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European status report on preventing child maltreatment

Authors: Dinesh Sethi, Yongjie Yon, Nikesh Parekh, Thomas Anderson, Jasmine Huber, Ivo Rakovac and Franziska Meinck

Child maltreatment is the physical, sexual and/or emotional abuse and/or neglect of children under 18 years of age. It was estimated in 2015 that 629 children died by homicide in the WHO European Region. Deaths represent just the very tip of the iceberg – for every death there are thousands of child protection referrals and hospital admissions for child maltreatment. Beneath the official statistics is a hidden pandemic of adverse childhood experiences, which are strongly related to maltreatment. It is estimated that child maltreatment affects at least 55 million children in the Region.

Biological systems are disrupted by child maltreatment during a time of major brain development, conferring serious risk to physical, psychological and reproductive health and societal attainment through the life-course. Some of the most intractable public health problems, including substance misuse, high-risk sexual activity, noncommunicable disease, mental illness and interpersonal violence, are influenced by experiencing maltreatment and other adversity in childhood. The costs to society from reduced social cohesion, lost productivity and avoidable health-service use are substantial.

Child maltreatment is preventable. Clear risk factors exist at individual, parent and caregiver, and community and society levels. Until recently, much of society’s reaction has been to respond to abuse and neglect only when, and if, detected. While a child protection response is critical, evidence shows strongly that prevention is much more cost–effective. It makes more sense to safeguard children’s right to a nurturing upbringing by preventing maltreatment from occurring in the first instance, rather than deal with its consequences.

The WHO Regional Office for Europe published the European report on preventing child maltreatment in 2013 to catalyse policy-makers and practitioners to take preventive action against child maltreatment. Following this, the WHO Regional Committee for Europe adopted resolution EUR/RC64/13, Investing in children: the European child maltreatment prevention action plan 2015–2020, in 2014. This set a target of reducing the prevalence of child maltreatment in the Region by 20% by 2020. The plan set out three main objectives for achieving this target:

1. make health risks such as child maltreatment more visible by setting up information systems in Member States;

2. strengthen governance for the prevention of child maltreatment through partnerships and multisectoral action by developing national plans; and

3. reduce risks for child maltreatment and its consequences through prevention by strengthening health systems in Member States.

The prevention of child maltreatment also features prominently in the Sustainable Development Goals, with four targets (5.2, 5.3, 16.1 and 16.2) addressing the ending of violence against children and several more (within goals 1, 3, 4, 5, 10, 11 and 16) focusing on risk factors.

This status report describes the progress made by countries in implementing the European child maltreatment prevention action plan 2015–2020.

The specific aims are to:

• detail the burden of child maltreatment in countries across Europe, and highlight the scale of surveillance and data collection in the Region to inform interventions;

• examine the scale of policy and legislative commitment from countries to preventing child maltreatment;

• identify the extent of evidence-informed programmatic interventions for child maltreatment prevention;

• describe the health and social care services in place to support the early detection of, and response to, child maltreatment; and identify gaps that should be addressed to achieve the 2020 target in the Region.