Updated KARA report from 2009;
Our terrific volunteer researcher from Macalaster College (Lelde) has been uncovering hard facts about abused and neglected children in Sweden.
The following are some of the more striking differences between our nations.
“converting the American figures for direct comparison with Sweden (2001), a comparative picture of the reported incidence of child abuse in Sweden and America is as follows:
Sweden – 57 per l00,000
America – 4,800/ per 100,000. ” (2016)
My note on the above; because America’s child protection systems is so overwhelmed, only severe cases of abuse are reported to child protection services and only a fraction of those receive the services they need. Minnesota’s new model for child protection has great promise and could lead to betterment by other states in the protection of their children.
In this nation today most states do not have adequate staff, resources or training to manage the severe mental health issues facing child protection workers. Mandated reporters (that I know) go out of their way to “not know” about reportable violence/abuse of the children in their classrooms and encounters. Foster care, group homes and juvenile justice are having the severe and repeated problems any institution would have in such overburdened conditions.
In 1998 comparative study of child abuse 9 years after the prohibition of corporal punishment in Sweden, 10.7% of American men and 8.2% of American women sampled stated that they had been victims of child abuse as children, compared to 3.9% of Swedish men and 0% of Swedish women in the sample. Finally, according to Joan Durrant, professor of family studies at the University of Manitoba in Canada, “Sweden went from a family violence- child death rate of 18% in 1970 to 0 percent in recent years”- a significant and congratulatory fact.
America today has an epidemic of violent crimes against children and could do well to study the practices of the Swedes to solve our child protection problems.
Child Protection in Sweden
While many might have an opinion that corporal punishment by parents for the purpose of discipline and correction is acceptable as a normal way of raising one’s children, several countries in Europe have disagreed moving towards abolishing all forms of corporal punishment of children.
This area of law dates back to 1979 when Sweden took the leading role on this issue and passed a law that prohibited children corporal punishment. To date 17 countries have abolished all forms of corporal punishment of children including the imposition of corporal punishment in the home or by parents.
These countries are Austria, Croatia, Cyprus, Denmark, Finland, Latvia, Norway, Germany, Italy, Israel, Sweden, Iceland, Ukraine, Bulgaria, Hungary, Belgium and Romania.
Around 75% of Swedish children live in traditional nuclear families with birth parents. To support parents and children, social and medical support systems were rapidly and radically expanded and changed during the decades after the World War II. Today they include preventive services with free (or very inexpensive) health controls during pregnancy, prenatal and postnatal education programs, and regular health controls for children during the school years.
The Swedish parental insurance system has gained international recognition, aiming at enabling both men and women to combine parenthood with employment- parental insurance allows the mother or father to stay at home up to 360 days after the birth of the child, with 80% compensation for loss of income.
Furthermore, parents have the right to stay home from work to care for a sick child in sum 60 days annually (per child under twelve years of age), with a cash benefit corresponding to 80% of their income.
II. Child Abuse and Neglect: Definitions in Swedish Law
According to Hessle and Vinnerljung, Swedish lawmakers have a stern attitude to physical abuse. Even minor physical punishment may be a reason for a court order.
Other circumstances that may lead to a court order include children who are repeatedly told they are stupid, clumsy, ugly or worthless. Frequent threats of physical or other punishment may also constitute reasons for intervention.
Exploitation mainly refers to sexual abuse but include cases where children are forced to do heavy labor. This criterion also applies to children who have “un-normal responsibilities in the home”, eg children who have to look after an alcoholic parent.
Inadequate care is an approximation of the international concept of neglect and covers a lot of ground: children receiving insufficient physical care, stimulation and emotional nurturing, substance abusing or mentally ill parents, children who do not get proper medical care, who are not receiving adequate supervision or are repeatedly left in the care of others.
III. Child Care in Sweden
Care for children and youth in Sweden can roughly be divided in three categories: foster (family), residential care; and homes for special supervision. Adoption without parent’s consent or procedures to ‘free children for adoption’ does not exist.
From WWII to the mid-1960ies, young “immature” mothers were as a matter of routine recommended/persuaded by local child welfare authorities to give up illegitimate children for adoption but now only a handful of children are left annually for adoption by Swedish parents. Childless couples have turned to international adoptions since the late 1960ies. An estimated 1.6 % of all children in current teenage cohorts were originally adopted from abroad.
Foster care is by law and long tradition preferred to residential treatment. Swedish children have been placed in foster homes since the 18th century, 100 years before the American “orphan trainee’ brought thousands of poor children from cast coast cities to substitute parents in the rural west. Research from 1974-1992 clearly shows that the century old practice of placing children from urban families in rural foster homes continues.
