Journal of Child Sexual Abuse

ISSN: 1053-8712 (Print) 1547-0679 (Online) Journal homepage: https://www.tandfonline.com/loi/wcsa20

A Psychosocial Understanding of Child Sexual

Abuse Disclosure Among Female Children in South
Africa

Shanaaz Mathews, Natasha Hendricks & Naeemah Abrahams

To cite this article: Shanaaz Mathews, Natasha Hendricks & Naeemah Abrahams (2016) A
Psychosocial Understanding of Child Sexual Abuse Disclosure Among Female Children in South
Africa, Journal of Child Sexual Abuse, 25:6, 636-654, DOI: 10.1080/10538712.2016.1199078

To link to this article: https://doi.org/10.1080/10538712.2016.1199078

Published online: 25 Aug 2016.

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JOURNAL OF CHILD SEXUAL ABUSE
2016, VOL. 25, NO. 6, 636–654
http://dx.doi.org/10.1080/10538712.2016.1199078

A Psychosocial Understanding of Child Sexual Abuse

Disclosure Among Female Children in South Africa
a b b
Shanaaz Mathews , Natasha Hendricks , and Naeemah Abrahams
a
Children’s Institute, University of Cape Town, Cape Town, South Africa; bGender and Health Research
Unit, South African Medical Research Council, Cape Town, South Africa

ABSTRACT ARTICLE HISTORY

Child sexual abuse is endemic in South Africa, driven by high Received 15 October 2015
levels of gender-based violence and underscored by structural Revised 4 February 2016
and social factors. This article aims to develop an understand- Accepted 15 March 2016
ing of the process of disclosure in a sample of female children KEYWORDS
and their caregivers. In-depth semistructured interviews were child sexual abuse;
conducted with 31 female children aged 8–17 years and their disclosure; girls and
caregivers at 3 intervals after presentation to a sexual assault adolescents; parental
treatment center. Nearly half of the children failed to disclose support; psychosocial; South
the sexual abuse immediately, fearing caregivers’ reaction. Africa; trauma; victim
Most children purposefully disclosed to a confidant through a blaming
process of identifying an intermediary to tell caregivers on
their behalf. The process of disclosure was influenced by multi-
ple factors, such as a fear of the caregiver’s reaction and
disbelief, which is related to parental style. Disclosure was
found to be a dynamic process that unfolds and not a single
or static event and influenced by multiple factors which all
impact on recovery. Our findings highlight the need to address
social norms on sexual abuse in order to improve responses to
disclosure to facilitate post-sexual-abuse adjustment for the
child and the family.

Introduction
Child sexual abuse (CSA) is considered to be endemic in South Africa. The
2014–2015 South African crime statistics report 22,781 sexual offenses
against children under the age of 18 years, which are estimated to be 44%
of reported sexual offenses (South African Police Service, 2014). But estab-
lishing the true magnitude of CSA is difficult due to underreporting and
underrecording, which are influenced by the developmental stage and psy-
chological responses of the child and by access to support and effective
services (Battiss, 2005; Jewkes & Abrahams, 2002; Jewkes, Penn-Kekana, &
Rose-Junius, 2005; Maniglio, 2009). A community-based prevalence study
among participants aged 18–26 years in the Eastern Cape Province of South
Africa found 38% of women and 17% of men reported experiences of sexual
abuse before the age of 18 (Jewkes, Dunkle, Nduna, Jama, & Puren, 2010).

CONTACT Shanaaz Mathews Shanaaz.Mathews@uct.ac.za Children’s Institute, University of Cape Town, 46

Sawkins Road, Rondebosc, Cape Town, South Africa.
© 2016 Taylor & Francis
 JOURNAL OF CHILD SEXUAL ABUSE 637

