Building Support for the Primary
Prevention of Child Maltreatment
Bernadette J. Madrid, MD
Head, Child Protection Unit
University of the Philippines Manila
and
Executive Director
Child Protection Network Foundation
PHILIPPINE SITUATION
• Population : more than 92 million
• Annual population growth rate: 2.04
• Poverty incidence worsened:
24.4% (2003) to 26.7% (2006)
• High income inequality compared to Asian
neighbors
• Off-track in meeting MDG targets for
Poverty
Education
Maternal health
Malnutrition
PHILIPPINE SITUATION
• Low spending on social protection programs
0.3% of GDP in 2007 to 0.8% in 2008
• Lack of policy & institutional coordination
• Social protection has a narrow base of
beneficiaries
• Social protection programs are: numerous;
with limited reach; inadequately funded;
short-lived
• High leakage rate
Philippine National Budget Year 2008
• National budget: 2008
Education = 13.8%
Social Welfare = 5.64%
Health = 1.6%
• The budget cannot
cover for basic services
Source: E-Net Philippines, 2008.
Traditional Political Support
• In the Philippines, education has the highest
political support and still it is not enough.
There are just so many deficiencies in
education.
• CSR of corporations and individual donors
usually support education.
• The Philippines is just preparing for public
kindergarten and after ten years: K12.
Support for Primary Prevention of
Child Maltreatment
• “It is unlikely that political leaders will
support the level of resources needed to
develop high-quality programs targeted at
preventing child maltreatment , which will be
seen as affecting only a small proportion of
children. “
Michael Wald (2009)
Preventing Maltreatment or Promoting Positive Dev’tWhere should a community focus its resources? In Dodge &
Coleman (Ed), Preventing Child Maltreatment
Community Approaches. New York: The Guilford Press.
Stages of Building Support for the Primary
Prevention of Child Maltreatment
• First National Meeting on Preventing Child Maltreatment
2007
2008
2009
• Research: Adverse Childhood Experiences (ACE) and
Health Risk Behaviors Among Adults in a Developing
Country Setting
• Research: Child Maltreatment Prevention the Philippines:
A country situation analysis
CPU Network & Department of Health in partnership with WHO
Stages of Building Support for the Primary
Prevention of Child Maltreatment
2010
2011
2012
• National Multi- sectoral Consultative Meeting on Strengthening
Responses to Child Maltreatment / Violence against Children in
the Philippines
• National Prevalence Study on Violence Against Children
• Triple P Positive Parenting Program Conference
• Completion of the Prevalence Study
• Start of the Triple P pilot project
CPU Network & Council for the Welfare of Children in partnership with WHO
Objectives of the First National Meeting
on Preventing Child Maltreatment
1. Recognize that child abuse and neglect is an
important problem in the Philippines today
and has life-long impact on risk behaviors
and chronic disease.
2. Appreciate that child abuse and neglect is
preventable and that there are prevention
programs that have been shown to work.
Objectives of the First National Meeting
on Preventing Child Maltreatment
3. Understand the problems that have
prevented programs from being adapted in a
wider scale.
4. Take the steps necessary to come up with a
national plan on the prevention of child
abuse and neglect.
PARTICIPANTS
of the First National Meeting
Leaders and policy makers
• Health
• Social Welfare
• Education
• Academe
• Professional Societies
• International Org
•
•
•
•
•
•
Congress
Local government
Legal
Labor
Media
NGO’s
NEXT STEPS recommended by the
First National Meeting:
• Creation/Expansion of Inter-Agency Committee?
• National Plan for Primary Prevention of Child
Maltreatment (to include framework for
coordination)
• Integration of Prevention of Child Maltreatment in
public health programs
• Data Management
• Evaluation Tool to measure effectiveness of the
interventions
What was obvious
• The Department of Health did not really want
to lead the process.
• Child Maltreatment is seen as a social problem
and as such the leadership should naturally be
the Department of Social Welfare and
Development.
