**The Cultural Reinforcers of Child Abuse**

Essam Al-Shail, Ahmed Hassan, Abdullah Aldowaish and Hoda Kattan

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/50693

## **1. Introduction**

18 Child Abuse and Neglect – A Multidimensional Approach

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[111] Oates RK. Sexual abuse and suicidal behavior. Child Abuse and Neglect, 2004;28(5),

[112] Martin G, Bergen HA, Richardson AS, Roeger L, Allison S. Sexual abuse and suicidality: Gender differences in a large community sample of adolescents. Child

[113] Gross AB, Keller HR. Long-term consequences on childhood physical and

[114] Maciejewski PK, Mazure CM. Fear criticism and rejection mediates an association between childhood emotional abuse and adult onset of major depression. Cognitive

[115] Shaffer A, Yates TM, Egeland BR. The relational of emotional maltreatment to early adolescent competence: Developmental processes in a prospective study. Child Abuse

[116] Spertus IL, Yehuda R, Wong CM, Halligan S, Seremetis SV. Childhood emotional abuse and neglect as predictors of psychological and physical simptoms in women presenting to a primary care practice. Child Abuse and Neglect, 2003;27(11), 1247-1258. [117] Burns EE, Fischer S, Jackson JJ, Harding H. Deficits in emotional regulation mediate the relationship between childhood abuse and later eating disorder symptoms. Child

[118] Hund AR, Espelage DL. Childhood emotional abuse and disordered eating among undergraduate females: Mediating influence of alexithymia and distress. Child Abuse

[119] Kim J, Cicchetti D. Longitudinal trajectories of self-system processes and depressive symptoms among maltreated and nonmaltreated children. Child Development,

[120] O'Dougherty-Wright M, Crawford EC, Del Castillo D. Childhood emotional maltreatment and later psychological distress among college students: the mediating

[121] Rich DJ, Gingerich KJ, Rosen LA. Childhood emotional abuse and associated psychopathology in college students. Journal of College Student Psychotherapy,

[122] Sackett LA, Saunders DG. The impact of different forms of psichological abuse on

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Mistreating children at the hands of parents or caretakers has a long history. Sari and Buyukunal (1991), in a study on the history of child abuse, report that from ancient times up to present many societies have exercised what it is recognized today as child abuse for various reasons. On reviewing child abuse literature in the Tobkabi Museum in Istanbul, they report that in ancient Greece fathers were permitted to practice infanticide whereby many infants who had any serious malformations were killed in order to preserve the race characteristics. Greek physicians during the second century were in the habit of advising midwives to examine each newborn and to get rid of those who were considered not fit to be raised. The study also presented the picture of Zal, the first known albino in the literature, exposed at the bottom of a mountain by his father because he was born with white hair. Stories of children being slaughtered in addition to other severe practices of child abuse were also illustrated. Such practices were said to be part of the lifestyle until approximately two centuries ago. Sexual abuse was reported to be common among Eskimos (Sari and Buyukunal, 1991). Their daughters were presented to their guests as an act of hospitality, and the death of those children during their first sexual experience was not a rare event. In India, the girls used to get married very early because it was considered disgraceful for a girl to remain unmarried until the time of menstruation.

Historically, parents used their children for profit. Among the poor families, children were put to work at early ages doing activities such as working on the family's own farm or elsewhere. Generally, boys were more likely to work earlier than girls who usually stay home to help their mothers. In large families, some children were sent to school to receive elementary education or were taught by their parents at home to acquire the necessary knowledge they would need to work and support their families. Only in wealthy families that boys, and to a lesser extent girls, would receive higher standards of education. Not until mid-nineteenth century that compulsory schooling was introduced and education became a common experience for all children.

