(PDF) Systematic review of social norms, attitudes, and factual beliefs linked to the sexual exploitation of children and adolescents

This evidence review aims to address these specific issues documenting what we know about the extent, nature and consequences of child sexual abuse and exploitation for children in different contexts and the evidence on effective interventions and strategies to prevent and respond to it.

Objectives: The objective of this review is to provide a systematic and critical summary of findings regarding empirical studies conducted on commercial sexual exploitation of children (CSEC) in Europe. The purpose is to gain an understanding of the characteristics and main topics addressed in European research on CSEC, identify gaps, and give suggestions for future studies.

Vaitla, B., Taylor, A., Van Horn, J., and Cislaghi, B. (2017). Social Norms and Girls’ Well-Being: Linking Theory and Practice. Washington, D.C.: Data2X The state of social norms theory and practice is strong. There is an emerging consensus on how to describe the phenomena central to social norms: group identity, expectations about typical and appropriate behavior, economic constraints, and personal capacities. Governments and civil society practitioners across the globe strive to implement policies and projects to change norms and catalyze improvements in girls’ lives. The linkage of theory and practice is, however, still in its nascent stages. Exploring these connections is the primary objective of this report. We first review the landscape of theory around social norms (“Theory”). We then investigate in detail two projects that have facilitated change around norms and practices of female genital cutting (FGC) and child marriage: Tostan’s Community Empowerment Program (CEP) in West Africa and Population Council’s Abriendo Oportunidades (“Opening Opportunities”; AO) project in Latin America (“Practice”). We conclude by discussing the implications of both theory and practice for the future of social norms change (“The Way Forward”).

Child Abuse & Neglect 104 (2020) 104471 Contents lists available at ScienceDirect Child Abuse & Neglect journal homepage: www.elsevier.com/locate/chiabuneg Systematic review of social norms, attitudes, and factual beliefs linked to the sexual exploitation of children and adolescents T Ana Maria Bullera,*, Marjorie Pichona, Alys McAlpinea, Beniamino Cislaghia, Lori Heiseb, Rebecca Meiksina a b London School of Hygiene and Tropical Medicine, 15–17 Tavistock Pl, Kings Cross, London, WC1H 9SH, United Kingdom Johns Hopkins Bloomberg School of Public Health, 615N. Wolfe Street, Room E4644, Baltimore, MA, 21205, USA A R T IC LE I N F O ABS TRA CT Keywords: Sexual exploitation Exchanging sex Transactional sex Trading sex Systematic review Social norms Background: Despite growing interest in the role of social norms in perpetuating the harmful practice of sexual exploitation of children and adolescents (SECA), little is known about the state of the literature on this issue. Objective: This systematic review aims to summarize what associated norms, attitudes and factual beliefs have been identiﬁed by the SECA literature worldwide. Methods: Multiple database searches were conducted using controlled vocabulary and keywords referring to SECA. Results: Our searches identiﬁed 3690 unique references. After applying our exclusion criteria, 49 studies, including over 14,000 participants from 37 countries and most world regions, were included. Across studies we identiﬁed six injunctive norms perpetuating SECA: owning goods as a social status marker ; being sexually active; exchanging sex for favors; contributing ﬁnancially to the household; stigma and discrimination against young people who experienced SECA; and lack of social sanctions for SECA perpetrators. These norms were supported by enhanced tolerance of SECA when it involved older or more physically developed adolescents and when it occurred in poverty-aﬀected contexts. Beliefs around markers that denote adolescents’ readiness for sex; men’s entitlement to sex; and the perceived beneﬁts of intergenerational relationships, also contributed to the maintenance and reproduction of SECA. Findings from all regions suggested that marginalized young people are particularly vulnerable to SECA. Conclusions: Interventions to reduce SECA must consider individual, social, and structural factors and how they interrelate. Context-speciﬁc social norms interventions are needed to address harmful norms, promote protective norms, and improve services for those who have experienced SECA. 1. Introduction The sexual exploitation of children and adolescents (SECA) is a form of sexual abuse aﬀecting the mental and physical health of millions of young people worldwide (Raﬀerty, 2013). SECA is widely underreported, and accurate prevalence ﬁgures remain unknown (Radford, Allnock, & Hynes, 2015). Reporting of SECA varies widely by country and is aﬀected by a range of factors, including Corresponding author. E-mail addresses: Ana.Buller@lshtm.ac.uk (A.M. Buller), Marjorie.Pichon@lshtm.ac.uk (M. Pichon), Alys.Mcalpine@lshtm.ac.uk (A. McAlpine), Ben.Cislaghi@lshtm.ac.uk (B. Cislaghi), Lheise1@jhu.edu (L. Heise), Rebecca.Meiksin@lshtm.ac.uk (R. Meiksin). ⁎ https://doi.org/10.1016/j.chiabu.2020.104471 Received 22 March 2019; Received in revised form 28 February 2020; Accepted 18 March 2020 0145-2134/ © 2020 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/). Child Abuse & Neglect 104 (2020) 104471 A.M. Buller, et al. laws, customs, religions, politics, armed conﬂicts, perceptions of police, and how abuse is understood (Radford et al., 2015). Despite a lack of global consensus on the deﬁnition of SECA (Greijer & Doek, 2016), most descriptions of the practice highlight the element of sexual exchange for material or non-material beneﬁt as the key characteristic that distinguishes SECA from other forms of child and adolescent sexual abuse (Research in Practice, 2017). For the purpose of this review we adopt the 2017 English Department for Education (DfE) deﬁnition of SECA which understands SECA as occurring in instances “where an individual or group takes advantage of an imbalance of power to coerce, manipulate or deceive a child or young person under the age of 18 into sexual activity (a) in exchange for something the victim needs or wants, and/or (b) for the ﬁnancial advantage or increased status of the perpetrator or facilitator. The victim may have been sexually exploited even if the sexual activity appears consensual. Child sexual exploitation does not always involve physical contact; it can also occur through the use of technology” (DfE, 2017). It is important to highlight that this deﬁnition has some limitations, namely the vagueness about what is exchanged (Research in Practice, 2017), how it diﬀers from other forms of harmful adolescent sexual behavior (Melrose & Pearce, 2013), and the lack of reference to the harm and trauma caused by SECA (Gladman & Heal, 2017), however we selected it from among a range of deﬁnitions (e.g. UN General Assembly, 1989; UN, 2013; Council of Europe, 2007) because we ﬁnd it to be broad and clear, and it has been used in many international academic publications on the issue (e.g. Franklin et al., 2018 Franklin, Brown, & Brady, 2018; McKibbin & Humphreys, 2019; Perkin, Merdian, Schumacher, Bradshaw, & Stevanovic, 2018; Radford, 2018). Another important consideration is that although we welcome the increasing recognition in the ﬁeld that both young people and adults perpetrate SECA (Barter, McCarry, Berridge, & Evans, 2009; Beckett et al., 2013; Firmin, 2015), peer to peer sexual exploitation is outside the remit of this review, as this manifestation of SECA seems to be supported by diﬀerent constellations of norms than that supporting adult perpetrated SECA. Literature on the topic of peer to peer SECA highlights for instance the key role of peer group dynamics and peer group relevant settings for peer to peer SECA to occur (Firmin, 2015). On the other hand, literature on adult SECA highlights the prominent role of imbalances of power due to age and adultism, which are less relevant, or absent, in peer to peer SECA (Buller & Schulte, 2018; Wamoyi et al., 2019). Moreover, children and adolescents who perpetrate SECA should receive a diﬀerent response to adult perpetrators, hence interventions that seek to address the exploitation of young people by other young people should be able to identify the unique characteristics of peer to peer SECA, and employ a nuanced approach which carefully reﬂects on the age of the perpetrator and aims to understand the perpetration against the backdrop of the perpetrator’s own potential victimisation (DfE, 2017). Global funding and intervention