Physical Child Abuse by Parents and Teachers in Saudi Arabia: a Systematic Literature Review

Abstract

A systematic review was conducted to find out what is known about the prevalence and nature of physical child abuse in Saudi. The review identified 15 abuse prevalence studies carried out in Saudi Arabia between 1998 and 2016, written in English or Arabic. An analysis of these revealed the known prevalence of different types of child abuse, the relationship of the abuser to the victim, and the level of awareness among school professionals of procedures and programs in Saudi to protect children from abuse. The review revealed many shortcomings of existing literature, including a paucity of published studies, lack of rigor in research design, an absence of data from many parts of the country, and an emphasis on hospital reports rather than data collected directly from victims. Studies conducted to date suggest that physical abuse of children is more widespread and severe in the Kingdom than previously acknowledged.

Introduction

The current literature review investigates physical child abuse in Saudi Arabia, a phenomenon that has been occurring for centuries but that has only recently come under public and professional scrutiny (Al-Shail et al. 2012). The first case of child abuse officially recorded in Saudi Arabia was in 1990. In 1994 a program for reporting incidents of child abuse was set up at a single Saudi Arabian hospital and, in the same year, a governmental committee was formed to oversee the protection of children’s rights in the nation. These programs have had minimal impact and little legislation has been enacted to protect children from physical abuse in the Kingdom, except where extreme violence including that leading to fatality is involved (Al Eissaa and Almuneef 2011). In addition, Saudi Arabia is a conservative society, built upon a closed tribal system and strict observance of Islamic law, in which child abuse is rarely discussed openly (Al Eissaa and Almuneef 2011).

In western culture, child abuse is often defined in terms of physical, sexual, and psychological abuse and neglect. Literature can be found covering definitions in all of these areas (Holden 2003). Literature relevant to abuse in Saudi Arabian society, however, tends not to addresses abuse in these terms and the limited literature that is available focuses mainly on physical abuse. This may be a consequence of social acceptance of physical punishment as a means of disciplining children and a reflection of a conservative ideology that shy’s away from acknowledgement of the existence of sexual and psychological abuse and neglect within Saudi Arabian culture.

Physical Punishment of Children in Saudi Arabia

In countries such as Saudi Arabia there is a long-standing and deeply embedded tradition of physically punishing children, by such means as hitting with a stick. Thus, it is relevant to consider how such punishment is defined. Physical abuse often involves injury and marks such as bruises, whereas physical punishment, according to some definitions, results in only minor or moderate temporary pain (Saunders and Goddard 2010). However, what is considered acceptable as non-abusive physical punishment of children has varied over time, between cultures, and within a society. In societies such as Saudi Arabia, where harsher punishment of children is traditionally common, there is a particular need to develop definitions of physical punishment and abuse that make it clear when the line between the two has been crossed (Kwok and Tam 2005). Among the factors involved are the level of force, number of strokes applied, region of the body struck, type of object used, and age of the child. On the other hand, many today would argue that a child should never be struck under any circumstances because of the negative psychological effects this can have (Hammarberg 2006). In Saudi Arabia the situation is unusual in that the definitions of child abuse and physical punishment widely accepted throughout the society are based on Islamic teachings. This presents a challenge to researchers and others engaged in work that is directed at improving child protection, because if moderate levels of force are widely condoned for use in punishment not only may such levels of force themselves be considered abusive but they may lead to the routine use of more extreme force that is more harmful to the child (Whipple and Richey 1997).

For the purpose of this study, the definition used is by Price-Robertson and Bromfield (2009), which states: “any non-accidental behaviour by parents, caregivers, other adults or older adolescents that are outside the norms of conduct and entail a substantial risk of causing physical or emotional harm to a child or young person.” In this case, “outside the norms of conduct” will be taken to mean outside the norms of physical disciplining as prescribed by Islamic law, since this is the basis for legislation and acceptable social behaviour in Saudi Arabia.

An important factor to be borne in mind is that, in Saudi Arabia, children up to the age of 18 spend the overwhelming majority of their time at home, in the presence of their parents, or at school, in the presence of their teachers. Discipline is regarded as important and physical disciplining by parents to a certain degree is condoned. Under specific circumstances, physical discipline is encouraged by Islamic scripture. It is also commonplace in Saudi Arabia for parents to give permission, and expect, teachers to perform physical disciplining of their children on their behalf during school time. Such disciplining may be harsh, by Western standards, and easily spill over into abuse (Al-Zahrani 2005). For these reasons, this study will confine itself to assessing the prevalence and effects of physical abuse on children by parents and teachers.

