CHILD SEXUAL ABUSE - ICASA



CHILD SEXUAL ABUSE

INTRODUCTION

Child sexual abuse is the sexual exploitation or victimization of a child by an adult, adolescent, or older child. The difference in age and sexual knowledge between a child and an older person makes informed consent to sexual activity impossible.

Sexual abuse includes a range of behaviors, including vaginal, anal, or oral penetration, fondling, exhibitionism, prostitution, and photographing a child for pornography. The sexual activity does not necessarily involve force. Children are often bribed or verbally coerced into sexual acts.

Child protective service and law enforcement statistics do not present the full extent of child sexual abuse since children often do not tell anyone of sexual abuse.

Incest is sexual relations between family members. Relatives may include parents, stepparents, siblings, uncles, grandparents and other blood relations as defined by law. Incest constitutes abuse when the child is unable to give informed consent to sexual activity due to the authority of the relative, the child's dependency and lack of power, and/or the difference in ages between the child and the relative.

STATISTICS

One in three girls and one in six boys are sexually abused before the age of 18.[1]

Over a third of all sexual assaults involved a victim who was under the age of 12.[2]

An estimated 906,000 children were victims of maltreatment in the United States in 2003. 10% of the children were found to be victims of sexual abuse.[3]

Of the 22.3 million adolescents in the United States today, 1.8 million have been victims of serious sexual assault.[4]

Between 300,000 and 400,000 U.S. children are victims of the sex trade each year, from juvenile pornography and street prostitution to selling sex at school.[5]

A survey of high school adolescents showed that 17% of girls were physically abused and 12% were sexually abused, while 12% of boys were physically abused and 5% were sexually abused.[6]

Approximately 1 in 5 female students reported being physically and/or sexually abused by a dating partner.[7]

For 60% of “sexually active” girls under 14, their only sexual experience has been a rape.[8]

The Women’s Safety Project survey reported the following results regarding child abuse: [9]

• 17% of women reported at least one unwanted sexual contact (narrowly defined) by a relative before the age of 16. This suggests that approximately 1 in 6 girls have been sexually abused by a relative in childhood.

• 34% of women reported at least one unwanted sexual contact by a nonrelative before age 16, suggesting that 1 in 3 girls is sexually abused by a nonrelative in childhood.

• In total, 42% of women reported at least one experience of incestuous and/or extrafamilial sexual abuse before age 16. 27% were sexually abused before age 8.

• If a broader definition is used, including unwanted kisses, nongenital sexual touching, or noncontact experiences such as having someone masturbate in front of them, 53.8% of women reported an unwanted sexual experience before age 16.

AGE

More than half (54 percent) of female victims and nearly three quarters (71 percent) of male victims were first raped before their 18th birthdays.[10]

61% of rape victims were sexually assaulted before the age of 18.[11]

29% of all forcible rapes occurred when the victims were under 11 years old.[12]

In a 1991 survey conducted by the National Victim Center, 29% of all forcible rapes occurred when the victims were under 11 years old. Another 32% occurred when the victims were between 11 and 17.[13]

Nearly 30% of child sexual assault victims identified by child protective services agencies in 1995 were between 4 and 7 years of age.[14]

In a national random survey, 27% of women and 16% of men disclosed that they had been sexually abused as children. The median age for girls was 9.6 years and for boys was 9.9 years.[15]

40% of men incarcerated for rape said their victims were children; 80% said their victims were under age 18.[16]

In a study of 4,295 convicted child sex abusers, 60% of the victims were age 13 or younger.[17]

DISABILITIES

Almost half of adult women with disabilities report that they were sexually abused as children, compared with 34% of non-disabled women.[18]

90% of girls and women referred to the Seattle Rape Relief Disabilities Project had been abused by relatives or individuals they knew.[19]

A study of 482 children with documented maltreatment evaluated at the Center for Abused Handicapped Children at Boys Town Research Hospital in Omaha, NE, reveals that more than half (53.4%) of the deaf children report being sexually abused.[20]