Such high levels of violence against children are arguably influenced by

structural factors such as poverty, patriarchal ideologies, and a weak criminal
justice system combined with dysfunctional families, poor parenting styles,
and substance abuse, which all increase children’s vulnerability (Jewkes et al.,
2005; Seedat, Van Niekerk, Jewkes, Suffla, & Ratele, 2009).
Developing an understanding of the dynamics of CSA is important in
reducing the risk for children and preventing the continued intergenerational
cycle of CSA. A sociological understanding of CSA highlights the importance
of childhood, notions of child-rearing, the social position of children, as well
as intergenerational perspectives of sexual desire (Jewkes et al., 2005). Child-
rearing practices are shaped by normative sociocultural practices, socioeco-
nomic conditions, and family formations and household structure (Risseeuw
& Palriwala, 1996). Children are socialized to respect and obey their elders
without question as the patriarchal gender order disempowers children
within the family and community (Townsend & Dawes, 2004).
Apartheid has had a profound impact on South African families and care
arrangements of children (Morrell & Richter, 2006). Large numbers of
children are raised by a lone mother, while kinship family care and child-
headed families are not uncommon (Madhavan, Townsend, & Garey, 2008;
Ramphele & Richter, 2006). The patriarchal nature of South African society
combined with the effects of a migrant labor system has resulted in frag-
mented families, with many fathers not meaningfully involved in children’s
lives (Nduna & Jewkes, 2012). These care arrangements increase the com-
plexity for children to disclose sexual violence, but disclosure remains the
most critical process to halt the sexual violence and to initiate treatment and
care to prevent long-term consequences.
Evidence suggests that children in South Africa are most at risk of sexual
abuse by a person known to them within a relationship of trust (Guma &
Henda, 2004; Mokoae et al., 2009). A child’s willingness and ability to
disclose sexual assault are influenced by this relationship and other factors
such as the age of the child, gender, relationship to perpetrator, severity of
abuse, perceived lack of social support, grooming by the perpetrator, fear of
the perpetrator, cultural considerations, fear of not being believed, and
feelings of shame and embarrassment (Alaggia, 2004; Freyd, 1994; Jonzon
& Lindblad, 2004; Kogan, 2004). In addition, anticipated parental response,
fear of family rejection and disbelief all influence CSA disclosure (Distel,
1999; Palmer, Brown, Rae-Grant, & Loughlin, 1999; Somer & Szwarcberg,
2001). Evidence from high-income settings shows that social support and a
mother’s support encourages CSA disclosure and facilitates recovery for the
child (Gries et al., 2000; Jonzon & Lindblad, 2004; Kogan, 2004; Lovett,
2004). Conversely, a lack of social support is often associated with the
mother’s emotional distress following the child’s disclosure and a lack of a
supportive social network (Hiebert-Murphy, 1998; Manion et al., 1996).
638 S. MATHEWS ET AL.

Mothers play an important role in protecting children from harm and

facilitating disclosure and recovery post-CSA (Plummer, 2006). It is also not
uncommon for mothers to be blamed for the CSA by fathers and other
family members or the community (Reitsema & Grietens, 2015). In addition,
parents’ inability to be supportive may reflect their own distress (Heflin,
Deblinger, & Fisher, 2000), such as their own experience of sexual abuse
(Alaggia & Turton, 2005). An urban South African study on disclosure found
that a quarter of children experienced nonsupportive reactions from friends,
family, and community members, that 16% ignored the disclosure, and that
10% of cases were pressurized to deny the abuse (Collings & Wiles, 2005b).
Nonsupportive reactions to disclosure of CSA have been associated with a
decreased likelihood of cases being reported to the police or children acces-
sing support services (Elliott & Briere, 1994; Lawson & Chaffin, 1992).
The social context combines with individual emotional factors and the
developmental phase of the child which influence disclosure (Sauzier, 1989;
Summit, 1983). Preschool age children are more likely to disclose accidentally
due to a precipitating event (Campis, Hebden-Curtis, & Demaso, 1993; Mian,
Wehrspann, Klajner-Diamond, Lebaron, & Winder, 1986; Sorensen & Snow,
1991). Abused adolescents seldom seek help when the abuse has been
ongoing, making disclosure harder (Bacon & Richardson, 2000).
Nevertheless, South African research, supported by findings from high-
income settings, indicate that older children are more likely to disclose
purposefully (Campis et al., 1993; Collings, Griffiths, & Kumalo, 2005;
Sorensen & Snow, 1991) while younger children tend to disclose in a more
incomplete and vague manner (Faller, 1988; Mordock, 1996).
A range of categories of CSA disclosure has emerged in international
literature: purposeful disclosure, accidental disclosure, prompted/elicited dis-
closure, behavioral/verbal disclosure, purposefully withheld and triggered dis-
closure (Alaggia, 2004; Campis et al., 1993; Keary & Fitzpatrick, 1994; Nagel,
Putnam, Noll, & Trickett, 1997; Sorensen & Snow, 1991). Purposeful dis-
closure is considered to be the predominant mode (Higson-Smith,
Lamprecht, & Jacklin 2004; Sauzier, 1989), although this is contested, as
some studies found this occurs only in a minority of CSA cases (Berliner &
Conte, 1995; Sgori, 1982). In a South African study, only 30% of respondents
made purposeful disclosures (spontaneous and unambiguous verbal disclosure
of abuse by the child), but most (43%) were facilitated by accidental detection,
which involved observed changes in emotional and behavioral states and
development of avoidance strategies and phobias, usually leading to the child
being questioned or referred for a professional opinion (Collings et al., 2005).
Despite the abundance of studies on CSA disclosure from developed
settings, there is a need for increased knowledge around the circumstances
of children’s disclosures within the South African context (Collings et al.,
2005). Perpetrators of CSA are often adults known to the child either within
 JOURNAL OF CHILD SEXUAL ABUSE 639