eﬀorts have historically focused on increasing prosecution, and on services for those who have experienced SECA, rather than on prevention (IOM, & NRC, 2014; Raﬀerty, 2013; Radford et al., 2015). More recently, governments, donors, scholars, and practitioners have increased investment in prevention (e.g. Barnardo’s, 2019; Sommarin, de Man, Renobales, & Trang, 2016; WHO, 2017), developing interventions aiming to increase awareness of SECA through education, and to enhance reporting practices (Hickle & Roe-Sepowitz, 2014; Lalor & McElvaney, 2010; Radford et al., 2015; The Children’s Society, 2020). Additionally, in the UK and Australia there has been explicit interest in social norms in relation to child sexual abuse more broadly, due to scandals around peer perpetrated sexual abuse in schools (Royal Commission, 2017; University of Bedfordshire, 2018). Although this is a step in the right direction, child protection and rights commentators (Ennew, 1986; Hallett, 2017; IOM, & NRC, 2014; Melrose & Pearce, 2013; O’Connell Davidson, 2005; UNICEF, 2017) suggest that increased attention of social norms addressing adult perpetrated SECA is also needed. Existing research has identiﬁed key determinants of SECA including: family violence, substance misuse by a family member, parental mental health problems, and parental disability, as well as children and adolescents being in residential care, misusing substances, and being disabled (Allnock & Miller, 2013; Brown et al., 2016; Pearce, 2009). Eﬀective SECA interventions must address drivers from across all environmental systems in which children develop – from the home and school systems, to the more expansive systems such as societal cultural values (Bronfenbrenner, 1979). Therefore, it is essential that we learn more about the social norms, attitudes and factual beliefs across the environmental systems that perpetuate the practice, so we can design interventions to address these issues. An attitude is an individual’s preference, judgment, or evaluation of something, and a factual belief is an acceptance that something is true about the world (Heise & Manji, 2016). Social norms are informal rules deﬁning appropriate behavior in a group. There are several theories of what social norms are and how they inﬂuence people’s action (Legros & Cislaghi, 2019). In this study we use the conceptualization put forth by Cialdini and Trost (1998), who refer to social norms as people’s beliefs about (1) what others in their setting do (descriptive norms) and (2) the extent to which others in their setting approve of a given behavior (injunctive norms). People comply with social norms for many reasons, but one frequently referenced mechanism is the anticipation of social sanctions – both rewards for complying with the social norm and negative consequences for violating it (Bell & Cox, 2015). Cislaghi and Heise (2018) suggest that research aiming to understand how social norms sustain gender-related harmful practices must also consider the system of power relations, structures, attitudes and factual beliefs in which social norms are embedded and that inﬂuence people’s behavioral decisions. In the global child protection arena interest in social norms has grown over the past 15 years, especially among groups interested in reducing harmful practices, such as female genital cutting, open defecation, and child marriage (Bicchieri, 2016; Mackie, Moneti, Shakya, & Denny, 2015). Recently, practitioners concerned with violence against children and SECA have begun to study the role that norms may play in promoting these practices (Buller & Schulte, 2018; Cislaghi, Mackie, Nkwi, & Shakya, 2019; Firmin, Warrington, & Pearce, 2016; Lilleston, Goldmann, Verma, & McCleary-Sills, 2017; Wamoyi et al., 2018, 2019), and some have already begun to consider this approach to tackle SECA globally, with mixed results (Banerjee , Ferrara, & Orozco-Olvera, 2019); CARE, 2017; Kaufman et al., 2015; LINEA, 2017; University of Bedfordshire, 2018; Werneck, 2015). However, no reviews have systematically looked at the social norms, attitudes and factual beliefs associated with SECA. This review aims to ﬁll this gap. We undertake a systematic exploratory review – the ﬁrst of its kind – to identify and synthesize data from the past 10 years on social norms, attitudes, 2 Child Abuse & Neglect 104 (2020) 104471 A.M. Buller, et al. and factual beliefs that have been linked in the global literature with SECA. Our goal is to inform future eﬀorts to understand, reduce and respond appropriately to this harmful behavior. 2. Methods We systematically searched ﬁve bibliographic databases (Global Health, IBSS, Popline, Social Services Abstracts, and Sociological Abstracts) on March 13, 2016. The search strategy included key search terms referring to children, adolescents, and sexual exploitation (see Appendix A for additional details). We contacted 15 experts from nine organizations to solicit eligible papers that might have been missed in our systematic search, and we hand-searched Google Scholar search results, non-governmental organization websites, and our research group’s internal database for relevant studies. We updated the search on January 8, 2019. Eligible studies (1) were published between 2009 and 2019; (2) were written in English; (3) included ﬁndings on people 19 years or younger, and provided data disaggregated for people in this age group; (4) constituted empirical research on SECA in any setting, conceptualizing SECA according to the English DfE deﬁnition; and (5) presented ﬁndings related to descriptive norms, injunctive norms, attitudes, or factual beliefs. We included studies on adolescents up to age 19 in line with the WHO (2013) deﬁnition of childhood, even though the English DfE deﬁnes children as aged 18 and under, so that we did not miss studies with relevant information. Studies were excluded if they (1) collected empirical data from experts only (e.g. case managers or police oﬃcers); (2) did not describe sampling methods; (3) were journalistic-style case studies or auto-ethnographies; (4) included ﬁndings on people 19 years and younger as well as adults over 19, and did not disaggregate ﬁndings for the younger age group; (5) did not explicitly mention an exchange for sexual content or activity; (6) addressed child or adolescent sexual abuse but did not disaggregate ﬁndings on SECA; and (7) addressed traﬃcking but did not disaggregate results for young people who had been traﬃcked for sexual purposes. We also excluded studies on child sexual abuse and labor exploitation more generally as they likely touch on diﬀerent motivations and social norms. When screening more than one paper on the same study, we included all papers presenting unique relevant ﬁndings. When more than one paper reported the same ﬁndings from the same study, we privileged peer-reviewed published papers. Although systematic review authors often quality-assess included studies, there is an ongoing debate in the ﬁeld of systematic reviews about whether standardized quality assessments accurately reﬂect the quality of study ﬁndings. This is especially pertinent when synthesizing qualitative evidence and ﬁndings from diverse disciplines which do not all follow the same procedures of methodological reporting (Carroll & Booth, 2015; Toye et al., 2013). In this review we chose not to use a quality assessment based on a checklist because there is no empirically tested, best practice for excluding qualitative studies based on quality, and poor methodological rigor does not necessarily indicate lack of insightful ﬁndings (Carroll & Booth, 2015). We also did not conduct a quality appraisal of included quantitative studies as our results do not aggregate estimates or comment on magnitude. We did, however, follow methods used in previous peer reviewed, published reviews to ensure the relevance and rigor of our analysis. Firstly, we only used ﬁndings from studies with the richest relevant results to reﬁne our codes and determine our key ﬁndings (Marston & King, 2006; Thomas & Harden, 2008). Additionally, all of our key ﬁndings represent themes that emerged from two or more studies (Mays & Pope, 2000). Following the EQUATOR systematic review protocol (Moher, Liberati, Tetzlaﬀ, Altman, & The PRISMA Group, 2009), we screened the studies identiﬁed through our search ﬁrst based on titles and abstracts and then, for those not excluded, based on the full text (Fig. 1). Two primary reviewers (RM) and (AM) and one senior reviewer (AMB) screened an initial set of 20 studies and reconciled discrepancies before independently screening the remaining studies. Where primary reviewers disagreed about study eligibility, the senior reviewer (AMB) made a ﬁnal decision. When the review was updated