Long Term Effects of Child
Maltreatment
• Adverse Childhood Experiences (ACEs) still
have profound effect 50 years later
• Transformed from psychosocial experience
into organic disease, social malfunction and
mental illness
• ACEs are the main determinant of the health
& social well-being of the nation.
Results of the Metro Manila
ACE Study
Those who were sexually abused are:
• 12 times more likely to engage in early sex;
• 9 times more likely to have early pregnancy;
• 5 times more likely to commit suicide.
Ramiro, Madrid, Brown 2010
Child Abuse & Neglect 34: 842-845
Results of the Metro Manila
ACE Study
Individuals who felt that they were not loved
during childhood are:
• Twice as likely to smoke, use illicit drugs,
have early sex and multiple sex partners
• 5 times more likely to commit suicide.
Ramiro, Madrid, Brown 2010
Child Abuse & Neglect 34: 842-845
Strong graded response between number of
ACEs & poor health
• Bronchitis/
emphysema
• Asthma
• Ischemic Heart Disease
• Hypertension
• Tuberculosis
•
•
•
•
Skin problems
UTI
Liver problems
GI problems- ulcers,
constipation, indigestion
• Depression
Ramiro, Madrid, Brown 2010
Child Abuse & Neglect 34: 842-845
CHILD MALTREATMENT PREVENTION IN
THE PHILIPPINES: A COUNTRY
SITUATION ANALYSIS
Bernadette J. Madrid, MD
Laurie Ramiro, PH.D.
John Go, MD
Juanita Basilio, MD
Supported by WHO, 2009
OBJECTIVES OF THE STUDY
1. To do a national situation analysis on child
maltreatment prevention using secondary data
and stakeholder interviews;
2. To assess how municipalities and barangays
implement their child maltreatment primary
prevention program.
Study Settings
• The study had a
national and local
coverage.
• Three barangays in the
city of Manila, 3 in
Quezon City and 3 in
rural San Juan,
Batangas.
METHODOLOGY
Aspects of prevention programs targeted:
1. Prevention readiness refers to the
knowledge, attitudes and attributions that
policy makers and opinion leaders have about
child maltreatment.
Qualitatively assessed through structured
conversations with key individuals and content
analysis of official documents and reports.
Quantitatively assessed using Community Readiness
Model of Plested, et al. (2006).
2. Prevention resources are what actually
exist by way of information and information
systems; and resources of government and nongovernment agencies specifically tasked to
prevent child maltreatment
Community Readiness Model
(Plested, Edwards, & Jumper-Thurman, 2006)
 A model for community change that integrates a
community’s culture, resources and level of
readiness to more effectively address an issue.
 Allows communities to define issues and strategies
in their own context
 Builds cooperation among organizations and
individuals
 Increases community capacity for prevention and
intervention
 Encourages and enhances community efforts
9. High Level of
Community Ownership
STAGES OF COMMUNITY
READINESS
8. Confirmation /
Expansion
7. Stabilization
6. Initiation
5. Preparation
4. Preplanning
3. Vague Awareness
2. Denial / Resistance
1. No Awareness
Child Maltreatment Prevention in the Philippines: A country situation analysis
Intervention
level
State &
society
Developmental stage
< 3 years
3-11 years
12-17 years
Adulthood
Implementing legal reform and human rights
•Translating the CRC into national laws
Very many laws: PD 603- The Child & Youth Welfare Code
RA 7610 – Child Protection
RA 7658 – Prohibiting child labor
RA 9231 – Worst form of child labor
RA 9262 - Against Domestic Violence
RA 9208 - Anti Trafficking
RA 9344 – Juvenile Justice Law
RA 9775 – Anti child pornography
Very many policies, local government codes
Child 21 (2025) –child sensitive & child friendly society
serves as the road map
National Plan of Action for Children- 5- year frame
MDGs
(Madrid, Ramiro, et. al. 2009)
Child Maltreatment Prevention in the Philippines: A country situation analysis
Intervention
level
State &
society
Developmental stage
< 3 years
3-11 years
12-17 years
Adulthood
Implementing legal reform and human rights
•Most laws are unfunded or the funds is “ embedded” in a
department’s budget
•Too many implementing bodies specified in the mandates
•It is not clear how it will be implemented in the local level
