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Child Abuse In The Philippines Research Paper

1 Introduction

Across the world, significant numbers of children experience maltreatment, resulting in life-long consequences for victims (WHO 2016). Responses to child maltreatment in the Global South in particular are under researched and under-conceptualised. In the Philippines, despite the significance and impact of child maltreatment (Ramiro et al. 2010), policy and research on this topic remains in its infancy. Policy imperatives in this area are given greater impetus with increasing international awareness of the need for children to grow up in safe and stable environments and to be protected from abuse and neglect (Price-Robertson et al. 2014), particularly in circumstances of significant child poverty and deprivation (PSA and UNICEF 2015). In the absence of reliable data on child maltreatment in the Philippines (Madrid et al. 2013), and limited understandings of child protection policy approaches, this review provides important insights into child maltreatment and its responses in the Philippines. It explores conceptions of child maltreatment and child protection, and provides a review of policy and program approaches, and in doing so, contributes to future child protection policy agendas in the Philippines.

2 Defining Terms

This review utilises the World Health Organisation's (WHO) definition of child maltreatment:

…all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power (WHO 2006, p. 9).

The WHO definition distinguishes four types of child maltreatment; physical abuse, sexual abuse, emotional and psychological abuse and neglect (WHO 2006, p. 10). Legislation in the Philippines reflects the WHO definition of child maltreatment; defining child abuse and neglect as “the infliction of physical or psychological injury, cruelty to, or neglect, sexual abuse or exploitation of a child” (Saplala 2007, 88). Here, it is important to note that ‘exposure to family violence’ is typically considered a form of emotional and psychological abuse (AIFS 2015) and fits within these definitions.

In the literature, legislation and policy, terminology such as ‘child maltreatment’ and ‘child abuse and neglect’ are often used interchangeably (AIFS 2015). However, regardless of the specifics of the definitions covering child maltreatment in any particular jurisdiction, the responses to such circumstances are usually defined in terms of the broadly understood conception of ‘child protection’ (Price-Robertson et al. 2014). For the purposes of this review, ‘child protection’ is defined by any activity, behaviour, policy, program or law with the aim of protecting children from maltreatment as described earlier. In the Philippines, legislation identifies children as “persons below eighteen years of age or those over eighteen years of age but who are unable to fully take care of themselves or protect themselves from abuse, neglect, cruelty, exploitation, or discrimination because of physical, mental disability or conditions” (Saplala 2007, 88).

2.1 Child Protection in the Philippines

A range of government agencies and mechanisms provide national policy and program responses to child maltreatment in the Philippines. These include; the Department of Social Welfare and Development (DSWD), the Council for the Welfare of Children (CWC) and the Committee for the Special Protection of Children (CSPC) based at the Department of Justice, and Barangay Community Councils. The DSWD is the primary welfare agency of the government. Its role is to set standards, accredit and provide consultative services to public and private institutions, organisations and persons engaged in social welfare activities, as well as monitor the performance of these bodies and enforce compliance to standards (Save the Children 2011). The DSWD provides and regulates residential care, domestic and inter-country adoption and a range of family based welfare program (PSA and UNICEF 2015). Another government agency, the Council for the Welfare of Children is the principal agency for children's issues and policy in the Philippines, tasked with designing, coordinating and monitoring policy for children, as well as monitoring children's rights in the Philippines (Bessell 2009; CWC 2011).

The criminal justice system's efforts to protect children is supported by the Department of Justice's Committee for the Special Protection of Children which provides legal protection of children and monitors and coordinate the investigation and prosecution of cases of child abuse detailed in the Republic Act 7610 entitled ‘An Act Providing For Stronger Deterrence and Special Protection Against Child Abuse, Exploitation and Discrimination, Providing Penalties for its Violation and For Other Purposes’, signed into law in 1992 (Save the Children 2011). This committee works to support this legislation and apply laws and policies that are designed to protect children. Additionally, the Barangay Councils for the Protection of Children (BCPC) operate across the local government level and offer an initial response to issues of child protection in local communities, assisting abandoned, maltreated and abused children (Save the Children 2011; ECPAT, 2006).

