Intimate Partner Violence Against Mothers Associated with Child Death in India
Mortality is elevated among infants and young children of mothers who have experienced intimate partner violence, according to a study conducted in India.1 Mothers' experiences of physical intimate partner violence were associated with an increased risk of mortality among children aged 60 months or younger (risk ratio, 1.2), including both infants younger than 12 months (1.2) and children aged 12–60 months (1.3). In addition, sexual and psychological abuse by an intimate partner were each associated with death among infants (1.4 and 1.3, respectively).
The data came from the 2005–2006 Indian National Family Health Survey, a nationally representative household-based study. The researchers analyzed survey responses from married women aged 15–49 who had had a singleton live birth in the past 60 months. Women were asked about a wide range of social, demographic and other characteristics, including their age, employment, wealth, caste, religion, age at delivery and degree of autonomy (whether they participated in decisions about obtaining health care, making household purchases, making large purchases and visiting relatives). They were also asked about their children's characteristics, including age, gender, birth order and age at death (if applicable). In addition, respondents reported their experiences with three types of abuse by intimate partners. Physical violence was defined as having ever been pushed, shaken, slapped, punched, hit with a fist or object, kicked, dragged, choked, burned, or threatened or attacked with a knife or gun, or having had one's arm or hair pulled by one's husband. Sexual violence was defined as having ever been forced by a spouse to have sex or perform unwanted sexual acts. Psychological abuse was defined as having ever been insulted, humiliated or threatened with harm by one's husband. The researchers conducted regression analyses to examine the relationship between women's experiences of intimate partner violence and infant and child mortality, with children (rather than mothers) serving as the unit of analysis.
The final sample consisted of 39,096 children, of whom 7,153 were infants (i.e., were aged 0–12 months), 30,466 were aged 12–60 months and 2,069 had died. Most were their mothers' first- or second-born child (30% and 28%, respectively), and about two in five (39%) had been born when their mothers were aged 20–24.
Most of the children's mothers were Hindu (69%) and did not have a paying job (64%); their mean age was 29. Forty-two percent had no formal education and another 30% had had no more than eight years of schooling. However, a substantial proportion (41%) reported a high level of autonomous decision making (i.e., they participated in decision making in all four realms).
Thirty-eight percent of the children's mothers reported having experienced some form of intimate partner abuse; 33% had experienced physical violence, 14% psychological abuse and 9% sexual violence. Some 15% had experienced multiple types of abuse, and 12% had been injured as a result of physical violence. The children who had died represented 5.3% of all children sampled and 6.4% of those whose mothers had been abused by an intimate partner.
Among children whose mothers had experienced any type of intimate partner violence, mortality rates were elevated for all those aged 0–60 months, as well as for infants (risk ratios, 1.2 for both). Having a mother whose partner had physically abused her was associated with an increased risk of death among all children aged 0–60 months, including both infants and children aged 12–60 months (1.2, 1.2 and 1.3, respectively); sexual violence was associated with death only among infants (1.4). Having a mother who had been psychologically abused was a risk factor for death among all children (1.1) and infants (1.3). Infants also had an increased risk of death if their mothers had experienced multiple types of abuse (1.5).
Several child and maternal characteristics were also associated with childhood mortality. Among all children aged 0–60 months, mortality was higher among those whose mother had autonomy in at least two of the four domains (1.1–1.3) than among those whose mother had autonomy in none of the domains; higher among those whose mother had a manual (1.4), nonmanual (1.5) or agricultural (1.3) job than among those whose mother did not work; and higher among those whose mother had up to 12 years of education (1.5–2.4) than among those whose mother had at least 13 years of schooling. Infants were at increased risk if their mother had an agricultural or manual job (1.6 and 1.7, respectively). For children aged 12–60 months, the risk of mortality was greater among third- and higher-order children (risk ratios, 1.8–2.5) than among first-born children. A child's gender had no bearing on his or her risk of death.
The direct causes of children's deaths were not determined by the study, but the researchers postulate that intimate partner violence may harm children through "physical or psychological maternal health outcomes that prevent proper care of the child, psychological stress resulting from observation of [intimate partner violence], or direct physical injury incurred by the child." The researchers propose that increased efforts by the medical, public health, public policy and public security fields to eliminate intimate partner violence could "improve health outcomes and…reduce social health disparities" among children.
1. Ackerson LK and Subramanian SV, Intimate partner violence and death among infants and children in India, Pediatrics, 2009, 124(5):e878–e889.