Sexual Abuse and Corporal Punishment During Childh&EPA Pilot 44 
oissiiiAll It 
Retrospective Survey of University Students in Cotta Rica' N S A 
4 
S"4‘  Scott Krugman; Leonardo Mata, MPH; and Richard Krugman, MD 
	
, 
.9'^!0=r1,1* 
ABSTRACT. A sample of 497 students at the University 
of Costa Rica completed a survey on perceptions and 
experiences with various forms of punishment and ex-
periences with sexual abuse during childhood. Spanking 
was shown to be the most widely accepted and most 
common form of discipline. The majority of the students 
considered most types of punishment forms of abuse. 
This study lacks a comparison group and cannot be 
generalized to the entire Costa Rican population. The 
section on sexual abuse demonstrated that 32% of the 
women and 13% of the men experienced some type of 
sexual abuse during childhood. The abuse mainly oc-
curred between the ages of 5 and 10, and men were most 
often perpetrators. Pediatrics 1992;90:157-161; corporal 
punishment, sexual abuse, child abuse, Costa Rica. 
Child abuse is emerging as an international issue 
as awareness of its high frequency and significance 
in social pathology increases. Although little research 
has been done in developing countries, it is widely 
believed that child abuse is prevalent in them) In the 
United States surveys of adults and college students 
reporting on past histories of child abuse have yielded 
important knowledge about the nature, prevalence, 
and impact of child sexual abuse in the United 
States.' Payne(' also utilized a survey to determine 
the Barbadian's perceptions of corporal punishment. 
In Costa Rica, the existence of child abuse has been 
recognized,7.8 but there is limited information on its 
prevalence. One organization (the PANIAMOR 
Foundation) exists to prevent all forms of child abuse 
and to advocate for children's rights. Other govern-
ment agencies work to recognize abuse cases. How-
ever, as of 1990, the country lacked an organization 
dedicated to the treatment of child abuse (one is in 
the beginning stages of formation), and recognition 
of children's rights in the judiciary system is limited. 
The purpose of this study was to obtain some 
preliminary data on the prevalence and nature of 
child sexual abuse and perceptions and experiences 
with corporal punishment in Costa Rica. The data 
offer a base for comparison with other nations. The 
survey was conducted at the University of Costa Rica 
in San Jose, Costa Rica. The institution has 25 187 
From the Instituto de Investigaciones en Salud at the University of Costa 
Rica, San Jose, Costa Rica, and The C. Henry Kempe National Center for 
the Prevention and Treatment of Child Abuse and Neglect, University of 
Colorado Medical School, Denver. 
Received for publication Jan 21, 1992; accepted Mar 10, 1992. 
Reprint requests to (R,K.) The C. Henry Kempe National Center, 1205 Oneida 
St, Denver, CO 80220. 
PEDIATRICS (ISSN 0031 4005). Copyright © 1992 by the American Acad-
emy of Pediatrics. 
students (full- and part-time) and the majority come 
from the capital province and other urban centers. 
METHODS 
Instrument 
A printed questionnaire contained four sections; background 
information, experiences with various forms of punishment, per-
ceptions on these forms of punishment, and experiences with sexual 
abuse. This form was filled anonymously and then placed in an 
envelope so that absolute anonymity was maintained (ballot sur-
vey) (L.M., unpublished observations). The corporal punishment 
items were in table form and contained two parts: experience and 
perception. The punishments, 11 in all, were partially selected from 
the Payne survey(' and from regional forms of punishment. The list 
was far from complete and gives little insight into the child-rearing 
patterns of the country. Furthermore, the question was complicated, 
yielding a large number of invalid responses which had to be 
excluded from the analysis. 
The sexual abuse questions were taken from the 1985 LA Times 
national sexual abuse survey.' The four questions asked about 
experiences with attempted or actual sexual intercourse; touching, 
grabbing, or kissing; exhibition, photos, or performance; and oral 
sex or sodomy.' Questions on the nature of the experience followed 
each screening question and were completed after a positive re-
sponse to having an experience. These questions also have their 
limitations. The definition of sexual abuse is left open to the 
student. This openness may have caused some false-positive and 
false-negative responses.' Also, the translation of the question 
about sexual intercourse from English to Spanish was slightly 
flawed, leaving the possibility that intercourse or attempted inter-
course did not occur (but some kind of 'relation" did happen). 
Finally, the questions following the screening question did not 
