Almost half of Bangladeshi women with young children experience violence from their husbands, and their children appear to have a higher risk of recent respiratory infections and diarrhea, according to a report in the August issue of
Despite substantial improvements in childhood survival in the previous decade, 77 per 1,000 children born in Bangladesh die before age 5, according to background information in the article. Diarrhea and acute respiratory infections are the leading causes of early childhood deaths. "Violence against mothers by their husbands is a factor hypothesized to relate directly and indirectly to the poor health of young children via exposure to violence, the incapacitation of mothers and direct mistreatment and neglect of children," the authors write.
Jay G. Silverman, Ph.D., of the Harvard School of Public Health, Boston, and colleagues studied 1,592 married Bangladeshi women with at least one child age 5 years or younger who participated in the 2004 Bangladesh Demographic Health Survey. Intimate partner violence was assessed on surveys given to the men, whereas women reported information about their children's health.
More than two of every five (42.4 percent) of the mothers had experienced intimate partner violence from their husband within the past year. Those who did were more likely to report that their children had acute respiratory infections (19.2 percent vs. 13.7 percent) or diarrhea (11.6 percent vs. 7.6 percent) within the past two weeks. "Importantly, because the present analyses were adjusted for potential confounders, these effects persist after consideration of socioeconomic status (e.g., poverty), household characteristics and environmental factors (e.g., sanitation)," the authors write.
Both direct and indirect mechanisms may be responsible for the elevated risk of illness among children exposed to intimate partner violence, they note. Trauma and anxiety are more common among children in violent households and could lead to suppression of the immune system over time. The children could also be experiencing direct physical harm from their fathers. "A growing body of work demonstrates that intimate partner violence occurs within a context of male-partner control, which can include interference in the ability of women to meet basic health needs for themselves and their children," the authors write. For example, women who are being abused may be less likely to have their children immunized or to breastfeed, both of which can compromise child health.
"Associations of maternal experiences of intimate partner violence with two leading causes of childhood mortality strongly suggest that such abuse threatens not only the health of women but also that of their children," the authors conclude. "Prevention of intimate partner violence perpetration by men may be critical to the improvement of maternal and child health."
Editorial: Findings Reinforce Pediatricians' Need to Treat the Family
"Nearly 30 years ago, pediatrician Bayard Allmon and colleagues reminded us that, although pediatrics is fundamentally a medical discipline focused on children and youth, the development and health of children is inextricably tied to the functional well-being of the family system," writes W. Thomas Boyce, M.D., of the University of British Columbia, Vancouver, in an accompanying editorial. "We pediatricians, both practitioners and scientists, would be wise to recall, from time to time, the acuity of this insight, as the article by Silverman et al reminds us to do."
"A world away from the exigencies and hardships of a young mother's life in Bangladesh, the findings of Silverman et al apply, as aptly and compellingly, to the North American mother who struggles to shield her child from the assaults of family violence, poverty, loneliness and fear," Dr. Boyce continues.
"One of the most broadly endorsed moral standards of democratic societies is the belief that all children should have equal opportunities for the realization of their innate human potential and for the achievement of a good, safe and gratifying life," he concludes. "When will we whose professional lives are dedicated to care for children's health find the will and temerity to expand our borders and direct what moral authority we can muster against the injustice and violence that are the backdrop of too many children's lives?"
- Jay G. Silverman; Michele R. Decker; Jhumka Gupta; Nitin Kapur; Anita Raj; Ruchira T. Naved. Maternal Experiences of Intimate Partner Violence and Child Morbidity in Bangladesh Evidence From a National Bangladeshi Sample. Archives of Pediatrics & Adolescent Medicine, 2009;163(8):700-705
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