In a study of 150 interviewed deaf youth at a residential school, 75 children reported being sexually abused, 19 reported being victims of incest, and 3 reported both physical and sexual abuse.[21]

GENDER

Of child sexual abuse victims identified by child protective services agencies in 1995, 75% were girls and 25% were boys.[22]

Girls are sexually abused three times more often than boys, according to the Third National Incidence Study. Boys are more likely to be seriously injured or die as a result of their abuse.[23]

Juvenile victims of sexual assault were more likely to be male (18%) than were adult victims (4%). Nearly a quarter (27%) of the victims under age 12 were male.[24]

One in six boys may be sexually abused at least once before age 18, with the median age of the first abusive episode being 9.9. 20% are abused by women and 80% by men.[25]

A nationwide study of nearly 3,000 male college students found that 7.3% reported having an abusive sexual experience before the age of 14.[26]

A survey of men revealed that 14% had been forced or coerced into sexual activity before they were 14 years old. The median age of their perpetrator was 27 years of age.[27]

Boys who have been sexually abused by relatives are 15 times more likely to be sexually abused as are other boys.[28]

RACE

In a 1994 survey, 44.8% of African-American women, 38% of white women, 25.6% of Latina women and 21.1% of Asian-American women had histories of child sexual abuse.[29]

A study by Wyatt and Russell found that African-American victims of child sexual abuse are often more severely abused, with more use of force, than Caucasian children. The African-American girls also are more often abused by relatives other than their fathers; often the offender is an uncle. African-American girls are sexually abused at about the same rate as Caucasian girls.[30]

OFFENDERS

CHARACTERISTICS

99% of persons incarcerated for sexual assault or rape are men. About 35% were sexually assaulted or abused as children.[31]

93% of child sexual abuse offenders are men.[32]

Most men who abuse boys define their sexual orientation as heterosexual.[33]

In a study of sexually abused girls, only 6.2% were abused by women.[34]

1/3 of convicted sex offenders were sexually abused as children.[35]

Adults were the offenders in 60% of the sexual assaults of youth under age 12.[36]

The typical child sex offender abuses an average of 117 children, most of whom do not report the abuse.[37]

OFFENDER’S RELATIONSHIP TO VICTIM

Strangers were the offenders in just 3% of sexual assaults against victims under age 6 and 5% of the sexual assault victimizations of youth ages 6 through 11.[38]

Of sexually abused girls, 53% are abused by their biological fathers; 15% by stepfathers, and 8.8% by uncles.[39]

11% of rape victims are raped by their fathers or stepfathers; another 16% are raped by other relatives.[40]

70% of incarcerated sexual abusers knew their victims. 40% said their victim was a child; 80% reported that the victim was under age 18.[41]

31% of women surveyed were sexually abused by a non-relative; of these, 20% were abused before age 14. 43% of the non-family abusers were boyfriends, 42% were acquaintances, and 11% were strangers.[42]

31% of women surveyed were sexually abused by someone outside the family; of these, 20% were abused before the age of 14.[43]

Offenders outside the family are often acquaintances of the victim. In one survey, 11% were strangers, 42% were casual acquaintances, and 43% were boyfriends.[44]

A survey of 4,340 adults examining sexual attitudes and experiences reported that 4.1 percent of respondents had a physical sexual experience with a teacher.[45]

SPECIAL ISSUES

INTERNET

Child pornography reports to CyberTipline, a congressionally mandated mechanism for monitoring child sexual exploitation, jumped 39 percent in 2004.[46]

Year Child Pornography Tips

1998 3,267

1999 7,736

2000 16,724

2001 21,611

2002 37,647

2003 76,178

2004 106,119

Based on interviews with a nationally representative sample of 1,501 youth ages 10 to 17 who use the Internet regularly during a one-year timeframe:[47]

• Approximately one in five received a sexual solicitation or approach over the Internet.

