Ethical Considerations in Pediatric Surgery

Pediatric surgeons need to learn to give as much importance to the ethical approach as they have been giving to the systemic methodology in their clinical approach all along. The law of the land and the governmental rules also need to be kept in mind before deciding the final solution. They need to always put medical problems in the background of ethical context, reach a few solutions keeping in mind the available resources, and apply the best solution in the interest of their pediatric patients.

Laws of child abuse in Indian perspective: A review

Child abuse is harm or neglect toward a child by another person, whether an adult or child. It is common in all cultural, ethnic, and income groups. It can be physical, emotional-verbal, sexual, or even neglect. Abuse may cause serious injury and may even result in the death of the child. The aim of the paper is to review the child abuse laws prevalent in our country. Literatures were collected from the Google Scholar and E-Journals of legal services to get a sight of the child protection laws and to enlighten indigent children. Even though our country has different sections in the Indian penal code and many laws for the protection of children, still at the zeroth hour many corrupt rises.

Realising economic and social rights for children with communication and swallowing disability: Sustainable Development Goals 1, 8 and 10

PURPOSE

This commentary describes the economic disempowerment of children with communication and/or swallowing disability and outlines why attending to their economic and social needs is essential for the realisation of the United Nations' Agenda 2030.

RESULT

Children with communication and/or swallowing disability encounter intersectional disempowerment on account of both their disability, and their status as children. In particular, they experience unique barriers to the realisation of their economic and social rights. This presents a number of challenges to the realisation of Agenda 2030, and its Sustainable Development Goals (SDGs). Drawing on the broader disability rights and child rights literature, we outline these issues, and describe four empowering solutions, within the scope of this special issue commentary.

CONCLUSION

We describe that speech-language pathologists must interpret the discussion of these issues as a call to action for our profession. This commentary focusses on the Agenda 2030 Sustainable Development Goals of, No Poverty (SDG 1), Decent Work and Economic Growth (SDG 8), and Reduced Inequalities (SDG 10), and also addresses the goals of Zero Hunger (SDG 2), Good Health and Well-Being (SDG 3), Quality Education (SDG 4), Gender Equality (SDG 5) and Partnerships for the Goals (SDG 17).

Integrating child rights standards in contraceptive and abortion care for minors in Africa

Minor girls in Africa face challenges in accessing high-quality contraceptive and abortion services because laws and policies are not child-friendly. Many countries maintain restrictive laws, policies, or hospital practices that make it difficult for minors to access contraception and safe abortion even when the pregnancy would risk their life or health. Further, the clinical guidelines on contraceptive and abortion care are silent, vague, or ambiguous regarding minors' consent. African states should remedy the situation by ensuring that clinical guidelines integrate child rights principles and standards articulated in child rights treaties to enable health providers to facilitate full, unencumbered access to contraceptive and abortion care for minor girls. A sample of clinical guidelines is analyzed to demonstrate the importance of explicit, consistent, and unambiguous language about children's consent to ensure that healthcare workers provide sexual and reproductive health care in a manner that respects child rights.

Healthcare Professionals' Conflicts When Treating Transgender Youth: Is It Necessary to Prioritize Protection Over Respect?

Increasingly, transgender minors are seeking medical care such as puberty-suppressing or gender-affirming hormone therapies. Yet, whether these interventions should be performed at all is highly controversial. Some healthcare practitioners oppose irreversible interventions, considering it their duty to protect children from harm. Others view minors, like adults, as transgender individuals who must be protected from discrimination. The underlying ethical question is presented as a problem of priority. Is it primarily relevant that minors are involved? Or should decision makers focus on the fact that they treat transgender individuals? The paper explores the relevance for medical practice. We provide results of an interview study with German healthcare professionals. We discuss the general question whether prioritization among different group memberships of the same person is ethically defensible. We conclude that priority conflicts between group memberships of the same person can be deceptive and should be addressed by an intersectional approach. Eventually, we discuss practical implications.

