Profiles

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.

Target 2.1 of the Sustainable Development Goals calls for an end to hunger, in all its forms, by 2030. Measuring food security among children under age 5, who represent a quarter of the world’s population, remains a challenge that is largely unfeasible for current global monitoring systems. The SDG framework has agreed to use the Food Insecurity Experience Scale (FIES) to measure moderate and severe food insecurity. The FIES is an experience-based metric that reports food-related behaviours on the inability to access food due to resource constraints. We present the first global estimates of the share and number of children below age 15, who live with a respondent who is food insecure.

In this paper we summarize evidence on six perceptions associated with cash transfer programming, using eight rigorous evaluations conducted on large-scale government unconditional cash transfers in sub-Saharan Africa, under the Transfer Project. Specifically, we investigate if transfers: 1) induce higher spending on alcohol or tobacco; 2) are fully consumed (rather than invested); 3) create dependency (reduce participation in productive activities); 4) increase fertility; 5) lead to negative community-level economic impacts (including price distortion and inflation), and 6) are fiscally unsustainable. We present evidence refuting each claim, leading to the conclusion that these perceptions – insofar as they are utilized in policy debates – undercut potential improvements in well-being and livelihood strengthening among the poor, which these programmes can bring about in sub-Saharan Africa, and globally. We conclude by underscoring outstanding research gaps and policy implications for the continued expansion of unconditional cash transfers in the region and beyond.

Approximately half of all mental health disorders begin by age 14, and three-quarters by age 24. Among adolescents, depression is one of the leading contributors to morbidity, while suicide and interpersonal violence are among the leading causes of mortality.

Unlike conditional cash transfers, unconditional transfers have the potential to impact all beneficiary household members across a range of productive and social domains. After two years, research shows that the Zambian Child Grant Programme has led to strong positive impacts in investment and diversification of income-generating activities, food security, and asset accumulation.

According to the 2008-2009 Kenyan Demographic and Health Survey, almost a third of the women of reproductive age were married before they reached their 18th birthday, and more than 75 per cent had their first child by age 24. The role of poverty in influencing adolescent fertility has been well documented and social cash transfers (SCTs) have been recommended as a successful reduction strategy. This Research Brief examines a study comparing two groups who had and had not received unconditional cash transfers. The authors identify four factors through which such cash amounts affect adolescent well-being: increased investment in girls’ education; delay in girls’ sexual debut; improved mental health and increased aspirations for girls; and increased household economic stability.

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).