include the age of the abuser; thus some of the responses may have 
been peer sexual activity or 'child's play.' This seems unlikely, 
however, because the question explicitly stated 'sexual abuse' and 
most people would not categorize child's play as a form of sexual 
abuse. Some experts are inclined to include these experiences as 
sexual abuse if the experience was unwanted or exploitative,'" 
whereas others do not include peer abuse at all." I° This analysis 
included all types of abusive experiences as perceived by the victim, 
regardless of the age of the perpetrator. Despite these limitations, 
questions of this nature (multiple and specific screening questions) 
elicit more reports of sexual abuse than general screening questions 
because they provide cues which trigger memories of past experi-
ences.' Finally, even though there may be some debate as to the 
exact type of abuse or age of the abuser, it is likely that some type 
of traumatic experience happened to all those who gave a positive 
response to the screening questions. 
Procedure 
Over a period of 2 weeks, 30 classes were sampled in six 
departments (History and Geography, Political Science, Law, Med-
idne, General Studies, and Electrical Engineering). The classes for 
this nonprobability sample were selected at different times of the 
day throughout the week. Students from each class were also 
selected at random (for example, all students with a student number 
that ended in an even number were asked to fill out the survey), 
and all students in their first class of the week were given a chance 
to complete the survey, to give equal opportunity to students who 
take one class a week as opposed to those who take four. The 
surveys took 15 minutes to complete and were passed out and 
PEDIATRICS Vol. 90 No. 1 July 1992 	 157 
collected on the spot (self-administration). This procedure yielded 
a 99.6% return rate with various unanswered questions on some 
of the suiveys (analyzed as missing values). 
• • 
. • 
Sample 
The sample consisted of 54% male students and 45% female 
students (0.8% did not respond). The majority of the respondents 
(77%) were aged between 17 and 22 and the rest between 23 and 
71 (due to a program for the elderly to take classes). The students 
tended to be from the capital providence (54%) and come from 
middle- to upper-class backgrounds (approximately 60%). 
RESULTS 
Experiences and Perceptions of Corporal Punishment 
Table 1 presents the experiences and perceptions 
of various forms of punishment. The most common 
forms of punishment were spanking (80%), hitting 
other parts of the body (not the head) with the hand 
(46%), and whipping (30%). The two most violent 
forms of punishment, burning and tying to a tree, 
were the least common (0.2% with each experience). 
The men experienced statistically equivalent amounts 
of punishment as the women, except for whipping, 
of which they experienced more (x2: P = .03). The 
two most violent forms of punishment (burning and 
tying to furniture) were experienced solely by women. 
The perceptions of abuse are concordant with the 
degree of violence of the punishment. The two least 
violent punishments, spanking and removing toys, 
were generally regarded as accepted forms of disci-
pline (around 80%). Hitting other parts of the body 
was also fairly accepted (38% considered it discipline), 
most likely because it was also widely experienced. 
The rest of the forms of punishment were considered 
abuse by more than 75% of the students. 
Sexual Abuse 
Table 2 shows the compilation of the four questions 
on sexual abuse. Overall, 32.2% of the female stu-
dents and 12.8% of the male students disclosed a 
history of abuse (anyone who answered all four ques-
tions and marked eyes- to one or more of them). 
Tables 3, 4, and 5 contain information about the 
nature of the abuse. The median age at the time of 
abuse was 7.0 for boys and 8.0 for girls. Forty-six  
percent of the boys and 35% of the girls (who had 
experiences) were abused before age 7. Boys were 
more likely to be abused by a neighbor (53.4%), while 
girls were equally likely to be abused by a stranger 
(23.2%), a neighbor (25.3%), or a relative (30.5%). Of 
the female experiences, 6.3% were caused by a step-
father and 3.2% by a natural father. A total of 3.5% 
of all women in the sample had an experience with 
either type of father. Also, 2.1% of the female expe-
riences were caused by a natural mother. Men were 
the perpetrators of most of the abuse: 63.2% of the 
offenders against boys and 92.0% of the offenders 
against girls. The majority of the experiences were 
one-time events: 69.6% of the male experiences and 
65.2% of the female. 
DISCUSSION 
Corporal Punishment 
To identify child abuse in a given culture, it is 
