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Profiles

Amber Peterman

Consultant (Former title)

Amber Peterman, Ph.D. joined UNICEF Office of Research – Innocenti in 2015 as a Social Policy Specialist and now works as a consultant with joint affiliation as an Associate Adjunct Professor at UNC Chapel Hill. Amber focuses on gender, violence and adolescent wellbeing and safe transitions to adulthood with the Transfer Project evaluations of social protection and cash transfers in Africa. She has led research in over a dozen countries and brings significant experience in large-scale surveys and impact evaluation in Africa, Latin America, the Middle East and Asia. Amber previously worked as an Assistant Professor at UNC Chapel Hill and as a Research Fellow at the International Food Policy Research Institute (IFPRI) in Washington DC., Kampala and Dakar. Amber obtained her PhD in Public Policy with focus on international maternal and child health from UNC Chapel Hill.

Publications

Evidence on Social Protection in Contexts of Fragility and Forced Displacement
Publication

Evidence on Social Protection in Contexts of Fragility and Forced Displacement

Rigorous research in humanitarian settings is possible when researchers and programmers work together, particularly in the early stages when responses to humanitarian challenges are designed. Six new rigorous research studies from five countries: Ecuador, Mali, Niger, Lebanon and Yemen illustrate this point.
Economic Transfers and Social Cohesion in a Refugee-hosting Setting
Publication

Economic Transfers and Social Cohesion in a Refugee-hosting Setting

There is increasing interest in understanding if social protection has the ability to foster social cohesion, particularly between refugees and host communities. Using an experimental evaluation of transfers, including cash, food and food vouchers to Colombian refugees and poor Ecuadorians in urban and peri-urban areas we examine if transfers resulted in changes in social cohesion measures. The evaluation was a cluster-randomized control trial examining a short-term programme implemented over six months by the World Food Programme. We examine six aggregate dimensions of social cohesion, derived from 33 individual indicators, in addition to an overall index of social cohesion. Overall results suggest that the programme contributed to integration of Colombians in the hosting community through increases in personal agency, attitudes accepting diversity, confidence in institutions, and social participation. However, while having no impact for the Ecuadorian population. There were no negative impacts of the programme on indicators or domains analysed. Although we are not able to specifically identify mechanisms, we hypothesize that these impacts are driven by joint targeting, messaging around social inclusion and through interaction between nationalities at mandated monthly nutrition trainings.
A mixed-method review of cash transfers and intimate partner violence in low and middle-income countries
Publication

A mixed-method review of cash transfers and intimate partner violence in low and middle-income countries

Exploring Women's Empowerment through Asset Ownership and Experience of Intimate Partner Violence
Publication

Exploring Women's Empowerment through Asset Ownership and Experience of Intimate Partner Violence

Intimate partner violence (IPV) is widespread globally, with an estimated one-third of women aged 15 years and over experiencing physical and/or sexual violence at the hands of an intimate partner during their lifetimes. Economic empowerment, or the financial standing of women, is often thought to protect against IPV, signalling sufficient economic autonomy to leave abusive situations or to prevent abuse. Asset ownership is one measure of economic empowerment, and can convey substantial agency as a wealth store, especially for large productive assets, such as agricultural land or home ownership. Despite the important implications of IPV reduction for policy and programming, evidence of this relationship is scarce.We hope this research will advance our global understanding of this potential.

Articles

Towards gender equality in social protection. Evidence gaps and priority research questions
Article

Towards gender equality in social protection. Evidence gaps and priority research questions

A mother and infant wait at a LEAP 1000 distribution point [© Michelle Mills]
Blog

Beyond targeting: Making social protection work for women in Ghana

Blogs

A mother and infant wait at a LEAP 1000 distribution point [© Michelle Mills]
Blog