• One in four had an unwanted exposure to pictures of naked people or people having sex.

• One in seventeen was threatened or harassed.

• Fewer than 10% of sexual solicitations and only 3% of unwanted exposure episodes were reported to authorities such as a law-enforcement agency.

• About one quarter of the youth who encountered a sexual solicitation or approach told a parent. Almost 40% of those reporting an unwanted exposure to sexual material told a parent.

Law enforcement at all levels made an estimated 2,577 arrests during the 12 months starting July 1, 2000, for Internet sex crimes against minors.[48]

More than 20,000 images of child pornography are posted on the Internet every week.[49]

PREGNANCY

The rate of pregnancy among children and adolescents who have been sexually abused is significantly higher than that of non-victims: [50]

• 66% of pregnant adolescents reported being sexually abused at some point in their lives.

• 62% were abused prior to their pregnancies.

• 30% had been raped.

• 44% had been victims of attempted rape.

• More than 50% were victimized by family members, most often stepfathers.

• Between 11% and 20% of the girls were pregnant as a direct result of rape.

• More than 3/4 of the sexual assaults against the girls involved force or threat of force, such as rape at knifepoint.

• At least 3/5 of the girls had been severely physically abused as well.

2/3 of births to teenage girls are fathered by men age 20 or older.[51]

60% of girls who had sex before age 15 were coerced by males averaging 6 years their senior.[52]

PROSTITUTION

Between 300,000 and 400,000 American children and youth are victimized by sexual exploitation each year.[53]

66% of all prostitutes were sexually abused as children. Of those, 2/3 were abused by fathers, stepfathers, or foster fathers and 10% were abused by strangers.[54]

The odds of a child sexual abuse victim being arrested for prostitution are 27.7 times higher than for a non-victim.[55]

Men and women who have been raped or forced to have sex in childhood or adolescence are four times more likely to have worked in prostitution compared with people who have not been abused.[56]

RITUAL SEXUAL ABUSE

Ritual abuse consists of the sadistic acts that accompany sexual abuse; and/or sexual abuse that occurs in conjunction with group acts of worship; and/or acts committed as a means of intimidating children to make them compliant victims and to keep their testimony from being believed.

David Finkelhor has defined three types of ritual abuse. These are: [57]

• Cult-based ritual abuse: This type of sexual abuse is a means of inducing a mystical or religious experience in the abuser, and involves an elaborate belief system or ideology.

• Pseudo-ritual abuse: Children are exploited through psychological, sadistic intimidation to inhibit disclosure of the abuse. Costumes and animal sacrifices are two of the methods used to frighten children into submission. Pornography is usually involved.

• Psychopathological ritualism: The abuser is an obsessive, sadistic individual, rather than a group concerned with religious or other experience.

Ritual aspects of sexual abuse may include ceremonies, torture of children or animals, frightening costumes, group sex, and/or animal sacrifice. Some of the most grotesque acts witnessed by a child may be simulations designed to intimidate the child into submission and discredit his or her testimony.

Most people's initial reaction to accounts of ritual abuse is disbelief. It may be difficult to accept reports of child victims and adult survivors who say they witnessed human sacrifices or were sexually tortured or put in underground coffins. Nonetheless, considering a child's literal interpretation of events and lack of broad factual knowledge, there is an amazing consistency to the stories of ritually abused children. Children across the country who have never met each other cite instances of sexual abuse, animal torture, chants, threats to parents and/or pets, and consumption of human waste, blood and body fluids.

Some ritual abuse experts maintain that body parts and fluids are consumed during rituals, with no evidence remaining. Other experts believe sacrifice rituals are usually staged, using dolls or stuffed animals as a form of psychological manipulation. Children also may be given drugs that alter their perceptions.

PREVALENCE

It is impossible to estimate the prevalence of ritual sexual abuse because many child victims and adult survivors do not reveal that they were abused. Victims fear they will not be believed, expect to be labeled crazy, and fear retaliation by the offender(s).

