According to the World Health Organization (WHO), “violence against women remains pervasive and devastating” affecting an estimated 736 million women worldwide. Women in low and lower middle income countries are disproportionately affected by violence. About 37 percent of women (15 to 49 years old) in the poorest countries are victims of violence, with a high prevalence of domestic violence in South Asia and sub-Saharan Africa, almost 33 to 51 percent (Figure 1) . The lowest prevalence (16-23%) was observed in regions of Europe, Central and East Asia.
The pandemic has further exacerbated violence against women, especially domestic violence showing an increase. The reasons include stress with loss of livelihood, disruption of social and protective networks, cramped living conditions and restricted movement. The Sustainable Development Goal (SDG) on gender equality calls for the elimination of “all forms of violence against all women and girls in public and private spheres, including trafficking and sexual exploitation and others “. Yet 49 countries do not have legislation on domestic violence. The implications of COVID-19 have led to a 30% increase in domestic violence in some countries.
Violence has immediate effects on women’s health — physical, sexual and reproductive, as well as mental and behavioral. It increases the risk of maternal mortality and pregnancy-related consequences: low maternal weight and stillbirths. Studies in several countries (Nicaragua, Bangladesh, India and the United States) report a high incidence of low birth weight babies and deaths among pregnant women due to domestic violence.
WHO conducted a multi-country study on women’s health and domestic violence against women which showed strong associations between violence and the physical and mental symptoms of poor health in women. Women exposed to domestic violence are 16% more likely to have a low birth weight baby. In addition to having a direct impact on women, domestic violence also affects children. Studies indicate an association with undernutrition in children in households affected by domestic violence. A review of Demographic and Health Surveys from 29 low- and middle-income countries showed a strong association between stunting and domestic violence among wealthy and poorly educated women. The impact of domestic violence is further camouflaged with the impacts of food insecurity, micronutrient deficiency and limited access to sanitation in poor households.
Evidence from Latin America on domestic violence and child nutrition indicates adverse effects on a child’s long-term nutritional status. The child is less likely to receive antenatal care and the child to be breastfed and vaccinated. A causal estimate of the intangible costs of violence against women in Latin America and the Caribbean suggests a negative link with women’s health, affecting both short-term health outcomes and human capital accumulation children.
However, the education and age of women tend to protect against the negative impact of violence on children’s health. The World Bank indicates that the cost of violence against women could amount to 3.7% of GDP. Studies in Bangladesh and Nepal show an association between violence and women’s nutritional status and a possible link with increased stress, poor self-care and nutrition. A study on Pakistan’s mother-child dyad shows a significant increase in the number of children suffering from underweight, stunted growth and wasting among women victims of domestic violence.
Results from a Bangladesh Demographic Health Survey show compromised child growth with an increased risk of stunting in children born to women subjected to lifelong domestic violence. Community studies from Nicaragua and Bangladesh suggest that improving the status of women is strongly associated with improving the health and nutritional status of children. A regression analysis of data from Bangladesh found that domestic violence, among others, was a risk factor contributing to stunting in children. The impact of violence against women lasts for generations, with severe demographic consequences that hamper educational attainment and income potential.
There is a growing concern about gender-based violence in India with significant economic and social costs. Previous surveys indicate an increasing trend of domestic violence in India, despite being a criminal offense under section 498-A of the Indian Penal Code. A study indicates an increased likelihood of stunting, underweight and wasting in children whose mothers have been victims of domestic violence. The results of the NFHS-5 2019-2020 data indicate a decrease in the rate of domestic violence in many states and EU territories (Figure 2). However, Karnataka, Assam, Maharashtra, Ladakh, Sikkim and Himachal Pradesh show increasing trends.
Atreyee Sinha and Aparajita Chattopadhyay demonstrated the link between domestic violence and children’s nutritional status using a conceptual framework (Figure 3). It shows how the health of children depends on the empowerment and health status of the mother, and domestic violence is an important intermediate factor influencing the health of children.
Evidence points to a direct causal relationship between domestic violence and children’s growth and development with a significant impact on stunting and underweight in children.
The impact of violence is more evident among unemployed women than among employed and self-employed women. Domestic violence is a human rights issue and reducing its incidence contributes to the resulting health benefits. Above all, the pandemic has added to the challenge for adolescent girls (10-19 years) to access essential services. The social and economic impact of COVID-19 has been profound for rural women who are further subjected to domestic violence, abuse and malnutrition. Similar results have been reported in rural and tribal communities in southern India.
Improving gender inequality could contribute to a 10 percentage point drop in the prevalence rate of stunting among children. It is also essential and imperative to combine nutrition-specific interventions with women’s empowerment measures to reduce child undernutrition. A randomized controlled trial in the slums of Mumbai suggests community mobilization to address the public health burden of violence against women and girls. A systemic review of interventions to reduce domestic violence calls for effective communication-based and community-based interventions.
There is an urgent need to scale up interventions and invest in reducing undernutrition, improving nutrition and education for women, promoting gender equality, empowering women and elimination of domestic violence against women in order to reduce the prevalence of malnutrition.
This article first appeared on ORF.
Warning:Dr Shoba Suri is Senior Fellow of ORF’s Health Initiative. She is a nutritionist and has experience in community and clinical research. The opinions expressed are personal.
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