in 2019, a fourth reviewer (MP) independently screened all new studies. In order to ensure continuity, AMB and RM also each screened a separate set of 20 of these new studies, and a mean inter-screener reliability rate of 86.6 % was achieved between each and MP. To guide our coding and interpretation, we drew on the Reasoned Action Approach (Fishbein & Ajzen, 2010) to create an analytical framework that situates factual beliefs as an inﬂuence on descriptive norms, injunctive norms, and attitudes, highlighting how these factors work together to inﬂuence SECA (Fig. 2). Data were coded and analyzed deductively and inductively. We developed a coding framework a priori, guided by the review’s aims, our analytical framework (Fig. 2), and an extensive scoping of the literature. This initial coding framework included four primary categories: descriptive norms, injunctive norms, attitudes, and factual beliefs. We also included injunctive norms sub-codes to capture references to social sanctions, and codes for contextual factors such as country, child gender, and type of SECA (described in Appendix B). We applied the deductive and inductive coding strategy to both qualitative and quantitative studies using NVivo 12. In the case of quantitative data, both tables and author narratives were coded. Two reviewers (RM) and (AM) ﬁrst dual-coded ﬁve studies and reconciled discrepancies in the codes. Three reviewers (RM), (AM), and (MP) then coded the remaining studies independently. 3. Results A total of 55 papers representing 49 studies met our inclusion criteria. These studies included over 14,000 participants (with a range of 6-5,660 participants, and mean of 298 participants per study), across 37 countries, representing almost all regions of the world – Africa, the Americas, Asia, Europe, and Oceania. The most-represented countries were the USA (12 studies), Thailand (5 studies), and South Africa (4 studies). The included studies used a range of study designs and methodologies. Most used qualitative methods (28 studies), and either purposive or convenience sampling (see Table 1 for information on each study, Appendix C for a detailed summary of each study, and Appendix D for a detailed summary of the ﬁndings of each study). We excluded three studies on 3 Child Abuse & Neglect 104 (2020) 104471 A.M. Buller, et al. Fig. 1. PRISMA 2009 ﬂowchart of the study selection process. Fig. 2. Analytical framework. the basis that the codes applied did not appear in any other included studies and therefore did not contribute to the key ﬁndings identiﬁed in the review (Menaker & Franklin, 2013; Menaker & Miller, 2013; Steely, Bensel, Bratton, & Lytle, 2018). The commercial sexual exploitation of children and adolescents and informal sexual exchange were the most commonly explored SECA types; only a few included studies explored child and adolescent pornography and live-stream cybersex or child and adolescent sex traﬃcking. Most included studies did not set out to investigate social norms as deﬁned in this review (Cialdini & Trost, 1998). Hence, our results highlight ﬁndings that, based on available empirical data, indicate social norms (descriptive and injunctive), attitudes, and factual beliefs as per our analytical framework and deﬁnitions. Table 2 summarizes the themes that emerged associated with descriptive norms, injunctive norms, attitudes, and factual beliefs relating to SECA. We present themes narratively, discussing attitudes in relation to the injunctive norms they underpin, and factual beliefs in relation to the injunctive norms and attitudes they underpin. We also present ﬁndings on a theme that emerged during the analysis and had not been identiﬁed a priori – that of intersecting marginalized conditions and identities that increase vulnerability to SECA. This section was included because it revealed social norms that although relatively distant from SECA, shape vulnerability to SECA, and therefore ﬁts with the objectives of this review. 3.1. Descriptive norms Few studies explored descriptive norms of SECA – beliefs about what others do – and those that did showed notable variation by 4 Author(s) (year) Country/Countries Study method(s) Age range Sample size Key themes 1 5 South Africa Estonia USA Mixed Quantitative Qualitative Not reported 17–18 14–18 Atwood et al. (2011) Bantebya et al. (2014)† Barnett and Maticka-Tyndale (2011) Cobbina and Oselin (2011) Liberia Uganda Nigeria Qualitative Qualitative Mixed 13–19 10–14 & 15–18 11–18 USA Qualitative 20–60 Cody (2017)◊ Daniel (2011) Dank (2009) de Santisteban et al. (2018) Dodsworth (2014) Farley et al. (2009) Franklin and Smeaton (2017)* Nepal, Philippines, & Thailand Dominican Republic USA Spain UK UK UK Qualitative Ethnographic Qualitative Qualitative Qualitative Mixed Mixed 10–36 6–14 Under 18 21-51 18–51 18–70 12–23 Franklin and Smeaton (2018)* UK Mixed 12–23 Hallett (2013) UK Qualitative 14-17 Hargitt (2017)◊ Horn (2009) Hoss and Eskell Blokland (2018) Hounmenou (2017) Ijadi-Maghsoodi et al. (2018) ILO-IPEC (2011) Kaiser (2014) Kaufman et al. (2015) Nepal, Philippines, & Thailand Ethiopia South Africa Niger USA Papua New Guinea Bangladesh Tanzania Qualitative Qualitative Mixed Mixed Qualitative Mixed Qualitative Qualitative Kheswa (2017) Kosuri and Jeglic (2017) Li et al. (2018) Lynch (2017)◊ Mac Domhnaill et al. (2011) Matthews (2012) McCleary-Sills et al. (2013) Montgomery (2009) Muriuki et al. (2018) Murphy et al. (2016) Perkins and Ruiz (2017) Plummer (2018) Potgieter et al. (2012) South Africa USA China Nepal, Philippines, & Thailand Ghana Cambodia, Lao PDR, Thailand, & Vietnam Tanzania Thailand Côte d’Ivoire USA USA Australia South Africa Qualitative Mixed Qualitative Qualitative Qualitative Mixed Qualitative Ethnographic Mixed Mixed Qualitative Qualitative Quantitative 10–36 12 & over 13–16 Under 18 12–19 5–17 13–14 Females 15–26, Males 30–56 17-19 Over 18 Not reported 10–36 15–16 10–89 12–14 & 15–17 6–14 6–19 14–18 12-18 38-67 26–45 ∼670 1,338 P1: 3 P2: 26 36 200+ 182 P1: 33 P2: 7 67 N/A 249 12 12 103 QN: 23 QL1: 34 QL 2: 27 QN: 23 QL1: 34 QL 2: 27 P1: 9 P2: 25 67 ∼7122 32 13 18 404 30 97 12 483 50 67 96 316 222 65+3 318 59 40 11 223 2 3 ✓ ✓ 4 5 6 7 8 9 10 12 ✓ ✓ ✓ 11 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ 13 14 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ (continued on next page) Child Abuse & Neglect 104 (2020) 104471 Adato et al. (2016) Ainsaar (2010) Anderson et al. (2014) 1 A.M. Buller, et al. Table 1 Characteristics and ﬁndings of studies included in the review. Author(s) (year) Country/Countries Study method(s) Age range Sample size Key themes 1 6 Reid (2018) Rocha-Jimenez et al. (2018) ± Samara (2010) Segundo et al. (2012) Servin et al. (2015) ± Soliman et al. (2018) USA Mexico Uganda Brazil Mexico Egypt Song (2012)‡ Song and Morash (2016)‡ St. Lawrence et al. (2013) South Korea South Korea Botswana Mixed Qualitative Qualitative Mixed Qualitative Qualitative and ethnographic Qualitative Qualitative Mixed Under 18 19–39 13–18 18–59 19–39 Not reported 54 20 6 1,231+4 20 42 Ethnographic Qualitative Qualitative 17 & over 17 & over P1: 13–19 P2: Not reported P3: 15–20 15–19 10–14 & 15–18 18 and over Cambodia, Lao PDR, Thailand, & Vietnam Uganda USA Rwanda Thailand Qualitative Qualitative Qualitative Qualitative Mixed Not reported 10–14 & 15–18 14–19 10–13 & 14–17 12–18 25 25 P1: 40 P2: 6 P3: 65 15 58 P1: 10 P2: 9 P3: 19 Not reported 200+ 28 202 278 Suarez (2017) Tahsini and Duci (2016) Van Bavel (2017) USA Albania Tanzania Vorng (2014) Walker et al. (2014)† Williams and Frederick (2009) Williams et al. (2012) Wongprom and Yenbumrung (2010) Zurkowska (2015) Bulgaria, Lithuania, Latvia, Moldova, Poland, & Ukraine Mixed Not reported 5,660 2 3 4 5 6 7 8 9 10 11 12 13 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ 14 A.M. Buller, et al. Table 1 (continued) ✓ ✓ ✓ ✓ ✓ ✓ Child Abuse & Neglect 104 (2020) 104471 † , ◊, *, ± , ‡ Papers with the mating notations report on data from the same study. FGD, focus group discussion; QL1, qualitative data 1; QL 2, qualitative data 2; QN, quantitative data; P1, phase 1; P2, phase 2; P3, phase 3. Theme 1: Descriptive norm – Belief about how common SECA is. Theme 2: Injunctive norm – Young people who own certain goods have higher status among their peers. Theme 3: Injunctive norm – Young people face social pressure from community members to be sexually active. Theme 4: Injunctive norm – Community members expect the exchange of sex for favors. Theme 5: Injunctive norm – Young people are expected by their communities to contribute ﬁnancially to their families. Theme 6: Injunctive norm – Sexually exploited young people are stigmatized by their communities. Theme 7: Injunctive norm – Perpetrators of SECA are socially tolerated by their communities. Theme 8: Attitude – Acceptance of SECA when used as a way to provide for oneself or family. Theme 9: Attitude – Disapproval of the commercial sexual exploitation of children and adolescents. Theme 10: Attitude – Acceptance of SECA when it occurs with older, or more physically developed, children or adolescents. Theme 11: Factual belief – Children and adolescents’ readiness for sex is determined solely by age or physical development. Theme 12: Factual belief – Men have powerful sexual urges that are hard for them to resist. Theme 13: Factual belief – Intergenerational relationships can be beneﬁcial. Theme 14: Intersecting marginalization – Social class, homelessness, pregnancy, disability, sexuality, gender, ethnicity. 