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Original Abstract

Background

Numerous national public inquiries have highlighted the problem of child sexual abuse in religious organizations. Despite this, evidence of population-wide prevalence is scarce.

Objective

To provide the first nationally representative prevalence estimates of child sexual abuse perpetrated by adults in religious organizations in Australia.

Methods

The Australian Child Maltreatment Study (ACMS) surveyed 8503 people aged 16 and over about their experiences of child maltreatment. Weighted prevalence estimates were calculated based on responses to the child sexual abuse questions from the Juvenile Victimization Questionnaire-R2: Adapted Version (ACMS).

Results

One in 250 people reported being sexually abused as a child by an adult in a religious organization (0.4 %, 95 % CI, 0.3–0.6 %). Men reported significantly higher rates of child sexual abuse by these perpetrators (0.8 %, 95 % CI, 0.5–1.2 %), compared to women (0.1 %, 95 % CI, 0–0.3 %). This type of sexual abuse was overwhelmingly perpetrated by men (0.4 %, 95 % CI, 0.3–0.6 %), compared to women (0 %, 95 % CI, 0–0.1 %), and was substantially more often experienced in Catholic organizations (71.9 %) than other Christian denominations or other religions. Prevalence of child sexual abuse in religious organizations has declined over time (2.2 % of men 65 years and older, compared with 0.2 % of 16–24-year-old men).

Conclusions

Child sexual abuse has been widespread in religious organizations in Australia. A decline over time indicates progress has been made in preventing sexual abuse of children. Religious organizations must take all reasonable measures to prevent child sexual abuse, with a particular need for interventions targeting male leaders, and organizational cultures

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Child Abuse & Neglect xxx (xxxx) xxxPlease cite this article as: Gabrielle R. Hunt et al., Child Abuse & Neglect, https://doi.org/10.1016/j.chiabu.2024.106946Available online 4 August 20240145-2134/© 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license(http://creativecommons.org/licenses/by/4.0/).The prevalence of child sexual abuse perpetrated by leaders or other adults in religious organizations in Australia Gabrielle R. Hunt a, Ben Mathews b,c,*, Daryl J. Higgins a, David Finkelhor d,e,f, Megan L. Willis g, Divna M. Haslam b,h,i, David Lawrence j, Franziska Meinck k,l,m, Hannah J. Thomas i,n,o, Eva Malacova o, Rosana E. Pacella p, James G. Scott q,r a Institute of Child Protection Studies, Australian Catholic University, Australia b School of Law, Queensland University of Technology, Brisbane, Australia c Johns Hopkins University, Bloomberg School of Public Health, United States of America d Crimes against Children Research Centre, United States of America e Family Research Laboratory, United States of America f Sociology at the University of New Hampshire, United States of America g Faculty of Health Sciences, Australian Catholic University, Australia h Parenting and Family Support Centre, University of Queensland, Brisbane, Australia i Queensland Centre for Mental Health Research, Wacol, Queensland, Australia j School of Population Health, Curtin University, Perth, Australia k School of Social & Political Science, University of Edinburgh, Edinburgh, UK l Faculty of Humanities, North-West University, Vanderbijlpark, South Africa m School of Public Health, University of the Witwatersrand, Johannesburg, South Africa n School of Public Heath, The University of Queensland, Australia o QIMR Berghofer, Medical Research Institute, Brisbane, Australia p Institute for Lifecourse Development, University of Greenwich, United Kingdom q Child Health Research Centre, The University of Queensland, Brisbane, Australia r Child and Youth Mental Health Service, Children's Health Qld, South Brisbane, Qld, Australia   A R T I C L E  I N F O   Keywords: Child sexual abuse Religious Clergy abuse Prevention A B S T R A C T   Background: Numerous national public inquiries have highlighted the problem of child sexual abuse in religious organizations. Despite this, evidence of population-wide prevalence is scarce. Objective: To provide the first nationally representative prevalence estimates of child sexual abuse perpetrated by adults in religious organizations in Australia. Methods: The Australian Child Maltreatment Study (ACMS) surveyed 8503 people aged 16 and over about their experiences of child maltreatment. Weighted prevalence estimates were calcu-lated based on responses to the child sexual abuse questions from the Juvenile Victimization Questionnaire-R2: Adapted Version (ACMS). Results: One in 250 people reported being sexually abused as a child by an adult in a religious organization (0.4 %, 95 % CI, 0.3–0.6 %). Men reported significantly higher rates of child sexual abuse by these perpetrators (0.8 %, 95 % CI, 0.5–1.2 %), compared to women (0.1 %, 95 % CI, 0–0.3 %). This type of sexual abuse was overwhelmingly perpetrated by men (0.4 %, 95 % CI, 0.3–0.6 %), compared to women (0 %, 95 % CI, 0–0.1 %), and was substantially more often experienced in Catholic organizations (71.9 %) than other Christian denominations or other * Corresponding author at: School of Law, Queensland University of Technology, Brisbane, Australia. E-mail address: b.mathews@qut.edu.au (B. Mathews).  Contents lists available at ScienceDirect Child Abuse & Neglect journal homepage: www.elsevier.com/locate/chiabuneg https://doi.org/10.1016/j.chiabu.2024.106946 Received 21 May 2024; Received in revised form 4 July 2024; Accepted 12 July 2024   Child Abuse & Neglect xxx (xxxx) xxx2religions. Prevalence of child sexual abuse in religious organizations has declined over time (2.2 % of men 65 years and older, compared with 0.2 % of 16–24-year-old men). Conclusions: Child sexual abuse has been widespread in religious organizations in Australia. A decline over time indicates progress has been made in preventing sexual abuse of children. Religious organizations must take all reasonable measures to prevent child sexual abuse, with a particular need for interventions targeting male leaders, and organizational cultures.   