GRAPHICAL ABSTRACT

INTRODUCTION

Child sexual abuse (CSA) is defined as any sexual activity involving children that degrades, humiliates, or violates their bodies and/or reproductive functions, potentially carried out through coercion, violence, or threats [1]. CSA is one of the most frequently reported forms of abuse in developing countries, particularly in Africa, South Asia, and Southeast Asia [2,3], including Indonesia. CSA harms not only children but also their families, communities, and the nation. Child victims are at risk of adverse health outcomes, including sexually transmitted infections (including HIV/AIDS), unwanted pregnancy, impaired physical development, sleep disorders, bullying, social withdrawal due to shame, depression, and prolonged trauma that can lead to dangerous behaviors and even death. As a result, children’s quality of life may decline substantially, hampering their potential for future development [4]. The Four Preconditions Model by Finkelhor et al. [5] and several studies have identified contributing factors to the high prevalence of CSA in developing countries, including gender-related issues, poverty, and restricted access to education [3,6]. However, much of the existing research on CSA in Asia and other low-income and middle-income countries (LMICs) has been derived from literature reviews [3,7,8], which have synthesized findings from diverse primary studies and therefore provided limited empirical evidence based on nationally representative datasets.

In Indonesia, child abuse cases have been systematically recorded through the Online Information System for the Protection of Women and Children (SIMFONI-PPA) since 2016. All child protection stakeholders at the district and provincial levels report cases through this system. Data from SIMFONI-PPA reveal a steady increase in the number of both cases and victims, with CSA consistently reported at 2 times to 3 times the level of physical violence and exceeding other forms of abuse. Reported CSA cases rose from 9588 in 2022 to 10 932 in 2023 and 11 781 in 2024. Most incidents occurred within children’s immediate environments, particularly at home and in school [9]. These data highlight CSA as a critical public health and social issue in Indonesia requiring urgent policy responses and targeted interventions.

Regulations have been enacted to provide a legal basis for child protection, including Law No. 35/2014 on Child Protection, Presidential Decree No. 36/1990 ratifying the Convention on the Rights of the Child, and the National Strategy for the Elimination of Violence Against Children (Stranas PKTA) [10]. Nevertheless, these policies have not been fully effective in reducing the prevalence of CSA.

Addressing CSA requires an evidence-based understanding of its risk and protective factors to strengthen prevention and response efforts within the Indonesian context. However, empirical research on CSA using national survey data in Indonesia remains limited. A previous study analyzed earlier rounds of the National Survey on Child and Adolescent Life Experiences (SNPHAR), particularly SNPHAR 2021, and primarily focused on the prevalence of and factors associated with violence against children in a broad sense, combining physical, emotional, and sexual abuse [11]. Consequently, CSA has rarely been examined as a distinct outcome. The availability of nationally representative data from SNPHAR 2024 provides an opportunity to address this gap. In this study, CSA is defined as any sexual activity involving a child that includes (1) coerced sexual intercourse through manipulation or promises, (2) non-contact sexual abuse, and (3) contact sexual abuse. Therefore, this study aims to identify risk and protective factors associated with CSA among adolescents aged 13–17 years in Indonesia using SNPHAR 2024 data. The authors predicted that environmental factors, attitudes towards gender, and awareness of child protection services may serve as protective factors, whereas witnessing violence and having a history of sexual intercourse may be associated with increased vulnerability to CSA. The findings are expected to provide a contextually grounded evidence base to inform the development of more effective child protection policies and interventions.

METHODS

Data Source

This study employed a cross-sectional design. It analyzed data from the 2024 SNPHAR, conducted by the Ministry of Women’s Empowerment and Child Protection in households using a stratified 4-stage cluster sampling design across 5 major regions of Indonesia: Sumatera (Aceh, North Sumatera, West Sumatera, Riau, Jambi, South Sumatera, Bengkulu, Lampung, Bangka Belitung Islands, and Riau Islands), Java and Bali (Jakarta, West Java, Central Java, Yogyakarta, East Java, Banten, and Bali), Kalimantan (West Kalimantan, Central Kalimantan, South Kalimantan, East Kalimantan, and North Kalimantan), Sulawesi (North Sulawesi, Central Sulawesi, Southeast Sulawesi, South Sulawesi, Gorontalo, and West Sulawesi), and other regions (including Nusa Tenggara Islands, Maluku, and Papua). Survey respondents were individuals aged 13–17 years and 18–24 years, with a response rate of 82.2%. The present analysis focused on respondents aged 13–17 years, yielding a sample of 6811 participants. Data were collected between May 2024 and June 2024, and the results were officially released in October 2025.