the family or within the neighborhood. This influences the dynamics of

disclosure as it may be met with disbelief and the seriousness of the abuse
may be minimized (Waterhouse, 2008). Most children find it difficult to talk
about their sexual abuse experiences (De Voe & Faller, 2002; Paine &
Hansen, 2002). It is therefore important to understand the dynamics of
disclosure and to see it as a multidimensional process that is embedded in
dialogue (Reitsema & Grietens, 2015).
We conducted a longitudinal observational study on a small sample of
girls to explore mental health adjustment post-CSA (Mathews, Abrahams,
Jewkes, Martin & Lombard, 2013). This study found high levels of psycho-
logical distress, with half (43.3%) of the participants still meeting the clinical
criteria for full symptom post-traumatic stress disorder 6 months postdisclo-
sure with standard therapeutic care. An additional analysis of the data
provided an opportunity to further explore the dynamics of CSA disclosure
and the factors that inhibit or promote it. Although a large body of research
on CSA disclosure has been developed, these were all located in developed
settings (Reitsema & Grietens, 2015). The strength of this study is the use of
child-centered methodology, allowing female children to describe their own
perspectives and experiences. This further analysis allows us to develop a
better understanding of the process of disclosure in South Africa, which can
assist in developing interventions for the improvement of reporting and
contribute to child protection policies for abused children and their families
in less resourced settings.

Methods
The data for this study was taken from a broader study that explored the
psychosocial adjustment of the child and their caregiver post-CSA (Mathews,
Abrahams, Jewkes, Martin & Lombard, 2013). Data was collected during
three separate in-depth interviews with each child and their caregiver. The
focus of the main study was to develop an understanding of mental health
adjustment of children post–sexual assault through the use of psychological
screening tools and semistructured interviews with caregivers and children.
The broader study also explored the use of support services and to what
extent they were meeting the needs of CSA survivors. For this article, only
data on disclosure of CSA from the three sets of in-depth interviews with the
children and their caregivers were analyzed.

Conceptualizing CSA disclosure

The concept of disclosure is considered inadequate because of its lack of
specificity and the variation in the way the term is used (Jones, 2000). The
term “disclosure” is more commonly used in relation to a child’s reporting of
640 S. MATHEWS ET AL.

abuse, while “telling” is more often used when adults share their abuse
experiences (Alaggia, 2004). Within the current study, disclosure will be
defined as the act of a child telling someone about the sexual abuse regardless
of whether that person is an authoritative figure.

Study design
The choice of qualitative research methodology is crucial in allowing the
researcher to focus on participants’ experiences and the meaning(s) they
ascribe to them while also allowing for a variety of data collection methods.
Studies with children who have been exposed to trauma in South Africa have
shown that qualitative methods, such as semistructured interviews, are a
viable approach for engaging children, thereby determining their levels of
psychological distress (Cluver, Gardner, & Operario, 2007; Seedat, Nyamai,
Njenga, Vythilingum, & Stein, 2004).

Study sample
A purposive sample of female children who experienced penetrative sexual
abuse and presented to either of two sexual assault centers located in the
Cape Town metropole, with their caregivers, were recruited into the study.
Thirty-one participants aged between 8 and 17 years and their caregivers
were recruited. Interviews with both the children and caregivers were used in
the analysis for this paper.

Data collection
Interviews were conducted by trained research assistants in three languages,
namely: English, isiXhosa, and Afrikaans. All interviews were recorded,
transcribed, and translated into English by the research assistants. The dura-
tion of interviews was between 30 and 45 minutes. All participants were
compensated by a voucher to cover transport and time costs. Interviews were
only conducted with adult participants who signed consent forms and, in the
case of minors, only with children whose main caregivers signed consent,
while children over 10 years also provided assent. Structured interviews were
conducted with the children using activity-based worksheets to allow for
discussion on issues such as the sexual assault experience, how the abuse
was disclosed, how they are coping since the event as described in an earlier
study (Mathews, Abrahams, Jewkes, Martin, & Lombard, 2013). Data were
collected through a range of participatory methods, such as drawing, story-
telling, and play. Worksheets were adapted from standardized screening tools
to measure depression, anxiety, and post-traumatic stress disorder, described
in an earlier study (Mathews et al., 2013).
 JOURNAL OF CHILD SEXUAL ABUSE 641

Data analysis
Thematic analyses of interviews were conducted. Transcripts were analyzed
inductively, which is a standard analytic technique characterized by a process
of iteratively coding and subcoding and interpreting the findings (Silverman,
2001). Initial codes broadly correspond to questions as grouped in the scope
of inquiry. Broad coding had been established, thematic categories were
refined, with subcategories being formed and relationships between these
elucidated.

