Journal of Childhood & Developmental Disorders

Keywords

Saudi Arabia; Child abuse; Child neglect; Child maltreatment

Introduction

Child neglect is a global problem with potentially significant short- and long-term consequences for the victim. Worldwide it is the commonest form of child abuse [1]. Child neglect is generally defined as an on-going failure to meet a child’s basic physical, mental, and/or emotional needs. It may involve a failure to supply sufficient nourishment, shelter, clothing, or other varieties of physical deprivation. Alternatively or additionally, it may involve a failure to see that a child is properly educated or able to grow in an adequate, socially nurturing environment, or to receive emotional support and love [2]. Child neglect is often, but not always, accompanied by other forms of abuse, including physical and sexual abuse [1,3]. Of all the forms of child abuse, neglect are perhaps the least well researched and documented academically [1]. There is a particular dearth of studies on this subject in low-resource countries and those where the cultural norm has been to suppress open discussion of maltreatment to children. Into this latter category falls the Kingdom of Saudi Arabia (KSA), which has a long history of harsh physical treatment of juveniles and only recently, since the 1990s, experienced a growing recognition of the scale of the Child Abuse and Neglect (CAN) problem within its borders [4]?

The present research focuses on neglect. However, there is much evidence to suggest that various forms of abuse are often linked. For example, in families where a child is subjected to physical or psychological abuse, they are more likely also to experience neglect of one type or another. This may be because some of the causative factors are the same: Parents under stress due to financial, social, marital, or other difficulties, psychological problems of a parent, or a family situation that is otherwise dysfunctional [5].

Even with the increased awareness and recognition of the extent of the child neglect issue in KSA, the reporting systems available remain in their infancy. Because such systems in other countries, such as the United Kingdom and United States, are far more comprehensive and effective, and thus gather more complete data, the erroneous assumption was made that the prevalence of child neglect in these countries was much greater [6]. The lack of accurate statistical information was compounded by the fact that historically most of the studies of CAN in KSA have been population-based surveys and official reports. Such techniques tend to greatly undercount the number of true occurrences and give a misleading picture of the scale and impact of the phenomenon [7]. In contrast, self-reports are capable of capturing much more accurate and detailed information and shedding important light on the nature of the problem through the perspectives, opinions, and experiences of the respondents [8]. Fortunately, in the past few years, more research has become available based on self-reports of children in KSA opening the way to the development of more effective programs and services to tackle the problem.

Aim

This study essentially seeks to perform an extensive review of literature pertaining to child neglect abuse in KSA so that the degree and nature of this issue can be ascertained. The outcomes of this study will then be employed to formulate recommendations for additional research, generate more effective practices by social workers, and provide further security against child abuse by having enhanced programs and policies. The study also aims to determine any variations in reported occurrences of child neglect abuse in KSA; to determine the degree to which researchers and social workers are willing to deal with the issue; and to recognize the programs and reforms being implemented by the government to deal with the issue of child neglect abuse.

Methodology

This study follows the method of systematic review. First, the selection criteria for inclusion and exclusion were established. This was done on the basis of the main objective of the study, namely to determine the nature and degree of the problem, and also the secondary objectives, which included determining the steps adopted at the official level to deal with the problem. Table 1 presents the selection criteria employed by the researcher.

Table 1: Selection criteria.

The publications, issued in the years 1990–2016, were examined, including the whole period in which the social science researchers and health care practitioners were presenting data on child abuse in KSA. The search also involved unpublished debates and theses; however, other material was not included unless it was published in peer-reviewed journals. The search involved the following keywords: ‘Saudi Arabia,’ ‘child neglect,’ ‘child abuse,’ and ‘child maltreatment’. In the beginning, general search engines were used, which led to the identification of various specific online databases and journals.

Several search engines were utilized: Hail University Library, Science Direct (Elsevier), Cross Search, Social Sciences Citation Index (New ISI XML) and Saudi Digital Library (SDL). The website of the library of King Fahd was also included in the search, as was as a manual search of key journals such as Child Maltreatment, Child Abuse and Neglect, Child Welfare, and Child Development.

After the inclusion and exclusion criteria were applied, twelve articles and two reports were shortlisted and considered appropriate for the current study (Table 2).

Table 2: Relevant papers, theses, and other documents identified by the search.

Results and Discussion

Child neglect, along with other forms of CAN, in KSA began to attract the attention of health-care professionals and academic researchers in the early 1990s following the reporting of a number of cases in the popular media. However, it was initially believed to be a rare phenomenon that affected relatively few children [4]. In the decade from 1990 to 2000 only 11 incidents of CAN, all of them case studies, were reported in the medical literature [9]. Despite this massive underreporting of the true scale of the problem, by 2000 recognition of child neglect within KSA had grown and a system of child protection centers been set up in major hospitals [9].