The total sample size was determined by the survey organizer based on population variability, the required precision of estimates, the level of estimation, and the costs associated with data collection. District/city samples were allocated to each island stratum using power allocation with a constant of 0.5, and census block samples within each district/city were allocated to urban and rural strata using a constant of 0.1. No exclusion criteria were applied during sample selection. If a respondent with a disability was encountered, interviewers attempted to conduct the interview. An interview was terminated if the respondent could not complete it, and the result was categorized as an “incomplete questionnaire,” with no replacement respondent selected.

The questionnaire was based on the global version developed by the Centers for Disease Control and Prevention (CDC), adapted to the Indonesian national context. A readability test was subsequently conducted to assess comprehensibility. Data were collected through standardized face-to-face household interviews administered by trained enumerators following field protocols to minimize interviewer bias and increase data quality. Data collection was performed in full compliance with ethical standards, ensuring the protection and safeguarding the rights of child respondents.

Statistical Analysis

The dependent variable in this study was the experience of sexual abuse, assessed across 3 types: (1) sexual intercourse obtained through persuasion in exchange for favors or gifts; (2) non-contact sexual abuse; and (3) contact sexual abuse. Respondents who reported at least 1 of these experiences were classified as having “ever” experienced sexual abuse. These measures were derived from a global questionnaire developed by the CDC, which provides a standardized framework for identifying multiple forms of CSA.

The independent variables included: (1) socio-demographic characteristics (school status, highest educational attainment, work experience, marital status, home ownership, and presence of biological parents in the home); (2) social support (family support and peer support); (3) attitudes toward gender; (4) witnessing violence; (5) sexual experience; and (6) information on child protection services (information about child rights, reproductive health, and child protection services and the reported availability of such services).

Because the dependent variable was categorical, all independent variables were analyzed in categorical form. Family support, peer support, and gender attitudes were originally measured as continuous variables; therefore, normality tests were conducted to determine appropriate cutoff points. As these variables exhibited non-normal distributions, median-based dichotomization was applied. This approach provides a more accurate representation of central tendency for skewed data and is commonly used in studies with non-parametric characteristics due to its empirical robustness and lower susceptibility to outliers [12,13]. Accordingly, scores below the median were categorized as “low,” whereas scores above the median were categorized as “high.”

The overall missing data rate was 17.8%, due to incomplete, partially completed, or un-interviewed responses and unknown age. These questionnaires were excluded from the raw dataset and were not included in the analyses or report. Bivariate associations between independent and dependent variables were examined using chi-square tests at the 95% confidence level, with p-value <0.25 used as the threshold for inclusion in multivariate analysis [14]. Before conducting binary logistic regression, multicollinearity diagnostics were performed to assess correlations among independent variables. Tolerance and variance inflation factor (VIF) values were examined; variables with tolerance >0.10 and/or VIF <10 were considered to have no evidence of problematic multicollinearity and were retained for regression analysis. All statistical analyses were performed using SPSS version 23.0 (IBM Corp., Armonk, NY, USA).

Ethics Statement

This study did not require institutional ethical approval because it used secondary data from the 2024 National Survey of Children and Adolescents’ Life Experiences (SNPHAR 2024). The authors did not conduct any direct interaction or intervention involving humans or animals. Access to the secondary dataset was formally requested and approved by the Ministry of Women’s Empowerment and Child Protection of the Republic of Indonesia. The authors were granted permission to access, use, and analyse the data and signed an agreement to report the utilization of the data as required.

RESULTS

Descriptive Statistics

Table 1 presents the collinearity test results, showing that all variables had tolerance values greater than 0.10 (0.562 to 0.993) and VIF values less than 10 (1.007 to 1.779). Therefore, the regression model did not indicate multicollinearity, and we could proceed to the interpretation of the regression coefficients.

Table 2 presents the distribution of sexual abuse experiences among adolescents aged 13–17 years in Indonesia. The results showed that among the 6811 adolescents included in the dataset, 595 (8.7%; 95% confidence interval [CI], 8.0 to 9.0) reported ever experiencing at least 1 form of sexual abuse. Although this proportion was relatively small compared with the majority who reported no such experience, the issue remains critical given the vulnerability of adolescents and the potential for serious physical and psychological consequences.

