Childhood sexual abuse and sexual risks among young rural-to-urban migrant women in Beijing, China

Abstract

Background.

Child sexual abuse (CSA) has substantial impact on women. The current study aims to explore the patterns of CSA in migrant women in China. Moreover, a relationship between experience of CSA and increased sexual risks was also examined among this vulnerable population.

Methods.

A final sample of 478 rural-to-urban migrant women was recruited from different work places in two urban districts of Beijing, China.

Results.

About 17% (n = 80) of migrant women reported ever experienced any kind of CSA before 16 years of age. Participants who had multiple sexual partners, drank before sex and had early age of sexual debut reported higher rate of overall CSA (45.7% vs. 23%, p <0.01; 41.2% vs. 24%, p <0.05; and 47.8% vs. 24.4%, p <0.05) and contact CSA (37.1% vs. 15.6%, p <0.01; 32.4% vs. 16.8%, p <0.05; and 39.1% vs. 17%, p <0.05) compared to their counterparts. The multivariate analysis confirmed the results of bivariate analysis that a history of CSA was associated with increased sexual risks in adulthood.

Conclusion.

The current study suggests that health-related prevention intervention programs (i.e., HIV-related sexual risks prevention intervention) targeting the migrant women population needs to take in consideration the possible experience of CSA. Moreover, effective school-based or community-based CSA prevention intervention should be conducted to reduce CSA rate and improve attention to CSA issues in rural communities in China.

Introduction

The relationship between childhood sexual abuse (CSA) and sexual risk behaviors has received considerable theoretical and empirical attention in recent years. A number of studies of CSA have been conducted in adolescents and adults including populations at high-sexual risks such as men having sex with men, prisoners, and patients of STD clinics (Mullings, Marquart, & Brewer, 2000; Paul, Catania, Pollack, & Stall, 2001; Senn, Carey, Vanable, Coury-Doniger, & Urban, 2006; Thompson, Potter, Sanderson, & Maibach, 1997). These studies have generally found a strong association between the history of CSA and sexual risk behaviors, including early onset of consensual sexual activity (Boyer & Fine, 1992; Roode, Dickson, Herbison, & Paul, 2009), substance abuse before sex (Littleton, Breitkopf, & Berenson, 2007), unprotected sexual intercourse (Arriola, Louden, Doldren, & Fortenberry, 2005), multiple sexual partners (Johnsen & Harlow, 1996; Mullings et al., 2000), exchanging sex for money or drugs (Arriola et al., 2005; Cohen et al., 2000), and infection of STD (Roode et al., 2009). However, existing studies have reported mixed findings; for example, some studies reported no association between CSA and sexual risks such as inconsistent condom use, multiple sexual partners, and early sexual debut (Mullings et al., 2000; Wilson & Widom, 2008).

Global literature indicated that women were more likely to be victims of CSA. Recent studies on CSA and sexual risks have focused on “high-risk” female populations such as female sex workers, HIV-positive women, women attending STD clinics, women having sex with injection drug users, or female prisoners (Cohen et al., 2000; Littleton et al., 2007; Mullings et al., 2000; Senn et al., 2006). There was a lack of such studies in migrant women. Furthermore, most of existing studies on CSA were conducted in the western countries with little data available from developing countries including China (Roode et al., 2009). Limited studies on CSA in China were conducted in adolescents or young adults (Chen, Han, & Dunne, 2004; Lian & Chen, 2006; Sun, Dong, Yi, & Sun, 2006). Some studies addressed the association between CSA and poor physical and mental health outcomes (e.g., depression, smoking, alcohol use, and suicide intention; Chen et al., 2004; Sun et al., 2006). There is a paucity of data on the association between CSA and sexual risks.