Double-Edged Sisterhoods: Transgender Identity, Peer Groups and the Commercial Sexual Exploitation of Transgender Girls

One of the existing gaps in the literature on the commercial sexual exploitation (CSE) of children is on transgender (trans) girls. Most of the available literature is heavily skewed toward experiences of cisgender girls. However, there is an undeniable need to understand the experiences of trans children given their unique experiences and vulnerabilities to CSE related to their identity. This article is a case study on the complex interaction between trans identity, peer influence, and other micro, meso, and macro factors that have predisposed trans girls to CSE. The paper is based on interviews with six trans girls, complemented by interviews with four social workers, research notes, and a review of related literature. Data was analyzed thematically. Based on the findings, peer groups provide critical support to trans girls, particularly, in terms of trans identity formation, gender transition information, security and protection, and other forms of support. Ironically, they play the contradictory role of priming and initiating them to CSE. Various structural and personal factors have compounded these and predisposed them to victimization. An interplay of macro (societal), meso (interpersonal), and micro (individual) factors have come into play in the commercial sexual exploitation of these trans girls.

Hiding and seeking: Children's lived experiences during COVID-19

A qualitative study explored the perspectives and lived experiences of school-age children during COVID-19 using a child rights lens. Twenty children between the ages of 7 and 12 participated in open-ended, virtual interviews. Our hermeneutic analysis found children's right to play and education were severely compromised leaving children to navigate between two worlds: the adult world of public health restrictions and that of their childhood. Despite challenges and lost childhood opportunities, children emerged as competent social agents and responsible citizens. Planning for future pandemics should include policies and practices that balance public health needs with the protection of children's rights.

Social Norms and Family Child Labor: A Systematic Literature Review

BACKGROUND

Research has established the family as the predominant context for child labor practices. Decisions to involve children in child labor within the family or by a family member (herein family child labor) is strongly motivated by cultural beliefs that normalize child labor. This systematic review sought to synthesize evidence on the social norms that support child labor practices, and the normative interpretation of international child labor legislation/standards.

METHODS

We followed the PRISMA procedure for systematic review by reviewing empirical articles published between 2000 to 2021 and contained within the four key databases: Scopus, ISI Web of Sciences, PubMed and Embase. Findings from 13 articles that met the inclusion criteria were analyzed thematically.

RESULTS

The review included studies from three continents: Africa, Asia and Europe. Gender norms, informal apprenticeship norm, norms on succession and sustenance as well as obedience, were key social norms that influenced child labor practices in the family. Parents' decision to involve children in child labor was strongly influenced by the collective acceptance of some occupations (e.g., cocoa farming and fishing) as family occupations, which need to be preserved, undertaken and passed on to children. Child rights and the UNCRC principle of children's participation were considered foreign to most non-western countries and interpreted as contravention to the cherished social norm of obedience. The findings underlie the link between social norms and the common social values of resilience, hard work, and respect.

CONCLUSION

The results provide foundations and target to develop normative change intervention programs to re-orient the negative interpretations of common social values and provide alternative pathways that prevent child labor within the social context.

Embedding Child Rights Principles and Practises in Mega Sport Event Planning

Recently, there has been growing concern about the lack of intentionality of mega sport event (MSE) organisers in ensuring that child rights are adequately respected, protected and promoted before, during, and after the events take place. In the context of the summer Olympic Games, reported child rights infringements have been on the rise, both in relation to abuse in sport itself and the negative consequences associated with planning and delivering the Games. In response to reports of child rights infringements, a coalition of actors, including non-governmental and civil society organisations have sought to pressure event owners and organisers to strengthen protections in the planning and delivery of their events. To date, however, child rights commitments have not been fully embedded in policies and principles guiding the planning and delivery of the Olympic Games. In this article, we explore the field of child rights in the context of the Olympic Games, focusing on a case study of the Tokyo 2020 edition. Drawing on documentary analysis and semi-structured interviews with Tokyo 2020 stakeholders and affiliates, detailed appraisal of the planning process was undertaken. Findings show that while the Japanese authorities have signed up to international child rights conventions and embedded some child participation strategies in Games-related activity, there was little evidence that Tokyo 2020 organisers had developed or implemented robust policies, principles or practises to respect, protect and promote child rights in Games planning. This absence, we argue, is because there was no requirement to embed child rights commitments during the bidding or planning phases, as the IOC had yet to enshrine human rights in its host city contract when the Games were first awarded to Tokyo. In conclusion, we argue that it is imperative the IOC embeds child rights principles and protocols in the bidding and planning processes to ensure that the risks to children are foregrounded and acted upon by host cities and their partners, elevating human rights to a position equal to other Games requirements. This study is of international significance as the evidence will aid future host city bidders to ensure children's rights are embedded in MSE policies for each nation.