Beyond targeting: Making social protection work for women in Ghana

I feel like a human being now and the luckiest one as well(LEAP 1000 participant, Barrington et al. 2021)The Government of Ghana launched the LEAP 1000 pilot – a ‘cash plus’ programme – targeted at pregnant women and those with infants living in poor households in 2015. The motivation of the pilot was to support children during the first 1000 days, a key period of physical and mental development, with the overall goal of reducing child malnutrition and improving child health outcomes.Participant women received both a bi-monthly unconditional cash transfer (of approximately USD $10-18), as well as a premium waiver for the national health insurance scheme. Ghana is not unique in offering this type of social assistance — in fact, a 2016 mapping of 127 non-contributory social protection programs implemented by governments in Africa found that unconditional cash transfers were the most common type of assistance, and households with children were the most common target group.Despite the clear benefits of putting cash directly in the hands of women, and meeting their practical needs during pregnancy, some questions remain: does LEAP meet and respond to the strategic needs of women or does it use women instrumentally to facilitate the goal of reaching and benefiting children? Furthermore, is targeting women enough to nudge participants towards better social and economic outcomes, or would the focus on women’s role as primary caregivers and mothers unintentionally reinforce gendered inequalities in the household?Questions around the positive and negative effects of the pilot programme on women were integrated into a mixed-methods evaluation led by experts under the umbrella of the Transfer Project. The overall findings were encouraging. Women’s health and wellbeing improved across multiple domains, beyond the explicit objectives of the program. For example, women’s economic standing as measured by their personal savings increased, as did enrollment in the national health insurance scheme and health-seeking behaviors. LEAP 1000 also increased women’s social support in their own households and the larger community, as cash increased dignity, self-esteem, and confidence and allowed them to participate in savings groups and reciprocate support to others.I couldn’t mingle with my colleagues but with the coming of LEAP I can now raise myself and be part of my colleagues (the other women). If I get to the market, I can buy salt or buy a few clothes for my children to wear. Even if don’t dress well myself I have been able to dress my children well so they can mix with their peers.(LEAP 1000 beneficiary, de Milliano et al. 2021)Alongside reductions in household poverty, improvements in women’s social and economic standing were important pathways that led to reductions in their experience of intimate partner violence, including reductions in experience and frequency of physical and emotional violence. Taken together, LEAP 1000 improved tangible development milestones, as well as meaningful improvements in the quality of women’s lives.Truly speaking, at first the relationship between women and their husbands wasn’t good, but now it is better because of the LEAP support. I can say it is … poverty that caused all problems.(LEAP 1000 participant, Barrington et al. 2021)These findings, alongside broader positive impacts of the program on children and households contributed to the decision to integrate the program into the flagship social protection scheme nationwide in 2017. They also led to LEAP 1000 being touted as an example of a ‘gender-responsive’ program in the eyes of numerous stakeholders. But what does this mean in practice?While the social protection community has increasingly recognized the value of paying attention to gender — and frameworks have been proposed unpacking a continuum from ‘gender- discriminatory’ to ‘gender-transformative’ — there is still debate and lack of clarity as to assessment criteria, and what qualifies a program as being truly transformative. Is placing benefits in the hands of women, and improving her wellbeing enough? It is a start, but ultimately the program needs to tackle the root causes of gender inequality and transform harmful gender norms — aspects that the qualitative work suggest were largely unchanged in the context of LEAP 1000. A challenge in understanding how to go about this is that there is no one-size-fits all template. Design and operational components that facilitate gender-transformative change, like gender norms and drivers of inequality, are often context-specific.So, what lessons can be drawn from Ghana’s experience with LEAP 1000? A few reflections emerge:For gender-transformative change, start from a solid base: Long-term change starts with building a strong gender-responsive system and framework to guide growth. In Ghana, stakeholders are moving towards the development of a national framework that provides guidance and political backing for integration of gender in program design, implementation, and monitoring—this anchoring sets the stage for future progress and financing.Think beyond cash to address gendered constraints: While cash transfers have been effective in improving many dimensions of wellbeing, they are limited by contextual barriers that women and poor households face. In Ghana, new work is underway strategically linking participants to a range of complementary social protection and referral servicesto accelerate improvements in health, protection, and violence, all with explicit gender components. Stakeholders are working toward institutionalizing and scaling up these integrated social services nationwide to promote better outcomes for women and children.Address gender in human resources: It is critical to address the limited institutional capacity and lack of collaboration on gender issues at both the national and district levels. The lack of integration between gender focal points and social protection service providers at the local level is a missed opportunity for operational and impact synergies. We cannot forget the importance of investing in people if we want meaningful change in communities.Leverage face time for gender dialogue: Work towards better communication and more effective use of interface between service providers and program participants. Meetings or other face time create spaces and opportunities to discuss issues with communities on topics like social discrimination, exclusion, and gender inequality. These spaces have the potential to influence perceptions on gender norms, and through open dialogue women are able to seek support and exercise agency in their own communities.Poverty cannot be sustainably reduced without tackling gender inequalities. Ghana’s experience shows that moving towards gender-transformative social protection must go beyond just reaching and benefiting women, using local learning and solutions. To truly change gender inequalities, we need political will, adequate financing, and support from broader social welfare services. For Ghana, the gendered evidence-to-action social protection journey is just beginning.#####Acknowledgements: The LEAP 1000 Evaluation Team included researchers from ISSER at the University of Ghana, Navrongo Health Research Centre, UNICEF Ghana, UNICEF—Innocenti and the University of North Carolina. Learn more about the evaluation here. We thank Clare Barrington, Tia Palermo, Nyasha Tirivayi and Dominic Richardson for helpful comments and suggestions on this blog. Authors: Christiana Gbedemah is a social policy specialist at UNICEF Ghana; Amber Peterman is an research associate professor at UNC Chapel Hill and a social policy consultant at the UNICEF Office of Research—Innocenti and Jennifer Yablonski is head of social protection unit and social policy specialist at UNICEF Ghana.Read more:Impact evaluation of a social protection programme paired with fee waivers on enrolment in Ghana’s National Health Insurance SchemeMore Evidence on the Impact of Government Social Protection in Sub Saharan Africa: Ghana, Malawi and ZimbabweCrowding-out or crowding-in? Effects of LEAP 1000 unconditional cash transfer program on household and community support among women in rural Ghana
Can social protection simultaneously reduce violence against children and violence against women?
Blog

