Executive Summary
Sexual abuse, including sexual assault or rape, of children and adolescents is a major global public health problem, a violation of human rights, and has many health consequences in the short and long term. The physical, sexual, reproductive health and mental health consequences of such abuse are wide ranging and need to be addressed. Data from several settings show that children and adolescents are disproportionately represented among the cases of sexual abuse that are brought to the attention of health-care providers.
This guideline provides recommendations aimed primarily at front-line health-care providers (e.g. general practitioners, nurses, paediatricians, gynaecologists) providing care to children, including adolescents up to the age of 18 years, who have, or may have, experienced sexual abuse, including sexual assault or rape. It can also be useful for other cadres of specialist healthcare providers who are likely to see children or adolescents. The guideline, while global, is particularly concerned with applicability in health-care settings in low- and middle- income countries, taking into account the more limited health-care resources available. Therefore, the feasibility of implementing the recommendations in low-resource settings was taken into account in the drafting.
This guideline aims to provide evidence-based recommendations for quality clinical care for children and adolescents who have, or may have, been subjected to sexual abuse, in order to mitigate the negative health consequences and improve their well-being. The objectives are to support health-care providers to provide quality, immediate and long-term clinical care and to apply ethical, human-rights-based and trauma-informed good practices in the provision of such care. Where relevant for provision of clinical care and where there is supporting evidence, sex-based differences and gender-based inequalities are flagged.
The guideline was developed according to the standards and requirements specified in the WHO handbook for guideline development, 2nd edition.1 The process involved (i) identification of critical research questions and outcomes; (ii) retrieval of evidence, including commissioning of systematic reviews; (iii) synthesis of the evidence; (iv) quality assessment, including by a Guideline Development Group (GDG); and (v) formulation of recommendations with the GDG and input from an External Review Group (ERG). No relevant conflicts of interests were identified for the GDG and ERG. The document also includes overarching principles that inform clinical practice and that are derived from ethical and international human rights standards. It includes good practice statements that are based on both the guiding principles and the values and preferences of survivors, their caregivers and health-care providers. The recommendations draw on existing WHO recommendations, as well as new content developed as part of this guideline development process.