1 84 FGDs averaging about 8 people each were conducted. 2 53 participants took part in a ranking exercise, 99 key informants were interviewed, and 7 district chairs were asked to recruit about 80 people each to participate in FGDs. 3 65 boys and girls aged 6–14 lived in the community in which the ethnography took place. Findings based on observations of other community members were also included. 4 1,214 participants partook in the quantitative research. 17 men and an unreported number of women partook in the qualitative research. Child Abuse & Neglect 104 (2020) 104471 A.M. Buller, et al. Table 2 Key themes capturing descriptive norms, injunctive norms, attitudes, and factual beliefs. Category Theme Countries Illustrative quote Descriptive norms (beliefs about what others in their setting do) 1. Beliefs about how common SECA is Brazil, Bulgaria, Latvia, Lithuania, Moldova, Poland, UK, Ukraine, & Uganda Injunctive norms (beliefs about the extent to which others in their setting approve of a given behavior) 2. Young people who own certain goods have higher status among their peers Botswana, Brazil, Cambodia, China, Ethiopia, Lao PDR, Liberia, Nigeria, Rwanda, South Africa, South Korea, Thailand, Uganda, USA, & Vietnam 3. Young people face social pressure from community members to be sexually active Cambodia, Ghana, Lao PDR, Liberia, Nigeria, South Africa, South Korea, Tanzania, Thailand, Uganda, USA, & Vietnam 4. Community members expect the exchange of sex for favors Botswana, Estonia, Ghana, Liberia, Nigeria, South Africa, Tanzania, Uganda, UK, & USA 5. Young people are expected by their communities to contribute ﬁnancially to their families Côte d’Ivoire, Dominican Republic, Egypt, Nigeria, Tanzania, & Thailand 6. Sexually exploited young people are stigmatized by their communities Bangladesh, Brazil, Cambodia, Dominican Republic, Lao PDR, Liberia, Nepal, Niger, Nigeria, Papua New Guinea, Philippines, South Africa, South Korea, Tanzania, Thailand, Uganda, UK, USA, & Vietnam 7. Perpetrators of SECA are socially tolerated by their communities Bangladesh, Dominican Republic, Nepal, Tanzania, & Uganda “Bulgaria stands out with the highest perceived prevalence of all forms of commercial exploitation (from 64 % to 71 %).” Study on attitudes towards commercially sexually exploited children and adolescents, Central and Eastern Europe (Zurkowska, 2015, p. 93). “Girls reported being directly pressured by friends to attain social standing through the goods available to them through sexual exchange… girls frequently spoke of envying their peer’s material possessions and putting pressure on themselves to have things like their peers in order to be ‘up to the level’ [have high social status].” Study on sexual exchange among students, Nigeria (Barnett & Maticka-Tyndale, 2011, p. 354). “The research team interviewed a group of men in Hai Phong who spent a great deal of money, time and eﬀort pursuing sex with virgin school girls. These so-called ‘sexchaser’ men described the important of conquest, in which ‘protest’ from the girls gave them a feeling (or illusion) that she was ‘well-bred’, something which made them feel more masculine.” Study on child and adolescent sexual abuse, Vietnam (Vorng, 2014, p. 45). “Immediately once the boy starts to buy you gifts the boy will ask you to have sex with him.” 15–16-year-old in-school girl, Ghana (Mac Domhnaill et al., 2011, p. 204). “In families that range from 7 to 11 members and have an unstable monthly income of $75-150 a month, daughters view this type of relationship as an opportunity to sacriﬁce for the family and help them ﬁnancially.” Study on “short-term [child and adolescent] marriages”, Egypt (Soliman et al., 2018, p. 135). “Most of the time family does not support [prostituted children]. They say ‘you are dirty. You have done this and that so we cannot keep you in the family.’ So most of them are kicked out of the home. Not just family but even neighbors, they even tell their own children ‘oh don’t touch her’ or they don’t use common source of water. If a girl who has been exploited touches water, nobody else touch that which is wrong. At this point the most diﬃcult [thing] that survivor faces she knows that it wasn’t her fault that she has been wronged but no one understands that it wasn’t her fault.” Child or adolescent who had been sexually exploited, Nepal (Lynch, 2017, p. 54). “While girls and adults all agreed that pressure and expectations from men are strong determinants of girls’ sexual behaviours, many adults did not fault men… many adult participants placed the bulk of the blame on the girls for not ﬁnding a way to avoid the pressure and risk.” Study on SECA, Tanzania (McCleary-Sills et al., 2013, pp 100-101). (continued on next page) 7 Child Abuse & Neglect 104 (2020) 104471 A.M. Buller, et al. Table 2 (continued) Category Theme Countries Illustrative quote Attitudes (an individual’s preferences, judgments, or evaluations of something) 8. Acceptance of SECA when used as a way to provide for oneself or family Australia, Niger, Thailand, Uganda, UK, & USA 9. Disapproval of the commercial sexual exploitation of children and adolescents Brazil, Cambodia, China, Ethiopia, Lao PDR, Nepal, Niger, Nigeria, Philippines, Poland, South Korea, Thailand, Ukraine, USA, & Vietnam 10. Acceptance of SECA when it occurs with older, or more physically developed, children or adolescents Brazil & Uganda 11. Children and adolescents’ readiness for sex is determined solely by age or physical development Brazil, Uganda, & USA 12. Men have powerful sexual urges that are hard for them to resist Brazil, Cambodia, Lao PDR, Liberia, Niger, Nigeria, Tanzania, Thailand, UK, & Vietnam 13. Intergenerational relationships can be beneﬁcial Botswana, Brazil, Egypt, Estonia, Liberia, South Africa, Spain, Tanzania, & Uganda “ Selling sex was not seen as a form of work, or indeed, exploitation; it was a way of realising obligations, supporting their parents and acting out a culturally approved model of dutiful sons and daughters.” Study on child sex tourism, Thailand (Montgomery, 2009, p. 136).). “I saw an older Western man with several young girls on the beach. It looked very suspect and I felt sickened… I didn’t feel I could do anything to help. I found it very confronting and disturbing, so much so that I don’t think I would return.” 36-year-old female Australian tourist who had recently travelled to Southeast Asia (Matthews, 2012, p. 21). “Any consensual sex involving a postpubescent girl is seen as a culturally acceptable and normal adult relationship. In other words, cross-generational sex is not in any way problematized.” Study on crossgenerational relationships, Uganda (Bantebya et al., 2014, p. 18). “You got ten year olds and eleven year olds out there… Like right after a girl receives her period, she can be sent out [by a pimp for sex work].” 14–18-year-old in-school girl, USA (Anderson et al., 2014, p. 115). “Some respondents referred to ‘biological determinants’: men consume sex based on their alleged natural tendency and propensity to satisfy their sexual ‘instincts’.” Study on commercial sexual exploitation of children and adolescents, Brazil (Segundo et al., 2012, p. 22). “Respondents expressed the derivation of sexual pleasure from old men because they comfort them. They further emphasized that older men are more compassionate in comparison to boyfriends of their age.” Study on “transactional sex” among adolescents, South Africa (Kheswa, 2017, p. 24). Factual beliefs (an acceptance that something is true about the world) respondents and setting. In Brazil, between 15 % and 38 % of survey respondents (depending on their sex and setting) thought that buying sex from girls under 18 was common among men (Segundo, Nascimento, Araujo, & Moura, 2012). In the UK, men who bought sex thought that on average 36 % of sex workers began selling sex before the age of 18 (Farley, Bindel, & Golding, 2009), while in Uganda young respondents believed that 40–60 % of relationships were intergenerational and/or “transactional” (Bantebya, Ochen, Pereznieto, & Walker, 2014). In a survey conducted in six Central and Eastern European countries between 37 % (Lithuania) and 71 % of respondents (Bulgaria) saw children and adolescents selling sex, when motivated by a desire for luxury goods and increased social status, as a “real problem, true for many people” (Zurkowska, 2015, p. 77). There was a similarly wide range in beliefs about how common it was to exchange sex for regular ﬁnancial support, or out of ﬁnancial necessity, across the Central and Eastern European countries (Zurkowska, 2015). 