Child abuse and neglect in Turkey: professional, governmental and non-governmental achievements in improving the national child protection system

Vulnerabilities of Syrian refugee children in Turkey and actions taken for prevention and management in terms of health and wellbeing

BACKGROUND

The Syrian crisis, which started in March 2011, has resulted in the displacement of 6.3 million refugees predominantly to neighboring countries in addition to the internal displacement of 6.2 million people. Turkey is the country hosting the largest number of refugees in the world with 3.6 million Syrian refugees 46 % of which are under 18 years old.

OBJECTIVE

The purpose of this article is to conduct a narrative review and analyze the vulnerabilities of refugee children in Turkey from the lens of the Sustainable Development Goals (SDG), more specifically SDG Goal 3: Good Health and Wellbeing, with a specific focus on Syrian refugee children. Moreover, this article explores the actions taken to prevent and mitigate issues that arise from these vulnerabilities.

METHOD

This narrative review article collected data from various primary and secondary sources on the Turkish refugee framework including national and international legislation, governmental and non-governmental data and reports, and scientific papers.

RESULTS

Syrian refugee children in Turkey are facing a variety of risks in terms of their health and wellbeing including communicable and non-communicable diseases, post-traumatic stress disorder, depression, family violence, child labor, and child marriage. The measures taken for prevention and response by governmental and non-governmental entities are multilateral and aim to address issues from multiple perspectives including medical, psychosocial, child protection, and legal.

CONCLUSIONS

The interventions and restructuring of the health system in Turkey contribute to the SDG number 3 for refugee children. The existence of a legal system which enables refugee access to health, protection, and other social services is key to achieve this goal. However, the existing system could be improved especially through solidifying the legal basis and centralizing the implementation for child and refugee protection. The engagement of all stakeholders to improve the health and wellbeing of refugee children remains vital.

The effects of adverse childhood experiences on pregnancy-related anxiety and acceptance of motherhood role

BACKGROUND

Adverse childhood experiences are a factor that may cause physical illness and deterioration of lifelong well-being in addition to many mental and psychiatric problems in the future. It is important to question and treat them.

OBJECTIVE

This study examined the effects of adverse childhood experiences on pregnancy-related anxiety and acceptance of motherhood role.

METHODS

This cross-sectional study was conducted on 536 pregnant women. The data were collected using the "Personal Information Form", the "Adverse Childhood Experience Questionnaire (ACEQ)", the "Acceptance of Motherhood Role (AoMR)" subscale of the "Prenatal Self Evaluation Questionnaire (PSEQ)" and the "Pregnancy-Related Anxiety Questionnaire-Revised 2 (PRAQ-R2)".

RESULTS

It was found that those with high levels of negative childhood experience had higher levels of anxiety in pregnancy and lower acceptance of maternal role than the other groups (p<0.05). Additionally, a one-unit change in the AoMR score led to a 0.23-unit decrease in the ACEQ score, whereas a one-unit change in the PRAQ-R2 score led to a 0.57-unit increase in the ACEQ score (p<0.001).

CONCLUSION

Adverse childhood events increase pregnancy-related anxiety and negatively affect acceptance of motherhood role.

Protective and Supportive Injunctions for Children Exposed to Sexual Abuse: The First Data from Turkey

Child sexual abuse (CSA) requires multidisciplinary approach by forensic, social, and medical services, thus Child Advocacy Centers (CACs) have been established to evaluate CSA cases in Turkey. At CACs the social needs of children are assessed by social workers. Protective and supportive injunctions (PSIs) are considered at each step of evaluation and are proposed to child courts. This study aimed to evaluate PSIs at a local CAC, which is one of the leading CACs in Turkey. The study group consisted of children and adolescents exposed to CSA admitted to Izmir CAC between April 2014 and April 2015. Socio-demographic characteristics, social investigation reports, psychiatric reports, and proposed PSIs were evaluated. The rate of social investigation necessity was 28.3% (n = 113), and the rate of being proposed for at least one PSI was 24.3% (n = 97). The most common proposed injunctions were maintenance care injunctions (n = 47; 48%) and counseling injunctions (n = 46; 47%). The rate of proposed PSIs was significantly higher in adolescents, incest cases and abuse types including penetration than in the other groups. This is the first study to evaluate PSIs in the child protection system. Our results provide data about the risk groups that need PSIs among the victims of CSA cases.

A retrospective study with ICAST-R (ispcan child abuse screening tools-retrospective) questionnaire for determination of child abuse in first year medical students in Turkish population

Child Abuse and Neglect (CAN) is an important problem both in Turkey and worldwide. Unfortunately, we still don't have enough and reliable data on this important subject. In this study, we aimed to investigate the prevalence of childhood maltreatment in a population of first year medical students in a Turkish university using the retrospective version of the ISPCAN Child Abuse Screening Tool (ICAST-R). One hundred seventy three first year medical students, aged between 18 and 24 years, who agreed to complete the ICAST-R questionnaire, were recruited in our study. Of 173 students who completed the survey, 51.4% are found to be subjected to at least one type of child abuse (physical, emotional or sexual). The prevalence is higher in male gender and the difference is statistically significant. Physical, emotional and sexual abuse exposure rates are found to be 23.1%, 40.5% and 11% respectively. Physical and emotional abuse rates are higher in male gender and the difference is statistically significant. We did not find any statistically significant association between gender and sexual abuse. Efforts to prevent child abuse and neglect are growing in our country, as they are worldwide. However, child abuse is still common and a problematic issue. It is important to determine the prevalence of child abuse in order to raise awareness. We need further studies investigating not only prevalence but also risk factors to have reliable data for our country.

Trichobezoar in Vagina: Assessment for Child Sexual Abuse and Diagnostic Result of Forensic Science

Vaginal discharge and bleeding in children require a through and thoughtful evaluation to diagnose the underlying problem including infections, sexual abuse, and vaginal foreign bodies. We report a 6-year-old girl presenting with bloody vaginal discharge, carefully evaluated for sexual abuse, and finally diagnosed as a vaginal foreign body after vaginoscopy. A rolling hair ball was extracted from the vagina and was diagnosed as trichobezoar pathologically without any endo-ecto-mesodermal residual tissue. The hair ball was genetically detected and diagnosed to belong herself by containing no foreign structure. Child sexual abuse was ruled out by forensic interview at CAC and report of forensic science that reported genetic structure belonging to the child. Medicolegal assessment helped in final diagnosis to exclude child sexual abuse.

Child Abuse and Neglect Among Children Who Drop Out of School: A Study in Izmir, Turkey

Child abuse and neglect (CAN), and dropping out of school have long been recognized as pervasive social problems globally, and Turkey is no exception. This study aims to explore the prevalence and incidence of CAN in children who drop out of school of Turkey, using the ISPCAN Child abuse Screening Tool, Children's Version, which is an appropriate tool for multinational comparisons. Data from a convenience sample of children who drop out of school age 11, 13, and 16 from Izmir were collected either by interviews or by self-completion. The results show that, compared to children who do not drop out of school, children who drop out of school have higher rates of psychological and physical abuse and neglect within the family. This study not only highlights the need for preventive laws for CAN and dropping out of school, but also points to direction for future research.