17 Sexual Abuse in Indigenous and Arctic Children and Adolescents in Scandinavia

Introduction

Adolescence and early childhood are vulnerable periods for adverse life events such as sexual abuse with regard to psychological, social and cognitive development (Geoffroy, Boivin, Arseneault et al, 2018).  Childhood sexual abuse (CSA) which refers to sexual abuse or harassment experienced in the childhood or adolescence, differs in many ways from sexual abuse among adults. Children and adolescents rarely disclose sexual abuse immediately after the assault (Braithwaith, 2018). The disclosure also tends to be a process over time (Ruggiero, Smith, Hanson, Resnick, Saunders, Kilpatrick & Best, 2004; Wyatt & Newcomb, 1990). Physical complaints or behavioral changes often initiate the disclosure. Early life stress and serious adverse life experiences can have long-term physiological and genetic influence on brain development and cognition in children and adolescents, and cause enduring negative psychological, social, educational, and physical health outcome through the lifespan (Anda et al., 2006; Weaver, 2014). The impact of longstanding abuse affects the child’s health and development trajectories more severely than single abusive events (Finkelhor, Omrodd & Turner, 2007). Sexual abuse, as a serious childhood trauma, is therefore a public health problem, as it affects many children´s development, particularly when the survivors do not have access to effective treatment and nurturing care.

In spite of sparsely scientific knowledge of CSA in Arctic Indigenous people, stories of sexual abuse and harassment in Norwegian Indigenous and religious communities have flared up in the media over the past few years (Minde & Weber, 2017). The #metoo campaign has also contributed to greater openness on this topic. In this chapter, the present knowledge of rates and determinants of childhood sexual abuse in Arctic and Indigenous communities will be presented, as well as the implications of sexual abuse on mental health.

Prevalence rates and determinants

International and Scandinavian rates of CSA

The rates of sexual abuse appear to vary across studies, according to the age of the respondents, study design, response rate, definition of sexual abuse, and awareness of sexual abuse in the community. In a systematic review of CSA under the age of 18 in 24 countries, the rate was found to vary between 8-31% for females and 3-17 % for males, depending on type of CSA (Barth, Bermetz, Heim, Trelle, & Tonia, 2013). Across the Nordic countries, the prevalence of sexual abuse in children and young people varies substantially as well (Kloppen, Haugland, Svedin, Mæhle, & Breivik, 2016). CSA (broadly defined) varies between 3–23% for males and 11–36% for females. Contact abuse occurred among 1–12% of the males and among 6–30% of the females, while penetrating abuse was reported by 0.3–6.8% and 1.1–13.5% of males and females, respectively.

Adolescence is a vulnerable time, as there is an increased risk of abuse from early adolescence and, due to the fact, that adolescent peers seem to constitute the largest group of victims (Kloppen et al , 2016). Ystgaard et al. found that, among 15-16 years olds in Norway, the rate of lifetime sexual abuse was 2.5% for boys and 10.7% for girls (Ystgaard, Reinholdt, Husby, & Mehlum, 2003).

Arctic and Indigenous Groups

The numbers of CSA in the Arctic areas have been described as higher than for non-Arctic areas. Among adolescents in Arctic Norway (the three northernmost counties) and Greenland, the prevalence of sexual abuse is higher than the national rates (Curtis, Larsen, Helweg-Larsen & Bjerregaard, 2002; Schou, Dyb, & Graff-Iversen, 2007). In a report of sexual abuse among 15-16 years old junior high school students in six different counties in Norway, the rates for adolescents in the Arctic areas were the highest. In the northernmost county, Finnmark, 9.2 % of females and 3.1 % of males reported sexual abuse, compared to an average of 6.1 % for females and 1.6 % for males across all counties (Schou et al, 2007).