Table 3 presents the results of descriptive analyses of the dependent and independent variables, stratified by exposure to sexual abuse. This enabled comparison between adolescents who had experienced sexual abuse and those who had never experienced it. The distribution of respondents’ gender was approximately balanced (boys, 50.1%; girls, 49.9%). Most respondents were still in school (90.5%), and most had completed a low level of education (60.9%). Most respondents had never worked (88.0%), were unmarried (99.7%), lived in their own homes (85.1%), and resided with their biological parents (97.3%). A large proportion reported low family support (63.9%) and low peer support (81.9%). More than half indicated that they held low gender-equitable attitudes (52.3%), most had never witnessed violence (68.5%), and nearly all reported no sexual experience (99.0%). Regarding information exposure, nearly half had never received information on child rights (44.5%), whereas 46.7% reported receiving information on reproductive health. Only a small proportion reported that child abuse prevention activities were available in their community (14.8%), although more than half (51.9%) were aware of the existence of child protection services.

The bivariate analysis results in Table 3 identify factors associated with the experience of sexual abuse among adolescents aged 13–17 years in Indonesia. Variables significantly associated with experiencing CSA included gender (p=0.006), educational attainment (p<0.001), work experience (p<0.001), marital status (p<0.001), attitudes toward gender (p<0.001), experience witnessing violence (p<0.001), history of sexual intercourse (p<0.001), and awareness of child protection services (p<0.001).

Table 4 presents the results of the binary and multivariate logistic regression analyses examining factors associated with the experience of sexual abuse among adolescents aged 13–17 years in Indonesia. As shown in Table 4, only variables meeting the inclusion criterion (p<0.25) in the binary logistic regression were entered into the multivariate model, thus retaining variables with potentially meaningful associations for further analysis. In the binary logistic regression, girls were more likely than boys to report experiencing sexual abuse (odds ratio [OR], 1.27; 95% CI, 1.07 to 1.50; p=0.006). Adolescents with higher educational attainment were also more likely to report sexual abuse (OR, 1.36; 95% CI, 1.15 to 1.61; p<0.001), as were those with positive gender attitudes (OR, 1.74; 95% CI, 1.46 to 2.06; p<0.001) and those who were aware of child protection services (OR, 2.70; 95% CI, 2.24 to 3.26; p<0.001). In contrast, adolescents who had never worked (OR, 0.56; 95% CI, 0.45 to 0.70; p<0.001), had never married (OR, 0.21; 95% CI, 0.08 to 0.54; p<0.001), had never witnessed violence (OR, 0.24; 95% CI, 0.20 to 0.29; p<0.001), and had never engaged in premarital gender (OR, 0.08; 95% CI, 0.05 to 0.14; p<0.001) were less likely to report experiencing sexual abuse.

After adjustment, the multivariate analysis revealed several significant protective and risk factors for sexual abuse among adolescents aged 13–17 years. Adolescents with no history of work were less likely to report sexual abuse than those who had worked (adjusted odds ratio [aOR], 0.77; 95% CI, 0.61 to 0.99; p=0.040). Similarly, adolescents who had never witnessed violence were substantially less likely to experience sexual abuse (aOR, 0.20; 95% CI, 0.17 to 0.24; p<0.001). In addition, respondents who had never engaged in sexual intercourse had markedly lower odds of reporting sexual abuse (aOR, 0.08; 95% CI, 0.04 to 0.15; p<0.001). These findings underscore the importance of minimizing exposure to high-risk environments (e.g., work settings and home environments where violence is tolerated) and reducing exposure to early sexual experiences.

However, counterintuitive associations were also observed. Adolescents with positive gender attitudes had higher odds of reporting sexual abuse than those with less positive gender attitudes (aOR, 1.56; 95% CI, 1.29 to 1.87; p<0.001). Another unexpected finding was that adolescents who were aware of child protection services had nearly 4-fold higher odds of reporting sexual abuse than those who were not aware (aOR, 3.85; 95% CI, 3.15 to 4.72; p<0.001). Although unexpected, these associations may reflect greater recognition of abusive behaviours among adolescents with stronger gender-equitable attitudes and/or greater awareness of available services.

No variables were treated as confounders because the objective of this study was to identify factors associated with the experience of sexual abuse rather than to estimate causal effects. Accordingly, the aORs represent the independent associations between each variable and the likelihood of reporting sexual abuse, controlling for all other variables included in the model.