To summarize, then, although there have been many studies of physical abuse in various parts of the world, few have been conducted in Saudi Arabia and the quality of these is open to question. Furthermore, there have been no reviews of the literature up to this point (Almuneef et al. 2014). The present study thus fills a significant gap, providing not only the first literature review of the subject but also the first investigation specific to physical child abuse by the main perpetrators, namely, parents and teachers.

Physical abuse involves beating, punching, kicking, or other forms of bodily harm. It may be perpetrated by parents, other relatives or family friends, teachers, or strangers, and has many different causes, especially when viewed cross-culturally (Hien et al., 2009). For example, in countries such as the United Kingdom attitudes toward physical punishment are informed by recent research into child development and positive parenting (Barth 2009) whereas the occurrence of physical child abuse in some other nations has a particular connection with socio-cultural attitudes toward physical discipline (Alanazi 2008). In Arabic countries, for instance, including Saudi Arabia, whose culture and legal system is deeply rooted in Islamic teachings, there is a tolerance, and respect for, relatively (by Western standards) harsh forms of physical punishment, which may easily spill over into outright abuse (Al-Shail et al. 2012).

Physical abuse is often associated with visible signs of punishment such as marks or bruising as a result of excessive force. Whipple and Richey (1997) identify parents may discipline a child without being aware of using too much force and, although abuse takes place, the parent does not recognise it as such. In other situations, the parent may be consciously abusive yet justify this on the grounds that it serves to correct behaviour (Runyan, Deblinger, Ryan, and Thakkar-Kolar, 2004). In Saudi Arabia teachers are permitted to use physical punishment of students as a means of controlling behaviour and teaching discipline. As in the case of parental discipline, in Saudi Arabia this approach is rooted in Islamic teaching and something parents are given to accept on the grounds of an appropriate response to producing ‘good’ citizens for the future.

What is regarded as “excessive physical discipline” is also open to interpretation, between different individuals and societies, so that what may be considered acceptable physical discipline to one may be deemed abusive to another (Rentein 2010). Effective operational definitions of child abuse and related terms are crucial to researchers in order to determine when abuse has taken place, compare data across studies and from different sources, and, ultimately, develop better abuse prevention strategies (Mills 2004). Definitions of physical child abuse, physical punishment, and discipline will be considered, and commonalities and differences between them explored in relation to Saudi society.

Contested Definitions and Prevalence Rates

Physical abuse of children has been defined in many ways. Some definitions concentrate on the physical harm perpetrated; others deal with non-physical factors, such as emotional or psychological harm, or take a broader view in the context of the social setting such as the home or school. Price-Robertson and Bromfield (2009) point to the involvement of both intentional and unintentional factors. The latter they define as: “any non-accidental behaviour by parents, caregivers, other adults or older adolescents that are outside the norms of conduct and entail a substantial risk of causing physical or emotional harm to a child or young person” (Price-Robertson and Bromfield 2009: 1).

A diversity of definitions as to what constitutes physical child abuse poses a challenge to researchers. This is especially so when the definitions need to be weighed in the context of a particular culture or society because such cultural and societal norms may be deeply rooted, passionately held, and based on principles other than those of Western scientific methodology. The tribal and Islamic cultural influences on the issue of physical child punishment in Saudi Arabia serve as a specific example of the complexity of the problem. Researchers must decide which operational definition to adopt within the framework of their work and the environment in which their studies are based (Corby 2006).

Where there is societal acceptance that physical punishment is acceptable this adds a further layer of complication to definitions of physical abuse. If it is acceptable to hit, slap or smack a child there is an inherent risk that the physical punishment of children and discipline, may be related to physical abuse and overlap with it, depending on the definition adopted (Haugaard 2000). Some of these definitions include a broad spectrum of physical actions taken against a child, including milder forms such as ‘slapping,’ whereas others are restricted to more extreme acts of violence (Miller-Perrin et al. 2009).

Any attempt to define physical abuse of children is complicated by the issue that, in some societies, strong physical punishment of children, for example through the use of hard strokes of a cane or flexible stick on the hand, as a means of behaviour correction is endorsed by parents, and sanctioned by schools and other institutions (Landsford et al. 2010). This is the case in Saudi Arabia. The National Family Safety Program in Saudi Arabia defines physical abuse as: “Infliction of an injury on a child (by beating, shaking, kicking, burning, biting, suffocating, or poisoning) regardless of the perpetrator’s intention” (Almuneef et al. 2014). Other definitions of physical abuse referred to in Saudi literature derive from Western sources and reflect an understanding of the complexity of the issue. For example, there is recognition that certain behaviour, such as corporal punishment, may be considered acceptable in one culture but abusive in another (Al-Shail et al. 2012).