Indigenous children and adolescents in the Arctic area seem to be more vulnerable to sexual abuse and violence than non-Indigenous peers (Curtis et al, 2002; Karsberg, Lasgaard & Elklit, 2012; Payne, Olsson & Parish, 2013; Eggertson, 2013). The effects of colonialism are assumed to contribute to the high rates of disrupted families, assaults, and negative health outcomes, but are not well documented (Bailey, Powell, & Brubacher, 2017; Du Mont, Kosa, Macdonald, Benoit, & Forte, 2017; Funston, 2013; Ross, Dion, Cantinotti, Collin-Vézina, & Paquette, 2015). Colonial structures, such as removal from traditional land, residential school settings, discrimination and racism, severe socioeconomic deprivation, forced assimilation, and marginalization were experienced by many Indigenous peoples. The consequences  of colonialism however,  showed great diversity and are not generalizable (Nelson & Wilson, 2017). Sami adolescents, for instance, have experienced more life adversities, but their mental health is in general not worse off compared to non-Indigenous counterparts (Reigstad & Kvernmo, 2017; Turi, Bals, Skre & Kvernmo, 2011).

In Greenland, 13% of female and 4% of male young people between 18-24 years of age reported CSA occurring before the age of 13 (Curtis et al., 2002). In approximately 50% of those cases, the abuse occurred within the family. For every fifth female, the perpetrator was the father and substance abuse in the family was more frequent. Furthermore, sexual abuse was significantly related to later health problems in adulthood (Curtis et al., 2002).

The prevalence of CSA in younger Greenlandic adolescents between 15 and 18 years, showed somewhat higher rates; 14.6 % among females and 4.4 % among males had experienced direct sexual abuse and indirect sexual abuse by 23.2 % of the females and 9.6 % of the males, respectively. Alcohol abuse in the family, rural living, physical violence from parents, and alcohol use debut before the age of 13 were all related to more frequent sexual abuse (Karsberg et al., 2012).

Sexual abuse among the Indigenous Sami are sparsely investigated. As far as known there are only two studies on this topic; one on the adult population (Eriksen, Hansen, Javo, & Schei, 2015) and one on adolescents (Kvernmo, n.d.). A recent study revealed that both adult Sami females and males in the Arctic part of Norway were more likely to report any lifetime emotional and physical violence than non-Sami counterparts were. For CSA, the prevalence for Sami women exceeded those for non-Sami counterparts with a prevalence of 16.8% for Sami versus 11.5 % for non-Sami females, respectively. No ethnic differences occurred for males with a rate of approximately 4%. Living in rural and Sami majority contexts, having a Laestadian religious affiliation, and Sami ethnicity all predicted more sexual violence in both genders (Eriksen et al, 2015).

In contrast to Sami adults in the Arctic area of Norway, the rate of sexual abuse in Sami adolescents did not exceed that of non-Sami peers significantly, although it was somewhat higher (Kvernmo, n.d.). For both ethnic groups, sexual abuse was associated with more emotional problems and for females with more suicide attempts (Reigstad & Kvernmo, 2017). In Sami adolescents, more parental control protected against sexual abuse. In the non-Sami group, substantially more risk factors were associated with sexual abuse than among the Sami, including less parental support, mental health problems in parents, and externalizing problems. Compared to other Indigenous groups, risk factors for CSA, such as substance use among parents, lack of parental involvement, and broken families are less frequent. These conditions can possibly  explain the lower rates of CSA in Sami compared to Indigenous peers (Reigstad & Kvernmo, 2017).

More research is needed to explore the present incidence of sexual abuse in Sami children and adolescents, as well as adults, but also in other ethnic groups such as national minorities and majority Norwegian population in Arctic areas.

Prevention programs of CSA are usually universal educational programs delivered in school settings. Evaluation of these programs has revealed increased knowledge of CSA in children, but have not shown a decrease in numbers of CSA (MacMillan et al., 2009; Mikton & Butchart, 2009; Wurtele, 2009). Wurtle (2009) and Collin-Vézina et al. (2013) argue that there is a need for redirecting prevention programs from a unilateral child approach towards targeting families and parents, and professionals working with children but also the general population to effectively prevent CSA, also in future generations.