In one group of 500 child sexual abuse victims, 55 were victims of ritual sexual

abuse: [58]

• 11 were victims of “pseudo-ritual” abuse, involving threats, group sex, drugs, and consumption of human waste.

• 10 were “private” rituals in which the behavior was committed by one perpetrator and was ritualized for personal, sadistic reasons.

• 32 were organized, group rituals. Out of these 32, four were intergenerational. Eight involved children taken into group ritual abuse situations by their parents, and 20 children were victims of extrafamilial ritual abuse that occurred outside of the home. Nineteen of these extrafamilial cases occurred in day care centers, and one in a Boy Scout troop.

13% of child sexual abuse cases in day care included ritual aspects.[59]

LAW IN ILLINOIS

In 1992, the Illinois Ritual Abuse of Children Task Force assisted in the passage of legislation that makes ritual abuse a specific crime. It is now a felony to involve a child in actual or simulated ritually abusive acts. The law enhances penalties for child sexual abuse with ritually abusive aspects.

OFFENDERS WHO COMMIT RITUAL ABUSE

Ritual abuse is often initiated by family members who abuse their own children. These abusers may have been abused as children themselves.[60]

One study found that 64% of ritual abuse perpetrators are women. In standard child sexual abuse cases, about 75% of the perpetrators are men.

The social background of the abusers is often upper-middle-class or middle-class, and includes people from all professions.[61]

IMPACT ON THE VICTIM

INITIAL EFFECTS

Psychological reactions that children exhibit following sexual abuse include fear, anger, hostility, guilt and shame, low self-esteem, anxiety, early overt sexual behavior, and behavioral disturbances (such as running away and truancy).[62]

Sexually abused children are often further exploited by others in emotionally and physically dangerous ways. In one study, 10% of sexually abused adolescents exchanged sex for money; 9% exchanged sex for shelter, 7% exchanged sex for drugs or alcohol.[63]

LONG-TERM EFFECTS

Psychological effects of child sexual abuse often last into adulthood. Adult survivors of child sexual abuse may exhibit depression, anxiety, sleep disorders, dissociation, and low self- esteem.[64]

40% of child sexual abuse victims seek mental health treatment after reaching adulthood.[65]

Survivors of incest may have particularly severe problems, especially if the offender was a father or stepfather.[66]

53% of adult survivors of incest said the abuse caused “some” or “great” long-term psychological effects.[67]

The duration of sexual abuse affects the severity of psychological trauma. The following percentages of survivors called their abuse “extremely traumatic”: 73% whose abuse lasted more than 5 years, 62% whose abuse lasted 1 week to 5 years, and 46% who experienced one incident of abuse.[68]

11% of pregnant adolescents reported becoming pregnant as a result of sexual assault, mostly incest.[69]

Victims suffer more long-term trauma when they are sexually abused by adults, rather than by adolescents.[70]

REVICTIMIZATION

55.4% of women who reported childhood sexual abuse also reported being subsequently raped. Revictimization occurred for only 20.2% of rape victims who did not report being sexually abused as children. Child sexual assault victims were 4.7 times more likely to be subsequently raped. Women who were both physically and sexually abused as children reported the highest rates of subsequent rapes.[71]

18% of women who reported being raped before age 18 said they were also raped after age 18, compared with 9% of women who did not report childhood rape.[72]

REPORTING

REPORTING SEXUAL ABUSE

Many children who are sexually abused do not tell anyone of the abuse. Often, the crime is never reported to the police. In one survey, 42% of all respondents who were sexually abused told someone of the abuse within a year; 21% told someone at some point after a year had passed, 36% never told anyone. Only 3% reported the crime to police.[73]

In a survey conducted by Diana Russell, only 2% of incest cases and 6% of extrafamilial child sexual abuse cases were reported to the police.[74]

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[1] Russell, Diana E.H. 1988. The Incidence and Prevalence of Intrafamilial and Extrafamilial Sexual Abuse of Female Children. In Handbook on Sexual Abuse of Children, ed., Lenore E.A. Walker. Springer Publishing Co.