Physical child abuse is a widespread international issue. Many studies have been conducted to ascertain the incidence and prevalence of abuse in different parts of the world, though a comparison of data is hampered by the existence of different definitions and cultural understandings of what constitutes abuse (Haugaard 2000). A recent meta-analysis found a vast difference in overall prevalence of physical abuse cases – 3 in 1000 (0.3%) to 226 in 1000 (22.6%) – depending on whether the studies were based on informants or self-reported measures. The highest prevalence rates were reported, perhaps not surprisingly, by studies that adopted a broad definition of physical child abuse, measured abuse over the longest period of childhood (from birth to 18 years), questioned abuse victims as adults, and asked more questions about physical abuse (Stoltenborgh, Bakermans-Kranenburg, and van Ijdendoorn, 2013). Thus, the outcome of prevalence studies depends not just on the definition of physical child abuse used by the researcher but on how the findings are reported.

Aims of the Review

This is the first study to conduct a systematic literature review of physical abuse of children in Saudi Arabia. Its primary aim is to establish the nature and prevalence of physical abuse in Saudi Arabia by parents, with whom children spend most of their time when not in school, and teachers, to whom physical punishment is typically delegated by parents. This is an aspect of child abuse especially significant in the Kingdom but one that, until recently, had received little attention at official levels.

Methodology

Four search engines were used: CrossSearch at Dundee University, Saudi Digital Library (for access to theses by students in Saudi Arabia); the website of King Fahd Library (for access to directories of all books and journals by Saudi authors); and the Education Resource Information Centre. In addition, a hand search was conducted on key journals including Child Maltreatment and Child Abuse and Neglect. The search terms used were ‘Saudi Arabia,’ ‘child abuse,’ ‘child maltreatment,’ ‘physical child abuse,’ ‘physical punishment,’ ‘punitive behaviour,’ ‘disciplining in Islam,’ ‘discipline in schools,’ and ‘domestic violence.’

Inclusion and Exclusion Criteria

The following inclusion criteria were used: literature related to child abuse in Saudi Arabia from 1990 onwards, including journal articles, professional studies, theses, books and medical studies; studies of abuse against male and female children aged 0 to 18; and studies in English and in Arabic. Child abuse in general was included because so few studies have been conducted that specifically apply to physical abuse.

The following exclusion criteria were used: studies not related to child abuse or child protection; unofficial written material, such as medical reports; studies by local organisations; and publications not in English or Arabic.

Results

A total of 16 studies of child abuse in Saudi literature were found by the search strategy. One of these provided useful background information on the history and culture of Saudi society as it related to child abuse. The results from the other 15 studies are summarised in Table 1.

Table 1.