Ethical considerations
Ethics approval for this study was granted by the University of Cape Town’s
Faculty of Health Sciences Research Ethics Committee. For the main study,
ethical approval was also granted by the South African Medical Research
Council’s Ethics Committee. Children were recruited into the study if they
were accompanied by a caregiver at the sexual assault center. Fieldworkers and
interviewers were well trained in working with children in a sensitive manner
to avoid retraumatizing the child and caregiver. A list of trauma counseling
services was given to all participants. Where children showed signs of distress
and trauma, they were immediately referred for crisis intervention at specia-
lized centers working with abused children and their families. Participation
was voluntary, and participants had the right to withdraw from the study at
any time. In cases in which the child’s safety was compromised, ethical
obligations led the researchers to refer the child to a social worker for
immediate intervention to ensure protection. Confidentiality was strictly main-
tained and all participants were referred for counseling to a service provider
for children and their families.

Results
Participant sociodemographics
The mean age of children was 13.5 years, with 80% of the sample 12 years
and older. Nine primary caregivers were mothers (29%), one was a father
(3.2%), 15 children lived with both parents (48.3%), and six were in the care
of other relatives (19.3%). Perpetrators mainly consisted of known persons
(75%) including acquaintances, family members, and friends. Half (n = 16) of
the children disclosed the abuse to relatives, friends, neighbors, teachers, and
the police rather than a caregiver. Disclosure by the children to caregivers
was seldom voluntary or purposeful; they were forced to disclose through
threats of punishment when parents noticed physical symptoms or changes
in behavior as well as when children were abducted and disappeared, which
alerted parents that something had happened. Children who disclosed within
642 S. MATHEWS ET AL.

24 hours were often sexually abused by a stranger, while those who disclosed
after a few weeks or months were more often abused by a known person, in
particular a family member. Three out of the 5 children who disclosed after a
few months were sexually abused by a family member. Four main themes
emerged and are discussed in the following discussion.

Factors promoting disclosure

Circumstances around the sexual abuse played an important role in disclo-
sure. Some children were abducted and kept captive for hours or days. When
these children were finally freed or managed to escape, they often feared
going home and being punished for “sleeping out” or “coming home late.”
Many of these children would seek help from the closest known person, or
from strangers on the street if they were stranded or lost. Some caregivers,
with the help of family and community members, would search for children
missing for 1 day up to a week, leading to immediate disclosure once found.
The circumstances around the sexual abuse often caused children to come
home late or sleep over at a friend’s home. This unusual behavior caused
great concern and distress among caregivers who confronted the child,
wanting to know what happened. A mother of a 14-year-old explained:
(xxx) she doesn’t come . . . (xxx) she doesn’t come. That time I check it out; it was
when I’m going to the toilet, past 12. Then I was going to (xxx’s) room to opening,
to check the bed, huh uh, (xxx) is not yet . . . and then I didn’t sleep right. Hey, I’m
worried about (xxx), man. . . . I don’t know where my child is.

This child returned home the following day, although she did not disclose
immediately, the mother knew something was wrong and placed pressure on
her with threats of a beating to elicit disclosure.
Sexual abuse has devastating psychological, emotional, and physical effects
on the child (Maniglio, 2009; Mathews et al., 2013). The process of disclosure
is complex and ambiguous as caregivers note changes in behavior or other
physical signs that are causing concern. For some caregivers this led them to
create a safe and enabling environment for the child to disclose what was
troubling them. A father explained that although he was quick to reprimand
and shout at his daughter for staying out late, he knew something was wrong:
My reaction was shouting at her because she had left and had me worried and now
she was crying because she thought I was mad at her and that would get her off. I
said to her, “Get out of my room; I do not want to hear anything.” But as I was
sitting there in my room I felt disturbed and I thought that I should go and talk to
her. I saw that she was bruised and I asked her what had happened and she told me
that she was raped.

Some caregivers had a feeling that their child was “not right,” “sick,” or
that “something was wrong.” Children would display different symptoms,
 JOURNAL OF CHILD SEXUAL ABUSE 643

from physical signs to changes in behavior and attitude. A 12-year-old girl

explained, “When I was at home, first day, my mother said she does not like
the way I was, she even said I was lost [in a daze].”
Behavior changes and physical signs also led to caregivers feeling worried
and suspicious. Such concerns would leave caregivers confused and fru-
strated about what was troubling their child. The reluctance of children to
disclose when caregivers were aware something was worrying them some-
times resulted in threats. Caregivers would threaten to beat or physically
punish the child in their desperation to establish what was “wrong.” This
would occur because the children did not sleep at home, came home late, or
started showing changes in their behavior or not obeying the caregiver.
Physical punishment was viewed by many as an acceptable means of parent-
ing, a form of discipline, and many children feared beatings, influencing their
willingness to disclose abuse.
A mother showing her anger toward her 12-year-old daughter, said:
We then asked her, “Where are you coming from, where did you sleep?” She does
not answer. My sister slaps her and takes her inside and I wanted to hit her so that
she can say where she was coming from, because I could not sleep, she was not
home and I did not know where she went . . . when I was about to hit her, my sister
said, “Wait, do not hit her; she is going to say where she is coming from.” My sister
hit her with a small pipe and she said . . .