[2] Bureau of Justice Statistics. U.S. Department of Justice. 2000. Sexual Assault of Young Children as Reported to Law Enforcement: Victim, Incident, and Offender Characteristics,.

[3] U.S. Department of Health and Human Services. Children’s Bureau. Child Maltreatment 1997: Reports from the States to the National Child Abuse and Neglect Data System. Washington, D.C.: 1999.

[4] Kilpatrick, Dean, and Benjamin Saunders. The Prevalence and Consequences of Child Victimization: Summary of a Research Study by Dean Kilpatrick, Ph.D. and Benjamin Saunders, Ph.D. 1997. U.S. Department of Justice. National Institute of Justice. Washington, D.C.

[5]“Estes, Richard. 2003. The Commercial Sexual Exploitation of Children in the U.S, Canada, & Mexico. Center for the Study of Youth Policy. University of Pennsylvania.

[6] The Commonwealth Fund. 1999. mproving the Health of Adolescent Girls: Policy Report of the Commonwealth Fund Commission on Women’s Health. New York, NY..

[7] Dating Violence Against Adolescent Girls and Associated Substance Use, Unhealthy Weight Control, Sexual Risk Behavior, Pregnancy, and Suicidality. 286(5) Journal of the American Medical Association (August 1, 2001).

[8] Adolescent Pregnancy Prevention Coalition of North Carolina. 1994. Adult Males + Teen Girls = Teen Pregnancies.

[9] Randall, Melanie, and Lori Haskell. Sexual Violence in Women’s Lives: Findings from the Women’s Safety Project, A Community Based Survey. Violence Against Women 1 (1995): 6 -31.

[10] National Institute of Justice. 2006. Extent, Nature, and Consequences of Rape Victimization: Findings From the National Violence Against Women Survey.

[11] American Academy of Pediatrics. Committee on Adolescence. Sexual Assault and the Adolescent. 5 Pediatrics. (1994): 761-765.

[12] Kilpatrick D.G., C.N. Edmunds, and A. Seymour. 1992. Rape in America: A Report to the Nation. Arlington, VA: National Victim Center.

[13] National Victims Center & Crime Victims Research and Treatment Center, 1992.

[14] U.S. Department of Health and Human Services. Children’s Bureau. Child Maltreatment 1997: Reports from the States to the National Child Abuse and Neglect Data System. Washington, D.C.: 1999.

[15] Finkelhor, David, et al. Sexual Abuse in a National Survey of Adult Men and Women: Prevalence, Characteristics, and Risk Factors. Child Abuse and Neglect 14 (1990): 19-28.

[16] Greenfield, Lawrence A. 1997. Sex Offenses and Offenders: An Analysis of Data on Rape and Sexual Assault. U.S. Department of Justice. Bureau of Justice Statistics. Washington, D.C.

[17] Bureau of Justice Statistics. U.S. Department of Justice. 2003. Recidivism of Sex Offenders Released from Prison in 1994.

[18] Webb, Tracy. Abuse of the Disabled: Violence against Women with Disabilities. Working Against Violence in Our Community.

[19] Paige, Carolyn S. 1991. Project Action Curriculum: Sexual Assault Awareness for People with Disabilities. Seattle Rape Relief Disabilities Project.

[20] Sullivan, P.M., M. Vernon, and J. Scanlan, J. Sexual Abuse of Deaf Youth. 132 American Annals of the Deaf (1987): 256-262.

[21] Sullivan, P.M., M. Vernon, and J. Scanlan, J. Sexual Abuse of Deaf Youth. 132 American Annals of the Deaf (1987): 256-262.

[22] Finkelhor, David, et al. Sexual Abuse in a National Survey of Adult Men and Women: Prevalence, Characteristics, and Risk Factors. Child Abuse and Neglect 14 (1990): 19-28.