1. Introduction Child sexual abuse is acknowledged globally as a major public health issue, with widespread prevalence (Mathews et al., 2024; Pereda et al., 2009; Stoltenborgh et al., 2011), and demonstrated association with a range of adverse mental and physical health outcomes and health-risk behaviors throughout life (Guiney et al., 2022; Noll, 2021; Scott et al., 2023; Teicher & Samson, 2013; Trickett et al., 2011). Child sexual abuse involves both contact and non-contact sexual acts by any adult or child for sexual gratifi-cation, where the child victim either does not have capacity to give consent, or has capacity but does not give valid consent (Mathews & Collin-Vézina, 2019). Child sexual abuse is generally two to three times more likely to be perpetrated against girls than boys (Stol-tenborgh et al., 2011), but in organizational settings, boys are more likely to be victimized (Bajos et al., 2023; John Jay Research Team, 2004; Mathews et al., 2024). Non-disclosure of child sexual abuse is common (Alaggia et al., 2017). This is influenced by multiple factors connected to the child's characteristics (including shame, self-blame, and fear), the perpetrator's characteristics (including relational power dynamics and threats); and factors at the societal level (including taboos around sexuality, and stigma attaching to victims; Collin-Vézina et al., 2015). In their review, Alaggia et al. (2017) found non-disclosure is even more likely for younger children, for boys, and where the perpetrator is a parent, adult family member, or an organizational or religious authority figure. Boys' reluctance to disclose is amplified by extreme anger, shame and withdrawal, fear of being labelled homosexual, fear of being perceived as a perpetrator, and fear of being seen as weak (Fontes & Plummer, 2010). Compared with other forms of child maltreatment, sexual abuse has additional unique characteristics that explain its strong as-sociation with mental disorders (Noll, 2021). The sexual abuse of children by adults entrusted with the care of children presents a range of additional concerns for society. When inflicted by individuals in relationships of power – such as parents, and religious authority figures these experiences may damage internal working models of attachment i.e., the trust, security and dependence underpinning those relationships (Edwards et al., 2012; Smith & Freyd, 2013; Smith & Freyd, 2014; Trickett et al., 2011). In religious settings, where the organizations and the adults within them hold themselves as figures of special trust and possess additional profound social and spiritual power that magnify children's vulnerability and dilute parental protective capacity, there are additional imperatives for prevention (Böhm et al., 2014). This paper examines the prevalence of child sexual abuse perpetrated by leaders or adults in religious organizations in Australia. The exploitation of spiritual authority by clergy and religious perpetrators of sexual abuse has been shown to be particularly insidious, exemplified by perpetrators who took advantage of their status as ‘God's earthly representative’ as well as the vulnerability of the child to punishment and exile for ‘sin’ (Australian Government, 2017a). This can force children into compliance and silence (Death, 2013). Accordingly, a child's experience of sexual abuse, within an organi-zational setting, perpetrated by religious authority figures, is both particularly egregious and of magnified harm because of this tripartite abuse of power. 1.1. Revelations of child sexual abuse in religious settings It is only in recent decades that the enduring social problem of child sexual abuse in religious settings has begun to be revealed, and mostly within Western societies (Mathews, 2019). Social and scientific awareness of child sexual abuse has developed since the late 1970s, both in relation to acts perpetrated by adults in familial and organizational settings. Here, a cornerstone of recent progress has been the uncovering of the widespread perpetration of child sexual abuse in religious organizations, often achieved through com-missions of inquiry. In Australia, a steady accumulation of state-based inquiries and media coverage placed organizational child sexual abuse squarely within the public discourse (Mathews, 2019), but organizational responses remained inadequate. In late 2012, the Prime Minister of Australia, Julia Gillard, initiated the Royal Commission Into Institutional Responses to Child Sexual Abuse (the Australian Royal Commission), due to intensified concern about the prevalence of child sexual abuse within public and private institutional contexts, the inadequacy of preventative and responsive measures undertaken by institutions, and active concealment of such abuse by institutions, including by the Roman Catholic Church (Australian Government, 2013). The Australian Royal Commission was a momentous undertaking, arguably the most comprehensive inquiry into institutional child sexual abuse ever conducted globally (Mathews, 2017). Part of its work involved conducting private sessions to hear from individuals who had experienced child sexual abuse in these settings. Over 8000 personal stories of child sexual abuse in institutions were heard, where over half (58.6 %) reported child sexual abuse in a religious institution (Australian Government, 2017a). A large majority of these private session reports relating to religious institutions were about sexual abuse that occurred in religious schools (39 %) and out- of-home care (35.2 %), as well as other religious contexts such as religious or worship services, youth groups, and church-run camps (26.4 %; Australian Government, 2017a). A significant proportion of child sexual abuse cases reported to the Royal Commission were from victim/survivors related to Catholic Church institutions (61.8 % of private sessions about sexual abuse in religious settings, or G.R. Hunt et al.                                                                                                                                                                                                        Child Abuse & Neglect xxx (xxxx) xxx336.2 % of total private sessions), with reports also coming from the Anglican Church, other Christian denominations (e.g., the Salvation Army and the Uniting Church etc.), Jewish institutions, and fewer cases in other religious institutions (e.g., Islamic, Baha'i, and Hindu institutions; Australian Government, 2017a; Australian Government, 2017b). 1.2. General prevalence of child sexual abuse in religious organizations: analyses by commissions of inquiry, and gaps in evidence of population-wide prevalence The Australian Royal Commission conducted separate analyses of claims or allegations made to institutions, in order to estimate the prevalence of child sexual abuse in Catholic Church settings and Anglican Church settings (Australian Government Royal Commission into Institutional Responses to Child Sexual Abuse, 2017b). For the Catholic Church, the Commission obtained data from 201 Catholic Church authorities to identify the number and features of claims of alleged child sexual abuse made to these authorities between January 1, 1980 and February 28, 2015, regarding abuse from 1950 to 2010. The survey also captured data on the number of clergy and non-clergy employed from 1950 to 2010, to enable esti-mation of the proportion of offenders. Overall, there were 4444 claimants who alleged incidents of child sexual abuse, involving 1880 identified offenders and 530 other unspecified offenders. Of the 4444 claimants, 78 % were male and the average age at the first alleged incident was 11.4 years (11.6 for males; 10.5 for females). Of the 1880 identified alleged offenders, 90 % were male, 37 % were nonordained religious, 30 % priests, 29 % lay people, and for the remaining 4 %, their religious status was not known (Australian Government Royal Commission Into Institutional Responses to Child Sexual Abuse, 2017b). For the Anglican Church, there were 1119 complaints of child sexual abuse made to all 23 Anglican Church dioceses between 1980 and 2015, involving 1085 individual com-plainants. Out of the 1085 claimants, 75 % were male and the average age at the first alleged incident was 11.8 years. These allegations involved 569 offenders, of whom 43 % were ordained clergy, 50 % were lay people, and for