necessary to understand the specific child-rearing 
practices of that culture." This survey touches the 
disciplinary practices of Costa Rica but cannot dem-
onstrate the reality of the situation. The primary 
problem is a lack of comparison. No previous studies 
have been done in Costa Rica about punishment, 
leaving these results as a base. It is impossible to 
know whether the perceptions And experiences of the 
university students reflect those of the rest of the 
country. A nationwide survey dedicated to child-
rearing practices would provide the needed compar-
ison for this study. 
Ths students' ideas about physical punishment can 
be given some international perspective, though. In 
Barbados, Payne showed that 70% of the Barbadian 
adults approved of the use of corporal punishment. 
Among those who approved, 76.5% sanctioned the 
use of whipping or flogging as an appropriate method 
of punishment.' On the opposite side, Sweden has 
made considerable efforts to eliminate corporal pun-
ishment, passing a law to make it illegal and starting 
a massive parent education campaign. i2 In the United 
States in 1988, 62% of the parents in a national survey 
used hitting or spanking as a form of punishment, 
9% more than six times during the year." One recent 
TABLE 1. 	 Perceptions and Experiences With Corporal Punishment 
Punishment Male Female 
Experience Perception (n = 162) Experience Perception (n = 162) 
Disc' Abuse Don't Know % n Disc* Abuse Don't Know 
Spanking 81.7 263 82.1 16.0 1.9 77.4 221 79.5 19.9 0.7 
Hits with hand to other 
parts of body 
44.4 259 38.3 59.9 1.9 48.9 221 39.1 58.9 2.0 
Whipping/flogging 35.2 261 23.5 74.7 1.9 24.5 220 17.2 82.1 0.7 
Removing toys 26.5 260 80.2 16.0 3.7 21.1 218 72.8 25.2 2.0 
Hits with hand to the 
head 
19.1 257 19.8 78.4 1.9 18.0 217 19.9 78.8 1.3 
Hits with an object 17.4 258 16.0 82.1 1.9 20.5 220 15.9 83.4 0.7 
Locking in a room 12.4 258 26.5 71.6 1.9 8.2 219 20.5 78.8 0.7 
Covered with cold 
water 
3.9 256 21.6 75.3 3.1 5.9 219 22.5 75,5 2.0 
Surpressing food 2.3 257 20.4 79.0 0.6 2.3 220 21.9 77.5 0.7 
Tying to furniture 0.0 257 14.8 84.0 1.2 0.5 218 12.6 87.4 0.0 
Burning/scalding 0.0 257 15.4 83.3 1.2 0.5 219 12.6 87.4 0.0 
• Discipline. 
158 SEXUAL ABUSE AND CORPORAL PUNISHMENT 
TABLE 2. 	 Percentage of Students Experiencing Sexual Abuse: 	 TABLE 4. 	 Distribution of Sexual Abuse Experiences: Respon- 
Compilation' 	 sible Person* 
Form of Abuse Men Women 
N n (%) N n (%) 
Sexual intercourse 265 17 (6.4) 222 24 (10.8) 
Touching/kissing/etc 261 24 (9.2) 214 62 (29.0) 
Exhibition/photos 258 7 (2.7) 212 11 (5.2) 
Oral sex/sodomy 260 11 (4.2) 208 5 (2.4) 
Total: one or more 
experiencest 
257 33 (12.8) 202 65 (32,2) 
N = number of students who answered (who answered all four 
in the total); n = number who had the experience. 
t Answered all four questions, 
study found that 73% of the parents of 2-year-olds 
used pushing, grabbing, shoving, slapping, or spank-
ing as a form of punishment. ' Another study by 
Straus' showed that more than 97% of American 
children experience physical punishment. The stu-
dents of Costa Rica reported widespread use of spank-
ing and hitting, with limited use of flogging. These 
attitudes seem to reflect those in the United States, 
where physical punishment is generally accepted, and 
do not seem to be as severe as those held by Barbados. 
But it is necessary to reiterate that these attitudes and 
experiences apply only to a small population of Costa 
Rica, and it is necessary to study further the actual 
child-rearing patterns of the country. 
Sexual Abuse 
The similar design of this survey to the LA Times 
survey of 1985 makes the data comparable, recogniz-
ing the population difference between the two sur-
veys. Using a more equivalent population, these data 
can also be compared with US college student surveys 
done by Finkelhor3 and Fromuth.4 The overall per-
centage of female students with a history of sexual 
abuse (32%) is not statistically different from the LA 
Times national survey, which found that 27% (x2: P 
= .61) of the women had had a childhood sexual 
abuse experience.2 Other studies showed slightly 
lower prevalences: The 1979 sample of New England 
college students found that 19.2% of the women had 
had a sexual abuse experience.' Similarly, Fromuth4 
found that 22% of Auburn University female students 
had experienced an incidence of sexual abuse. Two 
other studies found much higher prevalence rates. 
Russell' showed a prevalence rate of 54% in 1983 
and Peters et all° showed a rate of 62% in 1985, in 
Characteristic Men Women 
Sex (n = 57) (n = 88) 
Male 63.2 92.0 
Female 36.8 8.0 
Relationship to victim (n = 58) (n = 95) 
Stranger 19.0 23.2 
Neighbor 53.4 25.3 
Relative 19.0 305 
Stepfather 0.0 6.3 
Parent 0.0 5.3 
Other 8.6 9.5 
• Values represent percentages. 
TABLE 5. 
	