© 2012 Al-Shail et al., licensee InTech. This is an open access chapter distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2012 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Although the history of child abuse remains obscure in many parts of the world, it is argued that as from the late seventeenth century onwards children can be seen playing, sketching, and amusing themselves in portraits, which shows that there was a growing concept of childhood. Nevertheless, the number of abused children in modern times generally is still alarming, since the natural state of affairs is a zero-tolerance to child maltreatment, especially the forms of abuse that lead either to death or permanent physical or emotional impairment. In the USA, more than 4 million children were reported to child protection services as alleged victims of child maltreatment in 1999 alone, of which an estimated 1401 child abuse and neglect related fatalities were confirmed by the child protection services' agencies (Nation Committee for the Prevention of Child Abuse [NCPCA] 2000 Annual Fifty State Survey), while the confirmed child abuse deaths in 2002 were about 1400 children (National Data of the U. S. Department of Health and Human Services, April 2004).

The Cultural Reinforcers of Child Abuse 21

Sharia law whereby the Islamic orthodoxy and conservatism generally dominate the social and cultural characteristics and mechanisms of the Saudi society. Traditional tribal principles and customs, however, have significant influence over a wide range of cultural, behavioral, and attitudinal manifestations in the society. Children are usually well taken care of in terms of basic needs, and are expected to show almost total subordination and obedience to their parents. Corporal punishment by parents is a common practice, especially in less modernized portions of the society. The country generally has one of the lowest rates of serious crimes compared to other countries, despite the fact that nearly 8 million expatriate workers dwell in the country. This fact has been largely due to strict laws that organize all spheres of life, reinforced by the regular police force and members of an official body monitoring the public's compliance with the prevailing religious norms and rules. For the last twenty years or so, most families adopted the tradition of having expatriate housemaids to take care of household menial works including looking after the children in

The first program for detecting, reporting, and working towards preventing child abuse in Saudi Arabia was initiated by one of the leading hospitals in the country in 1994 as a Child Advocacy Committee, with an internal policy and procedure for dealing with all cases of child abuse that reached the hospital. The policy involved the hospital's security department and a mechanism to report cases of suspected or proven child abuse encountered in or

Subsequently, the National Family Safety Program (NFSP) was established in 2005 by a Royal Decree with a vision to establish a foundation that promotes a safe community and help victims of domestic violence Including child abuse victims. The strategic objectives of the NFSP include promoting awareness among individuals and institutions on the damage to individuals and the society caused by domestic violence and child abuse, and training staff members to deal appropriately and effectively with cases of domestic violence and child abuse. Since the implementation of the NFSP in 2007, the numbers of child protection

The National Family Safety Registry (NFSR) was established in 2009 as a web-based data registry system to provide a centralized database for child abuse cases from all over the country. It is aimed to provide a ground for collecting and analyzing data on child abuse cases in order to define the magnitude of the problem and to identify the risk factors leading to child abuse in the country, which is likely to help in formulating prevention strategies and policies.

A total of 616 child abuse cases have been registered in a period of 16 months between October 2010 and February 2012. Of these, 315 (51.1%) are males and 301 (48.9%) are females. The Saudi nationals among the abused children comprise 92.0% of the cases; however, non-Saudi children are mostly treated in private health sectors which are not yet represented by CPC. **Figure 1** shows the age distribution of the abused children included in the registry, , whereby the ages in a small proportion of the cases (2.8%) are missing. The figure shows that 15.9% of the total number of cases involves children younger than one

admitted to the hospital to legal authorities in the city.

year of age, as shown in **Table 1** below.

centers that provide NFSP services have increased From 4 to 41 centers.

the home.

The practice of child abuse was based on kinds of philosophies, cultural beliefs and understandings that gave way to a system of laws that, in turn, gave children few, if any, rights. Under the English Common Law, for example, children were considered as property owned by the parents, particularly fathers, who had great latitude over the treatment and discipline of their children. Such legal view was eventually incorporated into early laws in the United States as well. Common law tradition held that the male was head of the household and possessed the authority to act as both disciplinarian and protector of those dependent on him, including his wife and children as well as extended kin, servants, apprentices, and slaves. While common law obligated the male to feed, clothe, and shelter his dependents, it also allowed him considerable discretion in controlling their behavior. Domestic violence, however, was dealt with on the basis of local community standards, which were the most important yardsticks. Puritan parents in New England, for example, felt a strong sense of duty to discipline their children, whom they believed to be born naturally depraved, in order to save them from eternal damnation. Although Puritan society tolerated a high degree of physicality in parental discipline, the community did draw a line at which it regarded parental behavior as abusive, and those who crossed the line would be brought before the courts.

