This is going to tick Elvorin off, but this is only slightly more extreme that some of the things I've seen here in India. It's quite common to ride 3 up, and for women to be holding a baby in their arms while riding sidesaddle (note on the pic in the original post that the chain is fully enclosed), with another kid sandwiched between her and her husband. I've also seen kids as young as 2 riding on the tank holding the bars. Helmets here are rudimentary at best (think early 1970s; no EPS, soft plastic faceshields instead of polycarbonate), and more often than not the rider either has the helmet on his arm or propped on a mirror. The upside, if you can call it that, is that we think of motorcycles in terms of American bikes, which by and large are fast and powerful. However, over here the vast majority of bikes are 110cc or so, maybe 125, and are rarely ridden fast (25mph or so). Yes, that's still fast enough to hurt you if you fall, but nothing like the wrecks you see in the states. At that speed, a small kid is more likely to bounce than to break something, though road rash is still a definite possibility and head injuries are still possible.