The UN recently raised a red flag that we are heading for one of the worst humanitarian crises since 1945. 20 million people in four countries – South Sudan, Somalia, Yemen and Nigeria – face the risk of famine. The world could witness horrors again. Adding to our concern is the prediction that climate change will bring even more weather variability to these regions, interacting with many complex, man-made conflicts and risks. Children are among the most vulnerable: some will not survive and others will suffer the consequences of undernourishment, including stunting. The severe consequences of neglecting the needs of a child during their first thousand days, is well evidenced. The message about the importance of the first thousand days has echoed widely – perhaps to the point where concerns may be raised about the policy implications being overstretched. There is an anthropometric impact of famine on those exposed as infants, but surprisingly even more so on those exposed as adolescents.The world has witnessed famines before. Publicly available household survey data sets, such as UNICEF/MICS and DHS, enable us to shed additional light on the long-term consequences. An article in the American Economic Review (R. Akresh et.al. 2012) presents evidence of the long-term impact of exposure to the Biafra famine (Nigeria 1968-70). The outcome measure is height among adult women, with height loss well known to be a strong predictor of a range of adverse impacts. The study takes into account the regions and ethnicities most exposed to the famine, as well as the age at exposure and its duration. As expected, those women who were exposed to the famine as infants, are shorter, with the impact estimated to be minus 0.75 cm. Far less expected is that the height impact on those exposed as adolescents – the second period of life marked by a strong physical growth surge – is much greater, an astonishing minus 4.5 cm! The finding should raise some eyebrows, as stunting is almost exclusively discussed as a phenomenon linked to undernourishment among infants; much more rarely as a phenomenon developed in adolescence. Source: DHS, all available Cambodia data sets (rounds 2000/2005/2010/2014). Lines based on five-year rolling averages by age at exposure, using 1977 for age 0. Minuses if unborn (-5=born 5 years after 1977). All women above 20 at time of survey are included.The graph above conveys a highly simplified visual replication of the Biafra findings, related to another tragic famine: Cambodia 1975-79. In terms of excess mortality its estimated impact is 1.5-2.0 million. In an overview of 20th century famines (S. Devereux 2000) the Cambodia famine stands out in terms of its magnitude and the share of the population that was affected. In a spirit of simplicity, the above graph plots the average height of women (blue line) and the prevalence of adult female stunting (<145 cm, red line) against age in 1977. That year is chosen for being the mid-year of the 1975-79 episode. Data on height and year of birth has been brought together from all available Cambodia DHS surveys. All estimates are national averages; no adjustments have been made of more or less exposed regions or population groups, nor for the length of the exposure to the famine (both adjustments would probably further underscore the message conveyed by this graph). The graph echoes the message from the cited Biafra study: There is, as expected, an anthropometric impact of famine on those exposed as infants, but surprisingly even more so on those exposed as adolescents. These findings lend themselves to a number of interpretations. A first could be that excess mortality primarily affects infants, which implies that those most severely affected by famine are no longer with us in the data-sets we use. Additional research could probably indicate the extent to which this is a factor at play here. However, notwithstanding its importance, this does not diminish concerns over adolescent vulnerability. A second interpretation could be related to the much debated issue of catch-up growth. A recent study by Young Lives – based on longitudinal data from Peru, India, Ethiopia and Vietnam – does lend further support to earlier results, which indicate catch-up growth among adolescents who were stunted as infants. So one interpretation may be that we see less height impact on those exposed as infants in the graph above, or in the Biafra study, because catch-up growth has taken place. Furthermore, it may be that catch-up growth does not repair other detrimental impacts of infant stunting, and that the curve somehow masks that. The fast brain development of infants is often cited as a specific cause of concern. However, recent brain science research tends to emphasize the crucial brain growth that also occurs during adolescence. The research on the long-term consequences of stunting depending on at which age it occurs, have important contributions to make here. In any case, the notion of catch-up growth underscores one unique aspect of adolescents’ vulnerability to famines: Adolescents will not be given a second opportunity to grow. A third interpretation of the graph above, not necessarily incompatible with the first two, could be that adolescents are indeed disproportionately neglected during famines.  Concerns over such biases are not new (P. Salama 1998). Infants require less food and are possibly given more attention by immediate caregivers, as well as by emergency relief operations, while adolescents tend to be treated as adults, despite their nutrition-related vulnerability. If this is the case, then policies and practices need rethinking. At UNICEF Innocenti, we were considering setting up our own research project to add more evidence and nuance to the issue discussed here, including replicating it with more precision for other outcome variables and to other incidents of famine. However, given the urgency of the matter, we have chosen to share these incipient findings and puzzles, in a blog. We invite the research community to help us sort out this issue, urgently. Please share your findings and research plans in the comment field below, or contact us directly! If there is a sufficiently strong response, we may consider setting up an Innocenti conference on “Famines and anthropometric impact on adolescents,” hopefully soon enough to make a difference, as the world responds to the upcoming humanitarian disasters. Goran Holmqvist is Associate Director and Audrey Pereira is a consultant at UNICEF Innocenti. Explore the UNICEF Innocenti research catalogue for new publications. Follow UNICEF Innocenti on Twitter and sign up for e-newsletters on any page of the UNICEF Innocenti website.  