Can social protection simultaneously reduce violence against children and violence against women?

Despite the identification of cash transfers as a promising evidence-informed strategy to address violence against children (VAC) and violence against women (VAW) – until recently, there was little evidence from low- and middle-income country settings (LMICs), that assessed the effects of such interventions on both in the same study. Yet, cash transfers and broader forms of social protection have potential to address both forms of violence through shared risk factors, including reductions in poverty and economic stress, or through complementary ‘plus’ programming targeting risk factors related to conflict in the home or violence norms (see reviews on VAC and IPV).   In this blog, we summarize five studies completed in the last two years that examine impacts of cash, cash-for-work and cash plus programmes on both violent discipline of children and male intimate partner violence against women (IPV) from diverse LMICs – Bangladesh, Colombia, Mali, the Philippines and Rwanda. We include both studies evaluating the effects of cash alone, cash plus programming, as well as those that evaluate just the impacts of the ‘plus’. We focus on studies that were rigorously designed and measured violent discipline and IPV in the same household (rather than those focused on violence against adolescent girls, which might fall in the nexus of both categories of violence). To our knowledge, with the exception of a previous study in Mexico (from 2013), these 5 studies are the only available publications from LMICs examining both types of violence in the same evaluation. We also offer key take away messages and suggest areas for future research.     Bangladesh: An experimental study examined post-intervention effects of the Transfer Modality Research Initiative pilot, implemented in rural areas over 24 months by the World Food Programme. The intervention provided both transfers (cash and food), as well as a group-based nutrition behavior change (BCC) intervention to women with young children living in poor households. The evaluation found reductions in physical IPV of 26% among women in the cash plus BCC arm, however no impacts in the transfer only arm (and no impacts on emotional IPV). In addition, the authors examine two indicators of physical violent discipline from parents taken from the HOME inventory (whether mothers had hit the child during the week prior to the study and if parents react with physical discipline if they are hit by the child). The study found reductions of 25% to 38% across violent discipline indicators, again in the cash plus BCC arm (8 to 12 percentage points [pp]- reported in the online appendix). The author’s examination of mechanisms for IPV suggests that reductions in poverty-related stress, and increases in household economic status, which were larger in the BCC arm, may be a possible joint pathway for reductions in both violence measures (Roy et al. 2019 in the Review of Economics and Statistics).   Colombia: A quasi-experimental study of the government’s conditional cash transfer program targeted to poor households with school-aged children, Familias en Acción, used variation in the timing of bi-monthly payments at the municipality level paired with municipality-level administrative data on reported levels of violence from health and legal services. The authors show that rates of overall domestic violence, as well as rates of IPV from administrative data reported to health and justice systems, decrease by 6% in payment months. In contrast, there are no changes in reported domestic violence specifically against minors. Authors also show that household spending is higher in payment months—suggesting a poverty and stress reduction mechanism achieved via higher consumption expenditures (Camacho & Rodriguez 2020 in the CEDE Working Paper series)   Mali: An experimental study of the government’s Jigisémèjiri program, an unconditional quarterly cash transfer given primarily to male heads of household found decreases in IPV after 24-months. These decreases were concentrated in polygamous households (making up 40% of the sample), where reductions were found for controlling behaviors (23% or 16 pp), emotional IPV (37% or 13 pp) and physical IPV (40% or 7 pp). The study also reported on VAC among a target child aged 2 to 4 years old using the UNICEF Multiple Indicator Cluster Survey measures – showing similar trends as for IPV. Measures of psychological aggression against children were insignificant in the full sample, however physical punishment and number of total acts showed reductions—which increased in magnitude and significance among the polygamous households (showing decreases in psychological aggression of 16% or 11 pps and in physical punishment of 20% or 17 pps). Key mechanisms underlying impacts were reductions in men’s stress and anxiety, as well as in reported household disputes (Heath et al. 2020 in the Journal of Development Economics).   