Concept and objectives

Issues concerning child abuse and neglect transcend national borders, affecting developing as well as developed countries. As the 2002 United Nations landmark study on violence against children stresses out, violence against children occurs in every country and cuts across social, cultural, religious and ethnic lines. However, the Executive Director of UNICEF, during her speech in the Parliamentary Assembly’s ordinary session of the 23rd of January 2007, argued that data and legislation on violence against children are often alarmingly weak, while she pointed out that child abuse and neglect (CAN) should be a priority area in the international co-operation agenda. The lack of data and legislation is associated with the inconsistencies of classification of child maltreatment and a lack of common research methodologies; consequently, little internationally comparable data are produced. WHO (1999)1 and UNICEF-IRC (2005)2 have both arrived to the same conclusions.

The discrepancy in methodologies used internationally to collect data on child maltreatment, as well as the inherent difficulty of collecting data on childhood have often led European governments and international organizations to base their policy-making decisions and prevention and intervention planning on statistical data concerning child fatality rates (e.g. UNICEF-IRC, 2003)3 and number of cases of CAN reported to governmental authorities. However, there is much more CAN in the world than the reported cases’ statistics reveal, as all international organizations working on children’s rights point out.

If limited data are available in industrialized countries, even less is known about child abuse and neglect in non-European and/or European countries with relatively lower standards of socioeconomic development, such as the majority of Balkan countries. With the exception of Greece and Slovenia that provided some limited data on child maltreatment (principally, child mortality rates) to the ChildONEurope Secretariat for the purposes of a survey concerning the evaluation of European national systems of statistics and registration on child abuse (2007)4, we have no officially published data on CAN concerning the most of Balkan countries (Albania, Bulgaria, Romania, Former Republic of Macedonia, Turkey, Serbia, Croatia, Bosnia-Herzegovina). Balkan countries have faced many political, social and financial changes during the last decades. Balkan children have faced war, the effects of immigration, and the loss of their beloved ones, among other hardships. This makes them more prone to have witnessed, experienced, and be exposed to, one or other form of maltreatment. For example, a UNICEF opinion survey in 2001, conducted through interviews with 15.200 children from 9 to 17 years in 35 countries in Europe and Central Asia, indicated that 59% of children had experienced violent or aggressive behaviours within their families; of these children, 61% were residing in Eastern and Central Europe and Central Asia and 54% in Western Europe. In addition, Children’s Human Rights Centre of Albania has argued that in 2004 Albania had no national authority for the rights of the child, while and at the same time it was estimated that the number of Albanian children trafficked in Europe for sexual and economical exploitation was between 3000 and 5000. In Bosnia and Herzegovina, more than 3000 registered cases of abuse in the family were identified, while 33.8% of children studied by UNICEF and “Save the Children” (2004)5 claimed that they know between one to three children that have suffered abuse in the family. These numbers are suspected to be much higher in the general population, as in many traditional cultures of Balkan countries there is a widespread belief that family is the sole responsible for the child, and consequently instances of child abuse and neglect stay most of the time unreported and private (Sicher, Lewis, Sargent, Chaffin, Friedrich, Cunningham, Thomas, Thomas & Villani, 2000).6

The alarming rates of CAN in industrialized countries and the even higher suspected numbers in developing countries have led to the global will of creating a safer and more appropriate society for the children. The UN Convention on the Rights of the Child, which was entered into force on the 3rd of September 1990, is globally considered as the most specific and progressive human rights treaty ever adopted. Subsequently, the Council of Europe launched the campaign “Building a Europe for and with Children” aiming to promote children’s rights across the wider Europe and, in 2006, the European Commission published a Communication entitled “Towards a European Strategy on the Rights of the Child”, setting out its intention to lead the creation of the first-ever EU strategy on children’s rights and committing itself to a number of actions to this end. Meanwhile, WHO (2005)7 declared injuries and violence as a top priority area for action unfolding subsequent initiatives.

Although such initiatives create the appropriate political circumstances for actions, reliable, compatible and comparable data on CAN are considered to be a necessary tool for implementing the Convention on the Rights of the Child, as they will constitute an important step towards integration and cohesion of national EU policies. However, in the European area, only five EU Member Countries and one EU Candidate Country have established specific instruments, programmes or bodies dealing with the collection of statistical data on children (ChildONEurope, 2007).8

Thus, considering the lack and the urgency of obtaining internationally comparable consistent data on CAN; the lack of relevant data in the Balkan area; and the rapidly changing reality of the Balkan countries, a population-based epidemiological study on CAN in the Balkan area will be carried out. In order to obtain comparable data, the study will follow the ChildOnEurope’s suggestions on how to solve problems of comparison of data coming from different countries.9 Namely, all partners will agree on the concepts and definitions to be used, will follow the same methodology and apply the same instruments (subjects to cultural validation) for data collection, will consider the relevant law in force in each country, and will evaluate the data collected before data analysis in order to identify any discrepancies that could influence data compatibility. Particularly, ICAST instruments (created by ISPCAN/UNICEF and recommended by WHO) will be used for data collection in all participating Balkan countries. The existence of ethnic minorities in the Balkan countries will also be considered in the study’s methodology.