[23] Sedlak, Andrea, and Diane Broadhurst. 1996. Executive Summary of the Third National Incidence Study of Child Abuse and Neglect. National Center on Child Abuse and Neglect. U.S. Dept. of Health and Human Services.

[24] Bureau of Justice Statistics. U.S. Department of Justice. 2000. Sexual Assault of Young Children as Reported to Law Enforcement: Victim, Incident, and Offender Characteristics.

[25] Roesler, T.A., and T.W. Wind. Telling the Secret: Adult Women Describe Their Disclosures of Incest. Journal of Interpersonal Violence (1994): 327-338.

[26] Risin, Leslie I., and Mary P. Koss The Sexual Abuse of Boys: Childhood Victimizations Reported by a National Sample, cited in Rape and Sexual Assault II., Ann W. Burgess, ed. 1988. New York: Garland Publishing.

[27] Ratner, P.A., et al. Non Consensual Sex Experienced by Men Who Have Sex with Other Men: Prevalence and Association with Mental Health. 49 Patient Education and Counseling. (2003): 67-74.

[28] Holmes, W. C., M.D., MSCE & Slap, G.B., M.S., M.S. Sexual Abuse of Boys. 280(1) Journal of the American Medical Association (1998): 1855-1862, citing numerous studies.

[29] Urquiza, Anthony J., and Beth Goodlin-Jones, Beth L. Child Sexual Abuse and Adult Revictimization with Women of Color. 9(3) Violence and Victims (1994): 223-232.

[30] Russell, Diana E.H. 1988. The Incidence and Prevalence of Intrafamilial and Extrafamilial Sexual Abuse of Female Children. In Handbook on Sexual Abuse of Children, ed., Lenore E.A. Walker. Springer Publishing Co.

[31] Bureau of Justice Statistics. 1997, pp. 21-23.

[32] Crewdson, John. 1988. By Silence Betrayed. Little, Brown and Co.

[33] Urquiza, Anthony J., and Lisa Marie Keating. 1990. The Prevalence of Sexual Victimization of Males. In 1 The Sexually Abused Male: Prevalence, Impact, and Treatment., ed. Mic Hunter. Lexington, MA: Lexington Books.

[34] Roesler, T.A., and T.W. Wind. Telling the Secret: Adult Women Describe Their Disclosures of Incest. Journal of Interpersonal Violence (1994): 327-338.

[35] Groth, Nicholas A. 1979. Men Who Rape: The Psychology of the Offender. New York: Plenum Press.

[36] Bureau of Justice Statistics. U.S. Department of Justice. 2000. Sexual Assault of Young Children as Reported to Law Enforcement: Victim, Incident, and Offender Characteristics.

[37] National Institute of Mental Health. 1998.

[38] Bureau of Justice Statistics. U.S. Department of Justice. 2000. Sexual Assault of Young Children as Reported to Law Enforcement: Victim, Incident, and Offender Characteristics.

[39] Roesler, T.A., and T.W. Wind. Telling the Secret: Adult Women Describe Their Disclosures of Incest. Journal of Interpersonal Violence (1994): 327-338.

[40] Kilpatrick D.G., C.N. Edmunds, and A. Seymour. 1992. Rape in America: A Report to the Nation. Arlington, VA: National Victim Center.

[41] Bureau of Justice Statistics, p. 24, 1997.

[42] Russell, Diana E.H. 1988. The Incidence and Prevalence of Intrafamilial and Extrafamilial Sexual Abuse of Female Children. In Handbook on Sexual Abuse of Children, ed., Lenore E.A. Walker. Springer Publishing Co.

[43] Ibid.

[44] Ibid.

[45] Policy and Program Studies Service. U.S. Department of Education. 2004. Educator Sexual Misconduct: A Synthesis of Existing Literature.

[46] PR Newswire. National Center for Missing & Exploited Children. 2005.

[47] Ix – Online Victimization: A Report on the Nation’s Youth. 2005. PEW Internet Study.