The Philippines: An experimental study of a locally-adapted 12-session group-based parenting program (Masayang Pamilya Para Sa Batang Pilipino – or MaPa) layered on the government flagship conditional cash transfer (Pantawid Pamilya Pilipino Programme) reported impacts at program end and 12-months post program. The evaluated intervention reached female caregivers of children aged 2 to 6 years in low-income families in urban Manila. The evaluation found reductions in incidence and frequency of child maltreatment at both follow-up waves, measuring using the ISPCAN Child Abuse Screening tool (e.g. a 49% reduced risk of physical abuse at post-intervention and a 48% reduced risk of neglect). For IPV, risk reductions at program end were 63% and at 12 months post-intervention were 49%. Possible common mechanisms of impact were those reducing overall incidence of family conflict and stress, increased caregiver efficacy and confidence when dealing with male spouses, fewer daily child behavior problems, and lower parenting dysfunction, among others (Lachman et al. 2021 in The Lancet Regional Health – Western Pacific).   Rwanda: An experimental study examined the impacts of the Sugira Muryango program – a home-visiting-based parenting intervention – layered on a government flagship social protection program ‘Vision 2020 Umurenge Programme’ targeting poor households with direct cash support and public works. Sugira Muryango included 12 sessions delivered over 3 months by community-based coaches promoting early childhood development (ECD) and preventing family violence. The study examined outcomes at 12-months post-intervention, showing reductions in female caregiver reports of IPV experience (IRR=0.616, 95% CI 0.458 to 0.828) as well as VAC as measured by harsh parenting using the UNICEF Multiple Indicator Cluster Survey measures (IRR=0.741, 95% CI 0.657 to 0.835). However, no significant impact was shown on male caregiver report of IPV perpetration (among an alternate sample of households where male caregivers were surveyed). The program also showed significant increases in engaging fathers in childcare and select child development outcomes (Jensen et al. 2021 in BMJ Global Health).   Take away messages and future studies   Taken together, these studies suggest a similar pattern of impacts. Across all but one study (Colombia), where impacts are found on IPV—the similar direction of impacts are found for VAC. In Bangladesh, impacts are only observed with the addition of plus components. However, in Rwanda and the Philippines—the evaluation focuses exclusively on the plus intervention—thus we are unable to fully disentangle if there are synergistic or countervailing impacts of the economic component alone. In three cases (Bangladesh, the Philippines and Rwanda) the evaluation includes post-intervention effects, showing that reductions in both IPV and VAC are sustained even after the program ends. The lack of impacts for VAC in Colombia may be due to the use of administrative data on cases of violence reported to health and justice systems (which capture only a fraction of violence prevalence), or the identification strategy (relying on the timing of payments) may not be meaningful enough variation for impacts. In spite of differences in social protection strategies and methodologies used to measure impact, overall, these results show that social protection is a promising intervention and platform to reduce both violence against children and violence against women.   Moving forward, more studies are needed that explore the effectiveness of social protection on multiple dimensions of violence. In doing so, evaluations will need to take a more holistic approach to map out pathways of impact and measure violence. For example, to affect IPV, social protection evaluations often target and focus on women alone and seek to empower her and change her circumstances – however to fundamentally change violence inside the home and parenting practices tied to violent discipline, it is essential to involve and collect data from men as well. In addition, more evidence is needed on possible intergenerational effects – another key point of intersection between VAC and VAW — for example, linking benefits realized by adolescent girls in households receiving social protection benefits to stability and freedom from violence in future intimate relationships. From a methodological standpoint, this research agenda is ripe for inter-disciplinary collaboration between development economists who typically evaluate social protection programming, and public health experts on VAC and VAW.   Stay tuned for more work from UNICEF Innocenti and partners on the intersection of VAC and VAW, including systematic reviews (on effective interventions and shared risk factors) and results from Mozambique’s Child Grant evaluation measuring impacts on violent discipline and IPV.         Authors: Amber Peterman is a Research Associate Professor at UNC where she co-leads the Cash Transfer and Intimate Partner Violence Research Collaborative and consultant to UNICEF Innocenti, Alessandra Guedes is the Gender & Development Research Manager at UNICEF Innocenti.   The authors would like to thank Elena Camilletti and Zahrah Nesbitt-Ahmed for helpful comments.      
Sahrul Aini plays with her child at their home in East Lombok, Indonesia. Sahrul receives cash-based assistance from UNICEF, which she used to pay for the costs related to the birth of her child
Blog