DISCUSSION

This study identified the absence of work experience, never having witnessed violence, and no history of sexual intercourse as protective factors associated with a lower risk of sexual abuse among adolescents aged 13–17 years. The protective association of having no work experience aligns with previous studies emphasizing poverty as a key structural factor that increases adolescents’ vulnerability to sexual abuse. In many LMICs, including Indonesia, financial deprivation often pushes adolescents to work, predominantly in informal sectors where child protection regulations and enforcement mechanisms are weak [15,16]. Prior studies have shown that work participation can increase vulnerability to sexual abuse through unsafe working conditions, power imbalances with older employers or coworkers, and greater exposure to exploitation [17,18]. In contrast, adolescents with no work experience are more likely to spend time in relatively safer environments, such as home or school, where supervision and protective mechanisms are stronger. This interpretation is consistent with the socio-ecological perspective and Finkelhor’s Four Preconditions Model, which emphasizes the protective role of proximal environments in providing monitoring, protection, and constraints on offender access, thereby reducing opportunities for sexual abuse [5,19].

Another significant protective factor was the absence of exposure to violence. Adolescents who grew up without witnessing violence, either within the family or in the broader social environment, had a lower risk of experiencing sexual abuse. Conversely, exposure to violence has been associated with heightened stress responses, anxiety, depressive symptoms, and impaired cognitive and emotional regulation, which may reduce adolescents’ ability to recognize danger, assert healthy personal boundaries, or seek help [20,21]. Furthermore, several studies have shown that the effects of childhood exposure to violence can persist into adulthood, increasing the likelihood of maladaptive coping strategies, difficulties in establishing healthy relationships, engagement in risky behaviors such as substance use or alcohol misuse, and further experiences of or even perpetration of violence [20,22]. These findings underscore the importance of violence prevention not only at the individual level but also within families and communities to create safe, violence-free social environments.

Consistent with prior results, having no history of sexual intercourse was associated with a lower likelihood of sexual abuse among adolescents aged 13–17 years in Indonesia. This association can be interpreted from a developmental and relational perspective. Early sexual activity during adolescence commonly occurs within dating contexts characterized by developing autonomy and negotiation capacity, alongside unequal power dynamics that may increase vulnerability to coercion or exploitation [23,24]. Studies from China have similarly indicated that adolescents’ first sexual experiences, particularly those involving unprotected gender, are closely linked to sexual victimization [25,26]. Moreover, empirical research suggests that the increasing salience of peers and romantic partners during adolescence may intensify susceptibility to peer pressure and manipulation, elevating the risk of sexual exploitation and abuse [27].

Nonetheless, this study also revealed two counterintuitive findings. First, adolescents with positive gender attitudes had higher odds of experiencing sexual violence. This pattern is consistent with a study in China, which reported that adolescents aged 15–17 years with good knowledge, self-efficacy, and condom-use skills had a higher risk of experiencing sexual abuse [26]. Theoretically, positive attitudes toward health-related issues, including gender equality, are generally associated with better health outcomes [28], and gender-equitable attitudes were expected to protect against sexual abuse [29]. Second, adolescents who were aware of child protection services had nearly 4-fold higher odds of experiencing sexual violence. Conceptually, such awareness might be expected to be protective because adolescents who know about available services may be more likely to seek help, thereby reducing their risk [30].

Several theoretically grounded explanations may account for these counterintuitive findings. First, the association between positive gender attitudes and elevated risk of sexual abuse may reflect the influence of patriarchal social structures that remain deeply embedded in Indonesian society. Adolescents, particularly girls, with more gender-equitable attitudes may be more likely to express views related to gender equality and bodily autonomy. However, in patriarchal contexts where obedience, modesty, and men dominance are socially enforced, such expressions may provoke resistance from the surrounding environment, potentially increasing vulnerability to abuse rather than providing protection. Patriarchal norms may also structurally silence children’s voices—especially girls’—and limit their ability to negotiate safety or access supportive resources, increasing their susceptibility to sexual victimization. In some communities, these norms are institutionalized through child marriage practices that are culturally and religiously legitimized in certain settings, sometimes occurring immediately after menarche [3,31]. Unmarried girls beyond a socially accepted age may be stigmatized with labels such as “old maid” and regarded as a family disgrace; such stigma can reinforce power imbalances that heighten vulnerability to sexual violence [32]. Together, these perspectives help explain why gender-equitable attitudes may not function as protective factors in contexts where structural inequalities persist. Another plausible explanation relates to collectivist cultural norms that remain influential in many Asian societies, including Indonesia, where individual identity and decision-making are closely tied to the family and community [33]. Collectivist norms shape how sexual abuse is perceived, disclosed, and addressed. Although strong family and community ties may theoretically provide protection through social cohesion, empirical evidence suggests that, in the context of CSA, they can inhibit disclosure, delay intervention, and reduce willingness to report sexual abuse to preserve family reputation [34,35]. Moreover, prior studies have shown that collectivist norms may foster victim-blaming and stigma, whereby children who experience sexual abuse are blamed, labeled as bringing shame to the family, and denied appropriate support [36].