•There is no sanction if it is not implemented
•Since it is unfunded and no personnel, it is made to fit into
services already in place
(Madrid, Ramiro, et. al. 2009)
Child Maltreatment Prevention in the Philippines: A country situation analysis
Intervention
level
Developmental stage
< 3 years
3-11 years
12-17 years
Adulthood
Introducing beneficial social and economic policies
•Providing early childhood education and care
Early Childhood Care and Development Act
State &
society
•Ensuring universal primary and secondary education
Philippine National Plan of Action to Achieve Education for All
by year 2015
•Investing in good social protection systems
Achieving Universal Health Care for All Filipinos embodied in
DOH Administrative Order No. 2010-0036
(Madrid, Ramiro, et. al. 2009)
Child Maltreatment Prevention in the Philippines: A country situation analysis
Intervention
level
Developmental stage
< 3 years
3-11 years
12-17 years
Changing cultural and social norms
•Pending bill: Anti-corporal punishment
State &
society
Reducing economic inequalities
•Tackling poverty
Conditional Cash Transfer (3 Ps)
Environmental risk factor reduction
•No Smoking in public places
•Clean Air Act
(Madrid, Ramiro, et. al. 2009)
Adulthood
Child Maltreatment Prevention in the Philippines: A country situation analysis
Intervention
level
Developmental stage
< 3 years
3-11 years
parenting
programs e.g.
PES
12-17 years
Relationships
Home visitation
programs;
Parenting
Individual
Increasing access
Life skills education
to child care
UNICEF Child Friendly School Model
services, social
Personal Safety Lessons in Schools
support
(Madrid, Ramiro, et. al. 2009)
Parenting
programs e.g.
PES
Programs for the prevention of child
maltreatment
• Most of the programs were established not
specifically to prevent child maltreatment but to
improve the health, education and social status of
the child.
• The implementation is based on the “limited good
principle”.
• No evaluation of program effectiveness (A.I.D.S.)
• Provisions for children are scattered across various
departments, without any formal connections or
consistent policy or practice.
• NGO’s and international organizations fill in the gaps.
Child Maltreatment Prevention in the Philippines:
A country situation analysis
• Very few leaders except for those directly
involved e.g. social welfare, health, know
about the different laws involving children.
• There is really no separate budget for children.
• No updated data on child maltreatment.
(Madrid, Ramiro, et. al. 2009)
Level of Prevention Readiness
City/Municipality
Stage of Community Readiness
1.
Quezon City
Stage 5 (Preparation Stage)
2.
Manila
Stage 4
Post workshop
Stage 7 (Stabilization Stage)
San Juan, Batangas
Stage 3
Post workshop
Stage 2 (Denial Stage)
3.
(Preplanning Stage)
(Vague Awareness Stage)
Common Next Steps for the
3 areas involved in the study
1. Baseline survey on child maltreatment
prevalence
Quezon city – all forms of CAN
San Juan – corporal punishment
2. Orientation and training of leaders of the
community
3. Information dissemination to community
members about child abuse and neglect and the
programs of the city.
4. Plan for evaluation
Way to Go
• Formation of a coalition of government agencies
and NGO’s that will steer the country’s direction
towards prevention of child maltreatment
• National Prevalence Study on Child Maltreatment
• Invest on a primary prevention program that is
population-based; has been shown to work and
can generate political support: Parenting
Program
National Network to End Violence
Against Children
Government Agencies
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•
•
•
•
•
•
Council for the Welfare of Children
Department of Social Welfare &
Development
Department of Education
Department of Health
Department of Labor and
Employment
Department of Interior and Local
government
Philippine National Police
Non-government Agencies
• Child Protection Network
• Parenting Foundation of the
Philippines
• Open Heart Foundation, Inc.
• Lunduyan Foundation, Inc.
• Asia-Pacific Regional NGO
Representative to Follow-Up VAC
Recommendations
• National Council for Social
Development
• PLAN International, Inc.
• Save the Children
• ECPAT
• UNICEF Manila