Do Cash Grants Increase Pregnancies? Evidence from Asia and the Pacific says “No”

A common fear among policymakers is that government-provided benefits for households with young children – including cash transfers – may increase incentives to have children, to gain or maintain program eligibility. This is a topic we’ve had our eyes on for some time through the Transfer Project.  By conducting reviews of evidence and in our own impact evaluations, we’ve found little evidence to support this narrative from cash transfer programming in low-and middle income countries (LMICs).Until recently, however, evidence to support this from the Asia and the Pacific region has been absent from the debate. As fertility rates, norms around childbearing, and poverty levels differ across regions, it is possible cash transfer impacts may differ as well. With support from the Social Protection Approaches to COVID-19: Expert Advice (SPACE) helpline, I recently took a deep dive into evidence from the Asia and the Pacific region. I was curious not only to read new studies, but also to draw out implications for program design, to help inform design of new COVID-19 related cash transfer programs in the region.How might cash transfers affect pregnancy dynamics?There are a number of ways cash transfers could potentially increase or decrease incentives to have children, especially among programs targeted explicitly to pregnant women or households with young children. Policymakers may fear benefits will increase pregnancies, in line with pro-family policies in high-income, low-fertility settings. However, in theory, the impacts of cash transfers on pregnancies and births are equally likely in the opposite direction. For example, using increased income from cash transfers, parents are able to invest in the health, nutrition and education of their existing children, potentially leading couples to prefer smaller family sizes. The use of family planning may increase among transfer recipients due to income effects or more frequent interaction with the health sector, reducing unplanned pregnancies and allowing safe birth spacing. In addition, recent evidence demonstrates that cash transfers are some of the most promising interventions to delay early marriage and pregnancy for adolescent girls and young women. Therefore, it is possible that total fertility rates may decrease as a result of cash transfer programs over the longer-term. These dynamics are likely to vary based on underlying poverty rates, fertility rates and access to services in a given setting.What does the evidence from Asia and the Pacific say?After reviewing existing published and grey literature, compiled through targeted searches and existing review papers, I found a total of five high-quality studies. These studies evaluated cash transfers targeting households with pregnant women or young children and also measured key pregnancy-related outcomes.What did the studies find? The evidence shows no increase in pregnancies due to cash transfers, and in several cases showed impacts in the opposite direction (e.g. increased birth spacing, delay in first birth).Studies from Indonesia show that the government’s Program Keluarga Harapan (PKH) increased birth spacing among women of reproductive age in the short-term, however had no impact on early fertility of girls and young women aged 16 to 21 exposed to PKH when they were school-aged.A study of the government of Myanmar’s maternal cash transfer pilot measured both current pregnancy and total number of pregnancies after 30 months of enrollment—finding no impacts on current pregnancy, fertility desires or use of family planning. However, a small reduction in total number of pregnancies since the start of the program was found in the ‘cash only’ group.A study of the government of the Pantawid Pamilyana Pilipino Program (4Ps) in the Philippines showed no impacts on total fertility rates after three years among women of reproductive age. A second study found a delay in age of marriage and first birth among women in their early twenties who lived in recipient households of 4Ps for a short period when they were in their teens. This evidence showing no link between cash transfers and increased pregnancy is particularly policy relevant, given all programs were government run and often reach the poorest women and households. In addition, evaluations reported a host of beneficial outcomes for children, ranging from child nutrition and dietary diversity, to better schooling outcomes. Programming practicalities and the way forwardTaken together, evidence suggests a number of practical considerations for programs to both maximize wellbeing impacts for maternal and child health, as well as reduce potential unintended consequences:Pregnancy-related conditions: While there has been speculation about program designs enforcing pregnancy-related conditions in program eligibility (i.e. making benefits conditional on limiting additional pregnancies or total number of children per woman), others have noted the ethical dangers of such an approach. Conditions may “undermine women’s and couples’ rights to autonomy and reproductive freedom and may translate into dangerous unintended consequences”, which may include “hiding children, not seeking necessary preventative care and health check-ups for children, or, at the extreme, infanticide.” Assuming a wealth-fertility gradient, conditionalities based on limiting number of children will also exclude the most vulnerable women and households. Therefore, given there is little evidence of pregnancy increases in the first instance--it is recommended programs remain free of these types of explicit pregnancy-related conditions.Messaging and labeling: Program design should consider if a labeled cash transfer or messaging campaign could serve program objectives. This could include labeling the cash as funds for maternal and infant health, or providing messages at pay points or via community structures around the importance of children’s education or family planning. For example, a study in Zambia found that giving men messages quantifying risk of maternal mortality and morbidity led them to reduce fertility desires and communicate more about family planning, corresponding with a fall in their wives’ pregnancy rates. Messaging should also clearly lay out criteria for eligibility and programming, to both beneficiaries, as well as other community members to avoid misinformation.Transfer value and duration: A meaningful transfer value is a key factor in enabling improvements in poverty and broader welling for children and families. However, there may be subtle ways to defusing potential adverse effects via transfer design. For example, capping benefits to a maximum number of children per household – or calculating benefits at a household level could help delink benefit value to new pregnancies and births. Alternatively, expanding the child age range eligibility to 17 years—so caregivers are not worried about children “aging out”—may support families in the longer-term, defusing the need for them to ‘re-qualify.’Health infrastructure investments: Governments should seek to combine investments in cash transfers with improvements to health infrastructure and systems strengthening, including strengthening the quality and accessibility of pre- and post-natal care, family planning and other maternal health services. Studies have hypothesized the key role of these services in influencing positive pregnancy-related outcomes for women and families. If couples desire smaller families over time, but are not able to access family planning, or continue to experience adverse birth outcomes, reducing family size may not be possible.Rigorous evidence refutes the narrative that cash transfers produce increase pregnancies in LMICs, including from five recent studies of government-run programming in Asia and the Pacific. Building on momentum to date, I’m eager to see continued evolution of programs incorporating gender-responsive designs—focusing on promoting wellbeing of women, children and families—rather than on unintended consequences that are not evidence-informed. Finally, as a researcher, I’d be remiss without recommending the continued study of impacts of cash transfers on pregnancy outcomes, including use of family planning and safe transitions to adulthood, in the Asia and Pacific context and beyond.  Amber Peterman is a Research Associate Professor at UNC Chapel Hill and a consultant to UNICEF Innocenti focusing on gender and social protection.*** This work is based on the brief Do Child Grants Lead to Increased Pregnancies? An Evidence View from Asia and the Pacific, developed with support from Social Protection Approaches to COVID-19: Expert Advice (SPACE) - a joint initiative of FCDO’s Better Assistance in Crises (BASIC) and Gender Responsive Social Protection (GSP) programmes (funded by UKAid); GIZ (funded by the German Federal Ministry for Economic Cooperation and Development); and the Australian Government through the Department of Foreign Affairs and Trade (DFAT). Helpful comments were received by Juliet Attenborough, Abigail Bakker, Ric Goodman, Lisa Hannigan, Ginevra Jarmaine, Rachel Payne, Jacqui Powell, Dominic Richardson, John Rook and Kathleen Sullivan. SPACE materials including this blog do not necessarily represent FCDO, or GIZ or DFAT’s own views or policies or commit FCDO, GIZ or DFAT to any particular course of action. The author reports no conflicts of interest.
Five things we learned from research on child survivors of violence
Blog