The primary government and non-government programmatic response for victims of child abandonment, neglect and abuse is through residential (institutional care provided in a non-family group setting) care (Save the Children 2011). The most recent information provided by the DSWD reveals 915 private social welfare agencies licensed by the DSWD, and of those, 177 operating 197 residential care facilities for children and young people (DSWD 2016). The DSWD directly operates 46 residential care facilities for children who are victims of child maltreatment, experiencing homelessness or mental illness (DSWD 2016). These residential care facilities vary in capacity, from four to 490 children (DSWD 2016). The latest published DSWD annual report details 5819 children in the residential care facilities run directly by DSWD, however provides limited detail of the numbers norarrangements of children in the 197 DSWD licensed residential care facilities (DSWD 2015),

2.2 Justification and Focus of the Review

These child protection responses have received only limited investigation and critique. A report by Save the Children (2011) argues that there is a lack of reliable data, particularly official data, to inform child protection responses, and there is a prevailing lack of understanding and capacity of these agencies to enforce, implement and uphold responses to child protection issues (Save the Children 2011). Furthermore, despite national legislation and the approaches taken by these agencies and by local and international civil society organisations, large numbers of children in the Philippines continue to experience neglect, maltreatment and abuse in their most serious of forms (Ramiro et al. 2010). This suggests that current legislative, policy and operational frameworks of child protection may be inadequate, poorly implemented or managed or lack meaningful congruence with what children and families experience and need. Therefore, the key questions guiding this review are: How is child maltreatment experienced by children in the Philippines; and, what is known about child protection responses to these circumstances?

3 Method

A systematic approach to reviewing the literature was chosen to allow for an investigation of geographically diverse studies from multiple fields of research. The literature review takes a ‘systematic approach’ as outlined by Pickering and Byrne (2014). The review is systematic in that articles are assessed for inclusion prior to their incorporation and synthesis into the final collection of data informing the review. A systematic review's methods are pre-defined, transparent and replicable, and consequently serve to assist in removing (and minimise) the risk of author bias (Littell 2008). This technique maps the boundaries of the literature and exposes its generalisations and research gaps. A systematic approach also makes clear the processes and sources of the documents used, and thus allows for replication as might be required for further evaluation of the findings.

3.1 Key Search Terms

The key search terms were developed by the author with reference to the generally accepted definitions of child neglect, maltreatment and abuse, as detailed in the introduction this review. The subsequent terms, and combination of terms, are given in Table 1. However, it should be noted that variations in the syntax of some searches were needed to accommodate particular data bases.

(Child*) OR (youth*) OR (young person) OR (young adult) OR (adolesce*) OR (minor*) OR (kid*) OR (teen*) OR (juvenile*) OR (famil*) AND (Philippine* OR Filip*) AND (protect*) OR (abus*) OR (neglect*) OR (violen*) OR (‘sexual abuse’) OR (assault) OR (safe*) OR (unsafe) OR (maltreat*) OR (punish*) OR (labour) OR (labor) OR (exploit*) OR (traffick*) OR (harm*) OR (mistreat*) OR (cruel)* OR (injur*) OR (shelter) OR (orphan) OR (foster*) OR (adopt*) OR (out-of-home-care).

3.2 Databases Searched

The review of the literature was conducted by searching the academic databases presented in Table 2.

Academic Search Complete (EBSCO), Applied Social Sciences Index and Abstracts, Sociological Abstracts (ProQuest), JSTOR, Social Services Abstracts (ProQuest), Family and Society Studies Worldwide (EBSCO), Bibliography of Asian Studies, PERIND (Informit), AnthroSource, PubMed, and PsycINFO.

PERIND and the Bibliography of Asian Studies allowed for exploration of literature from South East Asia. The other databases represent major social science databases, while PsycINFO is a database for research in the field of psychology, and PubMed offers studies in life sciences and biomedical journals.