Summarised results from the other 15 Saudi studies on physical child abuse

No	Author and date	Study title	Nature of publication	Research design	Sample Size	Gender	Age range	Tools of data collection	Place of data collected	Study area
1	Al-Saud 2000	Child abuse in Riyadh: Types, causes and characteristics of victims.	Ph.D. thesis	Case study	82	Male/ female	Under 18	Standardized questionnaire	Hospitals	Riyadh
2	Ashul, 2003	Disciplining children in the family environment.	Peer-reviwed Arabic journal	Quantitative and qualitative analysis of questionnaire	126	Female	18–25	Standardized questionnaire	University	Dammam
3	Al-Zahrani 2004	Child abuse phenomenon in Saudi society.	Report of Home Office	Quantitative and qualitative analysis of questionnaire	2050	Male	10–17	Standardized questionnaire	Schools	Riyadh, Dammam, Makkah
4	Al-Zahrani 2005	Child abuse and neglect: Its causes and consequences in Saudi Arabia.	Ph.D. thesis	Quantitative and qualitative analysis of questionnaire	823	Male/ female	18–25	Standardized questionnaire	Home/ university	Riyadh
5	Al-Ayed et al. 1998	The spectrum of child abuse presenting to a university hospital in Riyadh.	Peer-reviewed Arabic journal	Individual child case study	13	Male/ female	1–11	Medical history	Hospital	Riyadh
6	Elkerdany et al. 1999	Fatal physical child abuse in two children of a family	Peer-reviewed Arabic journal	Individual case study	2	Male/ female	Under 2 years	Medical history	Hospital	Jubail
7	Karthikeyan et al. 2000	Child abuse: report of three cases from Khamis Mushayt	Peer-reviewed Arabic journal	Individual case study	3	Male/ female	Under 7 years	Medical history	Hospital	Khamis Mushayt
8	Alanazi 2008	The use of physical punishment on children in Saudi Arabia	Ph.D. thesis	Purposive sampling, data collection, quantitative analysis	530	Male/ female and parents	17–21; adults	Two standardized questionnaires: one for young people; one for parents.	Home/ university	Riyadh
9	Al Eissaa and Almuneef, 2011	Child abuse and neglect in Saudi Arabia	International journal article	Data collection form used, followed by descriptive analysis.	188	Male/ female	Mean age 5	Archive data collected by medical staff	Hospital	Riyadh
10	Al-Buhairan et al. 2011	Self-reported awareness of child maltreatment among school professionals in Saudi Arabia	International journal article	Stratified cluster random sampling. Descriptive analysis.	3777	Male professionals in schools	Adult	Self-administered questionnaire	Professionals in schools	Riyadh
11	Al-Yousif et al. 2005	Domestic violence: A field study in Saudi Arabia.	Report of Social Affair Ministry	Survey	491	Male/female	…….	Questionnaire	Hospitals	Riyadh
12	Council of Health Services, 2010	Child Maltreatment Registry, Annual Report, Council of Health Services.	Government report	Simple quantitative analysis based on web-forms	292	Male/female	Under 18	Government approved web-form completed at child protection centres	Hospitals	Riyadh
13	Council of Health Services, 2011	Child Maltreatment Registry, Annual Report, Council of Health Services.	Government report	Simple quantitative analysis based on web-forms	616	Male/ female	Under 18	Government approved web-form completed at child protection centres	Hospitals	Riyadh
14	Council of Health Services, 2012	Child Maltreatment Registry, Annual Report, Council of Health Services.	Government report	Simple quantitative analysis based on web-forms	263	Male/female	Under 18	Government approved web-form completed at child protection centres	Hospitals	Riyadh, Makkah, Eastern Provinces
15	Almuneef et al. 2014	Neglect, adverse childhood experiences, chronic diseases, and risky health behaviours in Saudi Arabia adults	International journal article	Survey	931	Male/female	Under 18	Standardised questionnaire. (ACE International Questionnaire)	Public venues	Riyadh

All the studies were conducted by Saudi researchers, several of whom were involved in more than one study. Consequently, there is less diversity among the literature and fewer different researchers involved than the number of studies would suggest. The researcher found no study published prior to 1998. In subsequent years the following number of studies were publisher 1999 (1), 2000 (2), 2003 (1), 2004 (1), 2005 (2), 2008 (1), 2009 (1), 2010 (1), 2011 (2), 2012 (1), and 2014 (1).

Type of Publication

Seven papers were published in peer-reviewed journals, three are Ph.D. theses, and five are reports by Saudi government agencies. One of the Ph.D. theses was conducted at King Saud University, and the other two in the UK. Five of the studies consisted of reports, from the Home Office (1), the Social Affair Ministry in Saudi Arabia (1), and the Hospital-Based Child Maltreatment Registry of the Council of Health Services (3). Seven of the studies were published in academic journals – four in Saudi publications and three in the international journal Child Abuse and Neglect. Although the Saudi studies discuss the issue of physical abuse from different angles, seven have the term “child abuse” in the title but with no qualifier. Only one specifies “physical child abuse” in the title; one each includes the following terms in their titles: “physical punishment,” “disciplining children,” “domestic violence,” and “neglect in childhood.” Although all the journals are peer-reviewed, only the three published outside Saudi Arabia are likely to have an international readership and be of higher quality in terms of the authority and impact of their content.

Research Design and Data Collection Tools

Seven studies used a case study approach, while the others used surveys; of the latter, seven involved questionnaires and one was based on archived data. One of the Ph.D. theses and three of the journal papers used individual case studies, and two Ph.D. theses and four of the journal papers used surveys. Two reports by the Saudi Social Affairs Ministry and Home Office used surveys, whereas the reports of the Council of Health Services were based on case studies. Eight of the studies employed questionnaires; seven used interviews. Thus the studies employed only a limited range of methodologies. Moreover, just under half focussed on specific incidents rather than generalizable findings, for example, the fatal physical abuse of two children in a single family.

Sample Size

Al Eissaa and Almuneef (2011) conducted a retrospective survey of data on child abuse cases reported to a hospital-based medical centre in Riyadh in three periods: 2000–2004, 2005–2006, and 2007–2008. Al-Buhairan et al. (2011) surveyed several thousand school professionals, using a questionnaire, from randomly selected schools across the country in order to ascertain their awareness of national policies with regard to child abuse. Almuneef et al. (2014) carried out a survey, using a WHO-developed questionnaire, of 50 decision-makers from organisations involved with child maltreatment issues to assess the readiness of Saudi Arabia to implement a nationwide, evidence-based child abuse prevention programme. Of the six case studies, two, those of Elkerdany et al. (1999) and Karthikeyan et al. (2000) involved just 2 and 3 children, respectively. That of Al-Ayed et al. (1998) examined 13 cases of abuse, of widely varying severity and type, presenting at a university hospital in Riyadh. The remaining three case studies were conducted by the same government body, the Council of Health Services.