Conclusion

Child sexual abuse is a form of maltreatment that provokes reactions in all societies and cultures and is a considerable public health problem. It continues to inflict detrimental impacts on a substantial part of the population in their important and vulnerable development. The consequences of CSA are broad with respect to impaired social, cognitive, and psychological development in children and adolescents, and a broad specter of mental and physical health problems across the life span. A broad range of risk factors are related to sexual abuse, including fragmentation of families and communities, socioeconomic disadvantage, dysfunctional families, parental mental health problems, and substance abuse to peer relations. Meanwhile, limited knowledge exists regarding protective factors and effective prevention programs.

Arctic and Indigenous groups worldwide are known to be in a disadvantage position of childhood sexual abuse. The long history of oppression, marginalization, and stigmatization of Indigenous peoples is claimed to contribute to violence against women and children, but little research exist to support this. In contrast to other Arctic Indigenous groups, the Sami have been in close and adaptable contact with the majority populations over hundreds of years, and occupied a less oppressed position. Cultural exchange has been a bi-directional process over time.

Sami youngsters do not differ in rates of sexual abuse from their non-Sami peers. The Sami population has during the last decades gone through a strong political and cultural revitalization, which has strengthen the Sami culture and political rights on group and individual level, and heightened the position of Sami in the dominant society. In addition, the Sami have experienced the same benefit of socioeconomically advantages taking place in Norway and other Nordic countries generally the last decades with regard to educational possibilities, social welfare, and access to health care, also including Indigenous-focused health care. In certain Sami areas, for instance, the educational level among Sami females is among the highest in Norway and the general socioeconomic status not in disadvantage compared to the non-Sami population.  Compared to many other Indigenous groups, the Sami are in a unique position which may explain the lower rates of CSA among Sami adolescents.

Overall, the prevalence of CSA is still too high and more preventive efforts are needed. Without a greater focus on CSA in communities and adults working with children, and a broader understanding of the complex nature of sexual abuse, which includes the cultural and social aspects of Indigenous peoples, the prevention of sexual abuse may not target the risk groups and offer good enough efforts. In addition, more knowledge of the effects of CSA is needed. Recent studies in adolescent groups also highlight the need for preventive efforts also targeting peer abuse. Stronger attention should also be put on more research on resilient factors preventing CSA and success factors in reducing rates of CSA.

Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., … Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience, 256(3), 174–186. https://doi.org/10.1007/s00406-005-0624-4

Anderson L.A., Whiston S.C. (2005). Sexual assault education programs: A meta-analytic examination of their effectiveness. Psychol Women, 29, 374–388.

Bailey, C., Powell, M., & Brubacher, S. (2017). Reporting rates of child sexual abuse in Indigenous communities in two Australian jurisdictions. Child Abuse & Neglect, 68, 74–80. https://doi.org/10.1016/j.chiabu.2017.03.019

Barth, J., Bermetz, L., Heim, E., Trelle, S., & Tonia, T. (2013). The current prevalence of child sexual abuse worldwide: a systematic review and meta-analysis. International Journal of Public Health, 58(3), 469–483. https://doi.org/10.1007/s00038-012-0426-1

Collin-Vézina,D.,Daigneault, I., & Hébert, M. (2013). Child and Adolescent Psychiatry and Mental Health, 7 (22). http://www.capmh.com/content/7/1/22

Curtis, T., Larsen, F. B., Helweg-Larsen, K., & Bjerregaard, P. (2002). Violence, sexual abuse and health in Greenland. International Journal of Circumpolar Health, 61(2), 110–122. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12078958

Du Mont, J., Kosa, D., Macdonald, S., Benoit, A., & Forte, T. (2017). A comparison of Indigenous and non-Indigenous survivors of sexual assault and their receipt of and satisfaction with specialized health care services. PLoS ONE, 12(11), 1–15. https://doi.org/10.1371/journal.pone.0188253