3.3 Inclusion and Exclusion Criteria

Recognising the aims of this research, studies selected for this review are limited to those that explored child maltreatment, as defined by the WHO (2006), in the Philippines. Additionally, publications had to be an original and empirical research article, as well as written in English. English was given preference over Filipino (based on Tagalog) and the eight dialects of the Philippines, because it is used by a majority of the population, is an official language and is principally used in organisational and educational contexts (Bernardo 2004), and used as the language of instruction in universities (Maxwell 2001). Articles had to be published after 1989. This date was chosen as the Convention on the Rights of the Child 1989 (UN 1989) marks a key date in the history of research on children and a focus on children's rights.

3.4 The Retrieval and Review Process

The retrieval and review process is outlined in Figure 1. The initial database search identified 146 articles for potential inclusion in the review. Duplicates were removed. The remaining articles were then appraised at the level of title and abstract. Articles deemed relevant at this level were then read in full and their reference lists appraised to identify any other potential articles not identified via the data-base search. Subsequently, a number of articles were excluded and a number of additional articles were identified and reviewed. This process resulted in 31 articles being retained for the review and are detailed in Appendix 1.

3.5 Quality Appraisal

A quality appraisal tool (McVilly et al. 2012) was used to assess the articles included in this review. This tool is suitable for evaluating articles that utilise a range of methodologies (e.g. quantitative, qualitative and mixed methods). A rating between zero and two was given to each article by the author based on an assessment for each of the following categories: review of literature, research focus, methods and procedures, participants, tools, data analysis, findings, results and implications. The subsequent scoring and ranking of articles assists to establish the research or highest quality identify research that is of low quality, and to highlight the most reliable research available.

As detailed earlier in Table 3, appraisal ratings of articles ranged between three and 19. The most frequent rating was 16. Ramiro et al. (2010) was the highest quality article; articles that received low scores have been retained for this review. This is because they are mostly articles authored by academics located in major universities in the Philippines and represent localised, contextual knowledge, considered important for this research. Any identified shortcomings according to the appraisal scale were not considered of sufficient severity to warrant their exclusion.

Acebes-Escobal et al. (2002)136
Ansara and Hindin (2009)182
Edralin (2002)89
Estrellado and Loh (2014)164
Fehringer and Hindin (2009)173
Figer (2008)311
Gunn and Ostos (1992)311
Hassan et al. (2004)182
Hindin (2005)164
Hindin and Gultiano (2006)173
Jeyaseelan et al. (2004)164
Ladion (2007)89
Lansford et al. (2010)164
Lansford et al. (2015)164
Lee (2004)164
Loh et al. (2011)173
Madrid et al. 201398
Maiquilla et al. (2011)164
Mandal and Hindin (2013)182
Mandal and Hindin (2015)182
Maxwell (2001)173
Maxwell and Maxwell (2003)164
Ramiro et al. (2010)191
Runyan et al. (2010)182
Sana et al. (2014)127
Sanapo and Nakamura (2011)136
Saplala (2007)610
Sugue-Castillo (2009)182
Tarroja et al. (2007)89
Terol (2009)155
Woodhead (1999)98

4 Results

This review first analyses the fields of research which these issues have been investigated, then considers the ethical arrangements governing the research, the methodologies adopted to explore these issues, as well as the geopolitical and cultural factors potentially influencing the research agenda and the subsequent analysis and interpretation of data. The review goes on to report on the varying contexts of child maltreatment, the concepts of child maltreatment and child protection adopted in these various studies, and their findings with respect to the magnitude of child maltreatment in the Philippines. The review reports on and critiques the extent to which current research addresses varying manifestations of child maltreatment in the Philippines. Finally, the review provides a critique of research investigating and evaluating current child protection policies and practices in the Philippines.