3.2. Injunctive norms Many included studies explored injunctive norms linked to SECA – beliefs about the extent to which others approve of SECA. These were driven by social rewards (often in the form of increased social status) and social sanctions (often in the form of stigmatization). Across studies, we identiﬁed six injunctive norms that sustain SECA in some settings: (1) young people who own certain goods have higher status among their peers; (2) young people face social pressure from community members to be sexually active; (3) community members expect the exchange of sex for favors; (4) young people are expected by their communities to contribute ﬁnancially to their families; (5) sexually exploited young people are stigmatized by their communities; and (6) SECA perpetrators do not appear to be stigmatized by their communities. 8 Child Abuse & Neglect 104 (2020) 104471 A.M. Buller, et al. 3.2.1. Owning status goods Many studies – most of which were conducted in low- and middle- income countries (LMIC) – found that material goods like fashionable clothes, mobile phones, and cosmetics were associated with social mobility and status (Bantebya et al., 2014; Cobbina & Oselin, 2011; Reid, 2018; Vorng, 2014; Walker, Pereznieto, Bantebya, & Ochen, 2014; Wongprom & Yenbumrung, 2010). Studies also found that, in some cases, young people were driven to sell or exchange sex to obtain these goods and meet societal expectations (Adato, Devereux, & Sabates-Wheeler, 2016; Atwood et al., 2011; Barnett & Maticka-Tyndale, 2011; Horn, 2009; Hoss & Eskell Blokland, 2018; Li, Cheung, Jia, Yu, & Nguyen, 2018; Segundo et al., 2012; Song & Morash, 2016; St. Lawrence et al., 2013; Williams, Binagwaho, & Betancourt, 2012). Studies in Brazil and Thailand reported that young people “showed oﬀ” goods to their peers (Samara, 2010; Vorng, 2014; Wongprom & Yenbumrung, 2010), and in the context of economic inequality in Uganda and the USA, studies found that, through sexual exchange, poorer girls aimed to access goods displayed by their better-oﬀ peers and improve their own social standing (Samara, 2010; Williams & Frederick, 2009). 3.2.2. Being sexually active Community expectations for young people to be in relationships and to be sexually active can contribute to SECA. Studies in South Korea, Thailand and sub-Saharan Africa found that young people faced pressure from their peers to be sexually active and/or have many partners (Atwood et al., 2011; Hoss & Eskell Blokland, 2018; Mac Domhnaill, Hutchinson, Milev, & Milev, 2011; Samara, 2010; Vorng, 2014; Wongprom & Yenbumrung, 2010). Having a boyfriend and being seen as sexually active was reported as fashionable among young women in Uganda and South Africa (Hoss & Eskell Blokland, 2018; Samara, 2010), and a study on children and adolescents in vulnerable groups in Thailand highlighted the large role that peers can play in sexual decision making: Friends give them pride; they can be admired if they can achieve something that the group values as ‘cool’. For instance, if one can ‘score’ a large number of boys or girls to have sex with within a short period of time, he or she can become the group’s hero. (Wongprom & Yenbumrung, 2010, p. 39). In Ghana, though some schools punished or expelled students for having sexual relationships, having a girlfriend or boyfriend was reportedly seen as modern, and students – especially boys – who did not have sexual partners were mocked as “old-fashioned or impotent” (Mac Domhnaill et al., 2011, p. 203). Studies in other sub-Saharan African countries found conﬂicting expectations of young people’s sexual behavior; for example, premarital sex was reportedly both “socially valorized” (Barnett & Maticka-Tyndale, 2011, p. 354) and seen as immoral, and girls were expected to avoid sex before adulthood despite persistent sexual pressure from peers and adult men (Atwood et al., 2011; Hoss & Eskell Blokland, 2018; McCleary-Sills, Douglas, Rwehumbiza, Hamisi, & Mabala, 2013; Samara, 2010). 3.2.3. Exchanging sexual favors Several studies from across sub-Saharan Africa addressing informal sexual exchange found that money, gifts, sex, and love were intertwined (Adato et al., 2016; Atwood et al., 2011; Bantebya et al., 2014; Barnett & Maticka-Tyndale, 2011; Samara, 2010). Adolescent out-of-school boys in Uganda said that, because they were not employed and could not “meet the demands of girls, like school fees, pocket money, good dresses and phones”, girls instead chose to date older men with money (Bantebya et al., 2014, p. 12). In another study in Uganda, adolescent girls explained that gift giving demonstrated love; failing to provide a gift was seen as a sign that a man might not be serious about the relationship (Samara, 2010). Girls reported not being free to refuse sex after receiving money, food, or other gifts (Adato et al., 2016; Hoss & Eskell Blokland, 2018; Mac Domhnaill et al., 2011; Potgieter, Strebel, Shefer, & Wagner, 2012; Samara, 2010). If they did, evidence suggests that men might recall their gifts (Mac Domhnaill et al., 2011), and if the girl did not return the gift the men might force sex (Hoss & Eskell Blokland, 2018; Mac Domhnaill et al., 2011; Samara, 2010). These expectations were reported to be well known and could result in young people being blamed for entangling themselves. According to an adult woman in Tanzania: [S]he shouldn’t accept gifts and things from him. She should know he will expect her to have sex if she takes money and gifts from him. (McCleary-Sills et al., 2013, p. 101). A similar ﬁnding emerged in a study on domestic sex traﬃcking of minors in the USA, where, as the authors explained, “Youth felt that if someone is doing you a favor by letting you sleep at their house you do not have the option to say ‘No’ [to sex]” (Perkins & Ruiz, 2017, p. 177). Studies in Ghana and Botswana found that social norms supporting sexual exchange were further supported by the cultural expectation that young people would defer to their elders (Mac Domhnaill et al., 2011; St. Lawrence et al., 2013). As authors of a study on intergenerational sex in Botswana explained: Youth also reported sexual initiations from teachers who oﬀered to inﬂate grades in exchange for sex… they did not feel comfortable standing up to an older adult, even when they were very uncomfortable about what was being proposed. (St. Lawrence et al., 2013, p. 275). 3.2.4. Contributing ﬁnancially to the family Studies from the Dominican Republic, Egypt, Nigeria, Tanzania, and Thailand indicated community expectations that young people would contribute ﬁnancially to support themselves or their families (Montgomery, 2009; Barnett & Maticka-Tyndale, 2011; McCleary-Sills et al., 2013; Soliman, Alsharqawi, & Younis, 2018). In these studies, community expectations that young women 9 Child Abuse & Neglect 104 (2020) 104471 A.M. Buller, et al. should contribute to the household had led families to take girls out of school (Daniel, 2011; Muriuki, Maposa, Kpebo, & Blanpied, 2018). Although they may initially be expected to contribute to domestic work, this exclusion from formal schooling reportedly increased their vulnerability to SECA, and sometimes selling sex was said to be the only option available to provide for themselves and their families (Montgomery, 2009; McCleary-Sills et al., 2013; Muriuki et al., 2018). For example, a study on child sex tourism in the Dominican Republic found that to raise a child, even one that was one’s biological child (although often the case for nonbiological children as well), “is often seen as a ‘charity’ act, and, for this reason, the child has to repay the family, helping by his/her work. This payment in kind is seen as fair and normal to justify the subsistence provided by the family.” (Daniel, 2011, p. 13). While some studies highlighted an explicit social expectation for young people to contribute ﬁnancially, most often these expectations were described in the context of poverty, and it was not typically clear to what extent they were underpinned by social sanctions and attitudes about what is appropriate as opposed to by material need. 3.2.4.1. Acceptance towards SECA when used as a way to provide for oneself or one’s family (attitude). An attitude related to the injunctive norm of contributing to the family was greater acceptance towards SECA when used as a way to provide. While generally SECA generated disapproval, participants in several studies, including some young people who sold sex, reported that they accepted SECA as a way to meet individual and household needs (Anderson, Coyle, Johnson, & Denner, 2014; Hallett, 2013; Hounmenou, 2017; Perkins & Ruiz, 2017; Plummer, 2018; Samara, 2010; Wongprom & Yenbumrung, 2010). For example, a young gay man who sold sex in Niger said: I’m not complaining at all. I live my life fully. Nothing in the world could make me change this life. (Hounmenou, 2017, p. 195). Participants in Uganda who described informal sexual exchange as “wrong” and “shameful” seemed to accept the behavior when it was in pursuit of education (Samara, 2010). For example, an in-school adolescent girl stated: Something-for-something love [cross-generational sexual exchange] can be good…some girls receive education from their boyfriends, education is important. (Samara, 2010, p. 514). 