In contemporary Chinese society, an estimated 147 million migrants, who move from rural areas to urban areas for jobs without establishing permanent urban residency, are believed to be a susceptible population for HIV infection and transmission (Meng & Wang, 2009). According to China’s national population census in 2005, the number of rural-to-urban migrant women reached 73.9 million (Duan, Zhang, & Lu, 2009). In general, migrant women are believed to be more vulnerable for HIV infection than their male counterparts due to biological susceptibility and inequality in relationship power (Yang et al., 2005). Moreover, the majority of migrant women came from remote rural area, where the issue of CSA is frequently neglected and unreported. Despite the theoretical and empirical importance to examine the characteristics of CSA and its association with sexual risks in migrant women, there were no prior data on this regard. The current study attempted to fill out the literature gap by answering two research questions: (1) What are the patterns of CSA in migrant women in China? (2) Is there a relationship between experience of CSA and increased sexual risks among this vulnerable population?

Methods

Participants

The current study was conducted in Beijing. Beijing, the capital of China, has jurisdiction over four central urban districts, four near-suburban districts, 10 outer-suburban districts, and counties. Participants were recruited from work premises that hire a large number of female migrants such as entertainment establishments (e.g., bathhouses and massage centers) and personal service sectors (e.g., restaurants and hotel). After obtaining permission from the owners/managers of these workplaces to conduct research on their premises, the trained outreach workers from the Dongchen Women Association and Beijing Normal University approached female migrants in these workplaces and invited them to participate in the study. Female migrants were eligible to participate if they: (1) moved from rural areas to Beijing city for jobs without permanent Beijing residency; (2) stayed in Beijing for at least one month; and (3) were under 35 years of age. A total of 488 rural-to-urban female migrants were recruited from different work places in two urban districts (i.e., Dongchen district and Haidian district) of Beijing. All participating women completed a self-administered questionnaire. Ten participants were removed from the data file because of substantial missing data on the questionnaire. A final sample of 478 (98%) was retained in the current study.

Survey procedure

Interviewers of the study were all graduate students and research faculty in Beijing Normal University. They had received training on human subjects protection prior to the start of the project. Once eligible participants were identified, research team members introduced the purposes, benefits, and risks of the study. After obtaining oral informed consents from the eligible participants, they were invited to complete an anonymous questionnaire. The questionnaire took about one hour to complete. The participants were told that the participation in the survey was entirely voluntary and they could stop at any time if they desired. The research protocol was approved by the Institutional Review Board of Beijing Normal University in China.

Measure

Demographic characteristics

The information collected include women’s age, educational attainment (i.e., ≤junior high school education vs. ≥high school education), marital status (i.e., never married vs. ever married), characteristics of workplace (i.e., low-risk workplace, including restaurants and hotels; vs. high-risk workplace, including public bathhouses, massage parlors, Karaoke centers, and barbershops), and sexual experience (i.e., never experienced vs. ever experienced).

Child sexual abuse (CSA)

The CSA scale that was validated for the Chinese population (Chen, Dunne, & Han, 2006) was used in the current study. The CSA scale asks participants whether they had experienced any CSA by checking a list of 12 CSA events (yes/no) before the age of 16. The scale included three items of non-physical contact CSA (e.g., some adult exposed their genitals to the child or some adult masturbated in front of the child) and nine items of physical contact CSA (e.g., some adult touched the child’s genitals with their mouth or some adult had intercourse with the child). The Cronbach’s α for this scale was 0.89 for the current study sample. A dichotomous variable was created to identify respondents with overall CSA experience (i.e., those who had ever experienced any CSA). Similarly, a dichotomous composite non-physical contact CSA score and a dichotomous composite physical contact CSA score were created.

Sexual risks of peers

Participants were asked about how many of their peers (none, few, some, and most) had engaged in several sexual risk behaviors, which include having multiple sexual partners, buying sex, selling sex, having premarital sex, and having had an STD. The internal consistency of the scale for the current study sample was 0.74. A composite score of 1–4 was created by averaging the responses to the items, with a higher score indicating a higher level of perceived peer-risk involvement.

Sexual risk behaviors

Participants were asked whether they had engaged in the following six sexual risk behaviors: having premarital sex (yes, no), having multiple sexual partners (1, ≥2), alcohol use before sex (yes, no), early age of consensual sexual debut (≤ 18 years), inconsistent condom use (yes, no), and inconsistent condom use in the last three sexual acts (yes, no).

Analysis

First, participants’ demographic characteristics were compared by their experience of CSA using Chi-square (for categorical variables) or ANOVA analysis (for continuous variables).