In cross section data 75% of all children placed in care are in foster homes, but since cross section samples contain a large overrepresentation of long placements, the picture changes if we look at longitudinal data. Among initiated placements in 1995 of children all ages, around 55% were made in foster care.
Time series data reveals that the use of foster care has decreased continually the last 13 years, from 72% of all initiated placements in 1983 to 55% 1995, while placements in different forms of residential care have increased (from 28% to 45%).
Swedish child welfare professionals have in the last 30 years tended to regard kinship care (fostering by relatives) with suspicion, probably due to a prominent influence in practice of theories on intergenerational transmission of psychosocial problems. A media supported political campaign by a group of relatives to children placed in care (called the “grandma revolt”) resulted in a change of law in 1997. When children must be place in care, primary consideration must now be given to relatives (or other close adults) as substitute caretakers.
Lastly, many local authorities use contracted foster homes for short term or emergency placements. These families usually have a contract, agreeing to care for a set number of children. Contracted foster families are used as replacements or complements to residential care.
The law of 1980 brought a change in definitions. It stated that if foster homes have four children or more and if foster parents’ main income came from fostering, they should be defined as a residential unit. The rationale behind this legal change was to bring professional care under stricter control. Furthermore, it paved the way for a private expansion in care that only partly can be explained by former foster homes being redefined.
There are now more residential units “in the market” than at the heyday of residential care in the 1930ies and half of them were established during the 1990ies. . Sweden’s care system has – if legal definitions are applied – slowly developed toward re-institutionalization and privatization during the last 15 years, even if foster family care still is the dominating form of care.
Some of the new private residential units would probably be defined as “specialist foster care” in other contexts. More than half of its owners/operators have experience from fostering. In 1995 they received almost as many children – 0- 1 8 years old – as publicly owned children’s homes. Residential care is mainly used for teenagers (60% of all initiated placements in 1995), but the private children’s homes have increased their 53 market share” substantially for younger children, mainly for intermediate and long term care, a new phenomena.
Placing young children in temporary residential care together with their parents is very common. Among children’s homes for 0- 12 year olds, 90% state that they receive children and parents together. Already in 1985, more than half of all children in children’s homes had at least one parent staying with them. The proportion is smaller now, since private small, home-like residential units are increasingly used for longer placements.
Homes for special supervision
Since youth justice is included in Swedish child welfare, criminal and drug-using youth make up a substantial part of teenagers in care. Sweden has for decades had special residential care for the “worst” in this group.
These homes for special supervision have facilities for locking up youth,
and are legally authorized to place violent youngsters in temporary solitary confinement and to perform (bodily) searches. There are 30 residential units of this category with around 600 beds today, since 1994 run by a national government agency (SiS). Most homes have been in operation for decades.
Residential care in this form does not exist in Denmark or Norway, but there are calls to replicate the Swedish example in these countries. Placements have increased since 1994 and the responsible government agency has strong ambitions of turning this form of care – traditionally punitive and confining – into an evidence-based treatment organization.
IV. Social intervention
In Sweden, social intervention is founded on the guiding principles of solidarity, parent rights and the child’s best interests but within the framework of family preservation.
The social workers have the professional latitude to focus on non-statutory interventions to ensure that the child has decent living conditions.
Therefore, in the Swedish model of social welfare the investigative and assessment aspects of social intervention are characterized by an inclination to focus on understanding acts or circumstances in the context of psychosocial difficulties experienced by families. As response in case of need, beyond the initial gate keeping function, often involves further assessment followed by the provision of therapeutic and practical services of the family members.
In a way, then, more than in any other country, the emphasis in Sweden is on a much broader notion of best interests and of a child’s needs and rights. Yet, at the same time, children have clearly defined rights to a satisfactory life conditions and not to be subjected to ‘physical punishment or other degradation’.
This approach means a greater willingness of the state to intervene in the private realm of the family – providing supportive measures such as adequate housing, decent day care, medical and dental services for children, and economically viable parental leave from the workforce.
Because of the strong social service structure in Sweden, there are a wider variety of services available to assist children in need which might mean earlier interventions, more preventive services and more services accessible to the family to deal with the issues as they arise. When combined in a table, and compared to the Canada’s Child Protection Model (for further information please see the section on child protection in Canada), Sweden’s model of child welfare is the following:
Child Welfare Model (Sweden) Child Protection Model (Canada)
A greater readiness to intervene
Less readiness to intervene and only most needy are eligible
Child welfare is assessment driven Child protection is structure driven
‘Best interests’ of the child are broadly defined to include well-being with the family ‘Best interests’ of the child are narrowly focused on preservation, protection and permanency planning.