Food is a basic necessity of life. You probably know the grim statistics: one in four children are stunted, approximately half of all deaths among children under 5 are attributable to malnutrition, and in the developing world alone,  66 million children of primary school age go to school hungry. These numbers are alarming and unacceptably high. And yet, they may actually underestimate the true extent of food insecurity. Food insecurity goes beyond the problem of not having enough food to eat.Food insecurity goes beyond the problem of not having enough food to eat. It includes aspects of food quality, psychological factors such as worry about food sourcing, and nutritional and non-nutritional consequences of inadequate access to food. Ironically, without data on how many children are food insecure, or where they live, we hope to achieve SDG 2.1, which calls for an  end to hunger by 2030. Measuring child food insecurity is tricky. Evidence on standard anthropometric indicators such as stunting or wasting (measured in z-scores, or, standard deviation units from the mean) are typically relied upon by programme managers and policy-makers. Understanding the extent of child food insecurity requires additional sources of data on household food practices. However, it turns out that parents and child caregivers can be unreliable sources of information, often underestimating children's food insecurity or failing to recognize how children respond and react to food insecurity. Children, on the other hand, are well aware of food insecurity in terms of decreased quality and quantity of food. They also experience shame and stigma associated with being food insecure. They recognize parental hardships, such as stress about food, and actively look for methods to alleviate it. Most importantly, children recognize how important food is for well-being, and grasp the complex social, economic and political factors surrounding it. Bahatu Abrahamani feeds her child Memunatu, 2, some Plumpy Nut therapeutic food supplement in the village of Moglaa, Ghana.Although it is not feasible to ask very young children about their experiences of food insecurity, some research has explored self-reports of food insecurity among older children, or even investigated food consumption to understand age and gender dynamics around food. At the recent Seventh International Conference on Agricultural Statistics held at FAO in October 2016, among the research presented were analyses that explored child and adolescent food insecurity. The UNICEF Office of Research-Innocenti presented preliminary research using Gallup World Poll data, which measures food insecurity as part of the Voices of the Hungry project. The analysis uses the Food Insecurity Experience Scale to develop proxy measures for global child food insecurity, and suggests that although the prevalence of food insecurity among households with children under 15 is the highest in Sub-Saharan Africa, the majority of the burden lies in South Asia. Also presented at the conference was evidence from the Young Lives study in India, which showed significant differences in intra-household food allocation by gender during mid-adolescence. The longitudinal study showed a pro-boy gap at age 15 in the number of food groups consumed, and that boys ate more nutritious foods than girls. Previous research in Ethiopia found that adolescent girls were more likely to report being food insecure than adolescent boys. Although all these studies add to a growing evidence base on how children experience food insecurity, the Ethiopia study is the only one to ask adolescent self-reports, thus highlighting the need for more research in this area. Ongoing studies in the US and Venezuela have begun to unpack this complex topic; however, we have a long way to go to capture children's experiences directly. Some food for thought on child food insecurity How do children across the world perceive and respond to food insecurity? What are the causes and consequences of child food insecurity across different contexts? Do children within the same household face different food security risks? How do these risks differ across contexts, particularly where households are prone to adverse shocks, such as conflict and fragility? It is important to keep in mind that access to food alone does not address the burden of food insecurity, for both adults and children. Food insecurity is a complex and multi-dimensional phenomenon that can only be addressed with a multi-sectoral approach. Understanding how children experience food insecurity, how many children are food insecure, and why, can help better inform programs and policy, and will bring us closer to a world with zero hunger. Audrey Pereira is a Social and Economic Policy Consultant at the UNICEF Office of Research-Innocenti. Follow her on Twitter @audsnends7. Thanks to Amber Peterman and Michelle Mills for their contribution. Explore the  UNICEF Innocenti research catalogue  for new publications. Follow UNICEF  Innocenti on Twitter  and sign up for e-newsletters on any page of the UNICEF  Innocenti website. Link to  the full program for the Seventh International Conference on Agricultural Statistics.