How Do Knowledge and Attitudes About Children's Rights Influence Spanking Attitudes?

Children's rights are about treating children with equality, respect, and dignity. Attitudes concerning children's rights have been linked to support for nurturance and self-determination. However, there is little research on how dimensions of children's rights are associated with other parenting constructs, such as attitudes toward physical punishment. This study examined the relationship between knowledge of and attitudes toward children's rights and attitudes toward spanking in a Canadian sample of 329 undergraduate students who completed an online study. Hierarchical multiple regression analyses indicated a significant negative association in that more favorable attitudes toward children's rights predicted less favorable attitudes toward spanking. There also was a significant moderating effect of child rights knowledge on this relationship, such that greater knowledge enhanced the effects of attitudes toward children's rights on spanking attitudes. These results raise awareness of the combined role of both knowledge of and attitudes toward children's rights in influencing spanking attitudes. The results also suggest that one pathway decreasing favorable attitudes toward spanking may be to increase the general public's knowledge of children's rights.

How are children's best interests expressed during their hospital visit?-An observational study

AIMS AND OBJECTIVES

To describe ways in which children's best interests were observed to be expressed in paediatric settings during their hospital visit.

BACKGROUND

The best interests of the child are embodied in national and international legal systems, although the definition remains problematic. The child's limited autonomy mandates duty bearers to have both a child perspective and the child's perspective when considering what the best interest of the child entails in care situations.

DESIGN

A qualitative descriptive study with overt, non-participant observations fulfilling the COREQ criteria.

METHODS

Thirty-two observations of interactions between children aged 2 to 17 years with both acute and chronic conditions, their parents and healthcare professionals were conducted at three paediatric hospitals in Sweden. Inductive and abductive reasoning were used in the content analysis of data, which followed the identification, coding, categorising and abstraction of observed patterns of the best interest of the child.

RESULTS

Findings reveal facilitating and obstructing factors for the child's best interests to be safeguarded in healthcare situations. Children were guided in or hindered from exercising their competence. The observations showed a variation in actions taken by both parents and healthcare professionals to safeguard the best interests of the child.

CONCLUSIONS

Determining the best interest of the child requires a case-by-case basis, as it is context-dependent, situational, flexible and dependent on all actors involved and actual decisions made.

RELEVANCE TO CLINICAL PRACTICE

Healthcare professionals' actions can facilitate or obstruct observed expressions of the child's best interest. It is essential to enhance healthcare professionals' communication skills, knowledge awareness and continuing education about the rights of children receiving healthcare services. Reflections and discussions on how to protect the best interests of children may help healthcare professionals to uphold children's best interest in daily clinical practice.

The implementation of child rights in healthcare services

BACKGROUND

Hospitalized children have the right to "partake in practices related to their treatment and care." Midwives and nurses have important roles and responsibilities regarding the protection and enforcement of these rights, such as providing information and advocating for children.

OBJECTIVES

This study aims to determine the attitudes of midwives and nurses toward their roles and responsibilities in the implementation of child rights in healthcare services and the factors affecting their attitudes.

METHODS

This descriptive cross-sectional study included 122 midwives and nurses in total. The data were collected through a questionnaire.

ETHICAL CONSIDERATIONS

Written permission was obtained from an ethics committee in the center of the city where the research was conducted.

RESULTS

The mean age of the participants was 36.70 ± 8.03 years; 58.9% of midwives and nurses stated that they understood the child's consent about the treatment by looking at the child's facial expression; 36% of midwives and nurses stated that children could not participate in decisions regarding their own health. It was observed that obtaining the child's consent in matters related to treatment does not make any difference between midwives and nurses. The rate of the midwives stating that they would report suspicious violence-neglect and abuse was found to be higher.

CONCLUSION

The variables of the unit of employment, the state of having children, choosing the profession and practicing in it willingly, and getting training on children's rights make a difference in terms of children's rights in healthcare services. Midwives and nurses should be reminded of child rights in healthcare services through regular in-service training programs.