3.2.5. Social sanctions against sexually exploited young people Stigmatization of sexually exploited children and adolescents was evident across every region covered in this review (e.g. Cobbina & Oselin, 2011; Daniel, 2011; Farley et al., 2009; Hounmenou, 2017; ILO-IPEC, 2011; Kaiser, 2014; Montgomery, 2009; Segundo et al., 2012). Manifestations ranged from internalized stigma – feelings of isolation, guilt, dirtiness, and shame among young people who sold sex (Dank, 2009; ILO-IPEC, 2011; Song, 2012) – to discrimination, violence, and other abuses from peers, families, communities, and society (Daniel, 2011; Dodsworth, 2014; Hargitt, 2017; Hounmenou, 2017; ILO-IPEC, 2011; Kaiser, 2014; Lynch, 2017). For example, an 18-year-old who sold sex in the USA explained: It’s degrading. It’s dirty. It’s shameful. I can’t tell my mom what I do. And it’s… hard for me to be in a relationship with somebody when I do that. I have to lie to them and go behind their backs most of the time. (Dank, 2009, p. 120). Studies found that stigma could perpetuate SECA in various ways, including by acting as a barrier to stopping selling sex (Dank, 2009; Dodsworth, 2014), to seeking help to leave sex work (Lynch, 2017; Williams & Frederick, 2009), to access and utilization of healthcare services (Cody, 2017; Ijadi-Maghsoodi, Bath, Cook, Textor, & Barnert, 2018; Van Bavel, 2017), or to returning to school (Hargitt, 2017; Hounmenou, 2017). Selling and exchanging sex was also reported to put girls’ future prospects at risk. For example, an adolescent in South Korea worried that selling sex might prevent her from getting married later on, and in Liberia adolescent boys said the girls involved in intergenerational transactional relationships may become “damaged before their time” and “have no future” (Atwood et al., 2011, p. 116). 3.2.5.1. Disapproval of commercial sexual exploitation of children and adolescents (attitude). Social sanctions against sexually exploited young people were underpinned by pervasive reporting of negative attitudes towards the commercial sexual exploitation of children and adolescents across all regions covered by this review (e.g. Barnett & Maticka-Tyndale, 2011; Murphy, Bennett, & Kottke, 2016; Segundo et al., 2012; Suarez, 2017; Vorng, 2014; Zurkowska, 2015). Community members (Wongprom & Yenbumrung, 2010), tourists (Kosuri & Jeglic, 2017; Matthews, 2012), and the children and adolescents selling sex (Cody, 2017; Hounmenou, 2017) shared these negative attitudes. 3.2.6. Social tolerance of perpetrators Evidence from the Bangladesh, the Dominican Republic, Nepal, Tanzania, and Uganda suggests that perpetrators of SECA are socially tolerated in their communities (Bantebya et al., 2014; Cody, 2017; Daniel, 2011; Kaiser, 2014; McCleary-Sills et al., 2013). Blame for SECA was reportedly sometimes placed on children and adolescents (Hargitt, 2017; McCleary-Sills et al., 2013; Segundo et al., 2012), particularly girls (Horn, 2009; Li et al., 2018), and other times on parents (Atwood et al., 2011; Kheswa, 2017; McCleary-Sills et al., 2013; Reid, 2018; Samara, 2010; Segundo et al., 2012; Suarez, 2017; Zurkowska, 2015), but we did not ﬁnd any evidence of blame being placed on perpetrators. The only evidence we found of negative social sanctions against perpetrators of SECA was that men who engaged in informal, intergenerational sexual exchange were sometimes called derogatory names. In Tanzania, these men were referred to as “fataki” (a Kiswahili word for “ﬁreworks”), which holds “negative connotations of destruction” (Kaufman et al., 2015, p. 2), and in Uganda they were called “mulya buto”, which means “deﬁlers” in Kiswahili (Bantebya et al., 2014, p. 13). There was no evidence, however, of further social consequences. A girl who sold sex in Bangladesh highlighted this double standard, in which children like her faced social exclusion while the men who bought sex did not: 10 Child Abuse & Neglect 104 (2020) 104471 A.M. Buller, et al. People spit at us but at night their father, uncle, brothers come to sleep with us… there is no punishment for them. (Kaiser, 2014, p. 102). 3.2.6.1. Acceptance of SECA when it occurs with older or more physically developed children or adolescents (attitude). Related to the social tolerance of perpetrators of SECA, in Brazil and Uganda, participants reported greater community acceptance of perpetrators of sexual exploitation of young people when the child or adolescent was older or more physically developed (Bantebya et al., 2014; Segundo et al., 2012; Walker et al., 2014). The age of the child also seemed to inﬂuence the assignment of blame. As a man from Brazil explained: If a 12 year old girl, or younger, is prostituting herself, it must be out of necessity… Now, if she’s older…that happens because she wants to. (Segundo et al., 2012, p. 29). Our ﬁndings suggest that these community attitudes, and the lack of negative social sanctions against SECA perpetrators, are underpinned by three factual beliefs: (1) children and adolescents’ readiness for sex is determined solely by age or physical development; (2) men have powerful sexual urges that are hard for them to resist; and (3) intergenerational relationships can be beneﬁcial for both parties. 3.2.6.2. Children and adolescents’ readiness for sex (factual belief). In the USA and Uganda, it was reported that physical changes such as menstruation and breast development were viewed as markers of sexual maturity (Anderson et al., 2014; Bantebya et al., 2014; Walker et al., 2014). In Brazil, participants reported that they saw people who had sex with children and adolescents aged 12–14 years as “animals”, “crazy”, and “sick”, but they were more understanding if the adolescent was 15 or 16 years old (Segundo et al., 2012). 3.2.6.3. Men’s sexual urges (factual belief). Several studies explored conceptualizations of manhood in various cultures, ﬁnding that aﬄuence and promiscuity (Atwood et al., 2011; Mac Domhnaill et al., 2011), sexual conquest (Vorng, 2014), and sexual prowess (Farley et al., 2009) were important features of masculinity in sub-Saharan Africa, Southeast Asia, and the UK, respectively. A study in Nigeria found that boys “were, or should be, persistently and in all circumstances driven by a desire for sex” (Barnett & MatickaTyndale, 2011, p. 354). Some evidence suggests these notions of manhood are linked to factual beliefs about men’s sexual needs. In sub-Saharan Africa, participants reported beliefs that men’s sexual urges were diﬃcult or impossible to resist (Barnett & MatickaTyndale, 2011; McCleary-Sills et al., 2013), and a survey conducted in Brazil found that 63 % of women in Rio de Janeiro and 49 % of men in Natal agreed with the statement, “men are always ready to have sex” (Segundo et al., 2012, p. 36). This points to beliefs that the demand for SECA is natural. 3.2.6.4. Intergenerational relationships (factual belief). In Brazil, men reported preferring younger partners, who they believed would oﬀer greater sexual satisfaction and feelings of shared youthfulness (Segundo et al., 2012). In Tanzania, sex workers reported that clients often preferred “adolescent sex workers” to adult sex workers because of the belief that they were less likely to be HIV-positive (Van Bavel, 2017). Studies in the Dominican Republic, sub-Saharan Africa, and Spain also highlighted beliefs that young people beneﬁt from the maturity, wisdom, ﬁnancial security, and sexual experience of older partners (Adato et al., 2016; Atwood et al., 2011; Bantebya et al., 2014; Daniel, 2011; de Santisteban, del Hoyo, Alcázar-Córcoles, & Gámez-Guadiz, 2018; Kheswa, 2017; McCleary-Sills et al., 2013; St. Lawrence et al., 2013; Soliman et al., 2018). 