4.1 Fields of Research

The articles included in this review were published in a variety of journals, with Impact Factors ranging from 0.203 to 5.573 (impact factors for three journals were not available), and reflecting a range of disciplines. The most common disciplines were public health (n = 12), psychology (n = 6) and a collection of fields within medicine (n = 6), including social medicine, paediatrics and legal medicine. The fields of childhood studies, criminology, behavioural science, international development and business were also represented among the studies, evidence of the multidisciplinary investigations of this topic.

4.2 Ethical Arrangements of Articles Reviewed

The ethical arrangements for the studies reported varied. Of the 31 articles, 12 made no reference to ethical review procedures, ethical considerations or institutional review or approval of their research. Nine studies articulated institutional approval for their research. Considering the sensitive nature of the content of child maltreatment research, and the potential vulnerability of participants, the lack of ethical review or considerations in a number of studies is noteworthy.

4.3 Methodological Variance Across Studies

There is methodological variance across the studies included in this literature review. Quantitative methods were utilised in 17 studies. This reflects the cross-national comparisons and public health approaches of much of the literature. Eight studies provide qualitative analysis, while the six remaining studies utilised mixed methods, case study or program evaluation approaches.

4.4 Geopolitical and Cultural Characteristics of Studies

Of the 31 articles reviewed, 12 articles were written solely by authors in the Philippines, and 21 had at least one author from a Filipino institution. However, 11 articles were published as a result of international collaborations, most commonly between the USA and the Philippines, in turn reflecting predominantly North American constructions of childhood and child protection. Participants in the studies were predominately from metropolitan areas in Manila or Cebu City, representing mostly urban experiences and conceptions of child maltreatment.

4.5 Contexts of Child Maltreatment

The literature predominantly focused on child maltreatment in the context of the family home. Of the literature reviewed, 18 studies focused on child maltreatment in the home, while seven studies did not distinguish between the home and community context. Notably, apart from Tarroja et al. (2007), there is an absence of literature that focuses on child maltreatment in institutions. Here, it should be noted that a considerable number of children in the Philippines reside in institutional care, operated either by the state or church organisations. Child labour is explored as a fairly distinct context of child maltreatment, and is explored in three articles (Edralin 2002; Gunn & Ostos 1992; Woodhead 1999).

4.6 Concepts of Child Maltreatment and Child Protection

There was great variation in the source and the articulation of the definitions of child maltreatment across the articles reviewed. This was in part due to the diversity of the types of child maltreatment explored, and consequently the more detailed conceptualisations of child maltreatment that were required for each research. Some studies defined child maltreatment through the survey tools they used (Jeyaseelan et al. 2004; Hindin & Gultiano 2006), utilising pre-established survey tools that define child maltreatment for use in research, such as the Adverse Childhood Experiences (ACE), providing definitions of maltreatment within the survey instrument (Ramiro et al. 2010). Other studies established a definition of the type of child maltreatment under consideration through the perspectives of participants, including children (Figer 2008; Lee 2004). Lee (2004) consulted Filipino men on the dimensions of domestic violence in their homes while Figer (2008) presented children's perspectives on emotional abuse.

None of the articles referred directly to the WHO's (2006) definition of child maltreatment, despite this being an explicit component of the search criteria for the current review. The absence of any direct reference to this definition brings into question the extent to which the work of the WHO influences the child protection research agenda in the Philippines. Only three studies drew directly on Philippine legislation to define the type of maltreatment under investigation (Tarroja et al. 2007; Saplala 2007; Sana et al. 2014).

A range of more specific concepts were drawn upon, such as; ‘child labour’ (Woodhead 1999; Edralin 2002; Gunn & Ostos 1992), ‘verbal abuse’ (Figer 2008), ‘psychological maltreatment’ (Loh et al. (2011), ‘adverse childhood experiences’ (Ramiro et al. 2010) and ‘child discipline practices’ (Runyan et al. 2010). Exposure to family violence was viewed through a range of differing definitions. These included; ‘intimate partner aggression’ (Fehringer & Hindin 2009), ‘physical intimate partner violence’ (Hassan et al. 2004), ‘physical violence between parents’ (Hindin 2005), ‘domestic violence between parents’ (Hindin & Gultiano 2006), ‘intimate partner violence’ (Jeyaseelan et al. 2004), ‘domestic violence as defined by participants’ (Lee 2004) as well as ‘inter-parental violence’ (Mandal & Hindin 2013). Future investigations need to take these constructions into account.