the remaining 7 %, their religious status was not known, and 94 % were male (Australian Government Royal Commission Into Institutional Responses to Child Sexual Abuse, 2017). These data provided a clearer understanding of the nature and extent of institutional sexual abuse in religious settings, though were significantly limited in that they only represented allegations formally made to the church and represents an experience for which many people do not disclose, therefore did not enable a population-wide understanding of prevalence. This evidence gap has been a longstanding issue in many countries worldwide. Informed by similar revelations to those occurring in Australia, inquiries into clergy-perpetrated child sexual abuse have been undertaken across several countries, such as England and Wales, Ireland, France, the Netherlands, Belgium, Germany, Canada, and the United States (Böhm et al., 2014; Terry, 2015). These inquiries have consistently highlighted the concerning nature and extent of child sexual abuse within religious settings, particularly the Catholic Church, the harms associated with these experiences, and the tendency for boys to be more vulnerable to sexual abuse in these settings compared with girls. The first extensive study of the prevalence of child sexual abuse by Catholic clergy occurred in the United States, where researchers generated a comprehensive description of reported child sexual abuse by Catholic priests. Their study collated data from church records on all known allegations of abuse between 1950 and 2002, from 97 % of all dioceses across the US. They found allegations against 4392 priests for sexually abusing nearly 11,000 children between 1950 and 2002, which equated to 4 % of priests in ministry during that time being the subject of allegations (John Jay College, 2004). Data collected over the following decade indicated 5 % of priests in ministry since 1950 were the subjects of allegations of abuse against approximately 15,000 minors (Terry et al., 2011). Yet, as with analyses by the Australian Royal Commission, even these comprehensive analyses were by their nature limited to allegations that had been formally made to the Church, and accordingly represent only a fraction of the true prevalence. Since then, surveys of the general population have been conducted in several countries, including the Netherlands (Langeland et al., 2015), Germany (Witt et al., 2019), and France (Bajos et al., 2023) to generate more reliable estimates of the prevalence of child sexual abuse in religious settings. In the Netherlands, Langeland et al. (2015) found an estimated 1.7 % of the population aged 40 years and older had experienced child sexual abuse by the Catholic Church since 1945. In Germany, Witt et al. (2019) found 2.8 % had expe-rienced child sexual abuse by a Catholic priest or Protestant pastor. More recently, in France, Bajos et al. (2023) estimated 0.8 % of children had experienced child sexual abuse in the Catholic Church since 1950. An earlier population survey in Ireland concluded that 5.8 % of all boys and 1.4 % of all girls who had experienced childhood sexual abuse were abused by clergy or religious (McGee et al., 2002). Men are consistently overrepresented as both victims and perpetrators of child sexual abuse in religious settings (Bajos et al., 2023; Langeland et al., 2015; Witt et al., 2019). These prevalence estimates in various countries have been specific to church leadership, particularly in the Catholic Church. While national inquiries have consistently shown child sexual abuse to be most common in the Catholic Church (the largest Christian denomination globally), there are reports in other Christian denominations and other non-Christian religious settings. Understanding the prevalence of child sexual abuse in all religious settings is essential for informing prevention efforts (Keenan, 2012; Witt et al., 2019). Although the Australian Royal Commission brought to light the severity of this issue, we have not yet had nationally repre-sentative prevalence data in Australia. The Australian Child Maltreatment Study (ACMS), a nationally representative survey on the prevalence of child maltreatment, found that 28.5 % of people experienced child sexual abuse, comprising 37.3 % of women, 18.8 % of men, and 51.9 % of people with diverse gender identities (Mathews, Pacella, et al., 2023). This Australian national prevalence is similar to child sexual abuse prev-alence estimates generated in comparable nations using similar survey items, such as the UK survey which identified child sexual abuse prevalence of 24.1 % (Radford et al., 2013). Further analysis in the ACMS identified prevalence of sexual abuse by eight different perpetrator classes, with one class comprising adult institutional caregivers, which included a wide range of adults in religious settings (both clergy and lay people), as well as sports coaches, teachers, and instructors in cultural, artistic and recreational settings (Mathews et al., 2024). Child sexual abuse by all G.R. Hunt et al.                                                                                                                                                                                                        Child Abuse & Neglect xxx (xxxx) xxx4institutional perpetrators combined was experienced by 2.0 % of the population, with significantly higher prevalence among those aged 45 years and over (2.8 %, comprising 4.2 % of men and 1.7 % of women), and significantly lower prevalence among those aged 16–24 years (0.5 %, comprising 0.6 % of men and 0.5 % of women; Mathews et al., 2024). However, this analysis did not explore the prevalence of child sexual abuse perpetrated by those in religious organizations. This information is needed to inform prevention and early intervention initiatives specifically targeting religious organizations. 1.3. Aim The current study aimed to estimate the first national prevalence of child sexual abuse in Australia perpetrated by leaders or other adults in religious organizations across a broad range of Christian denominations and other religions, using data from the ACMS. We have included consideration of each type of child sexual abuse, including differentiating between non-contact and contact child sexual abuse. 2. Method This study utilised data from the ACMS, a cross-sectional survey of 8503 randomly selected Australians aged 16 years and older. It included an oversample of young people aged 16–24 (n = 3503), with 2000 participants in the 25–44 and 45–64 age categories, and 1000 in the 65-year-old and over age group (Table 2). Women made up just over half of the sample (50.9 %; men = 48.1 %; diverse genders = 0.9 %; Haslam et al., 2023; Higgins et al., 2024). The sample was compared to Australian Census data and to National Health Survey data to ensure it was representative of the population, including across factors such as gender, age, and Indigenous status, and across all states and territories (Haslam et al., 2023). Participants were slightly more likely to have higher income and education, socioeconomic advantage, and be Australian-born. This was addressed by applying population weights to ensure analyzed outcomes were representative of the general population (Haslam et al., 2023). Computer-assisted telephone interviewing, using a fully mobile sample frame, was used to interview participants about their ex-periences of child maltreatment before age 18 years. The Juvenile Victimization Questionnaire (JVQ) – R2: Adapted Version (Australian Child Maltreatment Study) was used to assess experiences of child maltreatment by asking participants behaviorally-specific questions about their experiences in childhood, with binary response options of ‘Yes’ or ‘No’. The instrument was found to be reliable and valid for measuring child maltreatment (Mathews, Meinck, et al., 2023). In this analysis, we report responses to the items on child sexual abuse, including both contact and non-contact sexual abuse. 