More resources are available to support families and prevent harm Limited resources are directed at reacting to the consequence of harm committed.
Source: Khoo, E.G.; Hyvonen, U.& Nygren, L. Child Welfare or Child Protection: Uncovering Swedish and Canadian Orientations to Social Intervention in Child Maltreatment. Qualitative Social Work, Vol. 1 (4), pp.451-471.
As can be seen from the table, Sweden’s well-developed social welfare system as well as broadly defined ‘best interests’ of the child allows for a greater flexibility in finding the right approach to each separate situation.
Majority of the general and group targeted prevention work is done outside child welfare organizations, including but not limited to pre- and post- natal maternal care, subsidized child care, social support at schools etc.
In daily child welfare work there are hardly any standardized preventive services, available to families regardless of what “municipality” they live in. Rather, an array of different programs attempt to prevent negative child development, family breakdown, placement in care and asocial behavior in youths. The following list is by no means complete, and should be seen as an attempt to cover mainstream examples.
1. Agency cooperation and intra-agency service delivery- in the past 5 years, this service has become increasingly popular. With financial aid from the National Board of Health and Welfare, scores of local authorities have constructed services where maternity care, child health, pre-schools and child welfare either operate in the same locality or intensify cooperation. The aim is to give information and social advice, provide non-stigmatizing support to families-at-risk and strengthen their social network by group activities. Evaluations of these programs are so far too local, small sized and process oriented for conclusions about outcome.
2. Self-help groups for children- target, for example, children with alcoholic parents, single mothers, refugee parents, and young victims of sexual abuse. The extent of availability and service delivery on a national scale is not known. Evaluations of self-help groups are encouraging, especially so for children with alcoholic parents, yet is questionable if self-help groups can be labeled prevention, although many such programs have clear secondary prevention goals.
3. Parent training/education programs – these programs are rare, but exist in some municipalities yet the extent of their success is unknown and no Swedish evaluation studies of these programs exist.
4. “Summer families” and summer camps – these used to be part of every larger local authority’s service delivery. Children from towns and cities were offered to spend a month as guest in a rural family or at a summer camp for a very low fee. The general idea is to give a compensatory service to low income urban families. But preventive aims are also prominent, for example, reducing the risk of family breakdown by providing parents with temporary relief from stress. “Summer families” and summer camps still exist – and are in demand – but no figures of service delivery rates are known.
5. Agency financed and staffed programs- these programs are aimed at giving to at-risk youth meaningful after-school activities and nurture relations between youths and community workers. Examples of such programs include café-, boat- and theatre- projects. Also, youth in around 85% of the municipalities have access to a Youth Advice Centre.
These centers give advice and guidance to youth in sexual matters, sexually transmitted disease protection and birth control, and are often run jointly by local social and medical authorities. A few small centers that offer advice on drugs to youth and parents are in operation. Social workers in most local authorities regularly give information and advice on drug related matters in schools.
VI. Legal Criteria for “Hard” Interventions
Conditions that can lead to placement in care without parental consent are (LVU):
• Inadequate care/neglect;
• Other conditions in the home, e g very disturbed relations between the child and his/her parents;
• Children’s and youth’s substance abuse, crime or other socially destructive behavior.
Adverse home conditions are not by themselves sufficient ground for a court order, but their presumed short and long-term consequences. The law specifies that home conditions (or a child’s behavior) must constitute an “apparent risk to the child’s development or (physical/mental) health”.
This idea of prediction is firmly embedded in the fundaments of Swedish child welfare legislation, and has been so since the beginning of the century. Unfortunately, Swedish criteria for child protection are diffuse compared to many other countries. Evidence of abuse or harm to children is not even a typical precondition in practice. Andersson (1984, 1991) found that most preschool children taken into care during the 1980ies did not exhibit observable damages, dysfunction or maladaptive behavior.
They were placed due to parental life styles assumed to be harmful to children’s development, mainly mothers’ alcohol or narcotic abuse. Yet, several British writers have approvingly described the predictive elements in Swedish child welfare legislation. They have expressed regret about British law not permitting similar “theory based”, “pro-active” interventions.
From empirical evidence, it seems impossible to predict the development of children-at-risk or the future behavior of families-at-risk on an individual level with reasonable accuracy, especially so for low frequent phenomena like child abuse. The number of “false positives” in theory based screenings of families is simply so many that interventions labeling parents as potentially abusive become ethically impossible.
