Gender influences on child survival, health and nutrition: a ... - Unicef

<strong>Gender</strong> Influences On Child Survival, Health And Nutrition: A Narrative Review
violence were at greater risk of stunting or severe stunting (Rico, Fenn, Abramksy & Watts 2010).
However, a longitudinal nutrition experiment conducted in rural Bangladesh found that children born to
mothers exposed to domestic violence had lower weight for age and height for age scores from birth to
24 months (Åsling-Monemi, Naved & Persson, 2009). Overall these results provide evidence that in
some contexts women’s exposure to violence also has damaging consequences for their children’s
health and nutrition.
The review by Yount, DiGirolamo & Ramakrishnan (2011) also examines the possible pathways
through which these nutrition and health effects operate, although the authors point out that these
are as yet understudied. Nevertheless there is evidence from a case control trial conducted in South Asia
that children exposed to domestic violence or marital conflict had higher stress levels demonstrated by
higher levels of salivary cortisol and plasma amino acids (Zhang et al. 2008). A number of studies
conducted in Asia and Latin America have demonstrated various effects of domestic violence on
maternal mental health 19 . A study undertaken in Nicaragua found that malnourished and distressed
pregnant women more often have low birth weight children (Valladares et al. 2009), while studies in
Vietnam, Pakistan and Ethiopia found that mothers’ mental health status has a direct impact on their
infants’ weight and nutrition status (Deyessa et al. 2010; Harpham et al. 2005; Rahman et al. 2004).
Women’s own physical and nutrition status is affected by domestic violence, which in turn, impacts on
a child’s birth weight although the majority of the studies reviewed in this section of the review were
conducted in high-income settings. However, in Uganda, Brazil and in Asia, studies have found
associations between domestic violence and low maternal prenatal weight gain (Asling-Monemi et al.
2003; Kaye et al. 2006; Moraes, Amorim & Reichenheim 2006; Nunes et al. 2010; Valladares et al. 2002a;
Yang et al. 2006). Maternal risk behaviours such as smoking or alcohol or drug use (which have been
linked to poor child health outcomes) increased with exposure to domestic violence (Nunes et al. 2010;
Quelopana, Champion & Salazar 2008).
Domestic violence has also been linked to higher risks of obstetric complications in Uganda (Kaye et al.,
2006). A number of studies have found evidence that physical violence is linked to adverse pregnancy
outcomes (Ahmed, Koenig & Stephenson 2006; Arcos et al. 2001; Ganatra, Coyaji & Rao 1998; Jejeebhoy
1998; Kaye et al. 2006; Nunes et al. 2010; Valladares et al. 2002b; Valladares et al. 2009). A study in
Brazil also found that domestic violence in pregnancy impacted negatively on maternal responses to
breastfeeding (Lourenco & Deslandes 2008).
Finally the review examines the evidence on domestic violence and morbidity and morbidity-related
treatment and finds that studies have shown higher odds of respiratory infection in Chile and
Bangladesh (Arcos, Uarac & Molina 2003; Silverman et al. 2009) and poorer general health in Uganda
(Karamagi et al. 2007) among children exposed to domestic conflict.
The authors highlight three major draw-backs in the current research into child exposure to domestic
violence revealed by the review:
‣ There is over-reliance in the field on data from higher-income contexts. One of the most obvious
geographical gaps is in relation to African countries where very few studies have been carried
out in this area up to now. The authors however point to the potential usefulness of DHS data in
19 See for example Valladares et al 2005, Varma et al 2007, Zareen et al 2009, Fisher et al 2010, Gomez-Beloz et al
2009, Karmaliani et al 2009, Nunes et al 2010, Leung et al 2002, Ludermir et al 2010, Tiwari et al 2008.
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