Five things we learned from research on child survivors of violence

Understanding prevalence, characteristics and motives of disclosure, help-seeking and reporting of violence against children  Violence against children is a pervasive global phenomenon. Estimates indicate over 1 billion children under the age of 18 experience emotional, physical or sexual violence every year from a range of perpetrators – including parents, peers and intimate or dating partners. Despite these high figures, official figures of VAC are just the tip of the iceberg.How much do we know about children’s disclosure, help-seeking and reporting of violence? Most studies in low- and middle-income countries have narrowly focused on either reporting intimate partner violence among adolescent girls, on specific types of violence, or in specific settings. A new publication, analyzing nationally representative Violence Against Children Survey data from six countries, aims to broaden the focus. The publication, just released in BMC Public Health, led by UNICEF Innocenti, in collaboration with other UNICEF offices and government counterparts, examines data from Cambodia, Haiti, Kenya, Malawi, Nigeria and Tanzania.The study had three objectives:Measure the prevalence of informal disclosure (to family and friends among others), formal help-seeking (from social, health and legal services), formal reporting, and receipt of formal help;Document characteristics associated with disclosure and health seeking;Understand reasons why children did not seek help. Using nationally representative data from six countries, the study analyzed reports from children aged 13 to 17 who experienced any physical and/or sexual violence in their lifetimes. These samples of child survivors of violence represented a high percentage of total children across countries: physical violence among children ranged from 50 to 84%, while that for sexual violence ranged from 6 to 36%. What did we learn in terms of disclosure and reporting? Most children have never told anyone about the violence they experience: Across countries the percentage of children who ever told someone informally about their experience was low—23% in Cambodia and 32% in Kenya, to 42% in Tanzania and 54% in Malawi. These estimates show that children may be telling survey interviewers about violence for the very first time and confirms that violence is largely under-acknowledged and “hidden in plain sight.” It also means that children’s existing social networks—including family, friends, and neighbors are often a first source of disclosure and possible support system for children survivors. Formal services are rarely accessed or utilized by child survivors: The percentage of children who reported to formal sources was low—ranging from under 1% in Cambodia to 25% in Tanzania (formal disclosure)—and the percentage who received help was even smaller (1% in Nigeria to 11% in Tanzania, this outcome was not measured in Cambodia or Haiti). These statistics confirm that only a fraction of children attempt to contact health, social or legal services and even fewer receive any support, highlighting the importance of expanding accessibility and reach of assistance. Factors encouraging disclosure, help-seeking and reporting varied by country: Identifying factors that encourage these behaviors could help target services or develop secondary prevention programming. However, few factors were consistently positively correlated with help-seeking behaviors—including factors that are hypothesized to help, like household wealth and residing in urban settings. This lack of pattern underscores the importance of context and the challenges in targeting services using observable characteristics of child survivors. Self-blame, apathy and not needing or wanting services were top factors deterring children from disclosure: Across countries, common reasons cited for not seeking help were responses like “I felt it was my fault (self blame)”, “I did not think it was a problem (apathy)” or “I don’t want or need services.” For example, in Cambodia, the most common reason for not seeking help for physical violence was self-blame, mentioned by 56% of children, while the most common reason in Kenya, Malawi and Nigeria was apathy (25%-39%). Fewer children reported fear of repercussions or helplessness, while lack of access and financial constraints were rarely mentioned. These reasons highlight the role of shame and how the normalization of VAC is pervasive. Better data and methodological innovation is urgently needed: This study underscores the need for innovation in research methodologies to accurately estimate prevalence of sensitive topics. Improvements might include methods allowing self-administration of questions and those which allow for