Caregivers’ response to the children’s struggle to disclose the abuse further

pronounce the children’s sense of self-blame and shame, which can result in
long-term negative psychological consequences.

Factors inhibiting disclosure

Children’s accounts depict fear of caregivers’ reaction—such as punishment
or not being believed—as the primary factor inhibiting disclosure. The fear of
negative reaction, such as being scolded, punished, blamed, and not believed,
inhibited disclosure, thus many children spoke about being “afraid” to dis-
close to caregivers. This is not surprising as social norms of harsh parenting
that include physical punishment underscore these fears and are common in
South Africa. Many children therefore chose to disclose to another person
whom they felt they could trust, such as a teacher, friend, or neighbor who
could then take on the role of an ally. They act as mediators who would
eventually assist the child in reporting the sexual assault to the caregiver.
Most children displayed reticence to talk about the abuse, suggesting intense
emotional difficulties that children have in talking about sex and sexuality,
particularly with caregivers. It is often more difficult for children to disclose
CSA when the perpetrator is a family member or a known or trusted person
within the community as they are threatened not to tell. The anonymity of a
644 S. MATHEWS ET AL.

stranger appears to make it easier to disclose as some children rationalize this

as being more acceptable, and it possibly minimizes the feelings of shame and
blame, highlighting the complexity of disclosure when the perpetrator is
known to the child.
A 14-year-old who was raped by a friend reported, “When I got home I
was afraid of my father. At first I lied and said I was dragged by four men.”
Threats from perpetrators on the child’s life and that of their families were
reported by both caregivers and children as also affecting disclosure.
Children mentioned being “scared” or “afraid” to disclose because they
feared being killed or their families being harmed. Perpetrator threats are
common, especially if the perpetrator was a family member or known person.
This caused immense emotional and psychological distress and fear, inhibit-
ing the disclosure of the sexual assault. An 8-year-old, who was raped by her
landlord, explained, “And so he said to me if I’m going to say then he’s going
to shoot us all dead in the house . . . and so he threatened me with the gun.”
Many children came from fragmented families and experienced familial
instability, such as absent parent(s), parental separation, and divorce, all of
which can inhibit disclosure. In some families, either one of the parents or
both parents were absent due to death, imprisonment, or other social cir-
cumstances. Others came from homes where intimate partner violence or
domestic violence was a common occurrence. A 16-year-old girl was living in
a very violent home environment where her mother was experiencing long-
term sadistic partner violence by the father. She was raped at the time of her
parents’ divorce and internalized her experience. After the rape she became
very angry, started mixing with the “wrong crowd” and using drugs. Her
mother initially had no idea she had been raped and thought her acting out
was due to the divorce. Of significance, this mother had never disclosed her
own experiences of sexual abuse as a teenager and did so for the first time to
the researcher during her participation in the research. Her own vulnerable
emotional state could have influenced her inability to pick up cues from her
own child. The level of dysfunction in the family inhibited disclosure from
the child. The child did not want to burden the mother, and her emotionally
vulnerable state resulted in self-blame and her internalized feelings of anger
caused self-destructive behavior. The mother said:

He [father] used to come in drunk and he used to wake me up . . . grab me by the

throat and I used to keep quiet because I didn’t want them [children] to wake up.
But all the time she was awake and she used to lay with a knife under her pillow
and in her mind as a child she thought, “Just one move! And I’ll kill you.” At that
time [during divorce] I thought she was on drugs, maybe she’s experiencing,
experimenting on drugs and at that time I thought maybe she’s involved with
the wrong people to spite her father. Because she did everything in her power to
spite him.
 JOURNAL OF CHILD SEXUAL ABUSE 645

Caregivers often placed responsibility on children to protect themselves from

harm. Social norms in South Africa allow children relative freedom to walk
around unaccompanied and go on errands from a young age, while older
children in particular were given liberties such as staying out late and moving
around without restrictions. This mobility of children increases their vulner-
ability because children are not able to protect themselves. Caregivers appeared
to lack an understanding of children’s inability to protect themselves from
potential dangers, placing blame on the child for not reacting “appropriately”
or for “putting themselves” in a situation of danger. Caregivers often lacked an
understanding of the effects of rape on the child and how children respond to
such trauma and did not recognize the sign. Many children were blamed for the
sexual assault or not disclosing immediately. Children could not resist an attack
and were placed in a compromising position since they often trusted the
perpetrator. For example, a mother of a nine-year-old commented:
Even at the time they were pulling you, why did you not cry so that people would
hear? You should have at least cried or after this was done to you, you should have
come to me, your mother, and tell me what has happened so that I could see what I
can do.