[48] National Center for Missing & Exploited Children. 2003.

[49] . National Society for the Prevention of Cruelty to Children (Oct. 8, 2003).

[50] Boyer, Debra, and David Fine. Sexual Abuse as a Factor in Adolescent Pregnancy and Child Maltreatment. 24 Family Planning Perspectives (Jan. 1992).

[51] DeVita, Carol J. The United States at Mid-Decade. 50(4) Population Bulletin. Population Bureau, Inc. Washington, D.C. (March 1996).

[52] The Alan Guttmacher Institute. 1994. Sex and American Teenagers.

[53] Estes, Richard. 2003. The Commercial Sexual Exploitation of Children in the U.S, Canada, & Mexico. Center for the Study of Youth Policy. University of Pennsylvania.

[54] Silbert, M. Compounding Factors in the Rape of Street Prostitutes, cited in Wolbert-Burgess, A. Rape and Sexual Assault II. Garland Publishing, Inc., New York, 1988, p. 77.

[55] Widom, C. Victims of Childhood Sexual Abuse: Later Criminal Consequences. 1995. U.S. Department of Justice. National Institute of Justice. Washington, D.C.

[56] Population Reports: Ending Violence Against Women. 2000.

[57] Finkelhor, David, and Linda M. Williams. 1988. Nursery Crimes. Sage Publications.

[58] National Resource Center on Child Sexual Abuse. 1989. Think Tank Report: Investigation of Ritualistic Abuse Allegations.

[59] Finkelhor, David, and Linda M. Williams. 1988. Nursery Crimes. Sage Publications.

[60] Cook, Karen. 1991. Understanding Ritual Abuse. University of Colorado at Boulder.

[61] Ibid.

[62] Russell, Diana E.H. 1988. The Incidence and Prevalence of Intrafamilial and Extrafamilial Sexual Abuse of Female Children. In Handbook on Sexual Abuse of Children, ed., Lenore E.A. Walker. Springer Publishing Co.

[63] Boyer, Debra, and David Fine. Sexual Abuse as a Factor in Adolescent Pregnancy and Child Maltreatment. 24 Family Planning Perspectives (Jan. 1992).

[64] Russell, 1988.

[65] Finkelhor, David, et al. Sexual Abuse in a National Survey of Adult Men and Women: Prevalence, Characteristics, and Risk Factors. Child Abuse and Neglect 14 (1990): 19-28.

[66] Finkelhor, David, et al. Sexual Abuse in a National Survey of Adult Men and Women: Prevalence, Characteristics, and Risk Factors. Child Abuse and Neglect 14 (1990): 19-28.

[67] Russell, Diana E.H. 1988. The Incidence and Prevalence of Intrafamilial and Extrafamilial Sexual Abuse of Female Children. In Handbook on Sexual Abuse of Children, ed., Lenore E.A. Walker. Springer Publishing Co.

[68] Ibid.

[69] Boyer, Debra, and David Fine. Sexual Abuse as a Factor in Adolescent Pregnancy and Child Maltreatment. 24 Family Planning Perspectives (Jan. 1992).

[70] Finkelhor, 1990.

[71] Merrill, L.L., Newell, et al. 1997. Childhood Abuse and Sexual Revictimization in a Female Navy Recruit Sample. Naval Health Research Center. Pub. 97-5.

[72] Tjaden, Patricia, and Nancy Thoennes. Prevalence, Incidence and Consequences of Violence Against Women: Findings from the National Violence Against Women Survey. U.S. Department of Justice. National Institute of Justice. Washington, D.C. (Nov. 1998).

[73] Crewdson, John. 1988. By Silence Betrayed. Little, Brown and Co.

[74] Russell, Diana E.H. 1988. The Incidence and Prevalence of Intrafamilial and Extrafamilial Sexual Abuse of Female Children. In Handbook on Sexual Abuse of Children, ed., Lenore E.A. Walker. Springer Publishing Co.

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