As shown in Table 1, the sample size of participants ranged from 2 (Elkerdany et al. 1999) to more than 2000 (Al-Zahrani 2004), though there were relatively few large sample studies. The nature of the samples also differed. In most cases, they were of children. However, one was of male school staff-members, two were of young adults, and one was of both children and parents. Only five studies used sample sizes greater than 500 and these provided mostly general data about the incidence of abuse, without specifying the type or severity and when and for how long it was perpetrated. Two of the larger sample sizes included males only. Four of the studies involved fewer than 100 participants, and three of these just 13 or less. In conclusion, few studies have involved large sample sizes and there has been little attempt to collect data directly from those involved, either the abusers or those who have been abused.

Age Range

Four of the 15 studies supplied no data on ages because their aim was to explore the prevalence of abuse for all ages, from birth to 17. The age ranges of the samples of the other 11 are as follows: five studies used ages under 18 years; two focussed on young adults between the ages of 18 and 25 years to study what abuse they suffered as children; and one each dealt with ages between 10 and 17 years, between 1 and 11 years, under 7 years, and under 2 years. Thus, although all age groups of child, up to the age of 18, have been studied, in one way or another, the cumulative data are sparse and few conclusions.

Gender

Eleven of the studies included data on both genders. In two of the studies the samples were all male; in one the sample was all female. Additionally, one study focused on male staff-members in schools and aimed to find out the awareness of school professionals regarding child maltreatment and the current rules and procedures to investigate the level of effort to combat this problem in Saudi Arabia. One of the studies involved the participation of parents. Only four of the Saudi studies referred to the gender of abuse victims, and the proportion of male to female victims reported varies. In three of the studies, a higher proportion of males were found to have experienced abuse, while in the other the proportion of female abuse victims was higher. Based on the limit extent of the studies to date, no reliable generalisations are possible other than that physical abuse is directed at both genders and makes up a high proportion of abuse cases overall. As for ethnicity, most of the studies focused on indigenous Saudi participants. In one, by Almuneef et al. (2014), 20% of participants were of non-Saudi origin. Additionally, the reports of the Council of Health Services in 2010, 2011 and 2012 included some non-Saudis. No information appears in the literature on whether, for example, the prevalence of physical abuse is different for non-Saudis than Saudis, so few inferences can be drawn on the basis of ethnicity.

Places of Data Collection

Data for the studies were collected in different places and regions, depending on the aim of the researchers. The same type of location was, in some cases, referred to in more than one study. Nine of the studies were conducted in hospitals, three in universities, two in homes, two in schools, and one in a public venue. The studies focused on certain geographic areas. Nine were conducted in the capital, Riyadh, four focused on some areas in the east of the country, one in the west, and one in the south. The Riyadh sample sizes also tended to be among the largest, so there has been a large bias in the data toward this population centre, while other major cities in Saudi Arabia, such as Jeddah and Medina, have not been investigated at all. The results from Riyadh and the few other places in which studies have been carried out cannot be assumed to be generalizable across the whole country because, for example, of significant cultural and social differences from one part of Saudi Arabia to another.

Definitions of Physical Abuse

The definitions used in these studies are those provided by WHO and other Western and international sources. Although a number of the Saudi publications point out the complexity in defining such abuse, none attempt to provide a definition more specific to, or suitable for application to, Saudi society. Some of the studies do not include a definition.

In summary, few studies have been published in Saudi Arabia on child abuse, and fewer still that provide data on physical child abuse. Sample sizes tend to be small, the research design limited in scope, and the geographical coverage restricted. None of the studies attempt to provide a definition of physical abuse relevant to the social context of Saudi Arabia, nor do any of the studies inquire into the impact of abuse on the victims.

Findings of Saudi Studies

Table 2 shows the main findings of the Saudi studies on physical child abuse.

Table 2.