Impact of disclosure on caregiver

The trauma associated with the disclosure of CSA often negatively impacts the
caregivers’ emotional and psychological functioning. Many reported that they
felt “shocked,” “hurt,” “pain,” and “worried” after hearing about the assault.
Caregivers mentioned “not sleeping well,” “having visions,” “feeling sick,”
“feeling stressed,” “sad,” and even feelings of denial after disclosure. Some
were so distressed that it affected their ability to function at work, while others
felt they would rather be at work, where they could be distracted from thinking
about the sexual abuse. Two caregivers disclosed their own personal experi-
ences of being sexually abused during their childhood. In both cases, the
researcher was the first person to whom they disclosed. This indicates the
complexity of CSA disclosure, as explained by one of the caregivers when
talking about her daughter, “I suspected that she was raped . . . she didn’t care
about herself as a woman and she’s still young . . . I think of myself when I was
her age; I acted the same because it happened to me.”
Disclosure of CSA also led to self-blame and shame for some caregivers
and this had significant psychological consequences. Some felt an immense
sense of guilt and self-blame, while others were blamed by the child’s father
and held responsible for the girl’s sexuality. A mother of a 17-year-old who
was attending a funeral in a rural area at the time of the assault displayed
guilt, as she explained, “Because I am responsible for her, I feel I have failed
646 S. MATHEWS ET AL.

in that light. I, I should have, I told myself I should have never gone away
because, I, I, don’t usually leave them alone.”
All caregivers were concerned about the safety of their children and
their families following the rape as most perpetrators were not arrested,
lived in close proximity, and in some cases, threatened to harm the
child. Post-CSA disclosure, most caregivers became extremely overpro-
tective of the movements of their children. Many children were not used
to having boundaries set by their caregivers, and older children were
particularly overwhelmed by the rules implemented by their caregivers
after the sexual abuse. Children did not understand or welcome the
sudden change in parenting style and that often led to tension within
the parent–child relationship because they felt confused and punished.
When they disobeyed these rules, they would be viewed as disrespectful,
defiant, and completely uncontrollable by their caregivers. These despe-
rate attempts to protect the child also led to insinuations of blame. A
mother of a 13-year-old girl reported:

I don’t want her to be outside at night; I want her to be near me all the time
which is what she doesn’t want to do . . . she will come back saying she had just
accompanied so and so. And I said to her, “When this happened to you, you
were accompanying someone but still” . . . and her father said she must no
longer accompany people; she must stay in the house but still she is not doing
that.

Caregivers often reacted to the disclosure by keeping it a “secret” that

needs to be “hidden” from family, friends, and the community, particularly if
it was not visible through the child going missing. This has a negative impact
on the child, as it may lead to feelings of shame and embarrassment. Some
caregivers therefore did not want to tell others about the abuse and tried to
keep it to themselves, which in turn led to suppressed feelings with detri-
mental psychological effects. In these cases, the abuse was usually viewed as
something to be ashamed of and something others should not know of. This
stemmed from the belief in many communities that child sex is taboo, and
caregivers felt ashamed to be associated with the issue as their child would be
viewed as “spoiled goods” and blamed for the rape. Some mentioned that
their child’s “pride” had been taken away; they felt she had been “ruined” and
“messed up.” Many caregivers feared that their children and family would be
stigmatized by other family and community members, and they also feared
being ridiculed if the sexual assault was known. The mother of a 13-year-old
girl explained, “I think she may be talking about this to other people and that
worries and scares me. Because if she goes around talking about it, she is
going to grow and people will mock her [referring to the incident].”
 JOURNAL OF CHILD SEXUAL ABUSE 647

Impact of disclosure on child

Some caregivers reacted to disclosure by blaming the child. They blamed the
child for dressing “inappropriately” and “enticing men” with their developed
bodies, reflecting South African societal views about gender and rape that
regard women as responsible for men’s sexual aggression. This perception
was displayed in a mother’s reaction to her 13-year-old daughter:
And the way she dresses, she is beautifully proportioned I know, and clothes suit
her. So I can see that people think she is older in the way they look at her. . . . She
has a butt and when she is wearing a pants it suits her and I think men are going to
think she is older but she is not . . . I would say to her she must not go out at night
dressed like that because she will be raped. Before this thing happened!

In some cases, caregivers provided no support after disclosure and chil-

dren would seek support elsewhere or have no support at all. This lack of
support from caregivers places the child at further risk of psychological harm.
The child is placed in a vulnerable position by having to search for appro-
priate support from other members of the family and community, which may
not be available. A 16-year-old described her quest for support after disclos-
ing the rape to her mother:
When Miss [teacher] was done, I told her what happened [crying]. She
then suggested that I report this incident at home. I went to report what
happened and my mother said she does not understand why I went and she
does not understand the reason why I accompanied (xxx) [friend], she does
not have time to listen to me.
It is evident from these findings that CSA disclosure is a complex process
that is influenced by factors embedded in the parent-adult relationship as
well as family characteristics and dynamics. The devastating impact of CSA
disclosure on the child and caregiver leads to mental health distress and an
inability for families to provide children with the required emotional support.
This inhibits the child and family from seeking treatment and care for the
whole family, leading to long-term mental health distress and possible nega-
tive psychological outcomes.