Knowing the rates of child abuse and neglect:

  • Would facilitate the implementation of the Convention on the Rights of the Child in the Balkan area;
  • Would contribute to the necessary policy-making activities of the Balkan governments in order to comply with the suggestions of the aforementioned Convention;
  • Would provide information on factors that might allow the prevention or the early identification of CAN;
  • Would improve the assessment of effectiveness and efficiency of the health welfare practices related to the subject;
  • Would allow a financial planning closer to reality concerning the acts that should be taken to combat CAN;
  • Would allow a step towards unifying the diagnostic processes of CAN in the Balkan area allowing in such a way an easier and faster cooperation, with the option to extend these diagnostic processes to other countries in the European area;
  • Would facilitate further harmonization and unification in issues of child health and protection services and relevant legislation;
  • Would create a network of experts, who would be able to exchange information on the issue of child abuse and neglect on a common basis.

The dissemination of the results of the study is expected to sensitize governments and public alike, in relation to the public-health problem of CAN.

In this context, main objectives of the BECAN study are:

1. Mapping CAN in school-aged children (11 to 16 years-old) of the general population in the Balkan countries and,

2. Mapping CAN in children (11 to 16 years-old) that have dropped out school in the Balkan countries.

In order for the main objectives to be achieved, a series of steps should first be made:

  • National networks of experts and child services will be created in order for the Consortium to have access to information available on CAN issues in each partner country, including national databases of identified cases of CAN.
  • ICAST questionnaires that will be used for the collection of epidemiological data, will be translated and culturally validated for all partner countries (translation and cultural validation of the instruments will also consider ethnic minorities residing in partner countries) before their application to national samples.
  • Before starting main epidemiological study, pilot studies will first be carried out in order to test the appropriateness of the translated and culturally validated instruments and the methodology planned for data collection.
  • The data, that will have been collected during the main epidemiological study, will then be inspected and data analysis will be planned, in order to get the final results and arrive into conclusions.

A number of secondary objectives will also be achieved in the context of the present study:

  • A more realistic picture will be revealed concerning the difference between reported and hidden incidence and prevalence of CAN cases in school-aged children in Balkan countries. This secondary objective will be achieved through the Consortium’s access to national databases of identified cases of CAN and the obtaining of epidemiological data.
  • Comparable and compatible data on CAN will be delivered for all participant countries, thus facilitating common policy-making activities, future research and better understanding of CAN features. The data to be obtained will be comparable and compatible due to the use of common instruments for data collection in all partner countries.
  • The unification of definitions related to CAN issues and relevant research tools will be achieved among Balkan countries.
  • A group of specialized scientists throughout Balkan countries will be trained to deliver appropriately the ICAST questionnaires. That will create a “pool” of researchers able to repeat in the nearby future such research on demand by government, academic or other stakeholder.
  • An important secondary objective will be the project’s the contribution to decision and policy-making activities related to CAN issues in Europe, and particularly in Balkan countries. The final results of the epidemiological studies will allow the creation of a common strategic plan for all partner countries in order to follow up annually at CAN’s level. Following up annually at CAN’s level will provide a longitudinal view of the problem and thus a better understanding of the effectiveness of intervention and prevention programs, permitting for corrective decisions.

BECAN responds to the European Committee’s preoccupation concerning the promotion of healthy behaviour in children and adolescents (HEALTH-2007-3.3-1). Particularly, CAN is considered to be an important extrinsic factor that significantly influences behaviour and quality of life of children and adolescents. In addition, abuse and neglect is widely accepted to have a mediating influence on children’s healthy behaviour by its impact on intrinsic factors characterizing each child. The present study will, also, culturally validate the instruments to be applied to local societies. Additionally, it will entail a multidisciplinary analysis to the data to be collected. Therefore, it is expected that the present study will provide information on socio-economic and cultural determinants of CAN, which will then contribute to a better prevention and intervention planning.

Beyond its immediate relation to the part of the call addressing the promotion of healthy behaviour in children and adolescents, BECAN relates to other topics addressed by the present call, such as the need to identify trends of the population health, to conduct epidemiological studies, and to promote a European system of Diagnosis-related groups. In addition, the Balkan network to be created for the purposes of this study will, also, promote the mobility of researchers and health professionals, contributing to the transfer of knowledge in national and international level.



  1. WHO (1999). The World Health Report: Making a Difference. Geneva: World Health Organization.
  2. UNICEF-IRC (2005). Violence against the children in Europe: a preliminary review of research. Florence: UNICEF INNOCENTI IRC.
  3. UNICEF-IRC (2003).  A league table of child maltreatment deaths in rich nations. Innocenti Report Card, Issue No. 5, UNICEF INNOCENTI IRC.
  4. ChildONEurope Secretariat/ Italian Childhood and Adolescence Documentation and Analysis Centre Documentation, Research and Training Sector (2007). Review on national systems of statistics and registration on child abuse. Florence: Instituto degli Innocenti.
  5. UNICEF and “Save the Children” (2004). Child Trafficking in Bosnia and Herzegovina.
  6. Sicher, P., Lewis, O., Sargent, J., Chaffin, M., Friedrich, W.N., Cunningham, N., Thomas, R., Thomas, P., & Villani, V.S. (2000). Developing child abuse prevention, identification, and treatment systems in Eastern Europe. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 660-667.
  7. WHO/Regional Committee for Europe (2005). European strategy for child and adolescent health and development. 55th Session, Provisional agenda, Bucharest, Romania.
  8. ChildONEurope Secretariat/ Italian Childhood and Adolescence Documentation and Analysis Centre Documentation, Research and Training Sector (2007). Review on national systems of statistics and registration on child abuse.  Instituto degli Innocenti, Florence
  9. ChildONEurope Secretariat/ Italian Childhood and Adolescence Documentation and Analysis Centre Documentation, Research and Training Sector (2007). Review on national systems of statistics and registration on child abuse.  Instituto degli Innocenti, Florence