Findings of Saudi studies on physical child abuse

Author and date	Types of abuse	Exposure (more than 2 events) incidence	Abuser	Consequences
Al-Saud 2000	92% physical abuse (100% of sample) 8% missing data	39%	No data	No data
Ashul 2003	69% physical abuse (100% of sample) 31% missing data	69%	21% mothers 13% fathers 25% parents 4% other relatives	No data
Al-Zahrani 2004	54% physical abuse (100% of sample) 46% missing data	50%	No data	No data
Al-Zahrani 2005	13% physical abuse 27% neglect 22.8% emotional abuse (100% of sample) 38% missing data	40.5%	8% mothers 29.5% fathers	No data
Al-Ayed et al. (1998)	30% physical abuse 30% neglect 23% sexual abuse 7% Munchausen’s syndrome by proxy	No data	No data	7% fatality
Elkerdany et al. 1999	100% physical abuse	No data	No data	No data
Karthikeyan et al. 2000	66.66% physical abuse 33.33% Sexual abuse	No data	No data	No data
Alanazi 2008	No data	No data	No data	No data
Al Eissaa and Almuneef, 2011	76% physical abuse 24% missing data	No data	48.9% parents	7.9% fatality
Al-Buhairan et al. 2011	22% of school professionals were aware of Convention on the Rights of the Child	No data	No data	No data
Al-Yousif et al. 2005	No data	No data	No data	No data
Council of Health Services, 2010	60% physical abuse 15.4% sexual abuse 4.6% shaken baby syndrome 2.6% Munchausen by proxy (100% of this sample) 18% missing data	No data	77.4% of cases were not known	2% fatality
Council of Health Services, 2011	64.4% physical abuse 12.3% emotional abuse 22% sexual abuse (100% of this sample) 1.3% missing data	No data	No data	1.9% fatality
Council of Health Services, 2012	73% physical abuse 27% sexual and emotional abuse	No data	No data	No data
Almuneef et al. 2014	No data	32%	No data	22% risky health behaviour 12% sex out-of-wedlock 5% alcohol consumption 4% use of illicit drugs 17% anxiety 9% depression 6% other mental illnesses 8% of participants reported having had suicidal thoughts

Type of Abuse

Most of the 15 studies examined here discussed child abuse in general without a particular focus on physical abuse; however, eight of them did find physical abuse to be the most prevalent type. One of the studies did not refer to specific types of abuse because its aim was to investigate the awareness of school professionals regarding child maltreatment and the current rules and procedures in place to report it in Saudi Arabia. Two studies, by Karthikeyan et al. (2000) and Elkerdany et al. (1999), used very small sample sizes and were therefore of limited statistical value. Additionally, three studies, by Al-Yousif et al. (2005), Alanazi (2008), and Almuneef et al. (2014) gave no data regarding specific types of abuse.

Prevalence

Only five of the studies identified in this review provided specific data about the prevalence of child abuse and, among these, the figures vary significantly. At the low end, Almuneef et al. (2014) found that 32% of individuals in their sample had been exposed to abuse, whereas the studies by Al-Saud (2000), Al-Zahrani (2005), Al-Zahrani (2004), and Ashul (2003) give incidence figures for abuse of 39%, 40.5%, 50%, and 69%, respectively. These compare with the 22.6% self-reported global physical abuse prevalence rate quoted earlier. Al-Yousif et al. (2005) pointed out that lack of cooperation by families with authorities led to many instances of child abuse being unreported.

All of the studies reported only percentages without specifying the actual numbers of those who were abused; the proportion given as having experienced physical abuse varied widely. For example, Al-Saud (2000) reported 92% of participants had been exposed to physical abuse, while Al-Ayed et al. (1998) gave a much lower figure of 30%. In the case of some studies, for example those of Ashul (2003) and Al-Zahrani (2004), and also Al Eissaa and Almuneef (2011) and the Council of Health Services ( 2010; 2011; 2012), the prevalence figures for physical abuse were more similar. Such a wide spectrum of outcomes suggests that much more research is required, using larger and more diverse samples, in order to assess accurately the prevalence of physical child abuse across the whole nation.

Abusers

Only four of the 15 Saudi studies make reference to the relationship of the abuser to the victim and, of these, the findings differ significantly. Ashul (2003)) reports that, of the sample investigated, 21% of abusers were mothers, 13% fathers and 25% by parents, whereas Al-Zahrani (2005) finds that 8% of abusers were mothers and 29.5% were fathers. Al Eissaa and Almuneef (2011) state that, in their sample, 48.9% of abuse cases involved parents. The report of the Council of Health Services ( 2010) pointed out that in 77.4% of the cases it considered the relationship of the abuser to the victim was not known. Although the data to hand suggests that parents are involved in at least a significant minority, and possibly, a majority of abuse cases in Saudi Arabia, the limited research conducted to date gives a very incomplete picture. Additionally, it says very little about whom the other main perpetrators may be, including other family relatives, family friends, and teachers.