Second, the association between CSA experiences and each of the six sexual risk behaviors was examined using Chi-square. ANOVA was used to explore the relationship between CSA experience and sexual risk behavior composite score. Third, a multivariate regression model was employed to further examine the relationship between experience of any kind of CSA and sexual risks while controlling for potential confounders. In the multivariate model, the sexual risk score served as the dependent variable, the CSA and a number of key demographic variables (i.e., age, educational attainment, and marital status), and peer sexual risks were included in the model as independent variables. Adjusted regression coefficients and their 95% confidence intervals (CI) were used to assess the association. All statistical analyses were performed using SPSS for Window Version 15.0.

Results

Demographic characteristics and prevalence of child sexual abuse (CSA)

Table 1 summarized the characteristics of the sample. Among the 478 migrant women, mean age was 21.07 years (SD = 3.53). Most participants were never married (88.3%) and half of them had finished no more than junior high school education (46.3%). One-third of participants was ever sexually experienced (33.8%) and employed in high-risk workplaces (35.4%).

Table 1.

Migrant women’s demographic characteristics by experience of CSA.

		Ever experienced CSA
	Total	Never	Ever
Sample size, N (%)	478	398 (83.3)	80 (16.7)
Age (M ± SD)	21.07 ± 3.53	21.09 ± 3.49	20.94 ± 3.74
Marital status, N (%)
Never married	421 (88.3)	350 (83.1)	71 (16.9)
Ever married	56 (11.7)	47 (83.9)	9 (16.1)
Educational attainment, N (%)
≤ Junior high school	216 (46.3)	190 (88.0)	26 (12.0)*
> Junior high school	251 (53.7)	199 (79.3)	52 (20.7)
Characteristics of career, N (%)
High-risk career	169 (35.4)	139 (82.2)	30 (17.8)
Low-risk career	309 (64.6)	259 (83.8)	50 (16.2)
Ever experienced sex, N (%)
Yes	161 (33.8)	116 (72.0)	45 (28.0)**
No	315 (66.2)	280 (88.9)	35 (11.1)
Sexual risks of peers (M ± SD)	1.25 ± 0.38	1.22 ± 0.35	1.41 ± 0.44**

^*p <0.01;

^**p <0.001.

Based on the responses to the CSA questions, 16.7% (n = 80) of migrant women reported ever experienced any kind of CSA before 16 years of age. Of migrant women experiencing any CSA, 36.3% (n = 29) reported experiencing only non-contact CSA, 32.5% (n = 26) experiencing only contact CSA, and 31.2% (n = 25) experiencing both non-contact and contact CSA. Compared to their counterparts, those female migrants reporting CSA were more likely to receive a higher level of education (20.7% vs. 12%, p <0.01), ever experience sex (28% vs. 11.1%, p <0.001), and perceive a higher level of peers’ sexual risks (F = 15.94, p <0.001).

Sexual risk behaviors and experience of child sexual abuse (CSA)

The data presented in Table 2 indicated that the majority of the sample had engaged in premarital sex. About 22% of female women reported more than one sexual partner in their lifetime and 21.4% consumed alcohol before sex. Whereas relatively few reported early age of sexual debut (14.6%), the majority reported inconsistent condom use in their lifetime (84.5%) and in their previous three sexual episodes (80.4%). On average, the sample engaged in about three of the six sexual risk behaviors identified in the current study (mean = 2.96, SD = 1.21).

Table 2.

Migrant women’s sexual risk behaviors and associations with experience of CSA.