In 2010, the Saudi National Family Safety Registry (NFSR) produced its first annual report, which presented data on CAN from the 38 hospital-based Children Protection Centers then established across the Kingdom [10]. For the 12-month period up to September 4, 2010, it indicated there had been 292 registered cases of CAN of which 126 were cases of neglect (35 general, 32 medical, 27 emotional, 14 nutritional, 11 abandonment, and 7 educational). In 2011, the number of cases of CAN registered by the NFSR jumped to 895 of which 286 were cases of neglect [11]. By 2012, 41 CPCs had been established across the country; however, according to the 2012 annual report “there were 202 maltreated children 263 events reported by 21 of the child protection teams” [12]. Of the 263 events (a child may experience more than one abuse event, hence the discrepancy), 99 (37.6%) were of neglect. Altogether, from 2010 to 2012, the NFSR documented 1,450 instances of child abuse of which 511 (35%) were classified as neglect. Slightly more males (54%) than females suffered neglect according to the 2012 report; no gender data was provided in the 2010 and 2011 reports. The fact that only half of the hospital-based child protection teams registered child maltreatment cases indicates, in the words of the report that: “many of the healthcare professionals lack case recognition skills, awareness of referral and substantiation capabilities, or incompliance with the mandatory registry case reporting guidelines.” No explanation was given in the 2012 NFSR report for the sudden and dramatic fall in registered incidences of CAN to only 29% the previous year’s total. The Saudi government has issued no further reports of this kind after 2012.

What is clear from the official government statistics, as provided by the NFSR, is that they massively underrepresent the true number of cases of child abuse in general and child neglect in particular. For comparison, 16.8% of UK children were reported to be neglected in 2011 [13]. Even allowing for the difference in population–about 64 million in the case the UK and 29 million in the case of KSA–it is inconceivable that there are only a few hundred cases of child neglect in the whole of KSA every year. This is evidenced by more recent studies such as that by Al- Eissa [4], which use self-reporting methodologies for their data collection. The 2016 Al-Eissa study questioned 16,939 male and female students, aged 15 to 19, in secondary schools across five main regions of the country, and used ISPCAN Child Abuse Screening Tool (ICAST) as its sole method of data collection. Overall, 53% of participants said they had experienced neglect, the figure being somewhat higher in the case of girls than boys. By comparison, 50% said they had been physically abused and 65% psychologically abused. Thus, one study involving just 5% of all adolescent students in each of five (out of 19) regions in KSA, found 8,978 reported cases of child neglect as compared with a total of 511 such cases registered with the NFSR between 2010 and 2012. Another recent study found that children living in larger households (≥6 members) were 1.5 times more likely to suffer neglect than those in smaller families [14]. Other factors associated with higher levels of neglect include unemployment of the father and single/step-parent households [15-18].

Recommendations

Progress has been made over the past few decades and, in particular, as a result of several large-scale studies over the past few years, toward revealing the full extent of child neglect in KSA. However, more such studies are urgently needed that involve data collection via self-reporting and interviews with extensive samples of children and adolescents. Eventually and ideally, these studies should overlap so that they cover all demographic categories and regions of the country. Only then will it be possible to form an accurate picture of the nature and prevalence of child neglect across the country.

When the true magnitude and characteristics of this issue are known and recognized, among academics, medical professionals, social workers, government officials, and the public as a whole, the information will be available to set up a national system to prevent and protect young people from neglect and other types of abuse. Ideally, this should be on a par with those now found in, for instance, Western Europe, North America, and Australia and be staffed by professionals who are properly trained in recognizing the signs and symptoms of child neglect. At present, by NFSR’s own admission, this is not the case. There should also be a nationwide program of education to inform the public of the dangers and signs of child neglect and the resources that are available; both to families who wish to seek help in addressing problems they may face with regard to this issue and children who need a safe haven from neglect.

Conclusions

Several recent studies, together with historical accounts and cultural references, suggest that child neglect is a much bigger problem in KSA than previously published statistics by the government-run National Family Safety Registry would indicate. Although awareness of CAN continues to expand in KSA, the mechanisms and programs in place to deal with child neglect and other forms of abuse are still extremely inadequate to cope with the scale of maltreatment that exists. More fundamentally, there remain strong social and cultural barriers within the country that must be overcome in order that children can be adequately shielded from mistreatment, most notably at the hands of their own parents and other primary caregivers.

Within the past few years, evidence has accumulated that by their late teenage years, at least a half of all children in Saudi Arabia consider themselves to have suffered some form of neglect. This is on a par, for example, with some developing countries in Asia. Terms such as “child neglect” are open to a variety of interpretations and definitions. However, it is certainly the case that the problem in KSA is much greater than has been officially recognized in the past. Although some steps have been taken at a national level to tackle child neglect, along with other aspects of abuse, these now appear to be wholly inadequate in their present form.

Saudi Arabia is a deeply conservative country, in which change is slow to come. However, backed by a maturing literature on the subject of child neglect and more powerful research strategies, there is reason to hope that culturally-sensitive, effective measures will be put in place to properly deal with this troubling issue.

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