VII. Positive News: Violence Against and Abuse of Children Decreasing
Much of the available evidence indicates that Sweden has been extremely successful in reducing rates of child physical abuse over the past few decades and this reduction has been maintained since the passage of the corporal punishment ban.
Prevalence, frequencies and harshness of assaults against children have declined dramatically in Sweden over the last two generations. For example, research indicates that substantial proportions of women who became mothers in the 1950s struck their children at least weekly while 86% of youth who were born in the 1980s reported never having been physically punished.
Furthermore, practically no children are hit with implements in Sweden today. The currently positive situation might be explained due to the corporal punishment ban started in 1957 and finally implemented in 1999.
Another step to target children abuse was made in 1979 with the passing of ‘anti-spanking’ law which clearly stated that physical punishment and child abuse was not acceptable. In 1970s there was a worrying increase in the cases of physical child abuse which propelled government and children’s rights groups to act. A major research project concluded that stopping all physical punishment was the key to prevent physical child abuse in general.
As a result, in 1979 Sweden passed a law that claimed that “a child may not be subjected to physical punishment or other injurious or humiliating treatment.” As Whitney Glen explains, this law aimed not only to promote positive childrearing for all children, but to deter physical child abuse all together- all physical punishment of children, whether mild or severe, was banned. When the ‘anti-spanking’ law was passed, it was immediately followed by a far-reaching mass media campaign including the most expensive pamphlet distribution ever organized by the Ministry of Justice.
While there may have been many who disagreed about the necessity of such law, it inevitably spurred a discussion about an issue which might have previously been marginalized and ignored.
The core starting point which allowed for the establishment and legislation of such corporal punishment ban law was the “pshychologically and sociologically assumed connection between corporal punishment, domestic violence and child abuse.” Once this relationship was realized the only sensible action was to prohibit the use of physical punishment to prevent the further abuse of children. According to Norma D. Feshbach, Ph.D. and Chair of the APA task force on Rights of Children and Youth, “(T)he use of physical punishment or violence directed toward children is very close to the abuse of children.
It is often difficult to differentiate violence from abuse, just as it is difficult to legally establish the precise point at which corporal punishment becomes child abuse.” While physical discipline may not always be considered equivocal to physical child abuse, previous research indicates that they seem to be dynamically linked.
Between 1975 and 2000, the average annual number of homicides of children aged 0-4 in Sweden was 4 while between 1995 and 2000 the number decreased to 2.8 despite population growth. While it is hard to claim that the reason behind the decrease is the passed legislations banning child abuse, it is clear that in this regard Sweden excels among other industrialized nations:
the World Health Organization (2002) claims that homicide incidence figures for children aged 0 to 4 in Sweden (1999) was 3, in Canada (1997)- 24 and in the United States (1998)- 723. Even when taking into account that Canada’s population is approximately 3 times larger than Sweden’s and the U.S. population is approximately 20 times larger proportionally Sweden still ranks first.
The law is quite comprehensive because it includes supplementary measures provided for, including information policy, parent training, activity of child protective organizations and other support programs that provide primary, secondary and tertiary prevention by supporting families who need help in parenting.
As Glen indicates, there are no criminal sanctions or legal penalties against parents and guardians who spank their children, but instead infractions are heard in civil rather than criminal courts and adults who violate the law are referred to counselors and other programs for support, advice and training. The primary purpose of the law was to establish a norm against all forms of physical punishment , with a secondary purpose to make it easier to convict those who abuse and harm children under the Swedish Criminal Code.
Essentially, it was a process of setting certain expectations of parents and of society regarding the manner in child they treat children. As Ziegert puts it, the prohibition of corporal punishment had the “direct preventative effect of sharpening public awareness for the social problem of child abuse.”
While spanking has no legal sanctions in Sweden, the same cannot be said about child abuse. Legal sanctions for physical abuse of a child by an adult are defined in the Swedish penal code as follows:
– A person who inflicts bodily injury, illness or pain upon another or renders him unconscious or similarly helpless, shall be sentenced for assault to imprisonment for at most two years or , if the crime was petty, to pay a fine. If the crime is considered grave, the sentence shall be for aggravated assault to imprisonment for at least one and at most ten years (Lindell & Sveden 2001:151).
A study of police reports for physical child abuse conducted in 2001 revealed that 23 % of the children who had suffered abuse were immediately placed outside the family. According to the police reports, the number of child abuse and neglect cases in Sweden for 1996 were 57 per l00,000 people while in the United States the number of cases of substantiated child maltreatment was 14 for every 1,000 people and the number of reported, but undocumented cases was 45 for every 1,000 people.