4.7 The Extent of Child Maltreatment in the Philippines

The research retrieved provides evidence of each of the major forms of maltreatment identified by the WHO: neglect, emotional and psychological abuse, physical abuse and sexual abuse.

4.8 Neglect

In a developing country such as the Philippines, the likelihood of child neglect is higher because families are typically more exposed to poverty and associated issues (Ramiro et al. 2010). However, neglect is a contentious concept in the context of developing countries. Lansford et al. (2015) explains that what constitutes neglect is often contextual. For example, extreme poverty means that providing children with food, clean water, medical care and education is extremely difficult, while in high income countries, not providing these to children would constitute neglect.

According to the studies reviewed here, neglect of children is commonplace across the Philippines. Using a cross-sectional survey of a general population sample, Ramiro et al. (2010) found that 22.8 per cent of participants had experienced physical neglect during the first 18 years of their life. Taking a cross-national perspective, Lansford et al. (2015) found that the average incidents of ‘child reported neglect’ were ranked third out of the nine countries in focus. Childhood physical neglect was associated with a twofold increase in likelihood of using alcohol and illicit drugs in the Philippines (Ramiro et al. 2010). Child labour and exploitation can also be considered a form of neglect and is investigated by several studies (Edralin 2002; Gunn & Ostos 1992; Woodhead 1999).

4.9 Emotional and Psychological Abuse

Children's exposure to family violence, a form of emotional and psychological abuse that can affect the psychosocial wellbeing of children, and the ramifications of this for children, is a major theme of the literature in this review. In Ramiro et al.'s (2010) research, psychological abuse and emotional abuse among participants was high, with 22.8 per cent of participants experiencing psychological abuse and neglect under the age of 18. In addition, Mandal and Hindin (2013) outline that approximately 44 per cent of females and 47 per cent of males in the Philippines had witnessed their parents physically hurt one another during childhood.

Outlining the presence of violence in families more broadly, Ansara and Hindin (2009) found that approximately 26 per cent of women reported that either they, or their partner, perpetrated at least one physically aggressive act toward a partner in the last year. In a community in the Philippines, 21.2 per cent of participants had experienced physical intimate partner violence (Hassan et al. 2004) while Jeyaseelan et al.'s (2004) research concurs that domestic violence is widespread in the Philippines.

4.10 Physical Abuse

The literature on physical abuse predominantly focuses on harsh discipline and corporal punishment. The 1989 UNCRC (Art 19; Article 37) guarantees children's right to protection from abuse and cruel, inhuman or degrading treatment, which the Committee on the Rights of the Child has interpreted as prohibiting corporal punishment (Lansford et al. 2015). There is variation in studies' findings on the scale of physical abuse in the Philippines. Using a cross-sectional survey of a general population sample, Ramiro et al. (2010) found that only 1.3 per cent of the sample had experienced physical abuse as a child. Other research finds physical abuse more prevalent in the Philippines in the form of parental discipline (Runyan et al. 2010; Sanapo & Nakamura 2011).

In an international study comparing six countries, Runyan et al. (2010) found that ‘spanking’ rates are 76 per cent in the Philippine community, much higher than a community in India (26 per cent), suggesting cultural practice as a strong determinant of discipline practices. The same study found that all types of physical discipline are used by Filipino families; 9.9 per cent of families stated they used harsh physical discipline with their children, 83 per cent used moderate physical discipline, and 56 per cent used harsh physical discipline by hitting with an object (Runyan et al. 2010). Sanapo and Nakamura (2011) found that physical punishment is a common practice in the Philippines with 49.7 per cent of grade-six participants receiving physical punishment at home. They suggest that high rates of physical punishment in the household are related to Philippine law that allows for parents to physically punish their children. In a study across nine countries, including the Philippines, the more parents believed corporal punishment to be normative technique to modify children's behaviours, the more likely it was used (Lansford et al. 2015). While the ramifications of physical abuse of children in the Philippines is not explored in depth in the literature, Lansford et al. (2010) found that across four countries, including the Philippines, physical discipline influenced children's anxiety and aggression according to their mothers.

