In short

• Analysis of the Birth to Twenty Plus cohort identified distinct trajectories of physical and sexual violence across childhood and adolescence.
• Most children experienced increasing exposure to violence during adolescence, while a significant minority faced chronically increasing risks over time.
• Boys, children from poorer households and those with less educated mothers were more likely to experience persistent physical violence.
• Findings highlight the need for early, targeted and coordinated interventions across schools, families, health services and social protection systems.

Violence against children is a common and pervasive problem in South Africa; however, little research exists which examines how violence follows children throughout their early lives. A recent HSRC analysis of the largest and longest running study of child and adolescent health and development identified patterns and trajectories of physical and sexual violence among over 2,000 children.

Violence against children remains a major concern in South Africa. For example, according to a 2025 Action Society report, the child rape rate in 2022/23 stood at 87 per 100,000 children, consistently higher than the rate for the total population. The same report estimates that South Africa records between 700 and 1,000 child murders each year, or around five child murders per 100,000 children.  

However, official crime statistics capture only a portion of children’s experiences, as they do not identify how the violence that is experienced increases or abates over time. Additionally, studies indicate that at times, victims or their caregivers may delay disclosure or not report incidents of violence for a myriad of reasons. 

Action Society, a civil rights organisation fighting for the protection of South African citizens through active advocacy for policy change, has highlighted a forensic crisis in backlogs of DNA testing, procedural delays which cripple prosecution, and a National Register for Sex Offenders which remains closed to the public. These issues limit families’ and institutions’ ability to identify known offenders and protect children from repeat harm.  

Studying childhood trajectories 

Although many studies identify risk factors for violence against children and how pervasive the problem is, fewer studies have examined how children experience different forms of violence over time and whether these experiences follow different developmental pathways across childhood and adolescence.  

Therefore, HSRC researcher Dr Sara Naicker, in collaboration with Lilian Muchai and Prof. Juliana Kagura from the University of the Witwatersrand, recently conducted an analysed long-term data to identify how being subjected to physical and sexual violence changed throughout the early lives of children and what early-life factors predicted these experiences.  

The analysis was published in a recent journal article titled Early life factors associated with childhood trajectories of violence among the Birth to Twenty-Plus Cohort in Soweto, South Africa. 

Researchers took data from the Birth to Twenty Plus cohort, a long-running prospective birth cohort of children born in public health facilities in Soweto between 23 April and 8 June 1990. The original cohort enrolled 3,273 children and followed them through childhood and adolescence into adulthood, collecting data on physical, social and psychosocial development.  

To identify patterns of child victimisation Naicker, Muchai, and Kagura included children who had reported on their exposure to physical or sexual violence within a short period before at least two of four ages: five, 11, 15 and 18. Their analysis included 2,057 children with sufficient data for physical violence trajectories and 2,051 children with sufficient data for sexual violence trajectories.  

What is a violence trajectory?  A violence trajectory shows how children’s experiences of violence change as they grow up. Instead of looking at violence at only one point in time, researchers followed children from childhood into adolescence to see whether experiences of violence increased, decreased, or stayed the same over time.

Physical violence trajectories  

At age five, 14.0% of participants had experienced physical violence. This rose sharply to 71.8% at age 15, before declining to 38.6% at age 18. “Findings show that the majority of the children in the present study exhibited an increasing pattern of physical violence as they grew older and engaged with more environments outside the home,” the researchers wrote. 

Children’s experiences of violence did not follow a single, uniform route. For both physical and sexual violence, the researchers identified two distinct trajectories. The first group, labelled “adolescent limited” (65.1% of children in the physical violence group), included children whose risk of experiencing physical violence increased between ages 5 and 15, before declining by age 18. The second group, labelled “chronic increasing” (34.9% of children who experienced physical violence), included children whose risk of experiencing violence continued to increase throughout adolescence, rather than declining after mid-adolescence.  

Physical violence based on sex characteristics 

Boys were more likely than girls to belong to the “chronic increasing” physical violence trajectory. After adjusting for other factors, boys had 67% higher odds of being in this group than girls. “A possible reason for this is the fact that boys experience more conduct problems and exhibit greater externalising behaviour compared to girls, which places them at a heightened risk for both physical violence victimisation and perpetration,” the researchers wrote. 

Poverty and maternal education 

Children from middle socioeconomic households (that fell into the middle third of the study sample, based on household asset ownership) had 32% lower odds of being in the “chronic increasing” physical violence group compared with children from low socioeconomic households. Additionally, children whose mothers had secondary education had higher odds of belonging to the “chronic increasing” physical violence group compared with children whose mothers had post-school training.  

“In many contexts, caregiving responsibilities continue to fall disproportionately on women,” Naicker told the Review. “However, maternal education may also reflect broader household resources, access to opportunities, and structural inequalities that influence children’s exposure to violence.” 

Sexual violence trajectories 

Sexual violence followed a different developmental pattern to physical violence. Reported sexual violence was very low at age five (0.8%) but rose to 28.9% by age 18. The “adolescent limited” sexual violence group (74.1% of children who experienced sexual violence) reported low experiences at age five, but their risk began increasing around age 11, peaked around age 15 and then declined. Risk for the “late increasing” group (25.9% of children who experienced sexual violence) also began rising around age 11, but instead of declining after age 15, continued to increase to age 18.  

Fewer early-life predictors found for sexual violence 

“For sexual violence victimisation trajectories, higher socioeconomic status appeared to be protective against inclusion in the late increasing sexual violence victimisation group. However, this association was not significant after other factors were considered,” the researchers wrote.  

This was also true of lower household crowding and higher maternal education and paternal education. 

Why these findings matter 

“These findings show that violence is not a single event or fixed experience in children’s lives,” Naicker said. “For some children, risk rises during adolescence and then declines, but for others it continues to intensify. Understanding these pathways helps us identify when and where prevention efforts are most urgently needed.” 

Potential impact 

For physical violence, the findings suggest that children from low socioeconomic households, boys, and children whose mothers have lower levels of education may need support earlier to reduce the risk of violence becoming chronic. The authors argue that these findings could help guide family support services, school-based violence prevention, parenting programmes and community-level interventions, such as poverty alleviation initiatives, safe after-school programmes for adolescents, and community-based psychosocial support services in areas where children face overlapping social and economic risks. 

For sexual violence, the findings point to early adolescence as a critical window for prevention. Interventions before and around age 11 could help address risks before they rise sharply. This may include safer school environments, age-appropriate education on consent and bodily autonomy, trusted reporting mechanisms, and stronger links between schools, families, health services and child protection systems. 

The study also has implications for how South Africa measures and responds to violence against children. Official crime statistics show reported cases, but many children’s experiences may never enter the criminal justice system. Studies that follow children from birth until adulthood could help fill this gap by showing how violence unfolds throughout childhood, including before it reaches crisis point.  

“Taken together, the findings highlight the need to move beyond one-size-fits-all responses to child violence,” Naicker said. “Prevention needs to start early, intensify during adolescence, and be linked across schools, families, health services, social development, and justice systems.” 

Research contacts and acknowledgement 

This Review article was written by HSRC science writer Jessie-Lee Smith, with inputs from Dr Sara Naicker in the HSRC’s Equitable Education and Economies Division. It was based on the paper Early life factors associated with childhood trajectories of violence among the Birth to Twenty-Plus Cohort in Soweto, South Africa written by Dr Sara Naicker, together with Lilian Muchai and Prof. Juliana Kagura from the University of the Witwatersrand. 

The survey team included those who have worked on the Birth to Twenty Plus cohort since 1989.