3.3. Intersection between SECA and other forms of marginalization Findings from all regions covered in this review suggest that marginalized young people are particularly vulnerable to sexual exploitation (e.g. Bantebya et al., 2014; Daniel, 2011; ILO-IPEC, 2011; Kaiser, 2014; Lynch, 2017; Muriuki et al., 2018; RochaJimenez et al., 2018; Song & Morash, 2016; Suarez, 2017; Williams and Frederick, 2009; Williams et al., 2012), and that the ways that societies construct and engage with diﬀerent conditions (such as social class, homelessness, pregnancy, and disability), and identities (such as sexual and gender identity, and ethnicity), could increase vulnerability to SECA. For example, a woman in Mexico who entered sex work at 16 explained how the social consequences of a stigmatized teenage pregnancy had left her homeless and vulnerable to SECA: I was raped and I got pregnant…My father instead of helping me he kicked me out of the house… I slept in the sidewalks and a woman who owned the bar…she picked me up and she sold me [forced her into sex work]… (Servin et al., 2015, p. 8). Findings from the USA indicated that children and adolescents with intellectual disabilities did not know it was illegal for an adult to have sex with a child (Franklin & Smeaton, 2017, 2018), and adults reportedly didn’t take their reports of sexual exploitation seriously due to their disability (Franklin & Smeaton, 2018). Additionally, young participants with disabilities who wanted to explore their sexuality complained about their lack of access to information about healthy sexual relationships (Franklin & Smeaton, 2017, 2018). Findings from the UK and the USA indicated that this lack of education led some young people with disabilities to run away from home and engage in risky sexual behaviors, putting them at a high risk of exploitation (Franklin & Smeaton, 2017, 2018; Reid, 2018). Studies also found that exclusion from the social mainstream based on sexual orientation and gender non-conformity created vulnerabilities to SECA. Some children and adolescents reported that they were rejected from their families because of their sexual 11 Child Abuse & Neglect 104 (2020) 104471 A.M. Buller, et al. orientation, and were forced to live on the streets and turn to sex work to survive. They also reported facing discrimination from police and health workers due to their sexual orientation (Cody, 2017; Hounmenou, 2017). A transgender girl that had been sexually exploited in Nepal reported dropping out of school because the bullying became unbearable (Hargitt, 2017), and results from a study in the USA suggested that selling sex was “one of the only viable options” for marginalized transgender young people to earn money (Dank, 2009, p. 114). Regarding the intersection of social class, homelessness and ethnicity, a 14-year-old girl working and living on the streets in Albania described vulnerability among Roma young people: People think that since you are Roma they can harass you or oﬀer money to have sex with you. (Tahsini & Duci, 2016, p. 61). Whereas a study in Nepal suggested that young people in lower castes were more vulnerable to SECA (Cody, 2017). 4. Discussion Across the included studies we found very little information about descriptive norms, and the ﬁndings we did identify varied dramatically by context. We found evidence of six injunctive norms perpetuating SECA; some were evident across regions whereas others seemed to be more salient in speciﬁc contexts. Among the identiﬁed injunctive norms we found: aspirations for the increased standing among peers that accompanies ownership of status goods (especially in LMIC), community pressure to be sexually active (in both high-income countries and LMIC), community expectations of the exchange of sex for favors (with the majority of evidence on this norm coming from sub-Saharan Africa), the expectation of community members that young people contribute ﬁnancially to their families (particularly in LMIC), and social tolerance of SECA perpetrators (in all regions), in contrast to stigmatization of sexually exploited young people (in all regions). Studies reported disapproval of the commercial sexual exploitation of children and adolescents across all world-regions, and attitudes of greater acceptance for SECA in circumstances of poverty, and older or more physically developed adolescents. These social norms and attitudes were also found to be underpinned by factual beliefs that menstruation, breast development and older adolescent age signify readiness for sex, that men’s sexual urges are too powerful to resist, and that intergenerational sex can be beneﬁcial for both parties. Our ﬁndings highlight the need for social norms interventions that consider the general norms driving SECA, but also the speciﬁc norms driving the practice at the local level (Cislaghi & Heise, 2018). Past research strongly supports our ﬁnding that those who have experienced SECA are almost universally stigmatized and discriminated against (Kennedy & Prock, 2018). Pheterson (1993) argues that female sex workers are stigmatized because they engage in repeated sexual contact with multiple partners (sometimes strangers), take the initiative to attract men and satisfy their sexual desires, are perceived to be “experts” in sex, and commodify their bodies in the sexual exchange. Depending on the situation, SECA can involve all, or only one, of these components – that of sexual exchange. In some parts of sub-Saharan Africa, the UK, and the USA, however, we found evidence of norms promoting sexual exchange, and research in Tanzania found that girls and young women who do not beneﬁt monetarily from SECA also face stigmatization (Wamoyi et al., 2019). This suggests that other factors, such as the quantity of sexual partners, taking the initiative to attract them, or the perception of being a sexual “expert”, may play a greater role in perpetuating stigma in these contexts than that of exchange. These ﬁndings highlight how local conceptualizations of exploitation might shape the way norms operate in speciﬁc contexts. Social tolerance for perpetrators of SECA may reﬂect that the included studies focused on young people who were sexually exploited, or may indicate that social punishments for SECA are reserved for the young people involved. The ﬁnding of social tolerance is particularly interesting when considered alongside the reported negative attitudes towards the commercial sexual exploitation of children and adolescents across all regions. When there is a gap between reported attitudes and behaviors, this is often due to social norms and/or structural factors (Cislaghi & Heise, 2018). These gaps have been identiﬁed in the ﬁeld of gender-based violence more broadly, where evidence suggests that interventions (particularly those that are media-based) to address social norms are more eﬀective at changing behavior than those aimed at changing individual attitudes (Fulu & Kerr-Wilson, 2015; Marcus, 2014). This indicates a need to include a social norms perspective when addressing other forms of violence, such as SECA, while also taking into account structural factors at play. Our review identiﬁed factual beliefs that certain markers indicate when girls are ready for sex, including once they reach the ages of 15 or 16 years, begin menstruating, or develop breasts. These beliefs led to an increased demand for SECA, forcing young people into sexual situations at an early age. Researchers argue that readiness for sex is more nuanced, and is determined not only by these markers, but also by cognitive, social, and economic factors, and as children develop across all of these domains, they evolve in their capacity to take on more decisions about their sexual behaviors (Cook & Dickens, 2000; Buller & Schulte, 2018). In the literature from Africa and Latin America, this review identiﬁed a widespread reported belief that men could not resist sexual urges, suggesting that, if they engage in SECA, it is not their fault. This conceptualization of masculinity is reﬂected in global research reporting that young men feel they must have penetrative, heterosexual sex to prove they are “men” (Barker & Loewenstein, 1997; Barker, 2005; Marsiglio, 1988). Young men may not want to have sex themselves, but do in order to avert negative social sanctions including decreased social status, ridicule, or labeling as a coward or as homosexual (Barker, 2005). How society perceives the role of men likely plays a substantial role in perpetuating the sexual exploitation of girls and young women, and further research is needed to explore this dynamic in speciﬁc contexts. There is also growing global evidence on