In summary, the limited data available suggests that physical abuse is the most significant form of child abuse in Saudi Arabia, although its actual prevalence nationwide remains highly uncertain. Parents appear to be the main perpetrators of the abuse, although, again, the proportion of abuse due to parents and, by proxy, teachers, is not accurately known.

Other Findings

Al-Yousif et al. (2005) found that boys are more likely to be exposed to abuse than girls. Al-Saud (2000) found that in 92% of child abuse cases, younger children (under the age of 11) were more likely to be exposed to abuse than older children. The studies by Al-Zahrani (2005) and Ashul (2003) indicated that 69% of their samples had experienced physical abuse from parents. Al-Ayed et al. (1998) found that a majority of child abuse cases reported to doctors had been committed by young mothers.

Elkerdany et al. (1999) found a strong correlation between cases in which children were subjected to physical abuse and poor educational background of the parents, a finding later supported by Al-Saud (2000). Ashul (2003) concluded that there was a link not only between prevalence of abuse and education level, but also with religiosity level and economic status of the parents. Specifically, the prevalence of abuse tended to be higher for lower levels of education attainment and economic status of the parents, and also for higher levels of religiosity.

Al-Buhairan et al. (2011) found that only 22% of school professionals were aware of the Convention on the Rights of the Child or policies and procedures that dealt with child abuse. One-third of school professionals had a low-level of awareness regarding child maltreatment. Al-Yousif et al. (2005) confirmed that in many cases of child abuse reported to hospitals (77%) the victims were sent back home with their parents without any further action after medical treatment, leaving the victims vulnerable to further abuse.

Some notable discrepancies were evident between the studies. Of the sample examined by Al-Zahrani (2005) only 13% reported having been subjected to physical abuse, whereas in the sample of Al-Saud (2000) the prevalence of physical abuse was reported to be 92%; however, the lower figure given Al-Zahrani appears to be due to the fact that his study included child neglect as a broad category of abuse. Again, Al-Zahrani (2004) found that among children who had suffered physical abuse, the parental education level was high – a finding in complete contradiction to that of Elkerdany et al. (1999) which indicated that children whose parents had low education levels were more likely to suffer physical abuse. In the study by Al-Zahrani (2005) no relationship was found between the prevalence of abuse and parental education level.

Discussion

A great deal of literature is available from developed Western nations, such as the UK, USA, and Australia regarding the incidence and prevalence of physical child abuse, and its effects on victims. By contrast, little has been published to date on this subject in Arab countries, including Saudi Arabia. A principal reason for this is the traditional attitude within Arabic societies to the disclosure and open discussion of what are considered to be matters that should be dealt with exclusively within families (Al-Moosa et al., 2003). With the family’s honour and reputation at stake, it is considered shameful for any suggestion of child abuse or neglect to become public knowledge. Hence, such details have long been kept hidden. This, in turn, led to the belief, even among experts, that child abuse was rare in Arab countries and that little or no government action was needed to address the issue (Al Eissaa and Almuneef, 2011).

The first academic literature on child abuse in Saudi Arabia dates back only to the late 1990s, and what has been published since that time tends to focus on small sample sizes and/or restricted geographical areas, and uses relatively weak methodologies and analyses. The available evidence, from both popular media reports and academic research, suggests that child abuse in general, and physical abuse in particular, is widespread in Saudi Arabia. However, open discussion of it has been late in coming due to the conservative nature of society in this country and the almost universal acceptance of physical punishment as a way of disciplining children at home and in school.

Bearing in mind the paucity of Saudi data, it is worth mentioning the results of some child abuse studies from developed countries. Interviews with a large sample of British children and young adults, for example, indicated that roughly one in nine individuals had been the victims of physical violence by an adult during childhood. Of these, one in 12 young adults (8.4%), aged 18–24, said that they had experienced physical violence as a child due to the actions of a parent or a guardian. One in 14 (6.9%) in the age group 11–17 and one in 80 (1.3%) under 11 years of age reported parental/guardian violence (Chaplin et al. 2011). In 2013, information assembled in the US showed that the reported rate of child maltreatment was 70 per 1000 children, with 30% of these individuals being suspected victims of physical abuse (Dubowitz 2013). During federal fiscal year 2011–12, state and territory authorities in Australia received a total of 252,962 reports or notifications of suspected child abuse and neglect – a prevalence rate of 34 notifications for every 1000 children. Of these notifications, across four categories of child maltreatment – neglect, sexual abuse, physical abuse, and emotional abuse – 48,420 were substantiated. Physical abuse in 2011–12 accounted for 9927 cases, or 20.5% (one-fifth) of the total (Australian Institute of Health and Welfare 2013).