The complexity of the sociocultural underpinnings of child abuse is evident from the historical fact that the legal protections from cruelty was granted to animals long before they were granted to children. One of the first cases in the United States (the case of 8-year-old Mary Ellen Wilson) that arose national attention to child abuse in the early 1870s, got through the legal arguments only after an attorney for the then well-established American Society for the Prevention of Cruelty to Animals (ASPCA) took her case to court and successfully argued for children as being, just like all humans, members of the animal kingdom, hence entitled for the right to be treated with the same legal protection from cruelty as are animals (Shelman and Lazoritz, 2005; Watkins, 1990).

## **2. Child abuse in Saudi Arabia**

Saudi Arabia is a country occupying most of the Arabian Peninsula with a population of about 27 million who are entirely Muslims. The country is governed according to the Islamic Sharia law whereby the Islamic orthodoxy and conservatism generally dominate the social and cultural characteristics and mechanisms of the Saudi society. Traditional tribal principles and customs, however, have significant influence over a wide range of cultural, behavioral, and attitudinal manifestations in the society. Children are usually well taken care of in terms of basic needs, and are expected to show almost total subordination and obedience to their parents. Corporal punishment by parents is a common practice, especially in less modernized portions of the society. The country generally has one of the lowest rates of serious crimes compared to other countries, despite the fact that nearly 8 million expatriate workers dwell in the country. This fact has been largely due to strict laws that organize all spheres of life, reinforced by the regular police force and members of an official body monitoring the public's compliance with the prevailing religious norms and rules. For the last twenty years or so, most families adopted the tradition of having expatriate housemaids to take care of household menial works including looking after the children in the home.

20 Child Abuse and Neglect – A Multidimensional Approach

Although the history of child abuse remains obscure in many parts of the world, it is argued that as from the late seventeenth century onwards children can be seen playing, sketching, and amusing themselves in portraits, which shows that there was a growing concept of childhood. Nevertheless, the number of abused children in modern times generally is still alarming, since the natural state of affairs is a zero-tolerance to child maltreatment, especially the forms of abuse that lead either to death or permanent physical or emotional impairment. In the USA, more than 4 million children were reported to child protection services as alleged victims of child maltreatment in 1999 alone, of which an estimated 1401 child abuse and neglect related fatalities were confirmed by the child protection services' agencies (Nation Committee for the Prevention of Child Abuse [NCPCA] 2000 Annual Fifty State Survey), while the confirmed child abuse deaths in 2002 were about 1400 children (National

The practice of child abuse was based on kinds of philosophies, cultural beliefs and understandings that gave way to a system of laws that, in turn, gave children few, if any, rights. Under the English Common Law, for example, children were considered as property owned by the parents, particularly fathers, who had great latitude over the treatment and discipline of their children. Such legal view was eventually incorporated into early laws in the United States as well. Common law tradition held that the male was head of the household and possessed the authority to act as both disciplinarian and protector of those dependent on him, including his wife and children as well as extended kin, servants, apprentices, and slaves. While common law obligated the male to feed, clothe, and shelter his dependents, it also allowed him considerable discretion in controlling their behavior. Domestic violence, however, was dealt with on the basis of local community standards, which were the most important yardsticks. Puritan parents in New England, for example, felt a strong sense of duty to discipline their children, whom they believed to be born naturally depraved, in order to save them from eternal damnation. Although Puritan society tolerated a high degree of physicality in parental discipline, the community did draw a line at which it regarded parental behavior

Data of the U. S. Department of Health and Human Services, April 2004).

as abusive, and those who crossed the line would be brought before the courts.

man and Lazoritz, 2005; Watkins, 1990).