Sexual risk behaviors	Totala	Ever experienced any CSA	Experienced non-contact CSA	Experienced contact CSA
Premarital sex, N (%)
No	30 (19.5)	5 (16.7)	2 (6.7)*	4 (13.3)
Yes	124 (80.5)	39 (31.5)	26 (21.0)	28 (22.6)
Multiple sexual partners, N (%)
No	122 (77.7)	28 (23.0)**	19 (15.6)	19 (15.6)**
Yes	35 (22.3)	16 (45.7)	9 (25.7)	13 (37.1)
Drinking before sex, N (%)
No	125 (78.6)	30 (24.0)*	19 (15.2)	21 (16.8)*
Yes	34 (21.4)	14 (41.2)	8 (23.5)	11 (32.4)
Early age of sexual debut, N (%)
> 18 years old	135 (85.4)	33 (24.4)*	20 (14.8)*	23 (17.0)*
≤ 18 years old	23 (14.6)	11 (47.8)	8 (34.8)	9 (39.1)
Inconsistent condom use, N (%)
No	25 (15.5)	5 (20.0)	3 (12.0)	3 (12.0)
Yes	136 (84.5)	40 (29.4)	25 (18.4)	30 (22.1)
Inconsistent condom use in the past three sexual episodes, N (%)
No	31 (19.6)	6 (19.4)	4 (12.9)	3 (9.7)
Yes	127 (80.4)	38 (29.9)	23 (18.1)	29 (22.8)
Sexual risk behavior indexb (M ± SD)	2.96 ± 1.21	3.51 ± 1.31***	3.54 ± 1.26**	3.64 ± 1.32***

^aData were available from a subsample of female migrants who were sexually experienced (N = 161).

^bSexual risk behavior index (a composite risk score was created by indexing those who had premarital sex, had two or more sexual partners, drank before sex, less than 18 years old to experience sex, ever inconsistent condom use, inconsistent condom use in the past three sexual episodes). The possible sexual risk index ranged from zero to six with the higher score indicating a higher sexual risk.

^*p<0.05;

^**p<0.01;

^***p<0.0001.

In addition, migrant women engaging in premarital sex were more likely to report a higher rate of non-contact CSA (21% vs. 6.7%, p <0.05). Similarly, participants having multiple sexual partners and drinking before sex reported higher rate of overall CSA (45.7% vs. 23%, p <0.01 and 41.2% vs. 24%, p <0.05) and contact CSA (37.1% vs. 15.6%, p <0.01 and 32.4% vs. 16.8%, p <0.05) compared to their counterparts. Those with early age of sexual debut (i.e., less than 18 years old) experienced higher rate of overall CSA (47.8% vs. 24.4%, p <0.05), non-contact CSA (34.8% vs. 14.8%, p <0.05), and contact CSA (39.1% vs. 17%, p <0.05). However, there were no significant associations between CSA experience and inconsistent condom use (either in their lifetime or in the past three sexual acts). Overall, ANOVA analysis showed that the sexual risk behavior composite scores were significantly higher among participants with experience of any kind of CSA (F = 14.08, p<0.0001), non-contact CSA (F = 8.06, p<0.01), or contact CSA (F = 14.08, p<0.0001) than their counterparts.

Multivariate analysis

The multivariate regression showed that after simultaneously controlling for age, educational attainment, marital status, and peer sexual risks, overall CSA experience remained a significant predictor in the final model (see Table 3). The multivariate analysis confirmed the results of bivariate analysis that a history of CSA was associated with increased sexual risks in adulthood. Peer sexual risks appeared to be a confounding factor for the association between experience of CSA and sexual risks in the current study sample.

Table 3.

Multivariate regression of CSA on sexual risk behaviors.

	Sexual risk behavior
Demographics	Unstandardized coefficients		Standardized coefficients			95% Confidence interval for B
	B	Standard error	β	t	Significance	Lower bound	Upper bound
(Constant)	2.96	0.86		3.43	0.001	1.25	4.66
Age	−0.05	0.03	−0.18	−1.73	0.086	−0.11	0.01
Educational attainment (0 = high school, 1 = junior or less)	0.21	0.18	0.09	1.19	0.236	−0.14	0.57
Marital status (0 = married, 1 = never married)	0.48	0.26	0.20	1.89	0.061	−0.02	0.99
Sexual risks of peers	0.44	0.22	0.16	2.04	0.043	0.01	0.86
Ever experienced any kind of CSA (0 = no, 1 = yes)	0.43	0.21	0.16	2.10	0.038	0.03	0.84

Note: Dependent variable – sexual risk behavior index (a composite risk score was created by indexing those who had premarital sex, had two or more sexual partners, drank before sex, less than 18 years old to experience sex, ever inconsistent condom use, and inconsistent condom use in the past three sexual episodes). The possible sexual risk index ranged from zero to six with the higher score indicating a higher sexual risk. Model fit: F(5, 141) = 7.36, p = 0.000, R = 0.46, and adjusted R² = 0.18.

