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Breaking the Cycle: Understanding and addressing the intersections of violence against children and violence against women in Latin America and the Caribbean

23 Sep 2013
Alessandra Guedes, Regional Advisor, Pan American Health Organization & Sarah Bott, Independent Consultant,
Introduction

A substantial body of research indicates that violence against women and children can have long-lasting, intergenerational consequences (Heise and Garcia Moreno 2002). For example, studies from many settings have found that harsh physical punishment of children is more common in households where women experience violence by intimate partners compared with other households (Appel and Holden 1998; Runyan et al. 2002; verlien 2010). And evidence indicates that exposure to violence in childhood - either as a victim or witness of physical or sexual abuse - may increase the risk of experiencing or perpetrating violence later in life (Rivera-Rivera et al. 2005; Speizer et al. 2008; Gomez and Speizer 2009; Abramsky et al. 2011).

In this commentary we summarize some key findings about the intersections between violence against women and violence against children, based on a recent report entitled, Violence against women in Latin America and the Caribbean: a comparative analysis of population-based data from 12 countries. We then review some policy and program implications of this evidence, including the importance of developing an integrated, coordinated response to violence against women and violence against children.

PAHO/CDC’s comparative report: methods and findings

The PAHO/CDC comparative report (Bott et al. 2012) presented a secondary analysis of nationally representative data on violence against women and children from 12 Latin American and Caribbean countries 1 gathered by Demographic and Health Surveys (DHS) and Reproductive Health Surveys (RHS) in the Region. These surveys all included modules on violence against women, and some included detailed questions about exposure to violence during childhood and punishment of children in the current home. Key findings from this comparative report include the following:

- Large percentages of women in the region reported experiencing violence by intimate partners. In all 12 Latin American and Caribbean countries studied, large percentages of women ever married or in union reported ever experiencing physical or sexual violence by an intimate partner, ranging from 17.0% in the Dominican Republic (2007) to 53.3% in Bolivia (2003).

- Large percentages of women aged 15-49 experienced violence in childhood. In the six surveys that asked women detailed, comparable questions about violence in childhood, between 17% and 69% of women reported having been beaten or physically abused as children.2 In these surveys, approximately 1-2% of women reported forced sexual intercourse before age 15, 1-5% reported other unwanted sex acts before age 15, and 2.6% to 5.7% reported either type of childhood sexual abuse.

- The prevalence and odds of experiencing intimate partner violence were significantly higher among women who reported physical or sexual abuse in childhood than among those who did not. In all six surveys that explored this issue, the prevalence of intimate partner violence ever was significantly higher (p<0.001) among women who reported being beaten or physically abused in childhood compared with those who did not, and in three countries (El Salvador, Nicaragua, and Paraguay) the prevalence was more than twice as high. Likewise, women who were sexually abused in childhood reported significantly (p<0.001) higher rates of intimate partner violence than those who were not. In fact, having a father who beat their mother was the strongest and most consistent predictor of experiencing intimate partner violence, even after controlling for other potential risk factors.

- Children in households where women were abused were more likely than other children to experience harsh physical discipline. In the six RHS surveys that gathered comparable data on child discipline, 25-61% of women reported that children in their home were punished with hitting, beating, spanking or slapping.3 In all six surveys, children living in households where women had experienced intimate partner violence were significantly more likely to experience harsh physical punishment (p<0.001) than children in homes where intimate partner violence did not occur.

- In Latin America and the Caribbean, girls often experience forced or unwanted first sexual intercourse at early ages. Small but important percentages of women in all 12 countries reported that their first intercourse was ‘forced’ or ‘rape’ ranging from 2% in Paraguay to 21% in Haiti. And in surveys that asked about unwanted sexual debut, even larger percentages of women reported that their first sexual intercourse was unwanted (but not forced), as did nearly half (45%) of young women in the 2008 Jamaica RHS, 32% of women in Cusco, Peru interviewed in the World Health Organization (WHO) Multi-country survey and 22% of women in the Pernambuco, Brazil WHO survey.

- Early first marriage/union was significantly associated with greater prevalence and odds of ever experiencing intimate partner violence. In 11 of the 12 countries, the prevalence of intimate partner violence ever increased consistently as young women’s age at first marriage/union declined. Even after controlling for other key risk factors, young age at first union (age <15 or 15-19) was associated with significantly greater odds of intimate partner violence ever in most countries, suggesting that helping young women delay marriage and childbearing until after adolescence might lower their risk of experiencing intimate partner violence as adults.

- Early childbearing was also significantly associated with greater prevalence and odds of experiencing intimate partner violence. In all 12 countries, the prevalence of physical or sexual violence ever and in the past 12 months was significantly higher (p<0.001) among women who had their first live birth before age 17 compared with those who gave birth at later ages. In most surveys, the prevalence of partner violence was two to three times greater among women whose first birth occurred before age 17 (or age 15) compared with those whose did not give birth until after age 24.

Policy and program implications

These findings indicate that violence against women is closely associated with the experience of and exposure to violence during childhood, and these associations take multiple, complex forms. Moreover, both violence against women and violence against children are often supported by social norms that consider physical violence an acceptable form of ‘disciplining’ women or children for wrong behavior.

Taken as a whole, the implication of this evidence is that policies and programs need more integrated, coordinated strategies for addressing violence against women and violence against children. First, for example, service providers who assist abused women should also assess the safety and well-being of children and take steps to provide them with appropriate care. Conversely, those who provide services providing care to children who are victims of abuse should consider the possibility that intimate partner violence may co-occur in the home, and develop appropriate responses.

More generally, because intimate partner violence may have serious consequences for children of women who are abused, prenatal and pediatric health care providers should be educated about intimate partner violence and prepared to respond to the needs of mothers and children when they detect situations of abuse.

In addition, more investment is needed in strategies to change attitudes, norms, knowledge and skills of young people. In particular, policy makers and programmers should find ways to help girls make empowered, autonomous, coercion-free decisions about when to have sexual intercourse, enter into marriage/union, and begin childbearing. And more efforts are needed to change gender norms among boys and young men, including those related to sexual entitlement. In the Latin American and Caribbean Region, some of the most well documented and promising examples of these strategies are the ‘edutainment’ programs carried out by Sexto Sentido in Nicaragua (Solórzano et al. 2008) and the Promundo Program H in Brazil (Barker et al. 2007; Barker et al. 2010), but this is an emerging area of work.

Finally, there is a need to identify and implement effective interventions to help families at risk of intrafamilial violence, and children exposed to violence (as victims or witnesses) would receive help to prevent the intergenerational ‘transmission’ of violence. In some settings, such as in Chile, some programs have tried to improve parent skills and resources through the direct delivery of social services and support to at risk families in their homes as a form of violence prevention (Aracena et al. 2009; Kotliarenco et al. 2010; Aracena et al. 2011; Knerr et al. 2011; Knerr et al. 2013).

Sources:

1Bolivia, Colombia, Dominican Republic, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Jamaica, Nicaragua, Paraguay, and Peru.

2Most surveys asked about childhood experiences prior to age 15, expect El Salvador which asked about prior to age 18.

3Note that surveys did not always ask who punished the children, making it impossible to determine whether it was the mother, father or other adult carried out the punishment.

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