greater confidentiality. In addition, future surveys should include a wider range of household and community level indicators to understand underlying dynamics surrounding the child’s environment—for example, parental (mental health, parenting, time use), household (social and economic vulnerability factors), and community (gender norms, service availability) characteristics. What should we take away from these results? One concrete implication is that statistics based on violence against children reporting to formal sources such as data from health systems, police, or NGO reporting are likely to underestimate the total prevalence ranging from 4 to 940-fold depending on the country. This has implications for the analysis of such data during COVID-19, where there have been fears that children are even less able to access services—and that many cases of violence are uncounted. Our results show this is a huge issue and must be accounted for when interpreting the dynamics stemming from administrative data.Other implications relate to how to improve use of services for survivors. One strategy is to address barriers including social norms that normalize violence, and how these manifest in different contexts. Another is to improve linkages and raise awareness of child protection services and common touchpoints  for children, such as those within the education, health and community-based structures, which are likely to interact with children on an informal, daily basis. These trusted individuals in children’s lives are important entry points for formal services.It is also important to strengthen the capacities of professionals working in health, education and social sectors to be able to identify risks and respond using a survivor centered approach. Given the wide under-reporting and pervasive nature of violence against children, services which are targeted to only one setting or population are unlikely to result in broad uptake of services and assistance. Multi-sectoral responses and well-networked referral systems are necessary.Much more research is needed to unpack the dynamics around help-seeking and secondary prevention for survivors. We hope this analysis will serve as a starting point to advance research and practice to end violence against children and the long-lasting negative effects experienced by children over their lifetimes.***Special thanks to Alessandra Guedes, Alina Potts and Mary Shawa for helpful comments.Amber Peterman, Ph.D. joined UNICEF Office of Research – Innocenti in 2015 as a Social Policy Specialist and now works as a consultant with joint affiliation as an Associate Adjunct Professor at UNC Chapel Hill. Amber focuses on gender, violence and adolescent wellbeing and safe transitions to adulthood with the Transfer Project evaluations of social protection and cash transfers in Africa.Audrey Pereira is a Doctoral Student in Public Policy at The University of North Carolina at Chapel Hill.Tia Palermo is Associate Professor of Epidemiology and Environmental Health at the University at Buffalo (State University of New York) and an Affiliated Researcher with the Transfer Project. Full citation: Pereira A, Peterman A, Neijhoft AN, Buluma R, Kaloga IF, Harvey R, Islam A, Kheam T, Kitembe M, Lund-Henriksen B, Maksud N, Maternowska MC, Potts A, Rottanak C, Shawa M, T Palermo (2020). Disclosure, reporting and help-seeking among child survivors of violence: A cross-country analysis. BMC Public Health 20(1051).

Journal articles

Cash transfers: What’s gender got to do with it?
Journal Article

Violence against children during the COVID-19 pandemic

Cash transfers: What’s gender got to do with it?
Journal Article

Government Anti-Poverty Programming and Intimate Partner Violence in Ghana

Cash transfers: What’s gender got to do with it?
Journal Article

COVID-19 response measures and violence against children

Cash transfers: What’s gender got to do with it?
Journal Article

COVID-19: Reducing the risk of infection might increase the risk of intimate partner violence

Events

CGDev Online Event: Approaching COVID-19 Risk and Response through a Gender Lens
Event

CGDev Online Event: Approaching COVID-19 Risk and Response through a Gender Lens

By applying a gender lens to this pandemic, researchers and policy makers can better assess differential risks and target responses to ensure already-vulnerable populations don’t fall even farther behind. Join us for this online discussion with CGD experts, external researchers, practitioners, and advocates on how a gender lens helps us better understand and respond to the threat of COVID-19.

Podcasts

CGDev Online Event: Approaching COVID-19 Risk and Response through a Gender Lens
Podcast

#HEARMETOO: UNICEF Research on Gender-Based Violence for #16Days of Activism