4.11 Sexual Abuse

The extent and characteristics of child sexual abuse in the Philippines has been identified in the literature. Ramiro et al. (2010) found in a general population sample, during the first 18 years of life, that 6 per cent of women, and 4.5 per cent of men, have experienced sexual abuse. In a study of hospital case files of child victims of sexual abuse, the average age of victims was approximately 10 years, and were 97.3 per cent female. In 93.8 per cent of cases, the perpetrator was known to the victim (Sugue-Castillo 2009). Additionally, Maiquilla et al. (2011), also found that in most cases of child sexual abuse, the victim knew the offender.

Similarly, in a qualitative study that investigated the experiences of sexual abuse among girls with intellectual disabilities, it found that most of the perpetrators were familiar people and that detection of abuse came from caregivers (Terol 2009). Risk factors for child sexual abuse for these girls included low economic status and impoverished conditions, living in crowded urban communities, as well as their mental retardation (Terol 2009). Highlighting the social and health ramifications for participants who had been sexually abused as children, they were 12 times more likely to engage in early sex, nine times more likely to have an early pregnancy and five times more likely to attempt to commit suicide than those not sexually abused as children (Ramiro et al. 2010).

4.12 Child Protection Policies

There is limited analysis of child protection policies across the literature reviewed, and there is no comprehensive outline of child protection policies or systems in the Philippines. However, Madrid et al. (2013) provide insights into child maltreatment prevention practices and identify a range of shortfalls, including, limited funding and trained personnel and a clear absence of primary prevention programs. Further, despite laws related to children's protection and rights, they remain largely unfunded (Madrid et al. 2013).

Terol (2009) provides a brief critique of the way in which the health sector in the Philippines responds to child protection issues via multidisciplinary Child Protection Units (CPUs). Governed by the Department of Health there are 39 CPUs across the Philippines, while the The National Bureau of Investigation and the Philippine National Police have centres for medico-legal evaluation for cases of child sexual abuse (Terol 2009). However, CPUs typically operate in isolation in addressing cases of child sexual abuse (Terol 2009). Ramiro et al. (2010) argue that national laws and child protection policies should be better monitored and reviewed to ensure implementation at a local level.

Some research discusses findings in relation to programmatic and policy responses to specific child maltreatment issues, rather than system-wide policy approaches, and details some implications for interventions. For example, Ramiro et al. (2010) suggest that early prevention of child maltreatment could occur through screening for domestic violence and child maltreatment by health professionals. They also propose that communities could be supported via home visits of health workers and social workers, as well as community support groups and media messaging (Ramiro et al. 2010).

Mandal and Hindin (2015) recommend that child maltreatment interventions should focus on the whole of family to reduce intergenerational transmission of family violence. Terol (2009) suggests that protective services for women and children need to be strengthened, while Ladion (2007) advocates for spirituality as an impetus for recovery for survivors of child sexual abuse. Ramiro et al. (2010) highlight poverty reduction as a way to reduce child maltreatment. More specifically, in the criminal justice context, Sana et al. (2014) recommend a training program for workers who interact with victims of abuse to improve justice outcomes. Sugue-Castillo (2009) discusses the legal system as overloaded and having poor responses to child sexual abuse.

The findings of some studies included in this review offer some important considerations for future child protection responses. Sugue-Castillo's (2009) study revealed that referral source for cases of child sexual abuse at a medical centre are 43.4 per cent law enforcement, 21.4 per cent social work and 21.4 per cent walk-ins. Ramiro et al. (2010) warn of a ‘co-occurrence’ phenomenon whereby the more events of child maltreatment experienced by a child, the more health-risk behaviours they encounter later in life. They found that as the number of adverse childhood exposures increases, suicide attempts, use of illicit drugs and engaging in sexually risky behaviours become more prevalent (Ramiro et al. 2010).

