Decrease in child abuse notifications during COVID-19 outbreak: A reason for worry or celebration?

Abstract

Anecdotal reports have shown increased rates of domestic violence and child abuse as the result of the economic impact and stay-at-home orders in response to COVID-19.1 For children and adolescents, school closures and the disrupted provision of child protection services have been associated with a higher risk of maltreatment with physical outcomes especially for those living in low-income and crowded households.2-4 In this retrospective population-based study, we compared data on abuse of children and adolescents aged 0–17 years during the first half of 2019 and 2020 in Sergipe state, Northeast Brazil, which is recognised as the poorest region in the country. Information on child abuse was extracted from the official child maltreatment database of the Coordination of Statistics and Criminal Analysis of the Sergipe state. Our outcome of interest was non-accidental physical injury inflicted on a child by his or her parents or other person legally responsible for the child's care. Data also included gender, age and race/ethnicity and all cases were de-identified. Results were expressed in absolute and relative frequencies. Two-proportion Z-test was used to compare occurrences of child abuse between 2019 and 2020 according to children's characteristics. P values <0.05 were considered statistically significant. Sergipe has an estimated population of 2 298 696 people, Human Development Index of 0.665 and a monthly household income per capita of less than one Brazilian minimum wage (approximately USD 190/month). On 14 March 2020, the first case of COVID-19 in Sergipe state was identified and the first decree of the state government on the containment measures in response to the spread of COVID-19 was enacted on 24 March 2020 and included closure of all schools and universities. Until 10 September 2020, SARS-CoV-2 has infected 74 121 patients and resulted in 1920 deaths. From 1 January to 30 June 2020, 53 cases of child physical injury were notified, 15 (28.3%) in boys and 38 (71.7%) in girls. Most were aged 12–17 years (37 out of 53, 69.8%) and were either Blacks or Browns (mixed race) (39 out of 53, 73.6%). No differences were found in child abuse notifications according to gender, age and race/ethnicity between 2020 and 2019 (Table 1). However, compared to the first half of 2019, we found the reported rate of child physical injury decreased in 2020 by 24.3%. Decreasing rates were found in 4 (January, February, March and May) of the 6 months analysed (Fig. 1). Despite the lack of studies showing the influence of COVID-19 pandemic on registries of child abuse, social media reports suggest an increased risk of domestic violence during the social distancing period in Brazil.5 The reported surge in domestic violence including child abuse is alarming and may be associated with family financial constraints, increased burden on parents due to school closures, parent's stress and difficulty dealing with children's irritability during isolation, disruption of social support networks and reduction of child protective services. Recently, according to the Brazilian Ministry of Women, Family and Human Rights, the number of reports of violence against children fell 12% during the pandemic throughout the national territory. Similar results have been shown in some American states which reported double-digit percentage decreases in registries to child maltreatment hotlines.6 With child-helplines reducing staff and limiting child protection services due to imposition of curfew and reduction of funding especially in low- and middle-income countries, the incidence of child abuse may be unnoticed or under-reported.7 Measures to improve surveillance, identify risk factors, develop interventions and scale up effective policy and programmes8 must be implemented to support vulnerable people against domestic violence especially Black teenage girls in poor communities.9 This study was approved by the Ethics Committee of the Federal University of Sergipe (protocol number 33095120.4.0000.5546). We would like to thank the Criminal Analysis Statistics Coordination (CEACRIM), Sergipe state, Brazil for collaborating with the data collection, and CAPES and CNPq agencies. We dedicate this article to all the doctors, frontline health workers and other staff who are facing COVID-19. This study is part of the EpiSERGIPE project.