A/HRC/43/39 areas such as deinstitutionalization, child poverty, environmental protection, children’s mental health and child activists and human rights defenders. 30. The Special Representative supported the development of a report by the African Child Policy Forum entitled Sexual Exploitation of Children in Africa, a Silent Emergency11 and participated in its launch in Maputo. IV. Violence against children: a review of the research on its impact on children’s mental health A. Violence harms children’s mental health 31. The Convention on the Rights of the Child guarantees every child’s right to freedom from violence and to the highest attainable standard of mental health. The 2030 Agenda for Sustainable Development equally commits Member States to ending all forms of violence and promoting mental health and well-being. 32. Despite these obligations and commitments, children are increasingly exposed to violence, with a severe influence on their mental well-being as a result. This exposure can be direct, such as experiencing physical, sexual or emotional violence in their community, at home or at school, or indirect, such as witnessing violence and hearing or watching violent content online. Moreover, there is now a recognition that interpersonal violence spills from one setting to another, resulting in what is commonly known as polyvictimization. 33. Evidence from high-, middle- and low-income countries indicates clearly that violent experiences increase the risk of negative mental health consequences. These include depression, post-traumatic stress disorder, borderline personality disorder, anxiety, sleep and eating disorders, suicide and suicide attempts. In addition, exposure to childhood violence can increase a wide range of adult psychopathologies, including mood, anxiety, behaviour and substance disorders.12 34. Research has consistently shown that childhood adversity and violence are key risk factors for the onset and persistence of mental disorders. Exposure to adverse childhood experiences, such as violence, can be traumatic, evoking toxic stress responses that have immediate and long-term adverse physiological and psychological effects.13 35. The impact of violence on the architectural development of children’s brains is of particular concern, as this is linked with consequent emotional and behavioural disorders, poor health and poor social outcomes.14 Those effects are especially concerning in the light of the stark reality that more than 1 billion children – half of all children in the world – are exposed to violence every year. 36. Research has found associations between physical punishment and negative effects on children’s mental health, including behaviour disorders, anxiety disorders, depression and hopelessness. The available evidence also indicates that there is an association between physical punishment and increased aggression, reduced empathy and poor moral internalization.15 11 12 13 14 15 Available from http://africanchildforum.org/en/index.php/en/special-pages/child-sexualexploitation.html. See Susan D. Hillis, James A. Mercy and Janet R. Saul, “The enduring impact of violence against children”, Psychology, Health & Medicine, vol. 22, No. 4 (2017). Ibid. See Andrew S. Garner and others, “Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health”, Pediatrics, vol. 129, No. 1 (January 2012). See Global Initiative to End All Corporal Punishment of Children, “Corporal punishment of children: review of research on its impact and associations” (June 2016). 7