It is time to stop putting children second in the UK and USA It is time to stop putting children second in the UK and USA
The Lancet, July 17, 2004

Children worldwide have the right to be brought up free from fear of physical abuse, psychological harm, or loss of dignity, and to receive the best health care attainable. There is no excuse for British and American children to number among the exceptions.

The past 2 weeks have seen children's rights forced backstage in two countries normally expert at criticising others for human rights abuses. On July 5 in the UK, the House of Lords voted against making hitting children illegal. On July 7 in the USA, Congress heard evidence that children with psychiatric disorders were being locked up in juvenile detention centres instead of receiving appropriate treatment. Through these actions, both countries are signalling their disregard for children and, in particular, their rights, especially those clearly laid down in the UN Convention on the Rights of the Child, to which the UK is a signatory, and the USA has indicated its intention to sign.

In the UK, peers voted by 226 votes to 91 to approve an amendment to the Children Bill allowing parents to administer "moderate" punishment. If the House of Commons approves the amendment, and it receives royal assent, which is expected in November, then parents in England and Wales can continue to hit their children so long as there is no lasting red mark, bruising, breaking of the skin, black eye, or mental harm. In practice, though, what does this mean? In the short-term, the obvious, visible, physical damage done will depend on the type of skin, the location, and on the force used. Children's skins vary in their susceptibility to injury, and head injury or internal organ damage can be especially difficult to detect. After the acute injury in the longer term, the amendment ignores the wealth of evidence that hitting children not only increases the chances of aggressive and antisocial behaviour, and mental illness, in the children, but also induces these same traits when they reach adulthood, in addition to an increased risk of abusing their own child or spouse. There is also evidence, summarised in a review of meta-analyses, published in Psychological Bulletin in 2002, that hitting children can escalate into what is defined as child abuse. In this review, corporal punishment (defined as physical force used with the intention of causing pain but not injury) was linked with only one desirable behaviour--increased immediate compliance. Campaigners such as the National Society for the Prevention of Cruelty to Children point out that the Lords vote fails to give children the same protection from assault that adults have.

In the USA, between January 1 and June 30, 2003, 15 000 children were incarcerated in juvenile detention centres because there were no community mental-health facilities available. Giving testimony to the Senate Committee on Governmental Affairs, Democrat Henry Waxman, California, presented evidence from 524 juvenile detention centres in 49 states, representing three-quarters of all such centres. 347 juvenile detention facilities reported that they held youths who were waiting for mental-health services to become available; many were held without charge. Most reported holding children under 13 years old, many under 10 years, and one had a 7 year old. Suicide attempts had occurred in 168 of these detention centres. Depression, schizophrenia, substance abuse, attention-deficit hyperactivity disorder, learning disorders, anorexia nervosa, post-traumatic stress disorder, and autism were among the diagnoses. In most cases, no or inadequate treatment was available within the detention centre.

Such obvious failings in the US states' legal and medical systems have already led to calls for more community mental-health services, together with greater cooperation between law enforcement and mental health agencies. But when children in the USA are deprived of their right of access to appropriate health-care services, what hope is there for those in less privileged environments?

In continuing to put the rights of the child in second place to those of their parents, policy makers in the UK are ignoring the European Social Charter, and more than a decade's criticism of UK law, particularly that in England and Wales, from the UN. The 1989 UN Convention on the Rights of the Child, ratified by the UK and all countries except the USA and Somalia, calls for the outlawing of corporal punishment. Article 19 of the Convention states that children should be protected "from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation" while in the care of parents, legal guardians, or any other person given care of the child. In 1995, the UN Committee on the Rights of the Child called for the UK to abolish smacking. In 1998, the European Court of Human Rights ruled that UK law should be reformed to comply with the European Social Charter that required abolition of corporal punishment across Europe. In 2002, the UN Committee on the Rights of the Child renewed its attack on UK law, which constitutes "a serious violation of the dignity of the child", and called for reform to comply with the Convention. In June, 2003, even the House of Commons and House of Lords Joint Committee on Human Rights called for full compliance with the Convention. In 2003, Scotland became the first region in the UK to make it illegal to punish children by shaking, hitting on the head, or using implements such as a belt, cane, slipper, or wooden spoon. England, Wales, and Northern Ireland now lag behind 12 European countries, beginning with Sweden in 1979, and Israel, all of which have introduced legislation to prohibit parents from using corporal punishment on their children.

Article 24 of the Convention on the Rights of the Child spells out "the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health". Signatory or not, American children should be able to expect more from their health care.

Children worldwide have the right to be brought up free from fear of physical abuse, psychological harm, or loss of dignity, and to receive the best health care attainable. There is no excuse for British and American children to number among the exceptions. [Ephasis added]

* The Lancet

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