2.1. Child sexual abuse All four items that measured child sexual abuse – one item measuring non-contact sexual abuse, and three items measuring contact sexual abuse – were included in this analysis. These items were designed to conform to a robust conceptual model of child sexual abuse (Mathews & Collin-Vézina, 2019). Non-contact sexual abuse included abusive exposure or voyeurism for sexual gratification, constituted by a person looking at a child's private parts when they should not have, or making a child look at the person's private parts. Any response of ‘Yes’ to the non-contact sexual abuse item was counted as an instance of non-contact sexual abuse. Contact sexual abuse includes: touching a child's private parts for sexual gratification or making the child touch the offender's private parts; attempted forced sexual intercourse that was not completed; and completed forced sexual intercourse (Mathews, Meinck, et al., 2023). An affirmative response to any contact sexual abuse items was counted as an instance of contact sexual abuse. A ‘Yes’ response to any of the four items was counted as an instance of child sexual abuse. The survey also included two items assessing online sexual victim-ization, through non-consensual sharing of sexual images of the child, and adult solicitation. These items were only included for participants aged 16–24 due to the availability and use of online technology at relevant times; further, the responses to these items were not included in the calculation of child sexual abuse prevalence estimates, since these behaviors do not always satisfy the conceptual requirements to constitute child sexual abuse. 2.2. Perpetrators Participants who responded affirmatively to any of the child sexual abuse items were asked follow-up questions to elicit infor-mation about the characteristics of the experience. Participants were asked, “Who were all the people who ever did this to you?” Interviewers coded responses from a range of 42 options, spanning perpetrators within and beyond the family, including both adults and adolescents. We considered only instances perpetrated by leaders and other adults in a religious organization, which included male and female clergy members, priests, pastors or ordained leaders in a religious organization, as well as other male and female adults in a religious organization. Information on the perpetrator's religious denomination was gathered using a range of 17 options, and an overview of the prevalence by each perpetrator type has been provided in a supplementary file. 2.3. Age of onset Participants were asked how old they were the first time the experience occurred. Interviewers coded responses based on the year of age reported. G.R. Hunt et al.                                                                                                                                                                                                        Child Abuse & Neglect xxx (xxxx) xxx52.4. Statistical analysis Population-weighted prevalence estimates and 95 % Confidence Intervals (CIs) were calculated for the sample and by gender and age group, using the Taylor Series expansion method (Wolter, 2007). Confidence intervals that did not overlap were considered statistically significant at the 5 % level. Diverse genders included any person who identified in a way other than “man” or “woman”, including trans and non-binary people (Higgins et al., 2024). We also calculated the prevalence of child sexual abuse by perpetrator gender (man vs. woman). Analyses were conducted in SPSS (Version 29) and were independently checked. 2.5. Ethics approval The Australian Catholic University Human Research Ethics Committee (ACU HREC) approved the analysis of the ACMS dataset (2023-3004 N). The ACMS project was approved by the Queensland University of Technology Human Research Ethics Committee (#1900000477). 3. Results 3.1. Overall prevalence One in 250 people reported being sexually abused by a leader or adult in a religious organization during childhood in Australia (0.4 %, 95 % CI, 0.3–0.6 %) (Table 1). This is equivalent to an estimated 87,000 Australian adults who have been sexually abused as a child by leaders or other adults in religious organizations (95 % CI, 50,000 - 123,000). 3.2. Prevalence trends by gender Clear gender differences were observed. Men reported significantly higher rates of child sexual abuse by a leader or adult in a religious organization (0.8 %, 95 % CI 0.5–1.2 %) than women (0.1 %, 95 % CI 0.0–0.3 %) (Table 1). No people of diverse genders reported child sexual abuse by a leader or adult in a religious organization in our study. This finding does not mean that gender-diverse people do not experience this type of abuse. Rather, it may be explained by the low overall number of participants in the ACMS reporting gender diversity overall (n = 126), but particularly in the older age groups (65 years and older, n = 5), where child sexual abuse in religious settings was more prevalent. Women were more likely to report contact sexual abuse by a leader or adult in a religious organization (0.1 %, 95 % CI 0.0–0.3 %) compared to non-contact sexual abuse (0 %, 95 % CI 0.0–0.1 %), but men reported similar rates of contact (0.5 %, 95 % CI 0.3–0.9 %) and non-contact (0.5 %, 95 % CI 0.3–0.8 %) sexual abuse (Table 2). 3.3. Prevalence trends by age group We found differences in child sexual abuse by a leader or adult in a religious organization across the four age groups. The oldest (65 years and older) group reported significantly higher prevalence rates (1.0 %, 95 % CI 0.5–1.9 %), compared to the youngest (16 to 24 years age) group (0.1 %, 95 % CI 0.0–0.3 %; Table 1). This difference was particularly prominent for men: those aged 65 and over (2.2 %; 95 % CI 1.1 %–4.3 %) were significantly more likely to have experienced child sexual abuse in a religious organization than their counterparts aged 16–24 years (0.2 %; 95 % CI 0.1 %–0.5 %) or 25–44 years (0.2 %; 95 % CI 0.1 %–0.6 %; Table 1). In comparison, the prevalence rates by age group for women were consistently low (0–0.2 %), with overlapping confidence intervals. Table 1 Weighted prevalence estimates (with 95 % CIs) of child sexual abuse (CSA) perpetrated by a leader or adult in a religious organization during childhood by age group and gender.  