Violence against Children Surveys: Our Methods

Violence Against Children Surveys (VACS) are nationally representative household surveys of children and young adults ages 13 to 24 years. They are designed to measure the prevalence (number and percentage) and circumstances surrounding emotional, physical, and sexual violence against males and females in childhood (before age 18). VACS also measure the prevalence of violence in the last 12 months for girls and boys ages 13 to 17 years. The survey identifies risk and protective factors as well as consequences of violence. Experts from the U.S. Government and United Nations agencies, as part of the Together for Girls partnership, have consulted on the development of the survey, the VACS implementation process, and the plans for data analysis and reports.

Definitions of Key Terms in Surveys

For the purpose of VACS, the following definitions are used:

• Sexual violence includes all forms of sexual abuse and sexual exploitation of children. This encompasses a range of acts, including completed non-consensual sex acts (such as rape), attempted non-consensual sex acts, abusive sexual contact (such as unwanted touching), and non-contact sexual abuse (such as threatened sexual violence, exhibitionism, verbal sexual harassment).
• Physical violence is defined as the intentional use of physical force with the potential to cause death, disability, injury or harm. Indicators of physical violence typically include punching, kicking, whipping, beating with an object, choking, suffocating, attempted drowning, intentional burning, using or threatening with a knife, gun or other weapon. Physical violence includes acts of violence perpetrated by four types of potential perpetrators:
  1. Intimate partners, including a romantic partner, boyfriend or girlfriend, or spouse.
  2. Peers, including people the same age as the respondent not including an intimate partner. These include siblings, schoolmates, neighbors, and strangers.
  3. Parents, adult caregivers, and other adult relatives.
  4. Adults in the neighborhood such as teachers, police, employers, religious or neighborhood leaders, neighbors, or adult strangers.
• Emotional violence is defined as a pattern of verbal behavior over time or an isolated incident that is not developmentally appropriate and supportive and that has a high probability of damaging a child’s mental health, or his or her physical, mental, spiritual, moral or social development. The survey includes questions about emotional violence perpetrated by parents, adult caregivers, or other adult relatives.

Methodology

Study Design

The VACS is a cross-sectional household survey of 13 to 24 year old females and males, designed to produce national-level estimates of experiences of physical, sexual, and emotional violence in childhood. The surveys include a randomly selected, representative subset of the population, at one specific point in time, providing estimates of violence indicators by age group, sex, and other demographic factors. All data are collected through an in-person interview with trained interviewers.

All respondents are asked about lifetime and past 12 months experiences with sexual, physical, and emotional violence. For analysis purposes, lifetime prevalence estimates of childhood violence are based on responses from participants ages 18 to 24 reporting on their experiences prior to age 18. Estimates of current childhood violence are based on responses from participants ages 13 to 17 reporting on experiences occurring in the past 12 months before the survey.

Sources of violence indicators
Lifetime prevalence of childhood violence	Participants ages 18 to 24 reporting on experiences before age 18.
12-month incidence of childhood violence	Participants ages 13 to 17 reporting on experiences in the past 12 months.

Survey Questionnaire

CDC scientists together with UNICEF and the Together for Girls Secretariat and many external consultants developed a standardized global VACS core questionnaire. The questionnaire draws questions and definitions from a number of existing and well-respected survey tools, so that data on various measures can be compared with other studies as a useful validation. This approach also means that the questionnaire uses measures that have already been field tested in other studies.