Distribution of Sexual Abuse Experiences: Frequency 
of Abuse' 
Frequency 	 Men (n 	 Women 
= 56) 	 (n = 92) 
Once 	 69.6 	 65.2 
2-5 times 	 17.9 
	 27.2 
>5 times 	 12.5 	 7.6 
• Values represent percentages. 
local studies. The male student prevalence rate was 
not statistically independent from the LA Times na-
tional survey rate (13% vs 16%) (x2: P = .16)2 nor the 
college student survey rate (8.6%) (x2: P = .48).3  
When comparing the prevalence percentages be-
tween surveys, it is necessary to note the differences 
in methodology. The LA Times national survey was 
done by telephone, Finkelhor's college survey was a 
45-minute self-administered written questionnaire 
accompanied by personal interviews in social science 
classes, and Fromuth's survey was completed by vol-
unteers recruited from psychology classes. This sur-
vey, as stated, was self-administered, short, general, 
and done in a wide variety of classes. The differences 
in methodology may be a factor in the variant prev-
alence rates.1"6 
More specific comparisons can also be shown be-
tween surveys. The percentage of students in Costa 
Rica with an experience of attempted or actual sexual 
intercourse (barring the translational limitation) is 
statistically similar for both sexes (6.4% of the men 
and 10.8% of the women) to the LA Times national 
survey values (9.5% of the men and 14.6% of the 
women) (x2: P = .12 [men]; P = .14 [women]).2 
However, the percentages of students experiencing 
kissing, touching, or grabbing in Costa Rica are sig- 
TABLE 3. 	 Distribution of Sexual Abuse Experiences: Percentage of Victims by Age and Sex: United 
States (US) and Costa Rica (CR)' 
Age (y) at Time 
of Abuse 
Men Women 
CR (n = 48) US (n = 169) CR (n = 85) US (n = 416) 
3-6 46 12 32 14 
7-9 29 28 38 27 
10-12 12 29 27 37 
13-15 8 22 2 14 
16-18 4 6 1 6 
Mean age, y 	 7.9 	 8.0 
Median age, y 	 7.0 	 9.9 	 8.0 	 9.6 
US data from Finkelhor et al.2 
. SUPPLEMENT 159 
nificantly higher than Finkelhor's values (9.2% of the 
men and 29.0% of the women vs 4.5% of the men 
and 19.6% of the women) (x 2: P = .006 [men]; P = 
.008 [women]).2 The percentage of students in Costa 
Rica experiencing oral sex or sodomy is quite high: 
4.2% of the men and 2.4% of the women (Finkelhor's 
values were 0.4% of the men and 0.1% of the 
women).2 
A comparison of the age at the time of abuse 
between this survey and the LA Times national survey 
is presented in Figs 1 and 2. The median age of abuse 
of the students in Costa Rica was lower than those 
found by Finkelhor in 1979 and 1990. This survey 
showed median ages (male and female) of 7.0 and 
8.0, while Finkelhor's college student survey showed 
mean ages of 11.2 and 10.2,3 and the national survey 
showed median ages of 9.9 and 9.6.2 It is interesting 
to note that the abuse in Costa Rica appears to peak 
before 10 years of age, whereas in the United States, 
prepubescent children are more likely to be abused.' 
The characteristics of the perpetrator are also of 
interest. This study shows a high number of women 
abusers: 36.8% of the male experiences and 8% of 
the female experiences were caused by women. The 
percentage of male experiences caused by women in 
this survey is significantly higher than those in both 
Finkelhor's college survey (16%, x2: P = .089)3 and 
his national survey (17%, x2: P = .003).2 The per- 
PERCENT 
50 
40 
30 
20 
10 
3-6 
	