Age group Number of Respondents n Experienced CSA by Leader or Adult in Religious Organization % 95 % CI All  8503 0.4 % 0.3–0.6 % Men  4195 0.8 % 0.5–1.2 % Women  4182 0.1 % 0–0.3 % Diverse Genders  126 0 % 0 % 16–24 years  3500 0.1 % 0.0–0.3 % Men  1748 0.2 % 0.1–0.5 % Women  1662 0.1 % 0.0–0.5 % 25–44 years  2000 0.2 % 0.1–0.5 % Men  992 0.2 % 0.1–0.6 % Women  986 0.2 % 0.0–0.8 % 45–64 years  2003 0.4 % 0.2–0.8 % Men  964 0.8 % 0.4–1.6 % Women  1030 0.1 % 0.0–0.8 % 65 years and older  1000 1.0 % 0.5–1.9 % Men  491 2.2 % 1.1–4.3 % Women  504 0 % 0 %  G.R. Hunt et al.                                                                                                                                                                                                        Child Abuse & Neglect xxx (xxxx) xxx63.4. Perpetrators Prevalence of child sexual abuse perpetrated by male leaders or other adults in a religious organization (0.4 %, 95 % CI 0.3–0.6 %) was significantly higher than that perpetrated by female leaders or other adults (0.0 %, 95 % CI 0.0–0.1 %; Table 3). More specifically, prevalence of child sexual abuse perpetrated by male leaders (0.3 %, 95 % CI 0.2–0.6 %) was significantly higher than abuse perpetrated by other male adults (0.1 %, 95 % CI 0.0–0.2 %) or by females (leaders or adults = 0.0 %, 95 % CI 0.0–0.1 %). Participants were dramatically more likely to report that abuse had occurred in a Catholic organization (71.9 % of people reporting child sexual abuse in a religious organization; Fig. 1), than in organizations from other Christian denominations (21.8 %) or non-Christian religious organizations (5.1 %). Due to small participant numbers, other Christian denominations were combined and included Anglican, Je-hovah's Witness, Orthodox, and other Christian religions, and non-Christian religions, including Islam and others. Despite some experiencing multiple incidents of child sexual abuse in a religious context, each participant's experience occurred in only one religion or Christian denomination. 3.5. Age of first victimization The average age at which child sexual abuse was first experienced in religious organizations was 9.8 years across each sexual abuse type (ranging between 7.7 years for contact sexual abuse involving touching and 11.4 years for non-contact sexual abuse). Contact sexual abuse cases involving touching had a significantly lower average age at first victimization (7.7) compared to attempted in-tercourse (10.8), and completed intercourse (9.2; Table 4). 4. Discussion The current study provided the first nationally representative prevalence estimates of child sexual abuse perpetrated by a leader or another adult in a religious organization in Australia. These findings advance our understanding of this topic in the following ways: the national prevalence in Australia, as also compared with other nations; the contribution of child sexual abuse by religious perpetrators relative to the overall burden of child sexual abuse; the perpetration by men; the disproportionately high victimization of boys; the disproportionate contribution of perpetration in Catholic organizations; and the decline over time in sexual abuse of boys in religious organizations. Table 2 Weighted prevalence (with 95 % CIs) of participants who reported non-contact or contact child sexual abuse by a leader or adult in a religious or-ganization during childhood, by gender.  Age group N Non-Contact CSA by Leader or Adult in Religious Organization 95 % CIs Contact CSA by Leader or Adult in Religious Organization 95 % CIs All  8503  0.2 % 0.1–0.4 %  0.3 % 0.2–0.5 % Men  4195  0.5 % 0.3–0.8 %  0.5 % 0.3–0.9 % Women  4182  0.0 % 0.0–0.1 %  0.1 % 0.0–0.3 % Diverse Genders  126  0 % 0 %  0 % 0 %  Table 3 Weighted prevalence (with 95 % CIs) of participants who reported child sexual abuse by male or female leader or other adult in a religious or-ganization during childhood, by gender.  Perpetrator type Total (%, CI) Men Women Male leader 0.3 % (0.2–0.6 %) 0.6 % (0.4–1.0 %) 0.1 % (0.0–0.3 %) Other male adult (non‑leader) 0.1 % (0.0–0.2 %) 0.2 % (0.1–0.4 %) 0.0 % (0.0–0.2 %) Any male 0.4 % (0.3–0.6 %) 0.8 % (0.5–1.2 %) 0.1 % (0.0–0.3 %) Female leader 0.0 % (0.0–0.1 %) 0.0 % (0.0–0.2 %) 0 % Other female adult (non‑leader) 0.0 % (0.0–0.1 %) 0.0 % (0.0–0.2 %) 0 % Any female 0 % (0.0–0.1 %) 0.1 % (0.0–0.2 %) 0 %  G.R. Hunt et al.                                                                                                                                                                                                        Child Abuse & Neglect xxx (xxxx) xxx74.1. Prevalence Our analysis found that one in 250 participants experienced child sexual abuse (0.4 %) by a leader or another adult in a religious organization during childhood in Australia. Our overall prevalence estimates are slightly lower than prevalence estimates from other countries that focused on child sexual abuse in Catholic Churches alone. In France, Bajos et al. (2023) found 1.28 % of men and 0.34 % of women had experienced contact child sexual abuse by Catholic Church members. In the Netherlands, Langeland et al. (2015) found 1.7 % of people aged 40 and over (2.7 % of men and 1.7 % of women) had experienced contact child sexual abuse within the Dutch Roman Catholic Church. Here, we have provided nationally representative prevalence estimates of child sexual abuse by any leader or other adult, within Catholic and other religious organizations in Australia. It is possible that the extensive prevention efforts under-taken in Australia, especially as applied to organizations, together with other increased social awareness of child sexual abuse and heightened supervision of children, have contributed to a decline in younger generations (Mathews, 2017; Mathews et al., 2024). In addition, our sample included people aged 16 and over at the time of the survey, and some other studies with comparatively higher prevalence covered an older age group (e.g., Langeland et al., 2015). 4.2. Contribution of child sexual abuse perpetrated by religious leaders or other adults relative to total burden The ACMS found that the overall prevalence rate for child sexual abuse by any perpetrator was 28.5 % (Mathews, Meinck, et al., 2023). Within this, 2.0 % of the population experienced child sexual abuse by an adult in any organizational context; this included the 0.4 % we found for religious organizations, and prevalence of approximately 0.7 % in educational organizations, 0.4 % in cultural and Fig. 1. Weighted proportion (%) of people who experienced child sexual abuse by a leader or adult in a religious organizations by each religion/ denomination (n = 27, 0.4 % of ACMS participants). Note. The ‘Other Christian’ category includes Anglican, Jehovah's Witness, Orthodox, and Other Christian religions. The ‘Other non-Christian’ religious category includes Islam and other non-Christian religions. Table 4 Weighted prevalence (with 95 % CIs) and average age of first victimization by type of child sexual abuse by leaders and other adults in religious organizations.  Type of sexual abuse Total (%, CI) Average Age (Years) of First Victimization Religious (Standard Error) Non-contact sexual abuse 0.2 % (0.1–0.4 %) 11.4 (1.1) Contact sexual abuse (touching short of intercourse) 0.3 % (0.2–0.5 %) 7.7 (0.7) Contact sexual abuse (attempted intercourse) 0.1 % (0.1–0.3 %) 10.8 (1.3) Contact sexual abuse (abusive intercourse) 0.1 % (0.0–0.2 %) 9.2 (1.3)  G.R. Hunt et al.                                                                                                                                                                                                        