5 Discussion

This systematic review of the research literature was conducted to ascertain the dimensions and extent of child maltreatment and to investigate what is known about child protection responses in the Philippines. From a database search finding 146 articles, 31 were identified as meeting the search criteria.

5.1 How is Neglect Maltreatment and Abuse Experienced by Children in the Philippines?

The literature provides evidence of all four domains of child maltreatment (Ramiro et al. 2010). While the research varies on the extent and significance, physical violence is commonplace among families. Children experience harsh physical disciplining and corporal punishment, a common cultural and legally accepted practice in the family home (Runyan et al. 2010; Sanapo & Nakamura 2011). For example, in Lansford et al.'s (2015) cross-national research, corporal punishment involves slapping, spanking, hitting, shaking or beating, and finds the Philippines comparatively high on these measures. For example, across six countries, child discipline in the form of spanking is highest in the Philippines at a rate of 76 per cent among participants (Runyan et al. 2010).

In addition, the literature finds that children are also exposed to high levels of family violence involving both physical and psychological aggression and the use of weapons (Ansara & Hindin 2009), a form of emotional and psychological abuse that can affect children's wellbeing with nearly half witnessing their parents physically hurt one another during childhood (Mandal & Hindin 2013). In Fehringer and Hindin's (2009) study, the most common forms of physical violence among partners were ‘pushing, grabbing or shoving’, ‘hitting’ and ‘throwing objects, while Hassan et al. (2004) found the most common intimate partner violence in the Philippines was ‘slapping’ and ‘hitting’. Lee (2004) details that alcohol and drug use is a frequent element in family violence in the Philippines.

This review has found limited evidence for experiences of neglect because it is a multifarious and socially constructed concept, and hard to measure in the context of developing countries, where experiences of poverty can influence family's capacities to meet the primary needs of children. Despite this, Ramiro et al. (2010) found that 22.8 per cent of participants had experienced physical neglect during the first 18 years of their life. The literature reviewed also provided limited evidence of child sexual abuse, a surprising result given that a report by ECPAT International (2006) finds that the commercial sexual exploitation of children is a substantial problem in the Philippines. However, research by Terol (2009) and detail that risks factors for child sexual abuse include low economic status, living in crowded urban communities, as well as intellectual disability, while Sugue-Castillo's (2009) profile of victims details that they are approximately 10 years of age and in almost all cases female, while the perpetrator is known to the victim in 93.8 per cent of cases. It is clear that child sexual abuse requires further investigation in the Philippines.

5.2 What Do We Know about Child Protection Responses to These Circumstances?

There are limited empirical investigations or assessments of governmental child protection policy, or approaches to child protection within and by organisations, institutions and communities in the Philippines. In addition, while residential care is a central response to child protection, its extent, outcomes or practices are largely ignored by the literature, as are the experiences of children in this type of care. This represents a major shortcoming of research.

The literature does however provide small insights into specific responses. Responses from the health sector are predominately enacted through multidisciplinary Child Protection Unit’ (CPUs) embedded in hospitals, and the National Bureau of Investigation and the Philippine National Police have some dedicated centres for medico-legal responses to cases of child sexual abuse. However, CPUs provide a disjointed service (Terol 2009) and policies and laws relating to child protection suffer from poor monitoring and implementation at the local level (Ramiro et al. 2010).

Some of this literature provides suggestions to address shortcomings in preventing and responding to child maltreatment. These include; a focus on early intervention and family centred practice (Mandal & Hindin 2015), a better resourced legal system to respond to child sexual abuse (Sugue-Castillo 2009), preventative work through media messaging, community groups and home visits from professionals (Ramiro et al. 2010), and greater specific support for women and children (Terol 2009). More broadly, Ramiro et al. (2010) highlight poverty reduction as integral to reducing child maltreatment.