**2. Child abuse in Saudi Arabia** 

The complexity of the sociocultural underpinnings of child abuse is evident from the historical fact that the legal protections from cruelty was granted to animals long before they were granted to children. One of the first cases in the United States (the case of 8-year-old Mary Ellen Wilson) that arose national attention to child abuse in the early 1870s, got through the legal arguments only after an attorney for the then well-established American Society for the Prevention of Cruelty to Animals (ASPCA) took her case to court and successfully argued for children as being, just like all humans, members of the animal kingdom, hence entitled for the right to be treated with the same legal protection from cruelty as are animals (Shel-

Saudi Arabia is a country occupying most of the Arabian Peninsula with a population of about 27 million who are entirely Muslims. The country is governed according to the Islamic The first program for detecting, reporting, and working towards preventing child abuse in Saudi Arabia was initiated by one of the leading hospitals in the country in 1994 as a Child Advocacy Committee, with an internal policy and procedure for dealing with all cases of child abuse that reached the hospital. The policy involved the hospital's security department and a mechanism to report cases of suspected or proven child abuse encountered in or admitted to the hospital to legal authorities in the city.

Subsequently, the National Family Safety Program (NFSP) was established in 2005 by a Royal Decree with a vision to establish a foundation that promotes a safe community and help victims of domestic violence Including child abuse victims. The strategic objectives of the NFSP include promoting awareness among individuals and institutions on the damage to individuals and the society caused by domestic violence and child abuse, and training staff members to deal appropriately and effectively with cases of domestic violence and child abuse. Since the implementation of the NFSP in 2007, the numbers of child protection centers that provide NFSP services have increased From 4 to 41 centers.

The National Family Safety Registry (NFSR) was established in 2009 as a web-based data registry system to provide a centralized database for child abuse cases from all over the country. It is aimed to provide a ground for collecting and analyzing data on child abuse cases in order to define the magnitude of the problem and to identify the risk factors leading to child abuse in the country, which is likely to help in formulating prevention strategies and policies.

A total of 616 child abuse cases have been registered in a period of 16 months between October 2010 and February 2012. Of these, 315 (51.1%) are males and 301 (48.9%) are females. The Saudi nationals among the abused children comprise 92.0% of the cases; however, non-Saudi children are mostly treated in private health sectors which are not yet represented by CPC. **Figure 1** shows the age distribution of the abused children included in the registry, , whereby the ages in a small proportion of the cases (2.8%) are missing. The figure shows that 15.9% of the total number of cases involves children younger than one year of age, as shown in **Table 1** below.

The Cultural Reinforcers of Child Abuse 23

harm (Gough, 1996). As has been pointed out by Gough (1996), childhood itself is a social construct in which ages defining childhood have varied throughout history and across various sociocultural groups of the human societies. However, the word *child*, in its broad literal meaning, refers to "a person between birth and full growth; a boy or girl". The Convention on the Right of the Child (CRC), however, defines a child as "every human being below the age of 18 years unless under the law applicable under the child majority is attained earlier" (*Ref: http://www.unicef.org/crc/crc.htm*). Age of majority pertains solely to the acquisition of control over one's person, decisions and actions, and the correlative termination of the legal authority and responsibility of the parents (or guardian, in lieu of parents) over the child's persons and affairs generally. On the other hand, literally speaking, the word *abuse* is defined as "to use wrongly or improperly; to misuse, or to treat in a harmful, injurious, or offensive way; to speak insultingly, harshly, and unjustly to or about" (Collins English Dic-

A review of the literature on child abuse reveals several definitions to the term that are quite similar in content. For example, a definition of child abuse, as stated in a report on the consultation on Child Abuse Prevention Geneva (World Health Organization, 1999), refers to "any act, or failure to act, that violates the rights of the child that endangers his or her optimum health, survival and development". It adds that "child abuse, or maltreatment, constitutes all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power". A similar definition of the term is stated in the Child Abuse Prevention and Treatment Act (CAPTA), of the federal government of the USA, which states "…at a minimum, any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm." (The Child Abuse Prevention and Treat-

The various definitions of child abuse seem to imply a consensus on several implicit criteria. First, it implies that an act against a child is considered abusive if that act has the potential or likelihood of causing harm to the child, even if no harm has actually resulted from it. Second, it also implies that the forms of acts coming under the definition of child abuse do not always require to have been committed more than once in order to be considered abusive; that is, a single commission of an abusive act may warrant the application of the definition and, where applicable, the activation of subsequent relevant implications and interventions. Third, while most definitions of child abuse assert the non-accidental nature of such acts, they also do not assume the existence of an *intention to harm* in the part of the perpetrator who commits the abusive act. For example, an angry parent may, for example, throw a heavy object at the child that injures him or her, without a pre-existing intention to injure or harm the child; the par-

ent's behavior in this respect, nevertheless, is considered by many as an abusive one.