Child Abuse & Neglect xxx (xxxx) xxx8recreational organizations, 0.4 % in health organizations, and 0.1 % in sports organizations (Mathews et al., 2024, Supplementary File, Table 4). In the ACMS, child sexual abuse by any perpetrator was strongly associated with mental disorders (Scott et al., 2023), health risk behaviors (Lawrence et al., 2023), and health service utilization (Pacella et al., 2023). Considering the nature of child sexual abuse inflicted by perpetrators within religious organizations, this subset of child sexual abuse, although small overall, constitutes a highly significant burden of sexual victimization likely to be associated with a massive toll on mental health and health risk behaviors, particularly for men. While child sexual abuse by religious perpetrators appears less common than by some other perpetrator classes, and has declined in recent years for men, it has nevertheless affected tens of thousands of Australians and their families and com-munities, and remains a significant problem. As others have acknowledged (Shattuck et al., 2016), low percentage rates should not mislead us into concluding these events are numerically rare, and we must maintain prevention efforts in order to continue declines in prevalence. 4.3. Perpetration by men Child sexual abuse in religious organizations was overwhelmingly perpetrated by male religious leaders, compared to other male adults or female leaders or other adults. This finding about sexual abuse perpetration is consistent with findings elsewhere. For example, Bajos et al. (2023), found over 93 % of all cases of child sexual abuse in the Roman Catholic Church in France were perpetrated by men. This may be explained by a broader understanding of the perpetration of child sexual abuse, where it is over-whelmingly perpetrated by men not just in religious organizations but also in families, communities, other institutional settings, and by male adolescents (Mathews et al., 2024). In religious organizations, men are also much more likely to hold positions of power compared to women. 4.4. The victimization of boys This analysis found a reversal of the normal trend in overall child sexual abuse victimization by child gender. Prevalence of child sexual abuse by perpetrators in religious organizations was significantly higher for men (0.8 %) than for women (0.1 %). This is a reverse of the typical two to three times higher prevalence in girls compared to boys for sexual abuse by all perpetrators combined (Mathews et al., 2024). Among those in the older age groups, this disproportionate victimization was even more marked. Our findings on the victimization of boys in religious settings are consistent with other prevalence studies (Bajos et al., 2023; Langeland et al., 2015; Witt et al., 2019), including the John Jay Report, in which 81 % of victims were boys (Terry et al., 2011), and convenience studies in Australian inquiries in both Catholic Church and Anglican Church settings (Australian Government Royal Commission Into Institu-tional Responses to Child Sexual Abuse, 2017b, 2017). We detected no corresponding higher prevalence of child sexual abuse for gender-diverse individuals in this setting as has been found elsewhere overall (nearly 5 times the risk compared with men; Higgins et al., 2024). Men perpetrate child sexual abuse in all settings far more often than women, but in general, girls are more often victimized than boys. This raises the question of why boys are so more often victimized in organizational settings, especially in Catholic Church settings. A substantial body of scholarship indicates that the Catholic Church possesses cultural, environmental, spiritual and individual-related features that contribute to the risk of abuse of power, including through sexual abuse, in situations where boys' vulnerability is magnified (e.g., Bajos et al., 2023; Böhm et al., 2014; Doyle et al., 2006; Finkelhor, 2003; Frawley-O'Dea, 2004; Keenan, 2012; Terry, 2015; Terry et al., 2011). For example, Catholic schools and boarding institutions for boys historically were predominantly staffed by male clergy or religious teachers, boys for many decades exclusively performed trusted and prestigious roles like altar service in church services, and the Catholic Church for many decades attracted men with psychosexual problems, such as paraphilias or sexual dysfunction, to the priesthood. At the individual perpetrator level, the common factors uniting and magnifying these risks are the perpetrator's personal and psychosexual vulnerabilities, situational stressors, and access to boys in private locations. These factors then combine with the broader cultural, environmental, and spiritual risks to amplify the vulnerability of boys. In addition, although some have minimised the role of sexual identity in sexual abuse perpetration, Finkelhor (2003) persuasively argued that features of the Catholic Church, including its doctrine of celibacy for clergy, may have provided a refuge for several decades in the mid-late 20th century for young men struggling with sexual conflicts and same-sex attraction, while not providing them with the opportunity to direct their sexual orientation in healthy and safe ways, which in turn may have contributed to sexual misconduct. 4.5. The disproportionate contribution of Catholic organizations More than two-thirds of instances of people who reported child sexual abuse in religious organizations said this occurred in Catholic organizations. This is consistent with Australia historically having high levels of Catholic observance, teamed with a high proportion of Catholic organizations providing educational, health, and social services (e.g., the Catholic Church is estimated to be the largest provider of social services in Australia, and even currently, about 20 % of schools in Australia are Catholic; Camilleri & Winkworth, 2005). However, it is also consistent with a substantial body of scholarship identifying factors specific to the Catholic Church at organizational, cultural, doctrinal and individual levels that have contributed so powerfully to the disproportionate onset and continuance of child sexual abuse in these organizations, in contrast with others (Böhm et al., 2014; Doyle et al., 2006; Keenan, 2012; Terry, 2015; Terry et al., 2011). Briefly, in general, cultures and conditions specific to religious settings that contribute to the risk of child sexual abuse include G.R. Hunt et al.                                                                                                                                                                                                        