7-9 
	
10-12 
	
13-15 
	
16-18 
AGE 
C.R. U.S.  
Fig 1. Distribution of experiences of male victims by age: Costa 
Rica (CR) and United States (US). US values from LA Times 
survey.' 
PERCENT 
3-6 
	
7-9 
	
10-12 
	
13-15 
	
16-18 
AGE 
C.R. 	 u.s. 
Fig 2. Distribution of experiences of female victims by age: Costa 
Rica (CR) and United States (US). US values from LA Times 
survey.' 
centage of female experiences caused by women was 
significantly higher in the Costa Rican survey than 
the Finkelhor national survey, where he found only 
1% (x2: P = .007).2 Strangers were responsible for 
more of the male experiences in the Finkelhor national 
survey (40%) than in the Costa Rican survey (19%) 
(x2: P = .004).2 The college survey value of 30% of 
the male experiences caused by a stranger was not 
statistically different from the Costa Rican percentage. 
Exactly like both of the Finkelhor surveys, no sexual 
abuse between a natural parent or stepparent and a 
boy was found. Furthermore, the Costa Rican survey 
and Finkelhor's national survey found similar rates 
of incestual relationships between natural parents or 
stepfathers and girls. In Costa Rica, 6.3% of the 
female experiences were caused by a stepfather, com-
pared with 3% in the LA Times national survey (x2: 
P = .25); and 5.3% of the experiences were caused by 
a maternal parent, also compared with 3% in the 
same US survey (x2: P = .22).2 It is interesting to note 
that two of the experiences were caused by a natural 
mother in this survey. The overall percentage of 
women having a sexual abuse experience with a 
father or stepfather (3.5%) is concordant with US 
values. The LA Times survey found that 2% of the 
women had had an incestual experience,2 and Russell 
found that 4.5% of the women in her sample had 
had a similar experience.' 
The final comparison relates to the frequency of 
the abuse. Like the two Finkelhor surveys, this study 
showed the majority of the experiences were one-
time events: 70% of the male experiences and 65% 
of the female experiences. Finkelhor's college survey 
found 60% of the experiences to be one-time events,' 
and the national survey found that 73% of the male 
experiences and 65% of the female experiences oc-
curred once.2 
CONCLUSION 
This survey is a preliminary look at the prevalence 
rates of sexual abuse and experiences and perceptions 
of corporal punishment in Costa Rica. The study was 
a pilot and has a few limitations to its results. The 
high rate of abuse disclosed has led the PANIAMOR 
Foundation to embark on two nationwide surveys, 
one on child-rearing patterns and the other on sexual 
abuse. These two upcoming surveys will yield valu-
able comparison information for these data and verify 
the results obtained. 
Overall, although this work gives little insight to 
the child-rearing practices of Costa Rican parents, it 
does appear that the use of physical punishment is at 
least as widespread as it is in the United States. The 
prevalence rates of sexual abuse in Costa Rica also fit 
within the accepted rates in the United States. Al-
though the percentages reported here should not be 
generalized to the entire population (because of the 
kind of population, size of the sample, and method-
ology), they do demonstrate that sexual abuse and 
incest are not negligible in Costa Rica and that they 
may be as prevalent as in the United States. 
The need for more field research is clear. Sexual 
abuse prevalence studies can be accompanied by 
studies of risk factors and consequences of abuse. 
160 	 SEXUAL ABUSE AND CORPORAL PUNISHMENT 
6.  
7.  
8.  
9.  
10.  
11.  
12.  
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1979 
4. Fromuth ME. The relationship of childhood sexual abuse with later 	 15. 
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Payne MA. Use and abuse of corporal punishment: a Caribbean view. 
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Korbin JE. The cultural context of child abuse and neglect. Child Abuse 
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Solheim JS. A cross cultural examination of use of corporal punishment 
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Schulman Ronca and Bucuvalas Inc, for the National Committee for the 
Prevention of Child Abuse. Public Attitudes and Actions Regarding Child 
Abuse and Its Prevention. Chicago, IL: NCPCA Publications; 1988 
Wauchop BA, Straus MA. Physical punishment and physical abuse of 
American children: incidence rates by age, gender, and occupational 
class. In: Straus MA, Gelles RJ, eds. Physical Violence in American 
Families: Risk Factors and Adaptations to Violence. New Brunswick, NJ: 
Transaction Publications; 1990:133-148 
Straus MA. Ordinary violence, child abuse, and wife-beating: what do 
they have in conunon2 In: Finkelhor D, Gelles RJ, Hotaling GT, Straus 
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Finally, further studies of the child-rearing patterns 
will provide insight into the extent and perceptions 
of physical abuse in Costa Rica and other developing 
nations. 
ACKNOWLEDGMENTS 
We are grateful to The C. Henry Kempe National Center for the 
Prevention and Treatment of Child Abuse and Neglect for all 
information and support; Daniel Antich at Institute de Investiga-
ciones en Salud and Toni Miyoshi at the Kempe Center for com-
puter assistence; Tom Davis for statistical knowledge; and the 
students, faculty, and administration of the University of Costa 
Rica for their unselfish cooperation. 
SUPPLEMENT 161