Eriksen, A. M. A., Hansen, K. L., Javo, C., & Schei, B. (2015). Emotional, physical and sexual violence among Sami and non-Sami populations in Norway: The SAMINOR 2 questionnaire study. Scandinavian Journal of Public Health, 43(6), 588–596. https://doi.org/10.1177/1403494815585936

Finkelhor, D., Ormrod, R., Turner, H. (2007). Poly-victimization: A neglected component in child victimization. Child Abuse and Neglect, 31, (1), 7-26

Funston, L. (2013). Aboriginal and Torres Strait Islander worldviews and cultural safety transforming sexual assault service provision for children and young people. International Journal of Environmental Research and Public Health, 10(9), 3818–3833. https://doi.org/10.3390/ijerph10093818

Karsberg, S. H., Lasgaard, M., & Elklit, A. (2012). Victimisation and PTSD in a Greenlandic youth sample. International Journal of Circumpolar Health, 71. https://doi.org/10.3402/ijch.v71i0.18378

Kloppen, K., Haugland, S., Svedin, C. G., Mæhle, M., & Breivik, K. (2016). Prevalence of Child Sexual Abuse in the Nordic Countries: A Literature Review. Journal of Child Sexual Abuse, 25(1), 37–55. https://doi.org/10.1080/10538712.2015.1108944

Kvernmo S, R. B. (n.d.). Sexual abuse and violence in Sami and non-Sami adolescents; The NAAHS study

MacMillan, H. L., Wathen, C. N., Barlow, J., Fergusson, D. M., Leventhal, J. M., & Taussig, H. N. ( 2009). Interventions to prevent child maltreatment and associated impairment. The Lancet, 373, 250-66.

Mikton, C. & Butchart, A. (2009). Child maltreatment prevention: A systematic review of reviews. Bulletin of the World Health Organization, 87, 353 – 61.

Minde, G.-T., & Weber, A. (2017). Hvordan reagerer små samiske lokalmiljøer når kvinner forteller om seksuelle overgrep? Tidsskrift for Psykisk Helsearbeid, 13(03), 265–274. https://doi.org/10.18261/issn.1504-3010-2017-03-07

Nelson, S., Wilson, K. (2017).The mental health of Indigenous peoples in Canada: A critical review of research. Social Science & Medicine, 176, 93-112

Reigstad, B., & Kvernmo, S. (2017). Concurrent adversities and suicide attempts among Sami and non-Sami adolescents: the Norwegian Arctic Adolescent Study (NAAHS). Nordic J of Psychiatry, 71 (6), 425-432.

Ross, A., Dion, J., Cantinotti, M., Collin-Vézina, D., & Paquette, L. (2015). Impact of residential schooling and of child abuse on substance use problem in Indigenous Peoples. Addictive Behaviors, 51, 184–192. https://doi.org/10.1016/j.addbeh.2015.07.014

Schou, L., Dyb, G., & Graff-Iversen, S. (2007). Voldsutsatt ungdom i Norge -resultater fra helseundersøkelser i seks fylker. Norsk Folkehelseinstitutt, 8. Retrieved from https://www.fhi.no/globalassets/dokumenterfiler/moba/pdf/voldsutsatt-ungdom-i-norge.pdf

Ystgaard, M., Reinholdt, N. P., Husby, J., & Mehlum, L. (2003). [Deliberate self harm in adolescents]. Tidsskrift for Den Norske Laegeforening : Tidsskrift for Praktisk Medicin, Ny Raekke, 123(16), 2241–2245. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/14508543

Wurtele, S. K. (2009). Preventing sexual abuse of children in the twenty-first century: Preparing for challenges and opportunities. Journal of Child Sexual Abuse, 18, 1-18.

Wyatt, G.E., & Newcomb, M. (1990). Internal and external mediators of women’s sexual abuse in childhood. Journal of Consulting and Clinical Psychology, 58, 758–767.