Child Abuse & Neglect xxx (xxxx) xxx9social norms around sex and sexuality (Kaufman et al., 2016), doctrinal requirements for celibacy (Doyle et al., 2006), patriarchal and authoritarian beliefs (Dale & Alpert, 2007; Higgins, 2002; Higgins & McCabe, 1994), poor oversight, training, and screening of staff and volunteers (Dale & Alpert, 2007; Keenan, 2012; Ormerod, 2019), and the power, prestige, and special status associated with leadership, particularly men (Bajos et al., 2023; Higgins, 2002; Kaufman et al., 2016). More specifically, sexual misconduct in the Catholic Church and other religious organizations is acknowledged as being facilitated and supported by a closed culture with exceptionally strong organizational rules and authoritarian governance, with decision-making power vested in individuals, all of which has the primary function of protecting the organization's reputation at all costs (Death, 2015; Kaufman et al., 2016). This culture, and supporting doctrine and practice, prioritises the concealment of wrongdoing and protection of offenders (Higgins, 2002). Canon law and Church doctrine take priority over civil law and criminal law, and specific rules compel secrecy even in egregious cases of sexual abuse (Coughlin, 2011; Tapsell, 2014). An individual's involvement within this culture demands conformity with Church rules, silencing dissent and removing or limiting external oversight. At the individual level, the culture, environment and organiza-tional rules embed personal and sexual dysfunction through distorted masculinity, impaired psychosexual development, and truncated opportunities for healthy relational and emotional functioning, all of which increase the risk of offending (Doyle et al., 2006; Higgins, 2002). This is supported by doctrine that sees illicit sex primarily as a sin rather than as a crime. 4.6. The decline in sexual abuse of boys in religious organizations Prevalence was significantly higher for men aged 65 years and over, affecting 1 in 45 men in this age group. This alarmingly high prevalence in men aged 65 and over reflects an era in which, as recognised by Australian inquiries and both civil and criminal liti-gation, there were numerous prolific individual offenders, and schools, parishes and entire archdioceses that were regarded as epi-centres of Australia's organizational child sexual abuse epidemic (Parkinson, 2014). Our analysis has identified the population-wide high watermark, and a significant and consistent generational decline in preva-lence for boys. Several factors have likely contributed to the decline, especially but not only within the Catholic Church, which mirrors the decline in other nations at similar times. For example, in the US, sexual abuse in the Catholic Church peaked in the 1960s and 1970s, which some have noted corresponded with a general rise in other criminal behavior and social change, and declined from the 1980s (Terry, 2015). First, there has been a decline in religious observance and engagement across the Australian population, which has reduced the exposure of children to religious leaders. The Australian Bureau of Statistics reported that affiliation with the Catholic church decreased from 26 % in 1981 and 22.6 % in 2016, to 20 % in 2021. The Anglican church was the largest religious denomination in Australia, with 38.4 % of the population reporting affiliation in the 1911 Census (Australian Bureau of Statistics, 2022). This has declined over time, with 23.9 % reporting affiliation with the Anglican church in 1986, decreasing to 13.3 % in 2016 and 9.8 % in 2021. Affiliation with Jehovah's Witnesses has dropped slightly from 0.4 % in 2016 and 2011 to 0.3 % affiliation in 2021 (Australian Bureau of Statistics, 2022). Those reporting no religious affiliation increased from 10.8 % in 1980, 30.1 % in 2016 to 38.9 % in 2021. This trend in increasing reports of no religious affiliation between 2016 and 2021 was particularly true for young adults (Australian Bureau of Statistics, 2022). Those in the youngest cohort in our study, whose overall prevalence was lowest (0.1 %) are far less likely to have engaged with religious organizations than those from former generations. Second, there has been a general secularisation of Australian society and a dilution of the historic deference to organizational and religious authorities. In former generations, clergy had high social status, were revered as authority figures, and were easily provided access to children. This status diminished over time, influenced by broader impulses towards individual freedom, rejection of orga-nizational power, and increased social awareness of child sexual abuse both generally and in organizations in particular. In addition, broader societal awareness of child sexual abuse, especially within organizational settings, has intensified parental vigilance and protection of their children from abuse in these settings. Third, a decline in the number of male priests and ordained clergy has reduced the pool of potential perpetrators, including those within their ranks who may have been more inclined towards offending. While many perpetrators appear to offend infrequently, a not insignificant proportion offend over decades against a large number of victims (Parkinson, 2014). Accordingly, the presence of fewer of these particularly dangerous perpetrators would have a corresponding large positive impact in reducing perpetration in these settings. Connected with this, it is plausible that a contributing factor to the decline was the increased acceptance of diverse sexualities and of sexual expression in the latter 20th century, and the decreased shame and stigma associated with such diversities. This may have contributed to a decline in psychosexually troubled men, such as those with paraphilias or other sexual dysfunction, joining the priesthood, or remaining in it, which in turn may have contributed to the decline in the risk to boys from male leaders in religious organizations (Finkelhor, 2003). Fourth, partly as a result of Australian inquiries, organizations have been required to adopt more robust preventative policies and responses in order to comply with new regulatory frameworks, and to mitigate potential legal and financial liability (Mathews, 2019, Russell et al., 2023). These prevention mechanisms have likely contributed to the decline, along with organizational actions to prevent the admission of high-risk individuals and to more effectively prevent and interrupt offending when it has occurred. 4.7. Limitations and directions for future research Our study has generated the first nationally representative prevalence estimates for child sexual abuse by a leader or adult in a religious organization in Australia. However, these estimates are conservative, as they are limited to acts perpetrated by adults, and do not include acts perpetrated by adolescents, nor acts in other settings with religious affiliations, such as schools and out-of-home care G.R. Hunt et al.                                                                                                                                                                                                        