Discussion

The results showed that 16.7% of migrant women in this sample reported that they had experienced any kind of CSA before 16 years of age, with 11.3% ever experiencing any kind of contact CSA and 10.7% experiencing non-contact CSA. The proportion of migrant women who reported CSA (16.7%) among the current sample was comparable with the most frequently reported prevalence rates of 10–20% among women in various European and Asian countries, including China (Pereda, Guilera, Forns, & Gomez-Benito, 2009). Moreover, the rate of CSA appeared to be moderately higher than population-based Chinese urban adults aged 20–64 years, which showed the overall prevalence of childhood sexual contact was 3.3% for female adults (Luo, Parish, & Laumann, 2008). However, compared to Chinese female students’ population, the prevalence of CSA in the current study was slightly lower. For example, two studies showed the rate of CSA was 25.6% for 892 female medical school students (Chen et al., 2004) and 20.4% for female college students (Lian & Chen, 2006).

Even though the reported rate of CSA in the current study was within the general range of rates of CSA in many other countries, it is still possible that CSA was underreported by the migrant women in the current study for several reasons. First, migrant women lived in rural areas of China during their childhood. Most of them didn’t leave their rural hometown until they finished their junior middle school education. The rural environment of their childhood lives increased their vulnerability to experience CSA due to high rates of poverty, inferior socioeconomic status, low education, lack of awareness, and knowledge regarding CSA and other characteristics associated with poverty (Gillham et al., 1998; Yen, Yang, Yang, & Su, 2008). Moreover, there is much pressure within Chinese families to protect the family from shame associated with CSA (Tang, 2002), especially in rural culture, which is more apt to conceal internal or personal problems (such as CSA experience) for the fear of embarrassment, blame, or being stigmatized by their neighbors and relatives. Second, strong status-based discrimination and gender discrimination experienced by migrant women in urban areas, the rapid mobility and instability of living and employment conditions placed them in a vulnerable position, which increased the possibility of underreporting by concealing the “sensitive” personal issues (such as CSA) and might explain why the rates of CSA reported by migrant women in the current study were lower than those reported by women with more education (such as college students or medical students), as the latter may be less traditional or may have other salient differences that either made them more likely to recognize or report CSA or placed them at increase risk for CSA. Further study is needed to validate these speculations.

The finding of the current study is consistent with findings from previous research in western countries among “high-risk” female samples (e.g., commercial sex workers; Steel & Herlitz, 2005) and suggested an association between CSA and sexual risks among Chinese migrant women. Although the migrant women in the current study were the general population, which were expected to report fewer sexual risk behaviors compared to “high-risk” samples and might reduce the variance and the probability of an association between CSA and sexual risks, the association between the two variables remained robust after controlling for a number of potential confounders. The result suggested that experience of CSA before 16 years of age appeared to contribute to a life course or trajectory that is associated with elevated sexual risks in adulthood in migrant women.

The present study had several limitations. First, the data were collected through self-report and given the sensitive nature of the CSA questions, the responses are subject to error of recall and socially desirable reporting. Second, data on some important factors related to CSA, such as age of CSA onset, the identity of the perpetrators, were not available in the current study. Further analysis should examine these factors and get a better understanding of the CSA among the population.

Despite these limitations, there are a number of important implications to be drawn from the present study. Health-related prevention intervention programs (i.e., HIV-related sexual risks prevention intervention) targeting migrant women populations need to take into consideration the possible experience of CSA. In order for the programs to be effective, the programs should address not only issues of safer sex but also issues related to the stress and traumas resulted from a history of CSA and provide necessary psychosocial support and coping skill training for the women with such a history. Furthermore, effective school-based or community-based CSA prevention intervention should be conducted by schoolteachers, health care providers, or other intervention specialists to reduce CSA rate and improve awareness and attention to CSA issues in rural communities in China.