Within the current study, only 15 studies were found on child abuse in Saudi Arabia. This underscores the scarcity of reliable information on this subject in the Kingdom. The authors all used definitions relating to abuse given by WHO or that appear in Western published works. The samples used in the studies carried out so far have generally been small, placing limits on the ability to generalise from them. Many gaps are apparent in the research. For example, although the study by Al-Zahrani (2004) used a relatively large sample size of 2050, it dealt with other types of child abuse in addition to physical abuse and was not specific about the prevalence of physical abuse, how it was caused, or who caused it. Similarly, the studies by Al Eissaa and Almuneef (2011) and Al-Yousif et al. (2005) confirmed that a certain number of children had been subjected to child abuse without giving details of the nature of the abuse or the perpetrators.

The range of methodologies used in the research to date has been narrow in comparison to Western research. Seven of the 15 studies used standardized questionnaires, mostly adapted from questionnaires used previously by other researchers, three used medical reports, and four relied on collecting information about cases reported to hospitals. None of the studies used interviews or analysis of documents. Some of the questionnaires were distributed in the same places. Most notably, a number of the studies obtained their data from hospitals in Riyadh. Other studies were confined to certain geographic areas; aside from eight in Riyadh, four concentrated on regions in the east of Saudi Arabia, one to the west and one to the south. None gave information on child abuse in large cities such as Jeddah, Medina, Qassim, or Al-Jawf (Al-Dossari 2013), or in many provincial regions. Although the research to date has produced some potentially significant results, as identified earlier, caution is needed in drawing too many firm conclusions in view of the lack of scope or rigor of these studies. This review was limited to studies conducted in Saudi Arabia and did not extent to other countries with comparable (Islamic) societies and cultures. The review did not include Saudi literature of topics that might potentially be related to child abuse, such as domestic violence in general. It did not seek out any literature that may have been published before 1990 or take into account reports, such as those in newspapers and on TV on child abuse, that were not published in academic journals or theses.

Although the research conducted suggests that a high proportion of the child population of Saudi experiences physical abuse, the small number of studies published, together with limitations in sample sizes and methodologies, caution against hasty conclusions. Developed countries have a long history of gradual recognition of, research into, and action against physical child abuse, stretching back to the last quarter of the nineteenth century. By contrast, Saudi Arabia started its first program for reporting cases of child abuse as recently as 1994 (Al Eissaa and Almuneef, 2011). Many years of international studies have amassed a wealth of statistics on the nature, causes, effects, and prevalence of child abuse, whereas in the case of Saudi Arabia the statistics are inadequate, inaccurate, or simply absent altogether. Moreover, because of the conservative nature of Saudi society the overwhelming majority of abuse cases have probably gone unreported (Al-Mahroos 2007).

In developed countries, such as the UK, US, and Australia, researchers have explored a wide range of specific abuses and issues, whereas Saudi studies thus far have been mostly on a general level. There is also the difficulty in conducting such research in Saudi Arabia, given the nature of the society (Al-Zahrani 2005), which, even now, tends to be secretive and closed about the issue of abuse. Because of the maturity of the subject in developed countries, and more open attitudes toward the problem, many different organisations and programs, both governmental and private, have been developed to help protect children against abuse. Moreover these countries have laws in place to protect children and bring perpetrators of abuse to justice. In Saudi Arabia such laws are either absent, or where they do exist, are not generally enforced. Thus, although it is clear that Saudi Arabia has a major physical child abuse problem – one that is gradually coming to the surface – children still lack the means to report, quickly and safely, the maltreatment they have suffered (Al-Zahrani 2005).

The Saudi Arabian studies examined here suffer from many deficiencies, including limited sample sizes and restricted geographical applicability. Future research should be aimed at filling some of these gaps, for example, by interviewing children of both genders across a wide age range in schools in cities that have not been covered by earlier research, by focusing on physical child abuse, which has not been addressed specifically in studies involving large sample sizes, and by finding more about the psychological and social effects on children as a result of being physically abused by parents and teachers in Saudi Arabia. Other areas upon which future research could shed valuable light include: clarifying definitions of key terms such as “physical child abuse” within the Saudi context and culture; accurate evaluation of large scale prevalence and incidence of physical abuse; investigating the nature and extent of resultant symptoms; analysing moderating factors of gender, age, class, ethnicity; and establishing the nature of perpetrators and how they operate.

Author Contributions

Data collection, design, analysis and interpretation were done by Alsehaimi A. Drafting, critical revisions were done by Alsehaimi A, Barron I and Hodson A. Supervised by Barron I and Hodson A.