1.61-3.81). Interpretation Sexual violence is widespread among both girls and boys, and is associated with serious health problems. Associated factors require multi-sectoral responses to prevent sexual violence or mitigate consequences