the sexual exploitation of boys (Moynihan et al., 2018), and traditional beliefs about masculinity can increase their vulnerability to SECA and make them invisible to child protection service providers (Nicholls et al., 2014). Most critically, little information is available on age-appropriate methods to help boys with recovery and reintegration following SECA (Asquith & Turner, 2008). Although it was not an intended aim, this review also highlighted the importance of intersectionality in perpetuating SECA. We 12 Child Abuse & Neglect 104 (2020) 104471 A.M. Buller, et al. found that young people with marginalized conditions and identities, including social class, homelessness, pregnancy, disability, sexual orientation, gender, and ethnicity, were at increased risk of SECA, predominantly due to heightened exposure to perpetrators. In regards to intellectual disabilities, we found evidence in line with past research that in the UK and USA young people with disabilities are often seen by others as asexual and denied access to sexual education (Alexander & Taylor Gomez, 2017; Eastgate, 2008). Implicit to this review was the belief that children and adolescents’ age contributes to their vulnerability to sexual exploitation by adults. This age diﬀerence is marked by imbalances in power, which includes expectations that children and adolescents will obey adult authority (Buller & Schulte, 2018), contributing to a sense of entitlement to act upon young people without agreement, and increasing the perpetuation of SECA. This systematic review has limitations to consider. By adopting broad inclusion criteria, our results show a great deal of variation across contexts. The cross-cultural themes and similarities that were identiﬁed, however, are made all the more poignant by this variation. Although some norms identiﬁed were region- or country-speciﬁc this was a reﬂection of the data available, and does not necessarily indicate that certain norms are not relevant in other contexts as well. Additionally, the studies in this review did not set out to investigate social norms. They did, however, set out to investigate SECA, and our goal was to widen the interpretation of the results of these studies using social norms theory (Kärkkäinen, Bondas, & Eriksson, 2005). In the absence of comprehensive contextual knowledge about each study, we relied on authors’ interpretations, synthesizing verbatim quotes and evidence grounded in the data of the included studies (Lee, Hart, Watson, & Rapley, 2014; Morgan et al., 2016; Schumm, Skea, McKee, & N’Dow, 2010). In doing so, we relied on authors’ descriptions of their ﬁndings to identify the social norms, attitudes, and factual beliefs pertaining to SECA. Admittedly it was sometimes diﬃcult to diﬀerentiate between these constructs, however conceptual clarity was guaranteed by closely adhering to our analytical framework (Fig. 2) when conducting our analysis (Morgan et al., 2016). Given the diversity in methods and aims of the included studies, ﬁndings may not be comparable across contexts, types of SECA, or populations. Instead, this review highlights areas for further exploration. It is possible that this review omits some social norms, attitudes, and factual beliefs that inﬂuence SECA, either because they have not yet been explored or because the studies that explored them did not meet our inclusion criteria. Owing to global inequities in research and funding, ﬁndings from this review come disproportionately from “Western” countries, especially the USA, despite this region being one of the least aﬀected (Radford et al., 2015). Finally, studies published as grey literature are not always indexed in search engines, and some relevant studies might therefore have been missed. Identifying country-speciﬁc social norms around SECA was outside the scope of this review, as were studies published in languages other than English, but these also likely oﬀer ﬁndings on social factors linked to SECA and are important resources to consult to inform regionally-tailored prevention programs. Despite these limitations, this review provides a systematic, comprehensive, and global analysis of the evidence available on social norms, attitudes and factual beliefs linked to SECA. 5. Conclusion This review provides evidence to inform further research and theory-based interventions to prevent SECA, and highlights opportunities for improved service delivery response. Past research points to the need for, and eﬀectiveness of, social norms interventions to address sexual violence against young people (Alexander-Scott, Bell, & Holden, 2016; Powell, 2010; WHO, 2009; Royal Commission, 2017; Firmin and Hancock, 2018). Our ﬁndings support these eﬀorts, and point to strategies to improve outcomes in the case of SECA. First, additional studies exploring descriptive norms of SECA are needed. Interventions targeting descriptive norms can eﬀectively promote a wide range of positive health behaviors (e.g. White et al., 2010; Burger & Shelton, 2011), and a meta-analysis on the eﬀects of diﬀerent types of social norms on adolescent sexuality found that descriptive norms were the most closely associated with increased sexual activity (van de Bongardt, Reitz, Sandfort, & Deković, 2015). This suggests that further research on contextspeciﬁc descriptive norms surrounding SECA, and how they connect to the behaviors of both young people and those who sexually exploit them, could provide important insights for eﬀective SECA prevention interventions. Our ﬁndings also identiﬁed a stark diﬀerence in how young people who have been sexually exploited are stigmatized by their communities, and perpetrators are not. This norm is underpinned by adherence to harmful conceptualizations of masculinities, and research is needed to understand how men experience these social norms in speciﬁc contexts, and how they can be engaged to promote protective social norms around sex. Social norms interventions that address the bundles of harmful norms (Mollborn & Sennott, 2015), negative attitudes and factual beliefs underpinning SECA – such as the beliefs that age and physical development solely determine when adolescents are ready for sex, or that intergenerational relationships can be beneﬁcial to both parties – and promote protective norms – such as social disapproval and negative social sanctioning of perpetrators of SECA – could also play an essential role in combatting SECA. We must also recognize that to be eﬀective, interventions to reduce SECA should consider individual, social, and structural factors, and how they interrelate. At the individual level interventions could employ critical reﬂection groups that focus on helping young people identify and achieve long-term life aspirations (Kabiru, Mumah, Maina, & Abuya, 2018), supporting them in making informed sexual decisions that promote their health and well-being. Interventions must also address norms sustaining perpetration, focusing on decreasing norms promoting male entitlement to sex. Structural interventions, on the other hand, are particularly relevant in poverty-aﬀected areas, where lack of access to resources – in a context where young people face peer pressure to obtain status goods, and families expect young people to contribute ﬁnancially to the family – often drive SECA. Interventions that target norms and attitudes in the population, including those of service providers, are needed to promote the acknowledgement that girls are not to blame for their sexual exploitation, and that boys and disabled young people can also be sexually exploited, in order to decrease barriers to services for these populations and provide environments free from exploitation. Finally, ethical considerations must be taken to ensure interventions incorporate local perspectives and engage the main beneﬁciaries 13 Child Abuse & Neglect 104 (2020) 104471 A.M. Buller, et al. in their development, including those from the most vulnerable, marginalized groups. Funding This work was supported by OAK foundation [grant number OCAY-13-483]. The funder had no role in the design, analysis, and write-up of these results. Declaration of Competing Interest The authors declare that they have no competing interests. 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Systematic review of social norms, attitudes, and factual beliefs linked to the sexual exploitation of children and adolescents

Systematic review of social norms, attitudes, and factual beliefs linked to the sexual exploitation of children and adolescents

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Systematic review of social norms, attitudes, and factual beliefs linked to the sexual exploitation of children and adolescents

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