Discussion
Findings from this study provide valuable and important insight into the
complexities of CSA disclosure. Our study found that nearly half of the
children failed to disclose their abuse to their caregivers immediately because
they feared their reactions. Nevertheless, they purposefully disclosed to a
trusted adult whom they considered a confidant and able to act as mediator
to inform their caregiver and provide them with the required support. We
found a larger number of children made a purposeful disclosure compared to
another South African study that reported 30% of respondents purposefully
648 S. MATHEWS ET AL.

disclosed and a larger number (43%) were accidental detections (Collings

et al., 2005). Accidental detection was rare in our study, but nearly 40% of
disclosures were prompted or elicited when caregivers suspected something
had happened. Nevertheless, there was a difference between the study sam-
ples as this study used a community-based sexual assault health treatment
service, while the earlier study (Collings et al., 2005) drew on a sample that
was recruited via a therapeutic service.
Reluctance and difficulty to disclose to a caregiver has been illustrated by
other studies (Hershkowitz, Lanes, & Lamb, 2007; Kogan, 2004). Choosing to
disclose to a trusted confidante as a strategy has been described as a mechan-
ism to transfer the responsibility to a person whom the child perceives as
having the power to end the sexual abuse (Reitsema & Grietens, 2015). We
found that confidante selection, although a conscious process, served a some-
what different purpose not previously described. In our study a confidante acts
as an ally and intermediary, facilitating disclosure of the abuse to a caregiver
on the child’s behalf. Disclosure is therefore a dynamic process that unfolds
over time and should not be considered a singular and static event with the
aim to simply tell someone about the abuse (Reitsema & Grietens, 2015).
Anticipated parental reaction, combined with the fear of family rejection
and disbelief, emerged as a key factor in this study, as this influenced the
child’s willingness to disclose the sexual abuse. The fear of negative responses
by caregivers and the anticipated blame acted as a major barrier. Children’s
disclosure was often met with no response, supporting their fears and leaving
them with a sense of inertia. This lack of perceived support is difficult to
make sense of but can only be understood in the context of a combination of
social norms of deserving victimhood, norms on rape, and the lack of skill
and knowledge of how to respond, the latter most likely due to very high
levels of trauma experienced by many South Africans (Kaminer, Seedat, &
Stein, 2005). A number of caregivers related their own experience of trauma,
such as their own sexual abuse and intimate partner violence. Some care-
givers disclosed their own experiences of trauma for the first time during the
study, suggesting that they have internalized their own experiences, which
made it difficult to be emotionally supportive to the child.
Intergenerational experiences of trauma therefore have a profound impact
on children accessing support services. This blunted reaction by caregivers
was found in previous research in South Africa, where a quarter of children
experienced nonsupportive reactions at the time of disclosure (Collings &
Wiles, 2005b). To reap the full benefits of disclosure and to minimize adverse
long-term psychological effects due to sexual abuse, it is important that
children experience a positive reaction from significant others (Gries et al.,
2000). Yet we found that these children faced parental anger in multiple ways
post disclosure: anger for being away, anger for not wanting to disclose, and
possible anger for placing themselves at risk. This had a direct impact on
 JOURNAL OF CHILD SEXUAL ABUSE 649

