The Health of Children   11/96

While we may think that insuring a healthy next generation is a common goal for all of us, there are some very disturbing scenes on the horizon. This issue is meant to heighten our awareness.

The health of children begins in utero. Infant health is influenced by prenatal care, threatened by premature labor and life long disability may occur with complications at delivery. Child health is influenced by the socioeconomic status of the parents which affects availability of post natal, child, and adolescent care. It is influenced by single parenthood, whether by the primary absence of the father or secondary absence as in separation, divorce, or death. Kids raised in single parent families, according to Maggie Gallagher, the author of The Abolition of Marriage, have twice the risk of becoming high school dropouts, two to three times the rate of psychological disorders, and twice the risk of becoming unwed teen parents, perpetuating the downward spiral. However, schools that try to express disapproval of teen motherhood, according to Gallagher, run smack into the iron hand of the federal government. Since federal law in 1972 made teenage pregnancy a constitutional right, she feels we have raised a bumper crop of "children having children" who donít begin to comprehend the twenty years of work that follows a pregnancy, and this ignorance in turn causes deprivation of personal and emotional health.

The numbers of American children suffering from abuse, neglect and serious injury have soared in recent years while child protection efforts have lagged, according to a federal survey. From 1986 to 1993, the number of abused and neglected children doubled from 1.4 to 2.8 million. Those who were seriously injured increased fourfold from about 143 to nearly 570 thousand. The toll of sexual abuse rose from 133 to 300 thousand, a 125% increase. Children are at risk as early as age 3 and girls are the target much more often than boys.

Female genital mutilation is a common practice in Africa, the Middle East, Indonesia, Malaysia, and immigrants from these countries. However, recent California legislation has made it a crime. Assemblywoman Liz Figueroa, who authored the bill, feels that there will be few prosecutions and the practice will now disappear in our state. California also has a new law in which anyone convicted twice of molesting a child will not be released from prison unless he agrees to be medically or surgically castrated. First time offenders might fall within the scope of the law if a judge determines that the offense is particularly outrageous. This has brought an outcry from many including medical ethicists that someone who is a pedophile will not be stopped by castration and, furthermore, this is legally sanctioned "mutilation."

Concern for the physical and mental health of children has taken on global proportions. The World Congress against Commercial Sexual Exploitation of Children was attended by delegates from 120 countries. This international five day conference in Stockholm which mapped out strategies to combat crimes against children took on urgent proportions due to growing child sex atrocities in Belgium which have left at least two girls dead. Child sexual exploitation is a worse problem in Africa, Eastern Europe, Asia, the Philippines and Thailand.

The figures released at this conference were gruesome: more than one million children a year are added to the miserable total of youngsters used for commercial sexual purposes around the world; child prostitutes are visited by 10-12 million men a week; one-third of child prostitutes in Asia are HIV-positive. In some countries commercial sex with girls is outlawed, but not with boys. Pedophiles, thanks to inexpensive international air travel and good communications, can reach pornographic materials and young victims beyond the scope of their countries. Guided by word of mouth or by information on the Internet, sex tourists easily can escape prosecution.

The delegates in Stockholm heard even more disturbing news asserting that U.N. peacekeepers are also to blame. In a scathing report, they were told how Italian peacekeepers in Mozambique as late as 1993-94 were involved in trafficking and sexually exploiting children. According to this report, U.N. Staff employed street children as pimps; recruited schoolgirls for prostitution and urged them to give up their education; filmed pornographic videos of children; and arranged live sex acts with peacekeepers at a price of $1 with a condom, $1.10 without one.

When I was chairman of a board of education in our own community, a middle aged man attended the parish and volunteered as an assistant coach for the parochial school. He was seen photographing the young boys in shorts. When queried about this activity, he became evasive and was told by the principal and coach to stop. When he tried it again, court records were reviewed and he was found to have a pedophile record. It took a court order to remove him from the school premises. When the restraining order expired, he immediately reappeared and it took another injunction to remove him permanently.

The health of children is in serious crisis locally, in the state, in our nation and in the world. We must network with medical organizations at all levels. Our vigilance as physicians is needed to promptly diagnose and report problems whenever seen in our practice and as parents to take appropriate and immediate action as soon as any abuse occurs.