Refugee and Asylum-Seeking Children: Interrupted Child Development and Unfulfilled Child Rights

The 21st century phenomenon of "global displacement" is particularly concerning when it comes to children. Childhood is a critical period of accelerated growth and development. These processes can be negatively affected by the many stressors to which refugee and asylum-seeking children are subjected. The United Nations Convention on the Rights of the Child (CRC) is the most ratified human rights treaty in history, with 196 States Parties (SPs). The CRC provides a framework of 54 articles outlining government responsibilities to ensure the protection, promotion, and fulfillment of rights of all children within their jurisdictions. Among these are the rights of refugee and asylum-seeking children, declared under Article 22 of the CRC. Refugee and asylum-seeking children, similarly to all other children, are entitled to their rights under the CRC and do not forgo any right by virtue of moving between borders. The hosting governments, as SPs to the CRC, are the primary duty bearers to fulfill these rights for the children entering their country. This manuscript provides an overview of the health and developmental ramification of being displaced for refugee and asylum-seeking children. Then, an in-depth analysis of the provisions under Article 22 is presented and the responsibilities of SPs under this article are described. The paper provides some international examples of strengths and shortcomings relating to these responsibilities and closes with a few concluding remarks and recommendations.

ANALYSING MULTIDIMENSIONAL CHILD POVERTY IN SUB-SAHARAN AFRICA: FINDINGS USING AN INTERNATIONAL COMPARATIVE APPROACH

This study provides with a first indication on the number of multidimensionally poor children in sub-Saharan Africa. It presents a methodology measuring multidimensional child deprivation within and across countries, and it is in line with the Sustainable Development Goal 1 focusing on multidimensional poverty by age and gender. Using the Multiple Overlapping Deprivation Analysis (MODA) methodology, the study finds that 67% or 247 million children are multidimensionally poor in the thirty sub-Saharan African countries included in the analysis. Multidimensional poverty is defined as missing two to five aspects of basic child well-being captured by dimensions anchored in the Convention on the Rights of the Child, namely nutrition, health, education, information, water, sanitation, and housing. The analysis also predicts the multidimensional child poverty rates for the whole sub-Saharan African region estimating 64% or 291 million children to be multidimensionally poor. In comparison, monetary poverty rates measured as less than USD 1.25 PPP per capita spending a day and weighted by the child population size finds 48% poor children. The results of this study highlight the extent of multidimensional poverty among children in sub-Saharan Africa and the need for children to have a specific poverty measure in their own right.

Child Marriage Laws around the World: Minimum Marriage Age, Legal Exceptions, and Gender Disparities

The marriage of children below 18 is widely recognized in international human rights agreements as a discriminatory global practice that hinders the development and well-being of hundreds of millions of girls. Using a new global policy database, we analyze national legislation regarding minimum marriage age, exceptions permitting marriage at earlier ages, and gender disparities in laws. While our longitudinal data indicate improvements in frequencies of countries with legal provisions that prohibit marriage below the age of 18, important gaps remain in eliminating legal exceptions and gender discrimination.

Caring for Blind Parents: Cost to the Education and Well-Being of Children in Tamale, Ghana

In this study we explored the experiences of the guide children (children who guide adults with visual impairment to beg for a living on the streets) in Tamale, Ghana, to unearth the impact of the guiding role on their educational participation and well-being. Data were gathered from 104 children and 57 adults using a set of questionnaires and interviews. The results showed that adults chose many of the children to take on the guide role and many of the children did not attend school. The implications for the children's well-being are discussed in relation to needs and rights.

Urban inequities; urban rights: a conceptual analysis and review of impacts on children, and policies to address them

This paper explores current conceptual understanding of urban social, environmental, and health inequality and inequity, and looks at the impact of these processes on urban children and young people in the 21st century. This conceptual analysis was commissioned for a discussion paper for UNICEF's flagship publication: State of the World's Children 2012: Children in an Urban World. The aim of the paper is to examine evidence on the meaning of urban inequality and inequity for urban children and young people. It further looks at the controversial policies of targeting "vulnerable" young people, and policies to achieve the urban MDGs. Finally, the paper looks briefly at the potential of concepts such as environment justice and rights to change our understanding of urban inequality and inequity.