5.3 Research Gaps

While research on child protection in prosperous countries has moved to program evaluation, risk assessment and intervention (Lachman et al. 2002), the literature on child protection in the Philippines predominantly focuses on the incidence and prevalence of different types of child maltreatment. This literature provides only a narrow investigation of the influences of child maltreatment in the Philippines, frequently overlooking the cultural, gendered and social dynamics that influence child maltreatment, as well as its structural influences such as poverty and inequality (Pells 2012; Myers & Bourdillon 2012a). Research into the complex arrangements of child sexual abuse and exploitation is missing, along with research that investigates the complex arrangements of neglect, and the extensive use of institutional care as a child protection response.

This review has also revealed limited analysis of legislation and policy and a lack of meaningful involvement of children in research. This is important to note as children have emerged over the past few decades as rights holders, and conceptualised as competent social actors with valuable perspectives and knowledge (Corsaro 2011; Qvortrup 1994; Mayall 2002). Studies that do not directly engage children in research may fail to understand young people's lived experiences of maltreatment, nor appreciate some of the impacts and challenges that may not been observed by adults, impacting negatively on policy development (Salveron et al. 2013).

5.4 Limitations of Literature Review

The contributions of the grey literature are not part of the systematic review. It does not include possible research conducted in a language other than English. Because of their age, the contemporary relevance of some of the articles in this review is questionable.

5.5 Conclusion

Child maltreatment is not a neat or universal concept, but one that incorporates contextual and multiple definitions, operationalised in differing research fields and for differing research purposes. While they all fit within the broader WHO (2006) definition of child maltreatment, this review uncovers a diverse approach to understanding and interpreting child maltreatment. The literature exploring child maltreatment is predominantly epidemiological in nature, concerned with enumerating child maltreatment among children, rather than directly investigating the experiences of child maltreatment. It has established that multiple types of child maltreatment are prevalent in the Philippines and provides evidence that they impact negatively on the wellbeing of children at the time of maltreatment and later as adults. This research, however, does not investigate broader, structural, social and cultural influences on child maltreatment.

The contexts of child maltreatment outside the home, particularly in institutions, are severely under researched. This is particularly the case for sexual and physical abuse that can occur in a variety of contexts. Significantly, there is a dearth of policy analysis in the literature reviewed. The appraisal of policy approaches and evaluation of programmatic responses to child maltreatment is highly limited and, as this review suggests, should form an important part of further research in this area. These findings provide new understandings for literature on child protection policy, approaches and Filipino policymaking and can assist the development of future child protection policy development in the Philippines.

Appendix 1: Articles Subject to Review

Acebes-Escobal et al. (2002)Abuse of women and children in a Philippine communityInternational Journal of Gynecology and Obstetrics (1.537)Social medicineDemographic profiles, types of injuries and the characteristics of abusersSexual abuse, physical abuse, emotional and psychological cabuse (exposure to family violence)Family violence that requires medical careHome and communityRetrospective medical chart review1354 women and children who sought medical care for abuse and violence from one medical centre between 1997 and 1998Approximately 75% of sexual abusers of children and women were from outside of the victim's household

Physical abuse is most likely perpetrated by husbands and live-in partners in the home.

Ansara and Hindin (2009)Perpetration of intimate partner aggression by men and women in the PhilippinesJournal of Interpersonal Violence (1.210)Public healthPrevalence and causational factors of violence perpetrated by husbands and wivesEmotional and psychological abuse (exposure to family violence)Intimate partner aggression defined as physical assault from a partnerHomeAnalysis of survey data from the 2002 Cebu longitudinal health and nutrition survey in Cebu1861 women who were either married or living with a partner at time of surveyApproximately 26% of women reported that either or they or their partner perpetrated at least one physically aggressive act in the last year, and 22% reported sexual coercion by their partner. Reasons cited for violence included alcohol use, jealousy and ‘nagging’.
Edralin (2002)Kids at risk: plight of child workers in the tourism industry in CebuDLSU Business and Economics Review (0.203)Business management

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