In a new, large-scale study exploring the link between domestic violence and chronic malnutrition, researchers from the Harvard School of Public Health (HSPH) have found that Indian mothers and children experiencing multiple incidents of domestic violence in the previous year are more likely to be anemic and underweight. The findings were published online March 26, 2008 in The American Journal of Epidemiology and will appear in an upcoming print issue of the journal.

“This is strong evidence that domestic violence is linked with malnutrition among both mothers and children. In India, the withholding of food is a documented form of abuse and is likely correlated with the perpetration of physical violence,” said S V Subramanian, associate professor of Society, Human Development, and Health at HSPH, and co-author of the study.

The study population included 69,072 (aged 15-49 years) women and 14,552 children (12-35 months) from the Indian National Family Health Survey of 1998-99. The participants underwent face-to-face interviews by trained personnel, and the data collected included body measurements, blood samples, and information on women’s and child’s exposure to domestic violence in the previous 12 months.

The researchers found that women who reported more than one instance of domestic violence in the previous year had a 11% increased likelihood of having anemia and a 21% increased likelihood of being underweight, as compared to women with no such history. This difference was not explained by the mother’s demographic information. The associations between domestic violence and nearly all nutritional outcomes were similar for children.

The data suggest a relation between domestic violence and malnutrition among women and children in India. The authors note that preventing domestic violence could be just as effective as a pharmaceutical approach in combating anemia among women. The authors believe that one possible explanation is empowerment, such that perpetrators of domestic violence often use several types of abuse, including physical and psychological, to control the behavior of their family members. In India, the withholding of food as a type of abuse could be a factor in the link between physical domestic violence and nutrient deficiencies that cause anemia and underweight. Additionally, domestic violence has been strongly associated with a woman’s inability to make decisions for herself and her family, including the choice of types and quantities of food she prepares

The authors’ second explanation is that the link between domestic violence and nutritional deficiencies may also reflect the effects of psychological stress. Women and children who experience domestic violence tend to have higher levels of psychological stress, which has been associated with anemia and being underweight.

The authors believe that reducing domestic violence is clearly important from a moral and intrinsic perspective, and that this study provides a compelling case to also address the problem from the perspective of health effects. “More efforts need to be focused on the ‘non-health’ aspects or ‘social’ conditions that influence health conditions, and domestic violence represents one such adverse social/contextual aspect that we’ve identified in Indian society,” said Subramanian.

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The study was supported by National Institutes of Health by the National Institutes of Health Career Development Award.

“Domestic Violence and Chronic Malnutrition among Women and Children in India,” M. L. K. Ackerson, and S. V. Subramanian1, American Journal of Epidemiology, published online March 26, 2008.

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