recovery, as social support is one of the most important factors in facilitating

recovery from CSA. Children with less supportive families have been found
to have increased levels of post-traumatic stress disorder and dissociative
symptoms (Roesler, 1994; Tang, Freyd, & Wang, 2007).
Most children came from fragmented and dysfunctional families, and
children were exposed to conflict in the household, high levels of unemploy-
ment, substance abuse in the family or community, poverty, and a lack of
physical and social infrastructure and services. In this context, children are
expected to become self-reliant from an early age, responsible for their own
safety in the community or in participating in social engagements. Most
South African townships are deprived, disorganized, and riddled by crime
and violence, and education on safety, sexuality, and abuse is often neglected
and not prioritized. Caregivers often lack the capacity to supervise children
adequately as they are preoccupied with their own stressors, such as lack of
partner support and income insecurity, which may directly affect the care-
givers’ capacity to be responsive and supportive to their child (Tomlinson,
Cooper, & Murray, 2005). Supporting families to understand the needs of
children and to be more available to children in times of crisis is critical to
achieve psychological recovery posttrauma. Prevention of violence against
children is critical to shift the current high levels of violence and associated
long-term effects. There is an urgent need for services to integrate prevention
and education programs targeting parents to improve outcome for children.
We found that many caregivers changed their parenting style postdisclo-
sure, sometimes in response to perpetrators’ threats. The anxiety associated
with ensuring the safety of the child resulted in overprotective behavior by
creating new rules to control the child’s mobility. This causes much distress
for children who were normally given great freedom to move on their own.
In addition, many caregivers also feared stigmatization from others in the
family and community, not only as a result of the risk of HIV but also due to
the conceptualization of CSA in communities and the silence around it.
Children are often silenced as families do not talk about the abuse, which
makes it very difficult for healing, and this trauma then becomes internalized
if not constructively managed. This unrecognized and untreated trauma
often results in long-term negative psychological consequences that mental
health services are unable to effectively manage (Jennings, 1994). Parents,
caregivers, and the mental health system need to be educated on the impact
of keeping silent on the mental health outcomes for the child affected by
sexual abuse and how their reactions and treatment approaches should foster
healing and not long-term destruction (Jennings, 1994).
This study has some limitations as it is a secondary analysis of data from a
broader study, which did not specifically focus on CSA disclosure. However,
it provides us with valuable information on the process of disclosure, which
could be analyzed for the purposes of this article. All children in this study
650 S. MATHEWS ET AL.

presented to a sexual assault center and reported their abuse to the police,
therefore care should be taken as these data are not generalizable to broader
populations who did not necessarily follow this path. However, a strength of
this article is the direct engagement with child participants to obtain their
point of view and take into account their experiences to develop a better
understanding of disclosure. In addition, the study participants were only
female children, and we are therefore unable to generalize the findings to all
children in South Africa. Nevertheless, this article provides important
insights with respect to the process of disclosure among girls and is reflective
of the paucity of data on male children who experience CSA in non-Western
settings.
CSA disclosure is a complex process influenced by many factors such as
where and how the incident occurred, the child’s response to the abuse, caregiver
anticipated reactions and actual reactions, threats by perpetrators, dysfunctional
family environments, and social ideologies, all which have detrimental impacts
on the child and caregiver (Reitsema & Grietens, 2015). This study found most
children purposively disclosed the sexual assault to a trusted individual whom
they relied on to assist with disclosure to caregivers. This process of disclosure is
embedded in the parent–child relationship as most children in the study feared
“telling” parents, and parents’ responses often supported their fears. The process
of disclosure highlighted by our study suggests an urgent need to educate
parents, caregivers, and communities on how to respond appropriately to
disclosure and the role of support services post disclosure. It is important that
community members, including teachers, are equipped and educated to support
children when disclosure occurs. Building the capacity of children to understand
what constitutes sexual abuse and the importance of “telling” should be high-
lighted in the life orientation curriculum at all public schools. Community-wide
campaigns to increase both awareness and knowledge can assist communities to
deal more effectively with disclosure. Of importance is the need to strengthen
the caregiver–child relationship. Harsh parenting practices act as a deterrent to
disclosure to caregivers, and enhancing parenting skills by upscaling parenting
programs not just limited to the early years are critical if we aim to shift parent–
child relationships in South Africa. Finally, preventing stigmatization by shifting
social norms and developing an understanding of the dynamics of CSA should
be prioritized to facilitate disclosure and the development of an appropriate
therapeutic response to facilitate healing and recovery for all children.

Funding
This study was funded by the UK Department for International Development (DFID) as part
of a research project to support the development of the national curriculum on sexual assault
for health care providers in South Africa.
 JOURNAL OF CHILD SEXUAL ABUSE 651

Notes on contributors
Shanaaz Mathews, MHP, PhD, is an associate professor in the Faculty of Health Sciences
and the director of the Children’s Institute at the University of Cape Town. Her main
research interests include gender-based violence against women and children, intimate
femicide, fatal child abuse, the shaping of violent masculinities and multidisciplinary
approaches to strengthen child protection. She received her MPH at the University of Cape
Town and her PhD at the University of the Witwatersrand.

Natasha Hendricks, MA, MPH, is a researcher with Gender and Health Research Unit at the
South African Medical Research Council. Her research interest is youth violence and child
maltreatment using qualitative approaches.
Naeemah Abrahams, MPH, PhD, is a professor in the Faculty of Nursing at the University of
Cape Town and senior specialist scientist in the Gender and Health Research Unit at the South
African Medical Research Council. Her main areas of research include research in gender-based
violence including risk factor studies of men who use violence against women, femicide, health
sector responses to gender-based violence, stigma in sexual assault reporting, adherence to
postexposure prophylaxis after sexual assault, and violence within school settings.

ORCID
Shanaaz Mathews http://orcid.org/0000-0002-4743-3829
Natasha Hendricks http://orcid.org/0000-0001-6174-8985
Naeemah Abrahams http://orcid.org/0000-0002-6138-6256

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