Informed by the existing literature, the second counterintuitive finding may be explained by persistent inequalities in access to child protection services in Indonesia. Adolescents who reported awareness of child protection services may live in areas where such services are limited or difficult to access. From a structural access and health systems perspective, awareness alone is unlikely to be protective in the absence of accessible, responsive services and effective mechanisms. A prior study demonstrated that the availability and geographic accessibility of integrated health, education, and child protection services are critical in reducing the risk of CSA [6]. In Indonesia, access to child protection services remains uneven due to substantial geographic, infrastructural, and administrative disparities [37]. Within Indonesia’s decentralized governance context, child protection service capacity varies widely across regions, with more developed provinces possessing better infrastructure and reporting systems. In contrast, smaller or less developed provinces, particularly in remote areas, often face shortages of essential child protection services, limited institutional capacity, and underdeveloped infrastructure. The literature indicates that restricted service availability in these settings can hinder prevention efforts, delay case handling, and suppress disclosure and reporting of CSA, thereby increasing adolescents’ vulnerability and leaving many cases undocumented [38]. Collectively, consistent with the counterintuitive finding regarding child protection services, these considerations suggest that awareness of these services alone is not sufficient to function as a protective factor without equitable access and adequate service capacity. Strengthening child protection systems—particularly in underserved and remote provinces—through improved infrastructure, workforce development, and coordinated referral mechanisms may be essential to ensure that awareness can be translated into meaningful protection to prevent CSA.

Because the exposures (e.g., violence exposure in work and domestic environments, and information and awareness related to child protection services) and the outcome (experience of sexual abuse) were measured at a single point in time, the temporal sequence of these associations cannot be determined. For example, it remains unclear whether positive gender attitudes or awareness of child protection services preceded the experience of sexual abuse or emerged afterward as a consequence of victimization or participation in prevention programs. Similarly, although the absence of violence exposure appeared to be protective, the cross-sectional design prevents the determination of the direction of these relationships. Therefore, the associations identified in this study should not be interpreted as causal pathways. Future longitudinal research would provide a more robust understanding of whether the identified variables truly function as risk or protective factors by tracking temporal patterns and changes over time. Qualitative studies could also help clarify the cultural, relational, and contextual norms underlying both the expected and counterintuitive findings—for example, how adolescents perceive and manage risks, how families respond to disclosures of sexual abuse, and how broader structural norms influence vulnerability. Combining longitudinal and qualitative approaches could increase the robustness of the findings and validate the frameworks proposed in this discussion.

Use of the SNPHAR 2024 strengthened the external validity of the findings by supporting their representativeness for Indonesian adolescents. However, generalizability to other age groups or cultural contexts may be limited. Because the study focused on adolescents aged 13–17 years, the findings may not apply to younger children or older adolescents, who may have different experiences and risk profiles. Additionally, unique cultural elements in Indonesia, including family structures, gender roles, and child protection norms, may shape these associations, potentially limiting transferability to other countries or cultural contexts.

This study has several limitations. First, because the topic is highly sensitive, self-reported sexual abuse experiences are subject to recall bias and social desirability bias, which may affect response accuracy. Given the strong stigma associated with CSA, some respondents may have chosen not to disclose their experiences. This would likely bias the results toward underreporting, suggesting that the true prevalence may be higher than reported and that some associations may be attenuated. However, the survey implemented several standard quality-assurance procedures, including the use of validated and culturally adapted questionnaires for sensitive items, enumerator training, and standardized data collection protocols to reduce these potential sources of bias. Second, the proportion of respondents reporting sexual abuse was relatively small (8.7%). This outcome imbalance may weaken the statistical power of the analyses and contribute to unstable or seemingly counterintuitive risk estimates. Therefore, the findings of this study, particularly the counterintuitive associations, should be interpreted with caution and further examined through follow-up studies using qualitative or longitudinal approaches.

Notes

Conflict of Interest

The authors have no conflicts of interest associated with the material presented in this paper.

Funding

This publication was supported by the Indonesia Endowment Fund for Education Agency (Lembaga Pengelola Dana Pendidikan/LPDP), Ministry of Finance of the Republic of Indonesia.

Acknowledgements

The authors would like to express their sincere gratitude to the Ministry of Women’s Empowerment and Child Protection, Republic of Indonesia, for permission to access, analyze, present, and publish the data used in this study.

The funders had no involvement in the study design, data analysis, or interpretation of the results.

Author Contributions

Both authors contributed equally to conceiving the study, analyzing the data, and writing this paper.

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