From telling to receiving: the disclosure-and-services cascade after childhood sexual abuse across 15 low- and middle-income countries

Most children who experience sexual abuse in low- and middle-income countries never receive formal help, but few studies have followed survivors through the steps from telling someone to receiving services. In this pooled cross-sectional analysis, we combined 15 nationally representative Violence Against Children and Youth Surveys (VACS) fielded between 2013 and 2024 in sub-Saharan Africa, Latin America, and Eastern Europe to describe this disclosure-and-services cascade and the factors associated with each step. The analytic sample comprised 3,608 respondents aged 18–24 years who reported sexual abuse before age 18 (2,852 female, 756 male). We estimated survey-weighted proportions for four steps: told anyone, knew where to seek formal help, sought help (among those who knew), and received help (among those who sought it). Design-based logistic regression with country fixed effects estimated adjusted odds ratios (aORs) for individual, family, and community factors. Overall, 47.1% (95% confidence interval [CI] 44.4–49.7) of survivors had told anyone and 34.8% (32.2–37.5) knew where to seek formal help. Of those who knew (n = 1,208), 24.8% (20.9–29.1) sought help, and of those who sought help (n = 339), 81.9% (75.9–86.7) received it. In total, 7.0% (5.7–8.5) of survivors received formal help; this proportion ranged from 0.9% to 26.3% across countries. Compared with male survivors, female survivors were more likely to tell anyone (aOR 2.30, 95% CI 1.73–3.05) and less likely to know where to seek help (aOR 0.68, 0.50–0.93); among survivors who knew where to go, female survivors were more likely to seek help (aOR 2.66, 1.39–5.09). Knowing where to seek help was more likely with older age, more schooling, and a living mother. Survivors who had ever married or cohabited were less likely to have told anyone (aOR 0.75, 0.58–0.96). No factor other than sex was associated with seeking help among those who knew where to go. Most survivors are lost before they reach a service: two in three do not know where to go, and three in four of those who know ultimately do not seek help. Once survivors seek help, most receive it. Interventions should make services known to young people, particularly those with less schooling, and address the barriers that keep survivors, especially young men, from using services they know about.