It is generally agreed that most perpetrators of child abuse are parents or close relatives. For example, the 2002 national data on child abuse in the USA released by the U. S. Department of Health and Human Services (April, 2004) revealed that parents were the abusers in 77

ment Act, the Federal Government of the United States, 2011).

tionary, 2009).

**Figure 1.** Age Distribution of Abused Children


**Table 1.** Age and Gender of Abused Infants (<12 months)

### **3. Defining child abuse**

Definitions of child abuse or maltreatment have two main components: harm, which may be a harmful action or a harmful consequence, and a person or persons responsible for the harm (Gough, 1996). As has been pointed out by Gough (1996), childhood itself is a social construct in which ages defining childhood have varied throughout history and across various sociocultural groups of the human societies. However, the word *child*, in its broad literal meaning, refers to "a person between birth and full growth; a boy or girl". The Convention on the Right of the Child (CRC), however, defines a child as "every human being below the age of 18 years unless under the law applicable under the child majority is attained earlier" (*Ref: http://www.unicef.org/crc/crc.htm*). Age of majority pertains solely to the acquisition of control over one's person, decisions and actions, and the correlative termination of the legal authority and responsibility of the parents (or guardian, in lieu of parents) over the child's persons and affairs generally. On the other hand, literally speaking, the word *abuse* is defined as "to use wrongly or improperly; to misuse, or to treat in a harmful, injurious, or offensive way; to speak insultingly, harshly, and unjustly to or about" (Collins English Dictionary, 2009).

22 Child Abuse and Neglect – A Multidimensional Approach

**Figure 1.** Age Distribution of Abused Children

**Table 1.** Age and Gender of Abused Infants (<12 months)

**3. Defining child abuse** 

**Age (months) Male Female Total %**  0 3 5 8 8.2 1 3 3 6 6.1 2 4 5 9 9.2 3 4 5 9 9.2 4 1 5 6 6.1 5 7 4 11 11.2 6 8 6 14 14.3 7 5 1 6 6.1 8 7 4 11 11.2 9 4 2 6 6.1 10 2 2 4 4.1 11 4 4 8 8.2 **Total 52 45 98 100** 

Definitions of child abuse or maltreatment have two main components: harm, which may be a harmful action or a harmful consequence, and a person or persons responsible for the A review of the literature on child abuse reveals several definitions to the term that are quite similar in content. For example, a definition of child abuse, as stated in a report on the consultation on Child Abuse Prevention Geneva (World Health Organization, 1999), refers to "any act, or failure to act, that violates the rights of the child that endangers his or her optimum health, survival and development". It adds that "child abuse, or maltreatment, constitutes all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power". A similar definition of the term is stated in the Child Abuse Prevention and Treatment Act (CAPTA), of the federal government of the USA, which states "…at a minimum, any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm." (The Child Abuse Prevention and Treatment Act, the Federal Government of the United States, 2011).

The various definitions of child abuse seem to imply a consensus on several implicit criteria. First, it implies that an act against a child is considered abusive if that act has the potential or likelihood of causing harm to the child, even if no harm has actually resulted from it. Second, it also implies that the forms of acts coming under the definition of child abuse do not always require to have been committed more than once in order to be considered abusive; that is, a single commission of an abusive act may warrant the application of the definition and, where applicable, the activation of subsequent relevant implications and interventions. Third, while most definitions of child abuse assert the non-accidental nature of such acts, they also do not assume the existence of an *intention to harm* in the part of the perpetrator who commits the abusive act. For example, an angry parent may, for example, throw a heavy object at the child that injures him or her, without a pre-existing intention to injure or harm the child; the parent's behavior in this respect, nevertheless, is considered by many as an abusive one.