Child Abuse & Neglect xxx (xxxx) xxx10facilities. Accordingly, they underrepresent the true overall prevalence of child sexual abuse in religious organizations. Our study employed mechanisms to increase the likelihood of capturing accurate responses from a representative sample, including being fully random, allowing participants to remain anonymous, using non-confrontational telephone interviewing, and asking reli-able, validated, behaviorally-specific questions (Mathews et al., 2022). Reduced memory for childhood events may have under-estimated the true prevalence (Mills et al., 2016), and future studies with longitudinal designs may further strengthen the evidence base by mitigating some of these potential limitations. However, the older cohort (65 years and over) in our study did report significantly higher rates of child sexual abuse, compared to the youngest cohort (16–24 years). Further, some participants in the youngest cohort (16 and 17-year-olds) could not report on their experiences across the entire span of childhood, and it is known that a substantial proportion of child sexual abuse first occurs in those aged 15–17 years (Finkelhor et al., 2014). However, our findings showed the onset of child sexual abuse in religious organizations was pre-pubescence (between 7 and 11 years on average), so it is likely that any underreporting by the younger age group is minimal. In addition, some in the younger age group may have been reluctant to accurately relate their experience, given the tendency towards non-disclosure and delayed disclosure of religious- perpetrated child sexual abuse, as shown by the Australian Royal Commission that found victim-survivors take, on average, 23.9 years to disclose (Australian Government, 2017c). However, anonymous reporting in a survey setting via endorsement of behaviorally- specific questions is different from more comprehensive in-person disclosure, and this is unlikely to have substantially affected the findings of the decline in prevalence that is apparent in the younger age group. Child sexual abuse is a prevalent and pervasive issue in our society (Mathews et al., 2024; Mathews, Pacella, et al., 2023). Currently, there is limited evidence supporting interventions addressing child maltreatment in organizational settings, including religious organizations (Finch et al., 2021). There is a need for public health approaches to the prevention of child sexual abuse and other types of child maltreatment and adversity. Organizations, including religious settings, have a role to play in preventing and responding to harm to children (Higgins & McCabe, 1994). They are responsible for working to prevent child sexual abuse, and child maltreatment in their settings, and they also have a responsibility to respond well when faced with incidents that have affected their members in other settings. For example, religious organizations must play a role in responding to sexual abuse that may be occurring in the home or by others within the organization. Further research is needed to evaluate prevention efforts in organizational settings, including religious organizations, focusing on interventions targeting organizational cultures and perpetrators' behaviors (Finch et al., 2021). 5. Conclusion Child sexual abuse by religious perpetrators is a profound violation of the child's vulnerability, exploiting a tripartite power relationship driven by sexual, organizational and religious power. This research has contributed new knowledge to our understanding of the prevalence of child sexual abuse in Australia by perpetrators in religious organizations, and adds to the emerging international literature. Child sexual abuse by adults in religious settings is a significant issue globally, including within Catholic Church settings (Mathews, 2019; Terry, 2015), and presents an imperative for action in diverse nations, especially those with large populations and high religious observance. These findings are therefore particularly salient and instructive for future research, and for prevention. This Australian analysis has found substantial prevalence of sexual abuse in religious settings, and especially in Catholic Church settings, almost exclusively by men, against boys. The findings on mean age of onset add further insights into the timing of this risk. However, it has also found encouraging evidence of a decline in prevalence. Importantly, our findings represent only a portion of the overall prevalence of child sexual abuse in religious organizations. The ACMS collected data about sexual abuse experiences perpetrated by others, including teachers, family members, and other adolescents, but not the context in which the abuse occurred. It is likely that some cases of child sexual abuse perpetrated by these other adults or adolescents may have also occurred in religious settings, or in the context of relationships made in religious organizations. The findings have implications for the role religious organizations can and must play in preventing and responding to child sexual abuse. Collaborative efforts from church leadership and members are essential in fostering a culture of accountability, empathy, and safety. Addressing practical factors such as inadequate training, oversight, and screening, as well as cultural factors, such as imbalances of power, attitudes about sex and sexuality, and prioritising the voice and wellbeing of children, young people, and victim-survivors, help create conditions of safety. Supplementary data to this article can be found online at https://doi.org/10.1016/j.chiabu.2024.106946. Grant numbers The ACMS is supported by a National Health and Medical Research Council Project Grant (APP1158750). The ACMS receives additional funding and contributions from the Australian Government Department of the Prime Minister and Cabinet; the Department of Social Services; and the Australian Institute of Criminology. FM was supported by the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme [Grant Agreement Number 852787] and the UK Research and Innovation Global Challenges Research Fund [ES/S008101/1]. HT is funded by the Queensland Centre for Mental Health Research which receives its funding from the Queensland Department of Health. G.R. Hunt et al.                                                                                                                                                                                                        Child Abuse & Neglect xxx (xxxx) xxx11CRediT authorship contribution statement Gabrielle R. Hunt: Writing – review & editing, Writing – original draft, Project administration, Methodology, Formal analysis, Conceptualization. Ben Mathews: Writing – review & editing, Writing – original draft, Supervision, Methodology, Investigation, Funding acquisition, Conceptualization. Daryl J. Higgins: Writing – review & editing, Writing – original draft, Supervision, Meth-odology, Investigation, Conceptualization. David Finkelhor: Writing – review & editing, Conceptualization. Megan L. Willis: Writing – review & editing, Writing – original draft, Supervision, Methodology, Formal analysis. Divna M. Haslam: Writing – review & editing. David Lawrence: Writing – review & editing. Franziska Meinck: Writing – review & editing. Hannah J. Thomas: Writing – review & editing. Eva Malacova: Writing – review & editing. Rosana E. Pacella: Funding acquisition, Investigation. James G. Scott: Writing – review & editing. Data availability The data that has been used is confidential. Acknowledgements The authors are deeply grateful to all survey participants, and to members of the public including victim-survivors who participated in instrument development and piloting. We thank ACMS Technical Expert Panel members who advised on survey design. We also thank Social Research Centre interviewers and managerial staff, especially Nikki Honey and Diana Nguyen. References Alaggia, R., Collin-Vézina, D., & Lateef, R. (2017). 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