Thus, converting the American figures for direct comparison with Sweden, a comparative picture of the reported incidence of child abuse in Sweden and America is as follows: Sweden – 57/l00,000;America – 4,500/100,000.
After the anti-spanking law was passed, several studies were conducted that revealed significant decreases in the use of physical punishment, support of physical punishment, and numbers of cases of child abuse.
In 1998 comparative study of child abuse 9 years after the prohibition of corporal punishment in Sweden, 10.7% of American men and 8.2% of American women sampled stated that they had been victims of child abuse as children, compared to 3.9% of Swedish men and 0% of Swedish women in the sample.
Finally, according to Joan Durrant, professor of family studies at the University of Manitoba in Canada, “Sweden went from a family violence- child death rate of 18% in 1970 to 0 percent in recent years”- a significant and congratulatory fact. More than applying legal sanctions to those who would abuse children this law tended to shit the mentality and attitude towards using corporal punishment on children.
The 1979 anti-spanking law followed the principle stated by William James, the founder of the first psychology laboratory in United States in the 1870s, which claimed that we can use our behavior to control our attitudes and beliefs and that, in fact, behavior is easier to control than attitudes and beliefs.
More than passing a law regarding the prohibition of physical punishment of children, Sweden attempted to transform the previously accepted opinions and attitudes towards the issue. By changing the legal structure of society, Sweden’s laws allowed their people to better parents than their initial attitudes would suggest, and since physical punishment and child abuse are so closely linked, they have made significant strides toward reducing physical child abuse in Sweden as a whole.
Swedish child welfare stresses a social service approach by an emphasis on providing support. The rapid change in child welfare during the last decades can be dated back to three important conditions. Firstly, the emergence of the welfare state after VMI reduced the number of children in public care from 20 per 1,000 to 10 per 1,000.
Child neglect because of material poverty and misery eradicated as a reason for taking children from their families and placing them in institutions or foster homes. Secondly, the emerging family continuity principle in child care has dismantled the institutions for children – the whole family has entered care in Sweden.
Extended family and social networks are of increased importance in care, meaning that the world of the extended family is looked upon as valuable when considering children in placement rather than people to blame. Humanistic values and democratic ambitions that entered child care have created a revolution in child welfare.
Individualization of care and treatment has resulted in affirmation of the individual child in care. The welfare legislation has successively adjusted to these tendencies, and is constructed to offer services according to people’s rights rather than being part of charity.
Child protection legislation is diffuse and includes a high confidence in social workers ability to make predictions of children’s development. Another essential element can be added to this- a strong belief in the beneficial results of state interventions in families. Foreign observers have noted that Swedish child welfare has high legitimacy and support in the public, in spite of far reaching and diffuse powers.
At a Glance: Sweden Statistics. UNICEF. Accessible online at: http://www.unicef.org/infobycountry/sweden_statistics.html
Cocozza, M.; Gsutafsson, P.A.; Sydsjo, G. Child Protection in Sweden: Are Routine Assessments Reliable? Acta Pediatric, Vol. 95, No. 11, November 2006.
Durrant, J. E. Child Abuse in Sweden. April 9, 2003. Accessible online at: http://www.nospank.net/durrant2.htm
Glenn, W. The Effects of No Spanking Law on Child Abuse in Sweden. Associated Content Press, May 7, 2007. Accessible online at: http://www.associatedcontent.com/article/233338/the_effects_of_the_no_spanking_law.html
Hessle, S. & Vinnerljung, B. Child Welfare in Sweden- An Overview. Stockholm Studies in Social work, No 15, Stockholm University.
Khoo, E. G.; Hyvonen, U.; Nygren, L. Child Welfare or Child Protection: Uncovering Swedish and Canadian Orientations to Social Intervention in Child Maltreatment. Qualitative Social Work 2002; Vol.1. No.4
Lundstrom, T. Child Protection, Voluntary Organizations, and the Public Sector in Sweden. Voluntas: International Journal on Voluntary and Non-Profit Organizations, Vol.12, No.4., December 2001.
Nilsson, M. How a ban on corporal punishment has affected child protection in Sweden. Save the Children Sweden, July, 2009, Stockholm.
Prohibition of Corporal Punishment: An International Overview. The International Child and Youth Care Network. Article 19, Volume 1 Number 3, December 2005. Accessible online at: http://www.cyc-net.org/cyc-online/cycol-0206-article19.html