Questionnaire and survey protocols for each country are adapted through a consultation process with key stakeholders in each country who are familiar with the problem of violence against children, child protection, and the cultural context. The questionnaire includes questions on the following survey topics:

• Background (e.g. demographics, socioeconomic status, and education)
• Gender Attitudes
• Safety
• Witnessing Violence
• Violence Victimization including: Sexual Violence (i.e. Abuse, Non-Contact Violence, and Exploitation), Physical Violence, and Emotional Violence
• Violence Perpetration
• Health Risk Behaviors
• Health Outcomes
• Service Seeking and Utilization

Response Plan

Due to the sensitive nature of the questions in the survey, some respondents may recall frightening, humiliating, or painful experiences, which may cause a strong emotional response. Respondents could also be currently experiencing violence and want immediate assistance with the situation, or counseling. In order to respond to these needs, all countries develop a response plan with resources for interviewers to link respondents to support. During the survey, all respondents are provided with a list of services, reflecting free programs, services, and amenities currently offered in the country, including but not limited to services for victims of violence. Free direct referrals are often offered to individuals based on the country response plan.

Survey Pilot

In all countries, interviewers conduct a pilot (test run) of the questionnaire. The pilot usually consists of two or three days in the field interviewing respondents and one day for debriefing, discussion, and feedback. Communities that are not involved in the final data collection fieldwork are involved in the pilot. The pilot follows normal VACS survey protocols including a split sample approach, so that surveys for girls are conducted in different geographic areas than surveys for boys. This split sample helps to protect the confidentiality of the respondents and eliminates the chance that a male perpetrator of sexual violence and the female victim in the same community would both be interviewed. The primary purpose of the pilot is to test the questionnaire and survey protocols including activation of the response plan. The pilot helps interviewers assess willingness to participate, length of the questionnaire, and the cultural appropriateness of the questions. Information and feedback from the pilot is used to inform survey implementation. Adjustments are made to the protocol or to the survey as a result of the pilot feedback. This helps to make sure that the questions being asked accurately reflect the data the questionnaire is seeking.

Ethical Review

The VACS adheres to World Health Organization recommendations on ethics and safety in studies of violence against women. The U.S. CDC Institutional Review Board and the in-country ethics committees or other entities which protect the rights and welfare of human research subjects independently review and approve each survey.

Fieldwork Data Collection

Data collection for the VACS takes approximately 4–6 weeks in each country. Male interviewers conduct interviews with male respondents, and female interviewers conduct interview with female respondents.

Criteria for implementing a Violence Against Children Survey, from Together for Girls

VACS is designed by CDC and implemented under the leadership of country governments with participation from in-country partners and support from partner organizations (such as UNICEF and PEPFAR). In order for the VACS to be successful in collecting good-quality information and mobilizing national, multi-sector policies and programs to prevent and respond to violence against children, a number of factors need to be in place.

• Governments fully commit to the process by requesting a VACS.
• Presence of more than one Together for Girls partner on the ground and capacity of in-country Together for Girls partners to support implementation of the survey.
• Availability of funding to both implement the VACS and support CDC technical assistance for implementation.
• National and partner expression of support for action in response to survey findings, such as the ability to mobilize resources and having funding in place for programs and services.
• In-country capacity for ethical standards, including confidentiality, and provision of appropriate referral and counseling services to respondents requiring support.

Access to VACS data

Many of the data sets from the VACS are available for public use, as consistent with the agreements with country partners. The data are available through public use datasets prepared by CDC and made available with permission from the respective country governments.

The VACS data provide opportunities to enrich our understanding of the frequency, impact, and circumstances that lead to violence against children. Public access to the data can provide an opportunity to researchers to expand on the use and application of the data. Access to the public use datasets is coordinated through Together for Girls.

Key Principles to Consider when Undertaking the VACS:

• The success of the VACS is based on and built around strong engagement of in-country partners under the leadership of the government with participation from key civil society and development stakeholders.
• The data from the VACS are intended to inform policy and a comprehensive multi-sector programmatic response.
• Protecting and supporting children and young adults who have experienced or are experiencing violence and request help must be a central consideration in the design of the study protocol and the implementation of VACS. The highest possible ethical standards must also be upheld during the preparation and implementation of the VACS.
• Building the capacity of national institutions needs to be an inherent part of the process to ensure ownership and sustainability of the processes.