It is generally agreed that most perpetrators of child abuse are parents or close relatives. For example, the 2002 national data on child abuse in the USA released by the U. S. Department of Health and Human Services (April, 2004) revealed that parents were the abusers in 77

percent of the confirmed cases, other relatives in 11 percent. In addition, Sexual abuse was more likely to be committed by males, whereas females were responsible for the majority of neglect cases.

The Cultural Reinforcers of Child Abuse 25

culture. Likewise, parental behaviors that are appropriate at one stage in a child's development may be inappropriate at another stage of development. For example, the level of supervision needed for toddlers may differ from that for adolescents. On the other hand, another issue of dispute is the categorical definitions of child abuse or maltreatment. In other words, while some consider a child as either abused or not abused, still others hold the notion that the categorical definition approach fails to acknowledge that abusive and neglectful behaviors can differ markedly in terms of severity, the frequency and duration of occurrence, and the likelihood that they will cause physical or emotional harm. Another disputable dimension of defining child abuse is whether child maltreatment is defined on the basis of the abusive or neglectful adult behaviors committed against a child (e.g., hitting or shaking), or rather on the basis of the harm caused to the child as a result of such behaviors (e.g., displayed physical symptoms such as bruising or swelling). Further, as mentioned above, there is the justified question of whether the intent to maltreat a child is a necessary indicator of child maltreatment. In reality, there can be instances where abuse or neglect can occur even though the perpetrator did not intend to commit it (for example, neglectful par-

Child abuse occurs across socioeconomic, religious, cultural, racial, and ethic groups. The causes of child abuse or maltreatment are numerous, multiple, and complex. There is no single profile that describes all families within which child abuse occurs. On the other hand, supportive, emotionally gratifying relationships with a healthy network of relatives or friends may help minimize the risk of parents abusing their children, especially during stressful life events. Based on this understanding, research has recognized a number of risk factors commonly associated with child maltreatment. However, the presence of these factors does not necessarily always result in child abuse and neglect. In other words, the factors that may contribute to child maltreatment in one family, such as poverty, may not result in

Risk factors associated with child maltreatment have been grouped in four domains: parent or caregiver factors, family factors, child factors, and environmental factors. The interaction of multiple factors across these four domains is recognized to be underlying child

Parent or caregiver factors are related to personality characteristics and psychological wellbeing, history of maltreatment, substance abuse, attitudes and knowledge, and age. Family factors that may increase the likelihood of child abuse include marital conflict, domestic violence, single parenthood, unemployment, financial stress, and social isolation. Child factors do not imply that children are responsible for being victims of maltreatment. Rather, certain factors can make some children more vulnerable to abusing behavior. The age of the child, his or her physical, mental, emotional, and social development, may increase the child's vulnerability to maltreatment, depending on the interactions of these characteristics with the parental factors outlined above. Environmental factors are often present in combination with

ents may have had no intention of neglecting their children).

**5. Causes of child abuse** 

child abuse in another family.

maltreatment incidents.

On the other hand, **Table 2** shows data on the relationship of the abused child to the perpetrators extracted from the NFSR, Saudi Arabia. It illustrates that slightly more than one-third of the total cases of child abuse (37.9%) were reported by either of the parents or relatives, while approximately two-third of the cases were reported by others (which include: teachers, friends, house maids, neighbours, and healthcare professionals). Obviously, this data is not claimed to be representative of the status of child abuse in the whole country since both the registry and the program are at their early stage of life. In addition, these child abuse reports failed to specifically identify the exact perpetrators of the child abuse incidents involved in the reports. Similarly, the section on Saudi Arabia, in the article by Al-Mahroos (2007) that reviewed child abuse and neglect in the Arab Peninsula, did not mention the perpetrators of child abuse cases that the article has outlined with the exception of two reported cases of child abuse committed by two housemaids and were documented by secretly hidden cameras. This shortcoming in data collection is probably related in some way to a lack for a system of obligatory official legal and social interventions in child abuse cases in Saudi Arabia.


**Table 2.** Relation to the Abused Child of Persons Reporting the Abuse
